Pseudo Os Trigonum Sign: Missed Posteromedial Talar Facet Fracture

Giuffrida, A. Ylenia; Lin, Sheldon S.; Abidi, Nicholas A.; Berberian, Wayne S.; Berkman, A. Tevfik; Behrens, Fred F.

doi:10.1177/107110070302400813

Cited by 51 publications

(40 citation statements)

References 13 publications

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“…It is important to distinguish between these two distinct entities because failure to recognize and treat this fracture may lead to instability, pain, stiffness and post-traumatic subtalar degenerative arthritis (10). Lateral radiographs best demonstrate the presence of the os trigonum.…”

Section: Os Trigonummentioning

confidence: 99%

The Accessory Ossicles of the Foot and Ankle; a Diagnostic Pitfall in Emergency Department in Context of Foot and Ankle Trauma

Köse¹

2012

JAEM

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Numerous normal anatomic variants including different accessory ossicles and sesamoid bones are found around the foot and ankle region. They are usually of no clinical importance and are often recognized as an incidental radiographic finding. However, in the context of trauma, these ossicles may cause misdiagnosis due to various radiological pitfalls and this may result in under or overtreatment. Therefore, a thorough knowledge of these accessory ossicles and sesamoid bones is important for the physician to recognize the pathologic process and normal anatomic variants. This pictorial review summarizes the most common accessory ossicles found around the foot and ankle in skeletally mature subjects and the fractures that may cause confusion with accessory ossicles and sesamoid bones. (JAEM 2012; 11: 106-14)

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Section: Os Trigonummentioning

confidence: 99%

The Accessory Ossicles of the Foot and Ankle; a Diagnostic Pitfall in Emergency Department in Context of Foot and Ankle Trauma

Köse¹

2012

JAEM

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“…Early malunions and nonunions of talar process fractures can be salvaged by complete excision of the malunited fragments [6,18]. However, symptomatic subtalar arthritis develops rapidly after these injuries and in situ fusion of the subtalar joint may become necessary [7,19].…”

Section: Indicationsmentioning

confidence: 99%

“…The lateral part of the talar neck and body including the lateral process and subtalar joint are accessed via a curved or oblique anterolateral approach [20]. Posterior approaches are used for malunions of the posterior process or the posterior third of the talar body [5,6]. In most cases, a posterolateral approach allows a complete overview of the posterior part of the talar body.…”

Section: Techniquesmentioning

confidence: 99%

“…Non-union of the talar neck or body is seen in less than 10 % in most series [1,4]. Fractures of the lateral and posterior processes are frequently overlooked at first presentation and if displaced will rapidly lead to symptomatic arthritis of the subtalar joint [6,7]. Malunions of the talar head result from overlooked or underestimated fracture-dislocations at the midtarsal (Chopart) joint and severely affect function of the talonavicular joint [8,9].…”

Section: Introductionmentioning

confidence: 99%

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Corrective arthrodeses and osteotomies for post-traumatic hindfoot malalignment: indications, techniques, results

Rammelt

Zwipp

2013

International Orthopaedics (SICOT)

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Hindfoot malunions after fractures of the talus and calcaneus lead to severe disability and pain. Corrective osteotomies and arthrodeses aim at functional rehabilitation and reduction of pain resulting from post-traumatic arthritis, eccentric loading and impingement due to hindfoot malunion. Preoperative analysis should include the three-dimensional outline of the malunion, the presence of post-traumatic arthritis, non-union, or infection, the extent of any avascular necrosis or comorbidities. In properly selected, compliant patients with intact cartilage cover little or no, AVN, and adequate bone quality, a corrective joint-preserving osteotomy with secondary internal fixation may be carried out. In the majority of cases, realignment is augmented by arthrodesis for post-traumatic arthritis. Fusion is restricted to the affected joint(s) to minimise loss of function. Correction of the malunion is achieved by asymmetric joint resection, distraction and structural bone grafting with corrective osteotomies for severe axial malalignment. Bone grafting is also needed after resection of a fibrous non-union, sclerotic or necrotic bone. Numerous clinical studies have shown substantial functional improvement and high subjective satisfaction rates from pain reduction after corrective osteotomies and fusions for post-traumatic hindfoot malalignment. This article reviews the indications, techniques and results of corrective surgery after talar and calcaneal malunions and nonunions based on an easy-to-use classification.

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“…About two-thirds of the talus is covered by articular cartilage. The posterior process of the talus can exist as an accessory bone (os trigonum) in half of all cases and has to be distinguished from fractures of the posteromedial tubercle [ 8 ]. The posterolateral and posteromedial tubercles of the posterior process form a groove for the fl exor hallucis longus tendon.…”

Section: Anatomymentioning

confidence: 99%

Foot and Ankle Injuries

Rein

Tan

Rammelt

et al. 2014

Bone and Joint Injuries

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Man's foot is all his own. It is unlike any other foot. It is the most distinctly human part of the whole of his anatomical make-up.Wood Jones (1944) [ 1 ]The goal of this chapter is to further the understanding of pathomechanisms, performing diagnostics and reconstructing of injured feet, and to demonstrate ways to treat malunions and nonunions. Regaining anatomic joints if possible and rebuilding the normal shape of the foot, even by fusion of joints, is a safe way to avoid pain and to restore function. Anatomy of the FootThe human foot contains 28 bones and is divided into three parts: the forefoot, the midfoot, and the hindfoot ( Fig. 28.1 ) [ 3 , 4 ]. ForefootThe forefoot contains the fi ve metatarsals and toes with two sesamoids under the fi rst metatarsal head and an inconstant sesamoid beneath the fi rst interphalangeal joint. Six weight-bearing surfaces are located at the metatarsophalangeal level (two sesamoids and four lesser metatarsal heads) and fi ve weight-bearing surfaces are located under the distal phalanges in a normal foot.The metatarsals are short tubular bones with a base, shaft, neck, and head. The heads of the metatarsals are strongly connected by the intermetatarsal ligaments. The fi fth metatarsal has a tuberosity at its base, where the plantar aponeurosis, the peroneus brevis, and the peroneus tertius tendon insert.The fi rst toe has two phalanges and the other four toes have three phalanges. The fi rst metatarsal is slightly shorter, broader, and more mobile than the three middle metatarsals, and normally bears as much as one-third to one-half of the body weight through the forefoot and plays a key role in the gait cycle. The metatarsophalangeal joints are ellipsoidal joints, but only the fi rst and fi fth rays allow fl exion/extension and ab-/adduction. The joint capsules are strengthened by collateral ligaments on either side.The two sesamoids at the fi rst metatarsophalangeal joint are well embedded in the capsuloligamentous complex; the medial (tibial) sesamoid is larger than the lateral (fi bular) sesamoid, corresponding to its more important role in weight bearing within the medial sulcus of the metatarsal head.The sesamoids are held together by the strong intersesamoid ligament and the plantar plate, which is fi rmly attached at the base of the proximal phalanx and loosely attached at the neck of the metatarsal via the capsule. The sesamoids are located within the two slips of the fl exor hallucis brevis tendon. The abductor hallucis tendon inserts at the medial sesamoid, the adductor hallucis tendon at the fi bular sesamoid.

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Pseudo Os Trigonum Sign: Missed Posteromedial Talar Facet Fracture

Cited by 51 publications

References 13 publications

The Accessory Ossicles of the Foot and Ankle; a Diagnostic Pitfall in Emergency Department in Context of Foot and Ankle Trauma

The Accessory Ossicles of the Foot and Ankle; a Diagnostic Pitfall in Emergency Department in Context of Foot and Ankle Trauma

Corrective arthrodeses and osteotomies for post-traumatic hindfoot malalignment: indications, techniques, results

Foot and Ankle Injuries

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