Cases reported "Ankle Injuries"

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1/17. Osteoid osteoma of the lateral talar process presenting as a chronic sprained ankle.

    Pathologic conditions of the lateral talar process may be difficult to diagnose using physical examination and roentgenographs. A computed tomography scan of the hindfoot is often useful to define lesions of the lateral process. We report a case of osteoid osteoma of the lateral talar process that defied diagnosis for 4 years. The patient had an antecedent history of an inversion injury, which had been treated as a chronically painful sprained ankle without resolution of symptoms. The tumor was ultimately identified on a computed tomography scan, best seen on a coronal section through the talus. The patient had complete relief of pain after excisional biopsy of the tumor.
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ranking = 1
keywords = roentgen
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2/17. Multiple osseous tarsal coalitions: a case report and review of the literature.

    A patient with multiple tarsal coalitions presenting with symptoms at the age of 47 years is reported. The report highlights the presentation of symptomatic coalitions following trauma in adulthood. Coalitions can pose difficulties in diagnosis, particularly without previous history of pain or disability in childhood. A decrease or loss of subtalar movement, painful movement, and valgus deformity of the hindfoot are usually present in the adult patient but are not often pathognomonic and present a diagnostic conundrum, particularly with x-rays being misinterpreted. This report highlights the problem of diagnosing such a condition with the attendant difficulties in formulating treatment.
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ranking = 7.5083433671831E-6
keywords = x-ray
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3/17. Misdiagnosed iuxta-articular osteoid osteoma of the calcaneus following an injury.

    The diagnosis of osteoid osteoma, in usual localizations, is generally simple. In iuxta-articular localizations this tumor may be unrecognized and the diagnosis delayed. Injury has been sometimes correlated with the onset of symptoms and this can make the diagnosis even more difficult. We present a case of osteoid osteoma of the calcaneus iuxta-articular to the subtalar joint in a 17-year-old basketball player. He had a history of initial injury, ankle sprain during training, followed by pain and swelling. He was initially treated for lateral ligament lesion of the ankle with unsatisfactory results. After acute trauma the pain changed becoming chronic and mostly nocturnal disappearing when rofecoxib was taken. Standard x-ray didn't show the lesion. Nuclear Magnetic Resonance (NMR) and scintigraphic results were not well interpreted but these clinical changes and Computed tomography (CT) images supported the diagnosis of osteoid osteoma. The complete resection of the bone lesion resolved all the symptoms and the histological report confirmed the suspected diagnosis.
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ranking = 7.5083433671831E-6
keywords = x-ray
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4/17. arthrodesis of the ankle and subtalar joints.

    The late reconstruction of a complex nonunion of the distal tibial metaphysis, the ankle, or the subtalar joint was undertaken in five patients through a posterior surgical approach and the application of a blade plate into the os calcis. This technique was preferred as a salvage operation when the surrounding soft tissue envelope was compromised by the initial injury, previous surgical procedures, or infection. Each of the cases was notable for a segmental bone loss, an infected nonunion, or a collapse of the talar body. In the presence of a major soft tissue defect, the internal fixation was accompanied by the application of a microvascular free flap. The postoperative assessment of the posterior arthrodesis with the blade plate fixation was at an average of 33 months. Using a modification of the boston Children's Hospital ankle scoring system, a preoperative and postoperative assessment was made. The criteria included an objective rating system based on the intensity of pain, the cessation of drainage, the degree of independent ambulation, and the roentgenographic documentation of union. The average preoperative score was 13 (range, 8-16). After arthrodesis, the average score was 44 (range, 40-48), with three patients rated excellent and two rated good.
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ranking = 1
keywords = roentgen
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5/17. Bosworth fracture-dislocation of the ankle. A case report and review of the literature.

    The Bosworth fracture-dislocation is a rare fracture-dislocation of the ankle where the proximal fibular fragment lodges behind the tibia, rendering it irreducible by routine closed manipulations. Clinically the patient's foot is in severe external rotation. This external rotation makes the initial roentgenograms difficult to interpret. Consequently, the diagnosis is often overlooked, resulting in inappropriate treatment and a disastrous outcome. If properly recognized, these injuries can be successfully treated by closed or open techniques with return of near-normal ankle function. The problem is illustrated in a case involving a 40-year-old woman, as related to a review of the literature and discussion of the treatment rationale.
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ranking = 1
keywords = roentgen
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6/17. Arthroscopic treatment of sports-related anterior osteophytes in the ankle.

    Osteophytes on the anterior aspect of the tibia and anterior talus are common in athletes such as dancers, runners, and high jumpers who impact with quick and forceful dorsiflexion to this area. This pathology is often confirmed easily on lateral x-ray films. Excision, debridement, and/or abrasion arthroplasty can be performed arthroscopically to remove osteophytic bone. The joint space is easily approached and managed using small joint or even regular-sized arthroscopic instruments. Care is taken to reshape the anterior tibia and/or talus to its original contour, thus avoiding impingement of the joint space and scuffing of adjacent articular cartilage. Proper abrasion depths and punch lesions may be needed to expose bleeding capillary bone. This allows a regeneration of a fibrocartilage covering that not only decreases pain but also permits a return to functional and athletic activities. Postoperative treatment, including physical therapy, is described. Three case studies are presented that adequately demonstrate this problem, along with the corrective measures taken. Each case concludes with a brief summary of follow-up.
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ranking = 7.5083433671831E-6
keywords = x-ray
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7/17. Os peroneum fracture. A case report.

    A 40-year-old woman with a history of injury to the left foot was initially treated for an ankle sprain. When the initial roentgenograms were reassessed, os peroneum fracture with diastasis was diagnosed. This may be the second case of fracture of the uncommon anomaly to be reported in the literature. A fracture of the os peroneum may be confused with ankle sprain. Only careful examination of serial roentgenograms may avoid an incorrect diagnosis and further complications.
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ranking = 2
keywords = roentgen
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8/17. Changes in tibiofibular relationships due to growth disturbances after ankle fractures in children.

    We analyzed the longitudinal growth of the distal tibial and fibular physes and the longitudinal displacement of the distal metaphysis and epiphysis of the fibula relative to the distal metaphysis and epiphysis of the tibia during growth using a roentgenstereophotogrammetric technique in eight children: six with a traumatic growth disturbance in one or both of the distal tibial and distal fibular physes and two with a normal ankle. In the normal ankles the distal fibular metaphysis moved distally in relation to the distal tibial metaphysis and the growth in the distal fibular physis was slower than that in the distal tibial physis. Growth arrest in the distal fibular physis and continued growth in the distal tibial physis resulted in distal displacement of the fibular metaphysis relative to the tibial metaphysis, probably due to traction on the distal ligaments of the fibula or more rapid growth in the proximal fibular physis than in the proximal tibial physis, or both. Valgus deformity of the ankle developed when the growth of the distal tibial physis exceeded the distal sliding of the fibula, as shown by the stereophotogrammetric analyses and orthoroentgenograms. Growth arrest in the distal tibial physis and continued growth in the distal fibular physis resulted in proximal sliding of the fibula, as shown by the roentgenstereophotogrammetric analyses and serial orthoroentgenograms. This mechanism compensated to some extent for the overgrowth of the fibula. Simultaneous growth arrest in both the distal tibial and the distal fibular physis was associated with movement of the distal end of the fibula in a distal direction relative to the tibia, probably due to the more rapid growth in the proximal fibular physis than in the proximal tibial growth plate. Therefore, growth arrest of the distal tibial or fibular physis may result in either proximal or distal sliding of the fibular metaphysis in relation to the tibial metaphysis. Probably growth arrest in the distal fibular physis has a less favorable prognosis than arrest in the distal tibial physis, because after tibial arrest proximal sliding of the fibula may compensate for overgrowth of the fibula better than distal sliding of the fibula can compensate for fibular arrest and overgrowth of the tibia.
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ranking = 4
keywords = roentgen
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9/17. Post-traumatic growth disturbance of the ankle treated by the Langenskiold procedure. Evaluation by radiography, roentgen stereophotogrammetry, scintimetry and histology: case report.

    Progressive growth retardation and varus tilting were observed in a child with an ankle fracture of supination-adduction type initially treated by closed reduction and pinning. The patient was later operated with the Langenskiold procedure. Preoperatively, roentgen stereophotogrammetric analysis showed decreasing growth rates especially medially in the distal tibia, radionuclide scintimetry manifested reduced activity on the injured side, and tomograms showed a bony bridge medially. The evidence of growth in the distal tibia indicated the existence of an osseofibrous bridge between the epiphysis and the metaphysis. This was also confirmed by the findings at the operation and partly by microscopical investigation of the removed osseofibrous bridge. Postoperative stereophotogrammetric analysis showed reduction of the varus position in two steps. Roentgen stereophotogrammetry permits early detection of a growth disturbance, and evaluation of the effects of therapy.
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ranking = 5
keywords = roentgen
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10/17. Occult injuries of the talus diagnosed by bone scan and tomography.

    Five patients, four women and one man, were found to have an osteochondral lesion of one of the talar joints. All patients had normal plain radiographs of the ankle and foot and were referred to us as a second or third consultation for undiagnosed ankle and hindfoot pain. Bone scans of the tali demonstrated the specific talar joint that was injured, and tomography confirmed the presence of an osteochondral lesion. The average delay in the diagnosis between the onset of symptoms and the initiation of treatment was over 10 months. Bone scanning is an effective diagnostic tool in locating injuries of the talus not appreciated on routine x-ray.
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ranking = 7.5083433671831E-6
keywords = x-ray
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