Ortho Dx: Right lower extremity pain - Clinical Advisor

Ortho Dx: Right lower extremity pain

Slideshow

  • Lateral radiograph

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    Lateral radiograph

  • Oblique radiograph

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    Oblique radiograph

A 25-year-old man presents to the emergency department after a fall while rock climbing. He landed on his right ankle as he fell 10 feet off the face of the rock wall. He is unable to bear weight on the right lower extremity. Lateral and oblique radiographs (Figures 1 and 2) show a minimally displaced talar neck fracture.

This case has been brought to you in partnership with the Journal of Orthopedics for Physician Assistants.

Fractures of the talus are difficult to treat due to their high complication rates and potential for long-term disability. The talus is 60% covered with articular cartilage, which limits the available area for vascular perfusion. As a result, displaced fractures...

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Fractures of the talus are difficult to treat due to their high complication rates and potential for long-term disability. The talus is 60% covered with articular cartilage, which limits the available area for vascular perfusion. As a result, displaced fractures can disrupt blood supply to the talus leading to a higher risk for osteonecrosis. Displaced fractures also disrupt the congruity of the articular cartilage, which can result in post-traumatic arthritis. The most common fracture types are chip or avulsion fractures, although fractures through the talar neck, body, head, lateral process, and posterior process can occur. Fractures of the neck, body, and head are usually found on radiograph; however, subtle fractures that frequently occur in the lateral process often require CT to diagnose.1,2

Most talus fractures require operative fixation. Fractures that appear nondisplaced on radiograph should have a CT to confirm joint congruity. CT also assesses for malalignment, as the talus typically displaces in a plantar flexed and varus position. If the fracture is nondisplaced on CT, then a short leg weight-bearing cast can be applied for 6 to 8 weeks, followed by a weight-bearing cast or boot for an additional 4 to 6 weeks. If a step-off or displacement is noted on CT, then the patient should have an open reduction and internal fixation.1,2

Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).

References

  1. Sanders DW. Fractures of the talus. In: Court-Brown C, Heckman JD, McKee M, et al, eds. Rockwood and Green’s Fractures in Adults. 6th Edition. Philadelphia: Lippincott Williams & Wilkins; 2006:2249-2289.
  2. Weatherford B. Fractures of the talar neck. Available at: https://www.orthobullets.com/trauma/1048/talar-neck-fractures. Accessed on February 27, 2018.
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