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CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2020; 61(03): 094-100
DOI: 10.1055/s-0040-1715492
Case Report | Relato de Caso

Fractura del tubérculo medial de la apófisis posterior del astrágalo

Medial Tubercle's Fracture of Posterior Process of Talus
María Tíscar García-Ortiz 
1   Departamento de Cirugía Ortopédica y Traumatología del Hospital General Universitario de Elche, Elche, Alicante, España
,
Lorena Moril-Peñalver
1   Departamento de Cirugía Ortopédica y Traumatología del Hospital General Universitario de Elche, Elche, Alicante, España
,
Alexandra Sevilla-Monllor
1   Departamento de Cirugía Ortopédica y Traumatología del Hospital General Universitario de Elche, Elche, Alicante, España
,
María Dolores Fernández-Ruiz
1   Departamento de Cirugía Ortopédica y Traumatología del Hospital General Universitario de Elche, Elche, Alicante, España
,
Issam Menchi-Elanzi
1   Departamento de Cirugía Ortopédica y Traumatología del Hospital General Universitario de Elche, Elche, Alicante, España
,
Fernando López-Prats 
1   Departamento de Cirugía Ortopédica y Traumatología del Hospital General Universitario de Elche, Elche, Alicante, España
2   Departamento de Cirugía Ortopédica y Traumatología, Universidad Miguel Hernández, San Juan de Alicante, España
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Resumen

Objetivo Mostrar una fractura infrecuente del tubérculo posteromedial del astrágalo diagnosticado y tratado de manera aguda mediante osteosíntesis con tornillo Acutrak® (2014 Acumed® LLC).

Material y Métodos Varón de 28 años, que acude a Urgencias tras torcedura de tobillo con dolor al mover tobillo y hallux y tumefacción en cara interna. En Urgencias pasó desapercibida. En consulta a la semana refería sensación de que se le engancha el primer dedo con la flexoextensión. Se observa fractura del tubérculo medial de la apófisis posterior del astrágalo con desplazamiento >3mm y clínica de posible interposición del flexor hallucis longus. Se decidió tratamiento quirúrgico con tornillo Acutrak®. Se inmovilizó con férula 3 semanas y descarga 6 semanas.

Resultados A los 8 meses balance articular completo, sin dolor ni limitación para las ABVD y sin clínica de atrapamiento del flexor del hallux. Como complicación aguda, se verificó infección de herida quirúrgica que se trató con antibióticos.

Discusión Ese tipo de fracturas son infrecuentes. El mecanismo lesional suele ser dorsiflexión-pronación. Es importante un diagnóstico temprano y para ello es necesario una alta sospecha diagnóstica. Para su diagnóstico, son necesarias radiografías anteroposterior y lateral y si no se visualiza la lesión, proyección oblicua con 30°- 40° de rotación externa. En casos agudos resulta de utilidad la TAC y en casos crónicos la RM.

Conclusión Aunque generalmente el tratamiento es conservador, en ocasiones puede ser necesario la cirugía mediante osteosíntesis o exéresis del fragmento cuando la fractura provoca impingement.

Abstract

Objective Show an infrequent fracture of the posteromedial tubercle of the talus diagnosed and treated acutely by Acutrak® screw (2014 Acumed® LLC) osteosynthesis.

Material and Methods A 28-year-old man attended the Emergency Department after spraining his ankle with pain when moving his ankle and hallux and swelling on the internal face. In the ER it went unnoticed. A week later in the clinic, he refered to the sensation that the first finger is hooked with the flexion extension. A fracture of the medial tubercle of the posterior process of the talus is observed with a displacement of > 3 mm and clinical signs of possible interposition of the hallucis longus . Surgical treatment with Acutrak® screw was made. He was immobilized with a splint for 3 weeks and discharge for 6 weeks.

Results At 8 months complete joint balance, without pain or limitations for BADL and without hallux flexor entrapment symptoms. As an acute complication, surgical wound infection that was treated with antibiotics.

Discussion These types of fractures are rare. The injury mechanism is usually dorsiflexion-pronation. Early diagnosis is important and a high diagnostic suspicion is required. Anteroposterior and lateral radiographs are necessary for its diagnosis and if the lesion is not visualized, oblique projection with 30°- 40° external rotation. CT is useful in acute cases and MRI in chronic cases.

Conclusion Although the treatment is conservative, surgery may sometimes be necessary by means of osteosynthesis or excision of the fragment when the fracture causes impingement.

Palabras clave

fractura de cedell - fractura del tubérculo medial de la apófisis posterior del astrágalo

Keywords

cedell's fracture - medial tubercle's fracture of posterior process of talus


Publikationsverlauf

Eingereicht: 25. April 2020

Angenommen: 29. Juni 2020

Artikel online veröffentlicht:
02. Oktober 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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Rio de Janeiro, Brazil

 

  • Referencias

  • 1 Cedell CA. Rupture of the posterior talotibial ligament with the avulsion of a bone fragment from the talus. Acta Orthop Scand 1974; 45 (03) 454-461
    CrossrefPubMedGoogle Scholar
  • 2 Kinner B, Roll C. Peripheral Talus Fractures-A Clinical Observational Study of 16 Cases. Clin Res Foot Ankle 2018; 6: 264
    PubMedGoogle Scholar
  • 3 Kim DH, Berkowitz MJ, Pressman DN. Avulsion fractures of the medial tubercle of the posterior process of the talus. Foot Ankle Int 2003; 24 (02) 172-175
    PubMedGoogle Scholar
  • 4 Wolf RS, Heckman JD. Case report: fracture of the posterior medial tubercle of the talus secondary to direct trauma. Foot Ankle Int 1998; 19 (04) 255-258
    CrossrefPubMedGoogle Scholar
  • 5 Cohen AP, Conroy JL, Giannoudis PV, Matthews SJ, Smith M. Impingement fracture of the posteromedial process of the talus--a case report. Acta Orthop Scand 2000; 71 (06) 642-644
    CrossrefPubMedGoogle Scholar
  • 6 Dougall TW, Ashcroft GP. Flexor hallucis longus tendon interposition in a fracture of the medial tubercle of the posterior process of the talus. Injury 1997; 28 (08) 551-552
    CrossrefPubMedGoogle Scholar
  • 7 Watanabe H, Majima T, Takahashi K, Kawaji H, Takai S. Split fracture of the posteromedial tubercle of the talus: Case report and proposed classification system. J Foot Ankle Surg 2017; 56 (01) 187-190
    CrossrefPubMedGoogle Scholar
  • 8 Judd DB, Kim DH. Foot fractures frequently misdiagnosed as ankle sprains. Am Fam Physician 2002; 66 (05) 785-794
    PubMedGoogle Scholar
  • 9 Nasser S, Manoli II A. Fracture of the entire posterior process of the talus: a case report. Foot Ankle 1990; 10 (04) 235-238
    CrossrefPubMedGoogle Scholar
  • 10 Heckman JD. Fractures and dislocation of the foot. Fractures in Adults 1996
    Google Scholar
  • 11 Williams PL. Gray's anatomy. Nervous System 1995; 1240-1243
    PubMedGoogle Scholar
  • 12 Sarrafian SK. Anatomy of the foot and ankle. 1993 2Philadelphia; 1983
    Google Scholar
  • 13 Utrilla AL, López-Prats F. Consideraciones anatómicas, mecanismos y valoración de resultados en las fracturas de astrágalo. Rev Ortop Traumatol (B Aires) 2007; 51: 31-40
    CrossrefPubMedGoogle Scholar
  • 14 Ebraheim NA, Patil V, Frisch NC, Liu X. Diagnosis of medial tubercle fractures of the talar posterior process using oblique views. Injury 2007; 38 (11) 1313-1317
    CrossrefPubMedGoogle Scholar
  • 15 Kim DH, Hrutkay JM, Samson MM. Fracture of the medial tubercle of the posterior process of the talus: a case report and literature review. Foot Ankle Int 1996; 17 (03) 186-188
    CrossrefPubMedGoogle Scholar
  • 16 Ebraheim NA, Padanilam TG, Wong FY. Posteromedial process fractures of the talus. Foot Ankle Int 1995; 16 (11) 734-739
    CrossrefPubMedGoogle Scholar
  • 17 Kanbe K, Kubota H, Hasegawa A, Udagawa E. Fracture of the posterior medial tubercle of the talus treated by internal fixation: a report of two cases. Foot Ankle Int 1995; 16 (03) 164-166
    CrossrefPubMedGoogle Scholar
  • 18 Stefko RM, Lauerman WC, Heckman JD. Tarsal tunnel syndrome caused by an unrecognized fracture of the posterior process of the talus (Cedell fracture). A case report. J Bone Joint Surg Am 1994; 76 (01) 116-118
    CrossrefPubMedGoogle Scholar
  • 19 Majeed H, McBride DJ. Talar process fractures: An overview and update of the literature. EFORT Open Rev 2018; 3 (03) 85-92
    CrossrefPubMedGoogle Scholar
  • 20 Ebraheim NA, Karkare N, Gehling DJ, Liu J, Ervin D, Werner CM. Use of a 30-degree external rotation view for posteromedial tubercle fractures of the talus. J Orthop Trauma 2007; 21 (08) 579-582
    CrossrefPubMedGoogle Scholar
  • 21 Ebraheim NA, Skie MC, Podeszwa DA, Jackson WT. Evaluation of process fractures of the talus using computed tomography. J Orthop Trauma 1994; 8 (04) 332-337
    CrossrefPubMedGoogle Scholar
  • 22 Benmansour MB, Gottin M, Leclercq S, Dintimille H, Dib C, Catonne Y. [Associated fracture of the posteromedial tubercle and the lateral process of the talus: a case report. Contribution of computed tomography]. Rev Chir Orthop Repar Appar Mot 1999; 85 (07) 744-748
    PubMedGoogle Scholar
  • 23 O'Loughlin P, Sofka CM, Kennedy JG. Fracture of the medial tubercle of the posterior process of the talus: magnetic resonance imaging appearance with clinical follow-up. HSS J 2009; 5 (02) 161-164
    CrossrefPubMedGoogle Scholar
  • 24 Albert P, Patel J, Katz JI, Loria F, Parnell J, Brenner M. Magnetic resonance imaging, computed tomography, and radiographic correlation of nonunion of the posteromedial tubercle of the talus: a case report. J Foot Ankle Surg 2014; 53 (06) 787-790
    CrossrefPubMedGoogle Scholar
  • 25 Berkowitz MJ, Kim DH. Process and tubercle fractures of the hindfoot. J Am Acad Orthop Surg 2005; 13 (08) 492-502
    CrossrefPubMedGoogle Scholar
  • 26 Paulos LE, Johnson CL, Noyes FR. Posterior compartment fractures of the ankle. A commonly missed athletic injury. Am J Sports Med 1983; 11 (06) 439-443
    CrossrefPubMedGoogle Scholar
  • 27 Ahmad R, Ahmed SMY. Fracture of the posterior process of the talus: an unusual injury. Emerg Med J 2007; 24 (12) 867
    CrossrefPubMedGoogle Scholar
  • 28 Gómez Robledo J. Associated lateral process and posteromedial tubercle talus fractures with entrapment of the medial neurovascular bundle: a case report. Foot 2013; 23 (04) 149-153
    CrossrefPubMedGoogle Scholar
  • 29 Park J, Che JH. Talus Fracture of the Medial Tubercle of the Posterior Process: Interposition of the Flexor Hallucis Longus Tendon. J Foot Ankle Surg 2018; 57 (03) 615-617
    CrossrefPubMedGoogle Scholar
  • 30 Herrera-Rodríguez A, Martínez-Romero JL. Fracturas de la cabeza, cuerpo y apófisis del astrágalo. Rev Ortop Traumatol (B Aires) 2007; 51: 41-50
    CrossrefPubMedGoogle Scholar
  • 31 Bhanot A, Kaushal R, Bhan R, Gupta PN, Gupta RK, Bahadur R. Fracture of the posterior process of talus. Injury 2004; 35 (12) 1341-1344
    CrossrefPubMedGoogle Scholar
  • 32 Hsu AR, Scolaro JA. Posteromedial approach for open reduction and internal fixation of talar process fractures. Foot Ankle Int 2016; 37 (04) 446-452
    CrossrefPubMedGoogle Scholar
  • 33 Chen CW, Hsu SY, Wei YS. Fracture of the medial tubercle of the posterior process of the talus. Formosan Journal of Musculoskeletal Disorders 2011; 2 (02) 62-65
    CrossrefPubMedGoogle Scholar
  • 34 Letonoff EJ, Najarian CB, Suleiman J. The posteromedial process fracture of the talus: a case report. J Foot Ankle Surg 2002; 41 (01) 52-56
    CrossrefPubMedGoogle Scholar
  • 35 Gutierres M, Cabral T, Miranda A, Almeida L. Fractures of the posteromedial process of the talus. A report of two cases. Int Orthop 1998; 22 (06) 394-396
    CrossrefPubMedGoogle Scholar
  • 36 Banks AS, Caldarella D. Fractures of the posteromedial process of the talus. J Am Podiatr Med Assoc 1994; 84 (02) 66-70
    CrossrefPubMedGoogle Scholar
  • 37 Más Martínez J, Verdú Román C, Martínez Giménez E, Sanz-Reig J, Bustamante Suárez de Puga D, Morales Santías M. Arthroscopic treatment of a malunion of a posteromedial tubercle fracture of the talus. Arthrosc Tech 2017; 6 (06) e2107-e2110
    CrossrefPubMedGoogle Scholar
  • 38 Komur B, Yilmaz B, Kati YA, Turan A, Faruk O. Fracture of the entire posterior process of the talus: A case report and review of the literature. Int J Orthod 2017; 3 (01) 640-644
    PubMedGoogle Scholar
  • 39 Olivier D, Florent G, Philippe R, Ronan A, Solène Q. Nonunion of the Posteromedial Tubercle of the Talus: Interest of SPECT/CT. J Nucl Med Radiat Ther 2016; 7 (299) 2
    PubMedGoogle Scholar
  • 40 Yiannakopoulos CK, Kanellopoulos AD. Avulsion fracture of the medial tubercle of the posterior process of the talus: Three-dimensional (3D) computed tomography features. Foot 2007; 17 (01) 38-41
    CrossrefPubMedGoogle Scholar
  • 41 Giuffrida AY, Lin SS, Abidi N, Berberian W, Berkman A, Behrens FF. Pseudo os trigonum sign: missed posteromedial talar facet fracture. Foot Ankle Int 2003; 24 (08) 642-649
    CrossrefPubMedGoogle Scholar
  • 42 Hepple S, Guha A. The role of ankle arthroscopy in acute ankle injuries of the athlete. Foot Ankle Clin 2013; 18 (02) 185-194
    CrossrefPubMedGoogle Scholar
  • 43 Van Tongel A, Matricali GA. Fracture of the posterior medial tubercle of the talus: a case report and review of the literature. Acta Orthop Belg 2007; 73 (06) 804-806
    PubMedGoogle Scholar
  • 44 Rogosić S, Bojanić I, Borić I, Tudor A, Srdoc D, Sestan B. Unrecognized fracture of the posteromedial process of the talus--a case report and review of literature. Acta Clin Croat 2010; 49 (03) 315-320
    PubMedGoogle Scholar