![]() ![]() Variant: something that differs in some characteristic from the class to which it belongs, as a variant of a disease, trait, and so forth. Synostosis: the osseous union of two bones that are normally distinct. Supernumerary: in excess of the regular or normal number. Sesamoid: a small, nodular bone embedded in a tendon or joint capsule. Os: bone a general term that is qualified by the appropriate adjective to designate a specific type of bony structure or a specific segment of the skeleton. Their definitions are as follows (from Dorland’s Illustrated Medical Dictionary 1):Īccessory: supplementary to another similar and generally important thing.Īnomaly: marked deviation from the normal standard, especially as a result of congenital defects. Several words are frequently used when referring to variations of the skeleton. More common examples of the latter include the accessory navicular and tarsal coalition. Variations typically are incidental findings and asymptomatic, although symptomatology or pathology may occur secondary to a skeletal variation. However, variations in their appearance are not uncommon. (This number includes the distal tibia and fibula and the two sesamoids at the first metatarsophalangeal joint.) The previous chapter described the expected radiographic appearance of each bone in the many views available. ![]() Large or displaced fractures may require operative treatment.Thirty bones compose the foot and ankle complex. Small nondisplaced fracture: nonweight-bearing with compressive dressing or NWBSLC for four to six weeks Lateral radiograph (an accessory ossicle, the calcaneus secondarium, may be present) Point tenderness over the calcanealcuboid joint (approximately 1 cm inferior and 3 to 4 cm anterior to the lateral malleolus) Inversion with plantar flexion can lead to an avulsion fracture.įorced dorsiflexion compression fracture. Tenderness to deep palpation between the medial malleolus and the Achilles tendonĭifficult with standard views an oblique ankle radiograph taken with the foot placed in 40 degrees of external rotation has been successful. Posterior talar process (medial tubercle) Large or displaced fragments or persistent symptoms: operative treatment Minimally displaced fracture: NWBSLC for four to six weeks Lateral radiograph (an accessory ossicle, the os trigonum, may be present) Tenderness to deep palpation anterior to the Achilles tendon over posterolateral talus Posterior talar Process (lateral tubercle) Large or displaced fragments: operative treatment Small fragment with <2 mm Displacement: NWBSLC for four to six weeks Mortise view lateral view may show subtalar effusion Point tenderness over the lateral process (anterior and inferior to the lateral malleolus) Stage I, II, or III (see Table 3): NWBSLC for six weeks Stage IV (see Table 3): surgical treatment Tenderness posterior to the medial malleolus, along the posterior border of the talusĪP view: deep, cup-shaped lesion initial radiograph can be normal because changes in subchondral bone may not develop for weeks. Inversion with plantar flexion or atraumatic Stage III or IV (see Table 3), or persistent symptoms: surgical Treatment Stage I or II (see Table 3): NWBSLC for six weeks Mortise view: shallow, wafer-shaped lesion Tenderness anterior to the lateral malleolus, along the anterior border of the talus Computed tomographic scans or magnetic resonance imaging may be required because these fractures are difficult to detect on plain films. Delays in treatment can result in long-term disability and surgery. These fractures can often be managed nonsurgically with nonweight-bearing status and a short leg cast worn for approximately four weeks. Posterior talar process fractures are often associated with tenderness to deep palpation anterior to the Achilles tendon over the posterolateral talus, and plantar flexion may exacerbate the pain. Lateral talar process fractures are characterized by point tenderness over the lateral process. Fractures of the talar dome may be medial or lateral, and they are usually the result of inversion injuries, although medial injuries may be atraumatic. However, the clinical presentation of subtle fractures can be similar to that of ankle sprains, and these fractures are frequently missed on initial examination. Most ankle injuries are straightforward ligamentous injuries. ![]()
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