title: Missed talar neck fractures in ankle distortions.
abstract: OBJECTIVE
  Thirty-nine percent of the ankle and midfoot fractures in ankle distortions could be missed during initial evaluation in emergency department because of inadequate clinical and radiological evaluation in a limited time. We aimed to evaluate the follow-up and treatment outcomes of subjects with missed fractures, which were not diagnosed with plain radiographs obtained for ankle distortion, but with advanced imaging studies.
  
  
  METHODS
  Eight patients (4 females, 4 males) who were initially treated with a diagnosis of ankle distortion due to trauma between 2004 and 2008 were included in the study. Since there were no fractures in the initial radiographs reported by radiologists, conservative treatment was applied. However, the pain and swelling around the ankle were sustained and advanced imaging studies revealed talus fracture. All patients were evaluated with the scoring system of American Orthopedic Foot and Ankle Society (AOFAS).
  
  
  RESULTS
  Mean age of the patients was 22.37 years (range 20-40 years) at the initial fracture diagnosis. The talar neck fracture was diagnosed with computed tomography (CT) in 1 patient and with magnetic resonance imaging (MRI) in the remaining 7 patients. Mean follow-up time was 6 months (range 3-8 months), and mean AOFAS score at last follow-up was 93.7 (range 80-100).
  
  
  CONCLUSIONS
  Talus fractures can lead to serious complications because of its anatomical localization. Areas with edema, tenderness or pain should be defined on physical examination, and deep palpation should be applied on the lateral aspect of the talar neck. If there is pain in this area at late examination and no fracture was reported with conventional radiographs, the possibility of missed talar fracture should be considered and the patient should be evaluated with CT or MRI.
authors.affiliation: GATA Haydarpaşa Training Hospital, Department of Orthopedics, İstanbul, Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Rodop
authors.forename: Mahir
authors.initials: M
authors.lastname: Mahiroğulları
authors.forename: Mustafa
authors.initials: M
authors.lastname: Akyüz
authors.forename: Güner
authors.initials: G
authors.lastname: Sönmez
authors.forename: Hasan
authors.initials: H
authors.lastname: Turgut
authors.forename: Mesih
authors.initials: M
authors.lastname: Kuşkucu
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D050723:Fractures, Bone / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D013628:Talus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D014057:Tomography, X-Ray Computed; D055815:Young Adult