title: Plantar talar head contusions and osteochondral fractures: associated findings on ankle MRI and proposed mechanism of injury.
abstract: OBJECTIVE
  To evaluate the significance of plantar talar head injury (PTHI) in predicting osseous and soft tissue injuries on ankle MRI.
  
  
  METHODS
  The IRB approved this HIPAA-compliant retrospective study. The study group consisted of 41 ankle MRIs with PTHI that occurred at our institution over a 5 ½ year period. Eighty MRIs with bone injuries in other locations matched for age, time interval since injury, and gender formed a control group. Injuries to the following structures were recorded: medial malleolus, lateral malleolus/distal fibula, posterior malleolus, talus, calcaneus, navicular, cuboid, lateral, medial and syndesmotic ligaments, spring ligament complex, and extensor digitorum brevis (EDB) muscle. Twenty separate logistic regressions determined which injuries PTHI predicted, using the Holm procedure to control for family-wise alpha at 0.05.
  
  
  RESULTS
  PTHI strongly predicted the occurrence of injuries involving the anterior process of the calcaneus [24 % of cases, odds ratio (OR) 12.66], plantar components of the spring ligament (27 %, OR 9.43), calcaneal origin of the EDB and attachment of the dorsolateral calcaneocuboid ligament (22 %, OR 7.22), cuboid (51 %, OR 6.58), EDB (27 %, OR 5.49), anteromedial talus (66 %, OR 4.78), and posteromedial talus (49 %, OR 4.48). PTHI strongly predicted lack of occurrence of syndesmotic ligament injury (OR 19.6). The PTHI group had a high incidence of lateral ligamentous injury (78 %), but not significantly different from the control group (53 %).
  
  
  CONCLUSIONS
  PTHI is strongly associated with injury involving the transverse tarsal joint complex. We hypothesize it results from talo-cuboid and/or talo-calcaneal impaction from a supination injury of the foot and ankle.
authors.affiliation: Department of Radiology, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA, 19141, USA. Gorbacht@einstein.edu.
authors.forename: Tetyana
authors.initials: T
authors.lastname: Gorbachova
authors.affiliation: Department of Radiology, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA, 19141, USA.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Wang
authors.affiliation: Department of Radiology, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA, 19141, USA.
authors.forename: Bing
authors.initials: B
authors.lastname: Hu
authors.affiliation: Department of Anesthesiology & Perioperative Medicine, Drexel University, Philadelphia, PA, USA.
authors.forename: Jay C
authors.initials: JC
authors.lastname: Horrow
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064386:Ankle Fractures / Q000000981:diagnostic imaging* / Q000209:etiology; D002648:Child; D003288:Contusions / Q000150:complications / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D050724:Fractures, Cartilage / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D013628:Talus / Q000000981:diagnostic imaging* / Q000293:injuries*; D055815:Young Adult
keywords: Bone contusions; MRI foot and ankle; Talar fractures; Talo-cuboid and talo-calcaneal impaction; Talus