Presentation
Ankle pain for one week, worse at night. Alcohol dependence.
Patient Data
There are serpiginous central sclerotic lesions in the tibial plafond, medial cuneiform, base of the 1st metatarsal, and the posterior calcaneal tuberosity that have typical appearance for bone infarcts.
No articular collapse within the distal tibia, and ankle joint alignment is satisfactory.
Irregularity of the talar dome with central intra-articular step on the frontal projection and flattening evident on the lateral projection. There is some subtle irregular sclerosis in the medial aspect of the talar dome. This would be in keeping with pathological fracture, secondary to subchondral bone infarcts.
Medial and lateral joint effusions are noted. Soft tissue swelling noted over the malleoli.
IMPRESSION
Multiple lesions in keeping with bone infarcts, likely secondary to chronic alcohol dependence. Of concern, there is suggestion of a pathological fracture of the talar dome.
Serpiginous sclerotic bone infarcts confirmed in the tibial plafond, all the tarsals and the first metatarsal.
Undisplaced comminuted fracture of the talus involving the dome, neck and subtalar articular processes.
Case Discussion
Alcoholism is an uncommon but well known cause of bone infarcts.