Midtarsal joint injury - extra-articular avulsion fractures

Case contributed by Henry Knipe
Diagnosis certain


Twisting injury.

Patient Data

Age: 50 years
Gender: Female

Cortical avulsion fracture at the dorsal aspect of the talar neck.

The patient had ongoing pain 4 weeks after injury, a CT was performed for further assessment. 

Healing cortical avulsion fracture at the talar neck involving the dorsal talonavicular ligament.

Comminuted, undisplaced avulsion fracture through the lateral aspect of the anterior calcaneal process, likely involving the dorsal calcaneocuboid ligament. 

Case Discussion

Avulsion fractures of the dorsal talonavicular ligament may not be as innocuous as other cortical avulsion fractures as they can be an indirect sign of midtarsal instability. As seen in this case, there is a fracture of the lateral aspect of the anterior calcaneal process, presumably involving the dorsal calcaneocuboid ligament, that was occult on x-ray. 

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