Letters to the Editor



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Am Fam Physician. 2003 Mar 15;67(6):1187-1188.

Early Diagnosis and Treatment Vital in Cases of Foot Fractures

to the editor: I read with great interest the article, “Foot Fractures Frequently Misdiagnosed as Ankle Sprains,”1 which provided a thorough discussion of the various types of talus fractures and how they can be missed initially on physical examination. This is of particular importance in children, because talus fractures in children are extremely rare24 and may lead to lifelong morbidity unless they are diagnosed and treated appropriately. Furthermore, a large percentage of confirmed talus fractures are read as normal on initial radiographs.1,3

During a seven-year period, only 15 patients (average age: five years, five months) were identified at our institution who had either a talar head, neck, or body fracture (avulsion fractures and osteochondral fractures were excluded).2 The most common mechanism of injury was a motor vehicle crash, and the second most common was a fall from a height. Additionally, in 12 of these patients, the talar fracture occurred in conjunction with other ipsilateral lower extremity fractures. The initial radiographic diagnosis of these fractures was missed in 33 percent of the cases in the emergency department, which is similar to results found by Drs. Judd and Kim in the literature concerning lateral process fractures of the talus in adults.1

Talus fractures in children often present with concomitant injuries to the lower limb, causing them to be missed on initial examination. Even though they are rare, it is important for the physician to have a high index of suspicion for these injuries and to perform a complete history and physical examination of every child. A clear understanding of the epidemiology of these injuries, as well as appropriate radiologic studies of the foot and ankle, are necessary to help ensure positive clinical outcomes in children and adults.

REFERENCES

1. Judd DB, Kim DH. Foot fractures frequently misdiagnosed as ankle sprains. Am Fam Physician. 2002;66:785–94.

2. Strub WM, Mehlman CT, Todd LT Jr. Talus fractures in children. J Am Osteopath Acad Orthop. 2000;37:38–41.

3. Letts RM, Gibeault D. Fractures of the neck of the talus in children. Foot Ankle. 1980;1:74–7.

4. Louw JA, Grabe RP. Fracture of the talus in childhood. A case report. S Afr Med J. 1985;68:598–9.

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.



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