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Differential Diagnosis
- Calcaneus accessorius
- Fracture, anterior process of the calcaneus
- Fracture, dorsal navicular
- Fracture, tuberosity of the calcaneus
![31-Year-Old with a Twisted Ankle X-ray Resolution](https://www.jucm.com/wp-content/uploads/2022/02/03.22-JUCM-XR-1-2-Resolution.jpg)
Diagnosis
This patient was diagnosed with an avulsion fracture of the anterior process of the calcaneus (and also likely of the dorsal navicular).
Learnings and What to Look for
- An irregular crescentic bony fragment projects lateral to the foot on the AP view, corresponding to an avulsion of the anterior process of the calcaneus on the lateral view
- These fractures are missed 88% of the time and can lead to nonunion, unrecognized associated ligamentous injuries, and persistent ankle or foot pain
- Degan classification:
- Type I: Nondisplaced avulsion fractures with no calcaneocuboid joint involvement
- Type II: Displaced fractures but still no calcaneocuboid joint involvement
- Type III: Displaced fractures with calcaneocuboid joint involvement
Pearls for Urgent Care Management
- Types 1 and 2 are treated with plaster casting
- Type 3 is managed with open reduction internal fixation due to higher tendency for nonunion
Acknowledgment: Images and case presented by Experity Teleradiology (www.experityhealth.com/teleradiology).
A 31-Year-Old with Pain After Twisting His Ankle
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