Talus avulsion fractures: are they accurately diagnosed?

Dorsal talus avulsion fractures occurring along the supination line of the foot can cause pain and discomfort. Examination of the foot and ankle using the Ottawa ankle rules does not include examination of the talus, an injury here is easily missed causing concern to the patient. This is a retrospective study carried out in a major trauma centre to look at the assessment and diagnosis of all patients with a dorsal talus and navicular avulsion fractures over a one year period. Nineteen patients with an isolated dorsal talus avulsion fracture and five patients with an isolated dorsal navicular fracture were included. The correct diagnosis was made in 12 of patients with isolated dorsal talus avulsion fractures, 7 patients were given an incorrect diagnosis after misreading of the radiograph. Four patients with a dorsal navicular avulsion fracture were given the correct diagnosis. If not correctly diagnosed on presentation patients can be overly concerned that a 'fracture was missed' which can lead to confusion and anxiety. Therefore these injuries need to be recognised early, promptly diagnosed, treated symptomatically and reassurance given. We recommend the routine palpation of the talus in addition to the examination set out in the Ottawa Ankle Rules and the close inspection of plain radiographs to adequately diagnose an injury in this area.