Overlooked hindfoot fractures

Injuries of the foot and ankle are common in any emergency department. Plain radiographs remain the standard initial imaging offered, with fractures continuing to be the most common type of missed injuries, owing to various pitfalls and limitations, leading to increased use of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). Although claims related to missed fractures are relatively low volume and of low financial value, they have a financial cost and can have serious and prolonged impact on patients and the staff.

This article will focus on the most clinically and medicolegally relevant fractures of the hindfoot, that are at a higher risk of being overlooked, which would be beneficial to imaging interpreters of any grade. Main areas covered include various processes of the talus and calcaneum with a short review of avulsion fractures related to the distal tibiofibular joint. The article will discuss the anatomy, mechanism of injury, provide examples and briefly review the implications of missing such injuries.

With litigations related to missed fractures on the rise, it is critical to understand the limitations of plain film, role of early CT/MRI and interpret the plain films with increased awareness of high-risk areas with the maximum incidence of missed injuries. This article would be beneficial for radiologists, inexperienced and experienced clinicians of all grades in raising awareness with a view towards minimising and mitigating the risk of missed and delayed diagnosis of the more commonly overlooked fractures of the hindfoot.