Posterior compartment fractures of the ankle. A commonly missed athletic injury

This paper brings to the reader's attention an injury and symptom complex resulting from an ankle sprain during athletic competition. Twenty patients were reviewed and followed over a 3 1/2 year period of time. Three patients presented acutely and 17 patients presented after an extended period of time with residual ankle morbidity. Common to this group of patients was a history of having sustained an ankle sprain, most commonly secondary to a forced plantar flexion type injury. Subsequent disability was generally posterior and postero-lateral ankle pain associated with running and/or jumping. Clinical examination invariably demonstrated posterior ankle pain, particularly with forced plantar flexion of the foot. All patients demonstrated bony changes in the area of the posterior talus and/or tibia by x-ray, and all patients had a positive technetium bone scan of the posterior ankle area. If the injury is diagnosed acutely, cast immobilization is the treatment of choice. If diagnosed late, it is suggested that for those patients who fail conservative treatment, surgical removal of the fragment is best. The majority of patients in this study required surgical extirpation of the posterior talus bony fragment in order to relieve symptoms and return to full sports competition.