TY - JOUR
T1 - Congenital Pseudoarthrosis of Medial Malleolusin A Young Soccer Player - Diagnosis in Clinical setting of Ankle Sprain
AU - Cerulli, Giuliano Giorgio
AU - Fantasia, F
AU - Potalivo, G
AU - Placella, G
AU - Sebastiani, E.
PY - 2014
Y1 - 2014
N2 - Introduction:
Case Report:
Conclusion:
Keywords:
We report a case of a young female soccer player affected by congenital medial bilateral malleolus
pseudoarthrosis and os subfibulare. Congenital pseudoarthrosis is the failure of the bones to fuse prior or at birth.
The etiology is still unknown, although frequency is high in subjects affected by neurofibromatosis or correlated
syndromes, so it has been suggested that these congenital disorders may be the cause of congenital
pseudoarthrosis.
Our patient, a 16-year-old female, high level soccer player, was referred to us following a right ankle
sprain during a match. She reported no medical history of tibia-tarsus joint injuries or disease. Pain, swelling and
functional impairment were noted immediately after the accident. Standard radiographs in the emergency
department revealed a displaced fracture of the medial malleolus and the presence of os subfibularis. The patient
was transferred to our Traumatology and Orthopaedic Department to undergo malleolus ostheosynthesis.
Before surgery swelling, functional impairment and intense pain at the medial malleolus level were
confirmed. However, there was no radiological opening of ankle, instability or pronation pain; furthermore
the flexion-extension was preserved with slight pain. Twenty-four hours later a considerable remission of
symptoms was evident with increased range of motion and reduction in the swelling and post-traumatic
edema. A radiograph on the left ankle to compare with that of the right ankle was necessary to overcome the
discrepancy between the radiological diagnosis and the clinical examination. The radiographic results of
both medial malleoli were comparable although on the left the os subfibularis was absent. Since the diagnosis
of fracture by the association between the radiographs and the symptomatology was doubtful, a bilateral CT
was performed. The scan revealed a medial bilateral malleolus pseudoarthrosis and an accessory right
subfibularis nucleus. The patient was discharged from hospital with the diagnosis of “second degree right
ankle sprain in patient affected by congenital medial bilateral malleolus pseudoarthrosis”. A therapeuticrehabilitative
program was prescribed for the ankle sprain and unnecessary surgery was avoided. After 30
days there was an almost complete remission of pain. At a follow-up of six months the patient was completely
asymptomatic and gradually began competitive activity.
AB - Introduction:
Case Report:
Conclusion:
Keywords:
We report a case of a young female soccer player affected by congenital medial bilateral malleolus
pseudoarthrosis and os subfibulare. Congenital pseudoarthrosis is the failure of the bones to fuse prior or at birth.
The etiology is still unknown, although frequency is high in subjects affected by neurofibromatosis or correlated
syndromes, so it has been suggested that these congenital disorders may be the cause of congenital
pseudoarthrosis.
Our patient, a 16-year-old female, high level soccer player, was referred to us following a right ankle
sprain during a match. She reported no medical history of tibia-tarsus joint injuries or disease. Pain, swelling and
functional impairment were noted immediately after the accident. Standard radiographs in the emergency
department revealed a displaced fracture of the medial malleolus and the presence of os subfibularis. The patient
was transferred to our Traumatology and Orthopaedic Department to undergo malleolus ostheosynthesis.
Before surgery swelling, functional impairment and intense pain at the medial malleolus level were
confirmed. However, there was no radiological opening of ankle, instability or pronation pain; furthermore
the flexion-extension was preserved with slight pain. Twenty-four hours later a considerable remission of
symptoms was evident with increased range of motion and reduction in the swelling and post-traumatic
edema. A radiograph on the left ankle to compare with that of the right ankle was necessary to overcome the
discrepancy between the radiological diagnosis and the clinical examination. The radiographic results of
both medial malleoli were comparable although on the left the os subfibularis was absent. Since the diagnosis
of fracture by the association between the radiographs and the symptomatology was doubtful, a bilateral CT
was performed. The scan revealed a medial bilateral malleolus pseudoarthrosis and an accessory right
subfibularis nucleus. The patient was discharged from hospital with the diagnosis of “second degree right
ankle sprain in patient affected by congenital medial bilateral malleolus pseudoarthrosis”. A therapeuticrehabilitative
program was prescribed for the ankle sprain and unnecessary surgery was avoided. After 30
days there was an almost complete remission of pain. At a follow-up of six months the patient was completely
asymptomatic and gradually began competitive activity.
KW - ankle sprain
KW - medial malleolus
KW - pseudoarthrosis
KW - ankle sprain
KW - medial malleolus
KW - pseudoarthrosis
UR - http://hdl.handle.net/10807/60802
UR - http://www.jocr.co.in/wp/wp-content/uploads/7.-2250-0685.139.pdf
U2 - 10.13107/jocr.2250-0685.139
DO - 10.13107/jocr.2250-0685.139
M3 - Article
SN - 2250-0685
VL - 4
SP - 11
EP - 14
JO - JOURNAL OF ORTHOPAEDIC CASE REPORTS
JF - JOURNAL OF ORTHOPAEDIC CASE REPORTS
ER -