A, Ankle radiograph shows rotated fragment of bone (arrow) with adjacent soft-tissue swelling that is characteristic of avulsion of attachment of extensor digitorum brevis muscle. 9B 32-year-old female tennis player who inverted her foot and had dorsolateral bruising in foot. Andermahr et al. Alternative Practices 3 59-year-old man with type 1 calcaneal avulsion fracture who felt pop and acute posterior heel pain. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Patel M, Extensor digitorum brevis avulsion. Common calcaneal avulsion fracture. if (!document.MAX_used) document.MAX_used = ','; A global group of dedicated editors oversee accuracy, consulting with expert advisers, and constantly reviewing additions. B, Foot radiograph shows that fragment of bone (arrow) is located in dorsal and lateral region of anterior calcaneal body. A, 22-year-old man who sustained fracture during football game. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Injury of extensor muscle, fascia and tendon of other and unspecified finger at wrist and hand level S66.3 Injury of extensor muscle, fascia and tendon of other and unspecified finger at wrist and hand level S66.3-Type 2 Excludes. A Brijs's 3 research works with 20 citations and 25 reads, including: Spontaneous rupture of the bladder: An uncommon finding on excretory urography CONCLUSION. Peripheral Vascular Disease May follow a typical ankle sprain. Podiatry Practice OBJECTIVE. The extensor retinaculum acts as a pulley, stabilizing the anterior tibial (ATT), extensor hallucis longus (EHL), extensor digitorum longus (EDL), and the peroneus tertius (PT) tendons. The EDB muscle is broad and thin. It has two smaller inferior tubercles, the medial and lateral processes. Podiatry Schools & Programs FHL = flexor hallucis longus. Ultrasound Multiple planes There is an avulsion from the superior lateral side of the calcaneum at the site of extensor digitorum brevis insertion. Research Unable to process the form. Another clinical and radiographic pitfall may be a small avulsion fracture of the EDB insertion; however, in our experience, even small EDB fracture fragments contain more bone than just the cortex so they do not have the typical linear appearance of a calcaneocuboid ligament avulsion fracture. General Medicine Ligamentous ankle pathology mainly involve the lateral ligaments and to a lesser extent the. An official website of the United States government. All were treated surgically. The tendon most commonly ruptures near Lister's tubercle in association with distal radial fractures, but can also rupture spontaneously. The function of this muscle is to extend the first through fourth toes and the respective metatarsophalangeal joints. Common calcaneal avulsion fracture. Clinically, lateral foot pain over the calcaneocuboid joint and focal soft-tissue swelling occurring proximal to the fifth metatarsal are characteristic clinical findings. Forced inversion of the foot is considered the mechanism of injury so that the EDB is rapidly stretched beyond its physiologic limits resulting in a tear of the muscle along with an avulsion fracture [32]. MR findings include signs ofmuscle denervation: ab normal signal intensity or atrophy in the supinator, ex tensor digitorum, extensor carpi ulnaris, extensor digiti minimi, extensorpollicis longus and brevis, abductorpol licis longus, and extensor indicis, with sparing . Case study, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-81094. Articles are a collaborative effort to provide a single canonical page on all topics relevant to the practice of radiology. Careers. Surgery Fig. Authors Crim et al. ORTHOPEDIC MCQS BANK WITH ANSWER ANATOMY 02. A patient has right shoulder pain. Anterior talofibular ligament, calcaneofibular ligament, and anterior inferior tibiofibular ligament show normal echopattern. The fibers of the central cord envelop the aponeurosis of the flexor digitorum brevis muscle. As such, articles are written and edited by countless contributing members over a period of time. Unable to load your collection due to an error, Unable to load your delegates due to an error. Lassiter TE Jr, Malone TR, Garrett WE Jr. Orthop Clin North Am. 3); type 2, beak fracture with a horizontal fracture extending into the posterior body; type 3, infrabursal avulsion by the superficial fibers of the middle third of the Achilles tendon (Fig. and transmitted securely. Helps to extend the first four digits. The Extensor digitorum brevis is a broad, thin muscle, which arises from the forepart of the upper and lateral surfaces of the calcaneus, in front of the groove for the Peronaeus brevis; from the lateral talocalcanean ligament; and from the common limb of the cruciate crural ligament. An important calcaneal fracture is an avulsion of the origin of the extensor digitorum brevis (EDB) muscle [24, 32]. In these patients, the fracture occurs without a history of significant trauma or overuse activity. (A) The flexor digitorum longus, flexor hallucis longus, peroneus brevis, soleus, and extensor digitorum muscles are examined at this level for strain, tears, or fatty atrophy that may suggest denervation. official website and that any information you provide is encrypted This occurs as tendons can bear more load than the bone. assess for neuologic compromise due to swelling. [CDATA[ Some plantarflexion may be involved. Superiorly, there are three articular facets covered by hyaline cartilage. Zone 2 fractures are known as Jones . It is the initial striking surface of the foot during ambulation. It inserts via tendons into the base of the proximal phalanx of the 1st toe, and the middle phalanx of the . There is an avulsion from calcaneum at the origin of extensor digitorum brevis muscle. The sagittal bands attach volarly to the palmar plate of the MCP joint and dorsally to the extensor tendon. Because these fractures may be extremely difficult to detect, either CT or MRI is required to confirm the diagnosis in many cases, particularly when pain becomes chronic [23, 27, 28]. . Journals Medially, the calcaneus is concave and relatively smooth. However, 25% of fractures in adults are extraarticular, and the incidence is even higher in children [2, 3]. Websites Common injuries in this setting include avulsion of the dorsal calcaneocuboid ligament and calcaneocuboid component of the bifurcate ligament as well as extensor digitorum brevis origin avulsion. History of the left ankle twist about 10 days back. Patients complain of swelling and dorsolateral pain over the sinus tarsi region. The extensor mechanism is one of the most complex structures in the hand (5a). It associated with local subcutaneous edema. Radiology. 6B 45-year-old woman who felt ripping sensation in bottom of her ankle 2 weeks ago. Extensor digitorum brevis muscle (Musculus extensor digitorum brevis) Extensor digitorum brevis is a thin muscle found on the dorsum of the foot. These fractures typically are treated without surgery using a cast, boot, or hard-soled shoe and tend to heal within 6-8 weeks. 5). Impaction injuries medially may produce contusions or fractures of the talar head and navicular body. The vast majority of fractures are due to compressive mechanisms such as striking the heel against a ledge or from a fall from a height so that the resulting fracture may herald a more complex fracture. DOI: 10.1016/j.pmrj.2015.05.027 Corpus ID: 41275565; Calcaneal Osseous Avulsion of the Extensor Digitorum Brevis With Radiographic and Magnetic Resonance Imaging Correlation The two mechanisms of injury that result in a fracture of the anterior calcaneal process are compression or impaction forces and extreme tensile forces [29]. The flexor hallucis longus tendon courses in a groove underneath the sustentaculum tali. Extraarticular fractures are categorized as either compressive or avulsive types. The lateral branch of the deep fibular nerve travels under the extensor retinaculum, as well as the extensor digitorum and hallucis brevis muscles to innervate these muscles and nearby joints. Restoration of prehension with the double free muscle method following full avulsion of the brachial plexus. With an avulsion fracture, an injury to the bone occurs near where the bone attaches to a tendon or ligament. Origin Disclaimer, National Library of Medicine Fractures of the tuberosity are either from an avulsion or shear-compression mechanism of injury, with the latter constituting most fractures. type 2, beak fracture with a horizontal frac-ture extending into the posterior body; type 3, infrabursal avulsion by the superficial fi-bers of the middle third of the Achilles ten - don (Fig. Anatomy Anterior talofibular and calcaneofibular ligaments are normal. 7). Part I: Anatomy, biomechanics, diagnosis, and natural history. Ultrasound reveals an additional finding - an avulsion fracture from the cuboid. Unable to process the form. government site. ADVERTISEMENT: Supporters see fewer/no ads. There is no effusion in the anterior recess of the ankle joint. - function: - limits independent extension of ulnar 3 digits; - flexion of middle & little fingers at MCP joint, prevent its independent extension of ring finger; You can use Radiopaedia cases in a variety of ways to help you learn and teach. Accessibility Federal government websites often end in .gov or .mil. Insertion [edit | edit source]. Axial loading of the foot following a fall from a height is the most common mechanism for severe calcaneal fractures. Imaging Type 1 fractures are likely insufficiency fractures, occurring in elderly patients with osteoporosis after minor trauma such as tripping. Most injuries are caused by high-energy trauma that result in intraarticular fractures [1]. If the lateral view is equivocal, an oblique projection of the foot may be diagnostic [24]. Extensor digitorum brevis avulsion fracture: Versatility of the Extensor Digitorum Brevis Muscle Flap in Lower Limb Reconstruction. Articles. Wound Management, Extensor digitorum brevis avulsion fracture, Suggest an edit or suggest some resources, We have not yet got to this page to finish it yet. The site is secure. 2007 Shaw Bronner. The main function of the Extensor Digitorum Brevis Muscle is to control the movement of the toes. Lateral radiograph shows superiorly displaced bone fragment (curved arrow) and donor site defect in superior aspect of calcaneal tuberosity (straight arrow). This configuration gives it the viscoelasticity that allows it to absorb and adapt to forces that can approach 612.5 times body weight during running [7, 8]. INTRODUCTION Calcaneal fractures are relatively uncommon, comprising 1 to 2 percent of all fractures, but important because they can lead to long-term disability. Articles are a collaborative effort to provide a single canonical page on all topics relevant to the practice of radiology. 134 (1): 119-23. if (document.MAX_used != ',') document.write ("&exclude=" + document.MAX_used); Fig. The calcaneus is a relatively long tarsal bone that has the shape of a pistol grip (Fig. A pitfall is a normal small ossicle, the os calcaneus secondarius, which is adjacent to the anterior calcaneal process mimicking this fracture; however, these ossicles, which are seen in about 25% of the population, are completely surrounded by lamellar bone [33, 34] (Fig. [9 ] found that 28% of calcaneal fractures had associated peroneal tendon displacement, and only 10.2% of these associations were identied in the radiology report. 3 ); type 2, beak fracture with a horizontal fracture extending into the posterior body; type 3, infrabursal avulsion by the superficial fibers of the middle third of the achilles tendon ( fig. 1989 Oct;20(4):629-40. 1989 Oct;79(10):514-6. doi: 10.7547/87507315-79-10-514. complex, and extensor digitorum brevis (EDB) muscle. var m3_r = Math.floor(Math.random()*99999999999); The Achilles tendon is the strongest tendon in the body and has an average length of 15 cm. FOIA At the midbody level, a small prominence marks the attachment of the calcaneofibular ligament. In this article, we will show the characteristic appearance and location of these fractures, discuss the mechanisms responsible for these injuries, and illustrate potential pitfalls to consider. The middle talar facet is an inclined oval surface on the roof of the sustentaculum. The lateral cord arises from the lateral margin of the medial process and extends to the cuboid and base of the fifth metatarsal bone, enveloping the aponeurosis of the abductor digiti minimi muscle. Fig. This muscle spares the smallest toe from its control. The bulbous proximal end is the calcaneal tuberosity, and it serves as the attachment of the Achilles tendon. European Journal of Radiology, Vol. 1995;197(2):439-42. B, Axial proton-density MR image shows that avulsion occurred distally at cuboid attachment manifested as gap (arrow) between ligament and cuboid. The case shows x-ray and ultrasound findings of extensor digitorum brevis avulsion. Injury to these tendons is often the result of repetitive trauma and overuse and most commonly presents as tendinosis and tenosynovitis. The soft-tissue defects were associated with fractures in 40/64 (63%) patients. 8). It forms the anterior facet superiorly and the calcaneocuboid joint anteriorly. About half of these fractures are radiographically occult even when confirmed on MRI, whereas as many as 6% of radiographically evident fractures in adults are misdiagnosed as ankle sprains [23]. Ultrasonography and radiography can be used to make a diagnosis of calcific tendinopathy of the ankle and Depending on the affected tendon the differential diagnosis includes many diseases. The extensor carpi radialis brevis originates from the lateral epicondyle of the humerus by a common tendon shared with other muscles of the posterior superficial compartment including the extensor carpi ulnaris, extensor digiti minimi, and extensor digitorum. Before Would you like email updates of new search results? There is small linear bone fragment located lateral to calcaneocuboid joint (curved arrow). It passes obliquely across the dorsum of the foot, and ends . At the level of the MCP joint, the extensor digitorum tendon is joined by the sagittal bands, one of the main components of the extensor hood. Careful scrutiny of the cortex is necessary for making the diagnosis. The Role of Imaging in Diagnosing Diseases of the Distal Radioulnar Joint, Triangular Fibrocartilage Complex, and Distal Ulna, MR Imaging of Disorders of the Achilles Tendon, Review. Many variations to the classic anatomy of the extensor system are found.8 Examples include the presence of accessory muscles like the extensor carpi radialis intermedius and extensor medii proprius, which are present in 10% of hands.9 Variations exist in the number of EDC slips to the digits and anatomy of the juncturae tendinae over the dorsum of the hand.8 There is also variation within the . There is another avulsion fracture from cuboid at cuboid - 5th metatarsal joint. The marrow signal is abnormal, consistent with a marrow edema pattern: low signal on the T1-weighted image and high signal on the fluid-sensitive STIR image. The extensor pollicis longus (EPL) tendon resides within the 3 rd dorsal extensor compartment of the wrist, inserts upon the distal phalanx of the thumb, and is the primary extensor of the thumb. 30. The mechanisms of injuries include overuse and neuropathic conditions, although most cases are related to trauma. This ossicle is referred to as os calcaneus secundarius and is differentiated from fracture by lack of donor site in calcaneus. Another pitfall occurs in children. Pitfalls and Pearls in MRI of the Knee, Clinical Perspective. Type 2 Excludes Help. A female presented with left ankle injury followed by local pain. 11). . extensor digitorum brevis manus (EDBM) extensor medii proprius (EMP) extensor indicis et medii communis (EIMC) Differential Ganglion cysts Synovitis both produce dorsal wrist pain Treatment Nonoperative observation indications first line treatment Operative surgical decompression of 4th dorsal compartment (aEIP) or reduction of muscle belly (EDBM) Some plantarflexion may be involved. neurologic. Fig. Extensor Digitorum Brevis is one of the intrinsic muscles on the dorsum of the foot.It arises from the upper and lateral surface of the calcaneous, the floor of tarsal sinus, the talocalcaneal ligament, and the stem of the inferior extensor retinaculum . 6.14 Stress fracture on MRI. Although rare, an avulsion of the medial plantar process may occur when forceful tension on the plantar fascia enthesis occurs during falling from a height while landing on the tips of the toes, from forceful contraction of the Achilles tendon against a static long plantar ligament, or from violent contraction of the abductor hallucis muscle by forced dorsiflexion of the first ray [21, 22]. Download Free PDF View PDF. One pitfall is that an avulsion fracture of the attachment of the calcaneofibular ligament occasionally may appear similar on the anteroposterior ankle radiograph, but the fracture fragment appears more posteriorly located on the frontal radiograph of the foot and is usually smaller. Plantar fasciitis is the most common cause of heel pain, a degenerative process that results in fibrofatty degeneration, microtears, and collagen necrosis in the fascial enthesis. document.write ('&cb=' + m3_r); Avulsion can occur at origin of EDB at insertion into superolateral aspect of calcaneus. Reportedly, the percentage of unrecognized fractures in children is three to four times higher [4]. B, 30-year-old man who did not have trauma. This vulnerability may be due to progressive loss in height of the motion segment noted by the authors due to visoelastic deformation and creep resulting from repeated loading without sufficient periods . Dorsal foot. Derbolowsky sign p. 47 Ligament tests p. 37 Radiology Pelvic ligament insufficiency Sacroiliac joint motion restriction Osteoarthritis Rib vertebrae motion restriction Rib fracture Neurology Radiography (MRI/CT) Laboratory . Check for errors and try again. Nine major extensor tendons are located at the dorsal aspect of the wrist. 7B 25-year-old man who fell while skiing. Fractures in the medial process of the calcaneus may occur as a result of compressive or tensile forces. Calcaneal Osseous Avulsion of the Extensor Digitorum Brevis With Radiographic and Magnetic Resonance Imaging Correlation Calcaneal Osseous Avulsion of the Extensor Digitorum Brevis With Radiographic and Magnetic Resonance Imaging Correlation PM R. 2015 Dec;7(12):1309-1311.doi: 10.1016/j.pmrj.2015.05.027. Fig. Fig. [10] highlighted the association between hindfoot fractures and tibialis posterior tendon entrapment (16.1%) and subluxation (9.3%). Defect in tubercle was similar in size to avulsed fragment (curved arrow) and likely its source. The medial part of muscle known as the extensor hallucis brevis ends in a tendon and get inserted into the dorsal surface of the base of the proximal phalanx of big toe; The other three tendons get inserted into the lateral side of tendons of the extensor digitorum longus of toes 2,3 and 4; ACTION. Fig. More than 90% of calcaneal fractures are extraarticular in children younger than 7 years, and 60% of such fractures are extraarticular in children 814 years old [4]. The plantar fascia is a dense connective tissue band that resides in the inferior aspect of the foot and is composed of three cords: medial, central, and lateral cords. The structural integrity of these ligaments as well as the plantar fascia is necessary for proper function of the calcaneocuboid joint [39]. 10). : This paper attempts to familiarize the podiatrist with the pathologic entity of avulsion fracture at the extensor digitorum brevis muscle origin and its mechanism of injury, clinical presentation, and treatment. Calcaneal Avulsion Fractures: An Often Forgotten Diagnosis, Review. 64 Section . A fracture through abnormal or diseased bone and commonly occurring with little or no trauma. The tendon has a coiled collagen fiber pattern that spirals about 90 before its attachment [6]. Fig. Occasionally, the middle and anterior subtalar joints form a contiguous articulation instead of two discrete joints. Management of a Delayed-Union Sesamoid Fracture in a Dancer. The primary fracture line is parallel to the apophyseal scar, and the fracture affects the superior cortex but not always the inferior cortex. Fig. Paediatrics Fig. Just rostral or under the inferior extensor retinaculum, the deep fibular nerve branches into medial and lateral branches. The calcaneocuboid joint is a large lateral joint in the midfoot. Foot Orthotics It can be seen on routine radiograms and the problem it presents is one of diagnosis rather than treatment. Pharmacology Laterally, the calcaneus has two protuberances. Avulsion fractures at the base of the index finger or long finger metacarpals are rare. Download Citation | On Aug 15, 2020, Ammar Haouimi and others published Extensor digitorum brevis avulsion | Find, read and cite all the research you need on ResearchGate (B) The tibialis anterior, extensor hallucis longus, and extensor digitorum longus tendons are examined on every ankle MR examination . The lateral segments course distally to insert on the middle phalanges of the second through fourth toes, whereas the most medial segment forms the extensor hallucis brevis. Several ankle ligaments ensure the static and dynamic stability of the ankle joint, but they are prone to injury due to acute trauma as well as repetitive ankle sprains. Avulsion fractures at the EDB origin from the anterior process of the calcaneus may also occur and may be difficult to distinguish from those of the dorsal calcaneocuboid or bifurcate ligaments, although they typically produce a larger fracture fragment. A, Frontal 3D CT image of calcaneus in cadaver shows shelflike prominence of medial plantar process (arrow) where central and lateral cords of plantar fascia inserts. 2 ): type 1, simple avulsion with a variable-sized bone fragment ( fig. Post-traumatic left foot pain for the last 2 days. Figure 1 Frontal and oblique foot radiographs, not ankle radiographs, are most optimal for showing these fractures, which characteristically appear as variably small linear cortical fragments that rotate when the joint distracts. The cause is strong muscular contraction with the heel fixed to the ground and occurs only in a subset of patients who have a broad and extensive tendinous insertion [9]. Fig. Physical Examination of the Peripheral Nerves and Vasculature. The fracture is best depicted on the anteroposterior projection of the ankle or the frontal projection of the foot, and it characteristically appears as variably sized fragments of bone arising from the dorsolateral aspect of the anterior calcaneus (Fig. These facets are oriented in slightly different geometric planes and articulate with the inferior aspect of the talus to form the anterior, middle, and posterior subtalar joints. The calcaneus is the primary weight bearing bone in the heel, and its many surface contours render it a relatively difficult bone to visualize in its entirety. PMC 5A Images of medial plantar process. An avulsion fracture on the dorsolateral aspect of the calcaneus at the origin of the extensor digitorum brevis muscle was identified after inversion injuries of the ankle. We will eventually. A systematic evaluation of the calcaneus with attention to areas of vulnerability will assist those who interpret ankle and foot radiographs in maintaining a high diagnostic accuracy for these fractures. Radiology. As such, articles are written and edited by countless contributing members over a period of time. Keywords: avulsion, calcaneus, foot, fracture, ligament, plantar fascia, tendon. 4); and type 4, small beak fracture avulsed from the deep fibers of the tendon [9, 10]. Treatment ice, compression and elevation limitation of weightbearing for 3-4 weeks Mallet Finger. Lateral ankle ligaments are normal. Sagittal T1-weighted MR image shows small fragment of bone (straight arrow) arising from anterior calcaneus process corresponding to type 1 fracture. Fragment arising from the dorsal base of the distal phalanx with fixed flexion. A, Postsplint radiograph obtained 2 days after injury depicts ossific fragment (arrow) in Achilles tendon approximately 5 cm above enthesis. Biomechanics Closed rupture/avulsion of the extensor tendon (flexor digitorum profundus) may or may not be associated with an avulsion fracture from the volar aspect of the distal phalanx. if (document.context) document.write ("&context=" + escape(document.context)); A, Frontal radiograph shows swelling in lateral foot with its epicenter just proximal to base of fifth metatarsal bone (straight arrow). You can use Radiopaedia cases in a variety of ways to help you learn and teach. MRI may be necessary to confirm the diagnosis (Fig. Transfer of the supinator muscle to the extensor pollicis brevis for thumb extension reconstruction in C7-T1 brachial plexus palsy. 8B Type 1 fracture versus os calcaneus secundarius in two patients. B, 27-year-old male baseball player with acute heel pain after pushing off base while accelerating. The differential diagnosis is broad and includes gout or pseudogout, avulsion fractures, sesamoid bones, myositis ossificans and infection [156]. Conferences An avulsion fracture is caused by tension on the bifurcate ligament during forceful inversion and plantar flexion of the foot. A type 2 excludes note represents "not included here". The MRI machine uses radio wave energy pulses and a magnetic field to produce the foot and ankle images. While the most common Toussaint et al. Lateral radiograph shows linear break in medial plantar process (arrow). Please enable it to take advantage of the complete set of features! Pitfalls in Shoulder MRI: Part 1Normal Anatomy and Anatomic Variants, Perspective. Adapted with permission from Lee et al. Fig. decreased ankle plantarflexion strength with avulsion fractures. The extensor digitorum brevis (Latin: musculus extensor digitorum brevis) is a thin, short muscle of the foot that aids in the extension of the second, third and fourth fingers of the foot. document.write ("?zoneid=188"); 9). Figure 1a shows a gadolinium-enhanced transverse MRI scan at the level of the coracoid. From a radiographic perspective, the calcaneus is a relatively difficult bone to visualize in its entirety. It associated with local subcutaneous edema. - Anterior and posterior subtalar joints, which do not communicate. The most common cause is osteoporosis, Metastatic bone disease (lytic, blastic, or mixed lesions) secondary to carcinomas that metastasize to bone: breast, brain, thyroid, kidney and prostate. Insufficient views, our first pitfall. //]]>-->, Page last updated: Jul 27, 2022 @ 10:31 pm. Distal to the posterior subtalar joint is a depression called the calcaneal sulcus that extends medially to terminate at the sustentaculum tali. The anterior calcaneal process is a bony promontory in the anterolateral aspect of the calcaneus bordered distally by the navicularcuboid articulation and proximally by the sinus tarsi. Case Discussion A female presented with left ankle injury followed by local pain. - origin: most commonly from extensor tendon of ring finger; - insertion: juncture diverge from ring finger, & go on to attach to extensor tendons of middle and little digits. 6A 45-year-old woman who felt ripping sensation in bottom of her ankle 2 weeks ago. There is heterogeneous signal intensity within tendon and focus of low signal intensity (straight arrow) approximately 5 cm above enthesis. HHS Vulnerability Disclosure, Help Professional Organisations Subtalar joints. Interesting information It is located in the dorsal aspect of the foot and belongs to the dorsal foot muscles. A compressive fracture occurs by impaction of the anterior process from the cuboid and talus during eversion and dorsiflexion, which is referred to as a nutcracker lesion, or by forceful abduction of the forefoot with the heel fixed to the ground [30, 31]. It can be seen on routine radiograms and the problem it presents is one of diagnosis rather than treatment. Osseous erosions, all of which avulsion fracture of the spinous pro- metastases rarely cross intervertebral can reduce normal cess of the C6 or C7 vertebra caused by disk spaces, whereas infectious osteo- range of motion and, in abrupt hyperflexion of paraspinal mus- myelitis often erodes the vertebra and severe cases, lead to cles. Neurology Portion of bifurcate ligament is shown (curved arrow). We found six cases in the English language of a similar injury involving the extensor carpi radialis brevis. The avulsed fragment had arisen from the 369 Fulham Road, base of the third metacarpal and was clearly identified in London SW10 9NH, UK e-mail: gonzaloansede@gmail.com continuation with the extensor carpi radialis brevis. Avulsions of the hand and wrist are a heterogeneous group of injuries, but they often have a characteristic imaging appearance that relates to the intricate bone and soft-tissue anatomy and the mechanism of injury. As such, articles are written and edited by countless contributing members over a period of time. Extensor digitorum brevis pain can occur due to injury or trauma to the muscle and can result in medical conditions like dropfoot or interosseus syndrome. 1 Calcaneal anatomy. A, Close-up of oblique view of foot shows linear piece of bone (arrow) just proximal to calcaneocuboid joint. Oblique view of foot shows incidental ossicle (arrow) located between calcaneus, talus, navicular, and cuboid that mimics type 1 anterior process fracture. Fig. - 4 different US approaches to subtalar joints. 4B 43-year-old man who fell off horse and experienced pain and bruising in back of ankle. 1. Avulsion fractures of the fifth metatarsal tuberosity are also known as "pseudo-Jones fractures" or "dancers' fractures." The mechanism of injury involves inversion of a plantar-flexed foot, with tension on the lateral component of the plantar aponeurosis and peroneus brevis tendon .While the peroneus brevis tendon attaches to both the base and tuberosity of the fifth metatarsal, the . Patient Assessment and Examination A, Lateral radiograph shows fracture (straight arrow) through enthesophyte emanating from medial plantar process. Injury to the lateral ligaments of the ankle. 8A Type 1 fracture versus os calcaneus secundarius in two patients. Often soft tissue injury only. JF Norfray, LF Rogers, GP Adamo, HC Groves, WJ Heiser. Conditions in the fascia that produce pain in the heel can be attributed to either plantar fasciitis or fascial rupture. These fractures are important because they have a strong association with other foot abnormalities, such as rupture of the anterior talofibular ligament, other tarsal fractures, and injuries of the peroneal ten-dons [29, 32]. there are four types of avulsion fractures ( fig. 8600 Rockville Pike Distally, the tendon has a concave anterior and convex posterior surface tapering to its broad enthesis on the calcaneus located at the middle third of the posterior surface of the calcaneal tuberosity. Podiatrists Fig. So many fractures are visible only on a single view and if other views are not obtained, you are going to get false negatives. Fractures involving the anterior process are not as common as other fractures in the ankle but they are not rare, occurring in as many as 5% of patients with ankle fractures [2426]. B, Axial CT image shows that avulsion fracture (oval) corresponds to proximal attachment of dorsal calcaneocuboid ligament. Please. Note saucerlike defect in inferior aspect of calcaneus from bone lysis (curved arrow). The margins of this joint should be closely inspected for fractures in patients who have an inversion or plantar flexion injury of the foot or forced adduction injury of the forefoot. Twenty separate logistic regressions determined which inju- . Objectives: We are going to examine common radiographic pitfalls in lower extremity trauma and discuss strategies for dealing with them. There is an avulsion from the superior lateral side of the calcaneum at the site of extensor digitorum brevis insertion. What are some causes of pathological fractures? Neuropathic fractures are important because they have a much higher incidence of infection, nonunion, malunion, and failure of fixation and require a much longer time to heal than nonneuropathic insufficiency fractures. 1st metatarsophalangeal (MTP) joint. Articles. Microbiology and Infection Control 10A 21-year-old male basketball player who inverted his foot and had pain laterally. Bone lysis at the enthesis may be the only finding in many cases (Fig. 'https://flow.aquaplatform.com/ajs.php':'http://flow.aquaplatform.com/ajs.php'); A rupture of plantar fascia is far less common but is characterized clinically by severe focal pain inferior to the calcaneus that is associated with tenderness to palpation and an acute onset [19, 20]. Fig. Abdelrahman, . NERVE . 9A 32-year-old female tennis player who inverted her foot and had dorsolateral bruising in foot. (Drawings by Yu JS. If surgical needed excision of fragment,