PMC6151209_01
Plain radiographs obtained at the first visit. Anteroposterior weight-bearing radiograph of the right ankle (a) and left ankle (b) showing valgus talar tilt with joint space narrowing and collapse of the lateral talar dome. The left ankle was also accompanied by fracture of the distal fibula (b). Lateral weight-bearing view of the right foot (c) and left foot (d) showing the severe arch collapse and increased radiodensity of the body of the talus.
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An anteroposterior (AP) weight-bearing view of the left ankle joint revealed the fracture of the distal fibula, valgus talar tilt with joint space narrowing at the lateral tibiotalar joint, and collapse of the lateral talar dome (Figure 1(b)). An AP weight-bearing view of the right ankle joint revealed similar findings on the contralateral side excluding the fracture of the distal fibula (Figure 1(a)). Lateral weight-bearing views of both feet demonstrated severe arch collapse and increased radiodensity of the body of the talus (Figures 1(c) and 1(d)).
T1-weighted (a) and short-T1 inversion recovery (b) coronal magnetic resonance imaging of the left ankle showing a vertical fracture of the talar body and osteonecrosis of the lateral talar body fragment. Computed tomography images of the left ankle showing the comminuted fragments of the lateral talar body (c) and the fracture of the distal fibula with callus formation (d).
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Magnetic resonance imaging (MRI) of the left ankle revealed a vertical crack in the talar body extending from the center of the talar dome to the subtalar joint and a lateral talar body fragment with low signal intensity on both T1-weighted and short T1 inversion recovery images suggestive of osteonecrosis (Figures 2(a) and 2(b)). A computed tomography (CT) scan of the left ankle clearly demonstrated that the fracture lines extended from the talar dome to the subtalar joint with the comminuted lateral talar body fragments and the fracture of the distal fibula with callus formation (Figures 2(c) and 2(d)).
T1-weighted (a) and T2-weighted (b) coronal magnetic resonance images of the right ankle showing the depressed lateral talar dome and cyst formation in the talar body suggestive of a previous talar dome fracture. (c) T2-weighted spectral attenuated inversion recovery (SPAIR) image in the sagittal plane showing the cyst formation and surrounding bone marrow edema in the talus underneath the depressed lateral talar dome. (d) Computed tomography image of the right ankle suggesting a past fracture of the talar body and its bony union.
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MRI of the right ankle also revealed a depressed lateral talar dome and some cyst formations surrounded by bone marrow edema in the talar body suggestive of a previous talar dome fracture; however, the lateral talar body fragment maintained the same intensity as those of other bone marrow on T1- and T2-weighted images, negating osteonecrosis in contrast with the left ankle (Figures 3(a)-3(c)). A CT scan of the right ankle demonstrated the continuity of the bone trabeculae in the suspected area of the fracture suggesting bony union (Figure 3(d)).