Emergency Radiology

, Volume 26, Issue 5, pp 541–548 | Cite as

CT can stratify patients as low risk for tibial neuropathy following a talus fracture

  • Adam D. SingerEmail author
  • Tony Huynh
  • Phil Wong
  • Gulshan B. Sharma
  • Felix Gonzalez
  • Monica Umpierrez
  • Mara L. Schenker
  • Thomas J. MooreJr
Original Article



Determine the incidence of tibial neuropathy following talus fractures and CT’s ability to stratify patients at risk for developing post-traumatic neuropathy.

Materials and methods

In this IRB-approved retrospective analysis, 71 talus fractures and 8 contralateral control ankle CTs were reviewed by one observer blinded to clinical information. CT evidence suggestive of tibial neurovascular bundle injury included nerve displacement, perineural fat effacement/edema, and bone touching nerve. The association between these CT findings and clinically evident tibial neuropathy was analyzed. A semi-quantitative likelihood score was assigned based on the degree of the CT findings around the nerve. Interobserver agreement was calculated between 2 other readers.


Twenty-five percent of patients in this cohort had clinical evidence of tibial neuropathy. There was a high specificity (0.87–0.93) and negative predictive value (0.83–0.87), a moderate accuracy (0.80–0.82), but a lower sensitivity (0.33–0.56) associated with the CT findings. Among the CT findings, nerve displacement (p < 0.0001) and bone touching nerve (p = 0.01) were associated with tibial neuropathy. A likelihood score of 2–5 was associated (p = 0.007–0.015) with tibial neuropathy. The presence of tibial neuropathy and nerve recovery were not associated with hospital length of stay, while CT findings were. There was substantial agreement between the three readers: likelihood scores 2+ (k = 0.78) and 3+ (k = 0.72).


Tibial neuropathy occurs following talus fractures, and CT findings may help surgeons narrow down the number of patients requiring close neurological follow-up.


CT Tibial nerve Pain Talus Fracture 



Computed tomography


Tibial nerve


Electronic medical records


Length of stay


Compliance with ethical standards

This was an IRB-approved study.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© American Society of Emergency Radiology 2019

Authors and Affiliations

  1. 1.Department of Radiology and Imaging Sciences Section of Musculoskeletal ImagingEmory University HospitalAtlantaUSA
  2. 2.School of MedicineAugusta State UniversityAugustaUSA
  3. 3.University of CalgaryCalgaryCanada
  4. 4.Department of Orthopaedic SurgeryEmory University HospitalAtlantaUSA

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