Advertisement

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
  • 43 Downloads

Abstract

Objective

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.

Results

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).

Conclusions

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

Keywords

CT Tibial nerve Pain Talus Fracture 

Abbreviations

CT

Computed tomography

TN

Tibial nerve

EMR

Electronic medical records

LOS

Length of stay

Notes

Compliance with ethical standards

This was an IRB-approved study.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Corey RM, Salazar DH (2017) Entrapment of the superficial peroneal nerve following a distal fibula fracture. Foot Ankle Spec 10:69–71CrossRefGoogle Scholar
  2. 2.
    Ellanti P, Mohamed KM, O’Shea K (2015) Superficial peroneal nerve incarceration in the fibular fracture site of a pronation external rotation type ankle fracture. Open Orthop J 9:214–217CrossRefGoogle Scholar
  3. 3.
    Haugsdal J, Dawson J, Phisitkul P (2013) Nerve injury and pain after operative repair of calcaneal fractures: a literature review. Iowa Orthop J 33:202–207Google Scholar
  4. 4.
    Eastman JG, Firoozabadi R, Benirschke SK, Barei DP, Dunbar RP (2014) Entrapped posteromedial structures in pilon fractures. J Orthop Trauma 28:528–533CrossRefGoogle Scholar
  5. 5.
    Deng DF, Hamilton GA, Lee M, Rush S, Ford LA, Patel S (2012) Complications associated with foot and ankle arthroscopy. J Foot Ankle Surg 51:281–284CrossRefGoogle Scholar
  6. 6.
    Goss DA Jr, Reb CW, Philbin TM (2017) Anatomic structures at risk when utilizing an intramedullary nail for distal fibular fractures: a cadaveric study. Foot Ankle Int 38:916–920CrossRefGoogle Scholar
  7. 7.
    Iorio J, Criner K, Rehman S, Meizinger C, Haydel C (2014) Nerve and tendon injury with percutaneous fibular pinning: a cadaveric study. Injury 45:2051–2054CrossRefGoogle Scholar
  8. 8.
    Labronici PJ, Reder VR, de Araujo Marins Filho GF, Pires RE, Fernandes HJ, Mercadante MT (2016) Risk of injury to vascular-nerve bundle after calcaneal fracture: comparison among three techniques. Rev Bras Ortop 51:208–213CrossRefGoogle Scholar
  9. 9.
    Rbia N, van der Vlies CH, Cleffken BI, Selles RW, Hovius SER, Nijhuis THJ (2017) High prevalence of chronic pain with neuropathic characteristics after open reduction and internal fixation of ankle fractures. Foot Ankle Int 38:987–996CrossRefGoogle Scholar
  10. 10.
    Bhatia A, Bril V, Brull RT, Perruccio A, Wijeysundera D, Alvi S, Lau J, Gandhi R, Mahomed N, Davis AM (2016) Study protocol for a pilot, randomised, double-blinded, placebo controlled trial of perineural local anaesthetics and steroids for chronic post-traumatic neuropathic pain in the ankle and foot: the PREPLANS study. BMJ Open 6:e012293CrossRefGoogle Scholar
  11. 11.
    Girolami M, Galletti S, Montanari G, Mignani G, Schuh R, Ellis S, di Motta D, D’Apote G, Bevoni R (2013) Common peroneal nerve palsy due to hematoma at the fibular neck. J Knee Surg 26(Suppl 1):S132–S135CrossRefGoogle Scholar
  12. 12.
    Giuseffi SA, Bishop AT, Shin AY, Dahm DL, Stuart MJ, Levy BA (2010) Surgical treatment of peroneal nerve palsy after knee dislocation. Knee Surg Sports Traumatol Arthrosc 18:1583–1586CrossRefGoogle Scholar
  13. 13.
    Krych AJ, Giuseffi SA, Kuzma SA, Stuart MJ, Levy BA (2014) Is peroneal nerve injury associated with worse function after knee dislocation? Clin Orthop Relat Res 472:2630–2636CrossRefGoogle Scholar
  14. 14.
    Medina O, Arom GA, Yeranosian MG, Petrigliano FA, McAllister DR (2014) Vascular and nerve injury after knee dislocation: a systematic review. Clin Orthop Relat Res 472:2621–2629CrossRefGoogle Scholar
  15. 15.
    Samson D, Ng CY, Power D (2016) An evidence-based algorithm for the management of common peroneal nerve injury associated with traumatic knee dislocation. EFORT Open Rev 1:362–367CrossRefGoogle Scholar
  16. 16.
    Woodmass JM, Romatowski NP, Esposito JG, Mohtadi NG (2015) Longino PD. a systematic review of peroneal nerve palsy and recovery following traumatic knee dislocation. Knee Surg Sports Traumatol Arthrosc 23:2992–3002CrossRefGoogle Scholar
  17. 17.
    Kizilay YO, Aytan O (2017) Low-energy Hawkins type III talar neck fracture-dislocation with neurovascular and tendon entrapment in a pediatric patient. J Foot Ankle Surg 56:1288–1291CrossRefGoogle Scholar
  18. 18.
    Redfern DJ, Sauve PS, Sakellariou A (2003) Investigation of incidence of superficial peroneal nerve injury following ankle fracture. Foot Ankle Int 24:771–774CrossRefGoogle Scholar
  19. 19.
    Mitsiokapa EA, Mavrogenis AF, Antonopoulos D, Tzanos G, Papagelopoulos PJ (2012) Common peroneal nerve palsy after grade I inversion ankle sprain. J Surg Orthop Adv 21:261–265CrossRefGoogle Scholar
  20. 20.
    Nitz AJ, Dobner JJ, Kersey D (1985) Nerve injury and grades II and III ankle sprains. Am J Sports Med 13:177–182CrossRefGoogle Scholar
  21. 21.
    Ballard DH, Campbell KJ, Blanton LE, Williams JT, Sangster G, Hollister AM, Simoncini AA (2016) Tendon entrapments and dislocations in ankle and hindfoot fractures: evaluation with multidetector computed tomography. Emerg Radiol 23:357–363CrossRefGoogle Scholar
  22. 22.
    Fokin A Jr, Huntley SR, Summers SH, Lawrie CM, Miranda AD, Caban-Martinez AJ, Steinlauf SD (2016) Computed tomography assessment of peroneal tendon displacement and posteromedial structure entrapment in pilon fractures. J Orthop Trauma 30:627–633CrossRefGoogle Scholar
  23. 23.
    Golshani A, Zhu L, Cai C, Beckmann NM (2017) Incidence and association of CT findings of ankle tendon injuries in patients presenting with ankle and hindfoot fractures. AJR Am J Roentgenol 208:373–379CrossRefGoogle Scholar
  24. 24.
    Rosenberg ZS, Feldman F, Singson RD (1986) Peroneal tendon injuries: CT analysis. Radiology 161:743–748CrossRefGoogle Scholar
  25. 25.
    Rosenberg ZS, Feldman F, Singson RD, Price GJ (1987) Peroneal tendon injury associated with calcaneal fractures: CT findings. AJR Am J Roentgenol 149:125–129CrossRefGoogle Scholar
  26. 26.
    Thordarson DB, Shean CJ (2005) Nerve and tendon lacerations about the foot and ankle. J Am Acad Orthop Surg 13:186–196CrossRefGoogle Scholar
  27. 27.
    Tresley J, Subhawong TK, Singer AD, Clifford PD (2016) Incidence of tendon entrapment and dislocation with calcaneus and pilon fractures on CT examination. Skelet Radiol 45:977–988CrossRefGoogle Scholar
  28. 28.
    Crim J, Enslow M, Smith J (2013) CT assessment of the prevalence of retinacular injuries associated with hindfoot fractures. Skelet Radiol 42:487–492CrossRefGoogle Scholar
  29. 29.
    Kim DH, Ryu S, Tiel RL, Kline DG (2003) Surgical management and results of 135 tibial nerve lesions at the Louisiana State University Health Sciences Center. Neurosurgery. 53(5):1114–1124CrossRefGoogle Scholar
  30. 30.
    Dodd A, Lefaivre KA (2015) Outcomes of talar neck fractures: a systematic review and meta-analysis. J Orthop Trauma 29:210–215CrossRefGoogle Scholar
  31. 31.
    Hawkins LG (1970) Fractures of the neck of the talus. J Bone Joint Surg Am 52:991–1002CrossRefGoogle Scholar
  32. 32.
    Jordan RK, Bafna KR, Liu J, Ebraheim NA (2017) Complications of talar neck fractures by Hawkins classification: a systematic review. J Foot Ankle Surg 56:817–821CrossRefGoogle Scholar

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

Personalised recommendations