目的:踝关节是运动中最常见的损伤关节。虽然脚踝扭伤肯定是最常见的伤害,踝关节骨折可经常发生。据报道发病率低的一种踝关节骨折是孤立的后踝关节骨折。由于发病率低,孤立的后踝骨折可以提出诊断挑战。本病例报告的目的是描述用于这种罕见伤害的诊断过程,这种罕见伤害发生在一名身体活跃的大学女性中,该女性在军事障碍赛道上摔倒时摔伤了脚踝。
方法:一名19岁的美国军事学院女学员到一家直接进入物理治疗诊所就诊。她一瘸一拐的,不使用任何辅助设备,在她的右脚踝/脚周围戴着王牌绷带。两天前,她在执行军事障碍路线时从“10英尺高”的结构中跌落。她不记得影响的细节,但是几个旁观者告诉她,似乎她右脚着陆,然后立即过渡到臀部,然后过渡到背部。
结果:渥太华脚踝规则和韧带测试均为阴性;但是,她在跟腱前方和内踝后边缘的外侧触诊时很温柔。基于后踝关节损伤和压痛的机制,我们怀疑有潜在的后踝关节骨折,随后通过踝关节的影像学检查,包括标准X线片和计算机断层扫描,证实了这一点.
结论:虽然渥太华踝关节规则通常可有效检测许多类型的踝关节骨折,临床医生不应仅仅依赖这些预测规则.这个案例强调了完成彻底的历史和进行彻底的身体检查的重要性。本病例报告侧重于鉴别诊断。重要的是集体考虑患者评估过程的所有方面,而不是单独考虑检查片。
OBJECTIVE: The ankle is the most commonly injured joint during athletic activity. While ankle sprains are certainly the most common injury, ankle fractures can occur frequently. One type of ankle fracture with a reportedly low incidence is the isolated posterior malleolar fracture. Because of the low incidence, isolated posterior malleolar fractures can present a diagnostic challenge. The purpose of this
case report is to describe the diagnostic process used for this rare injury that occurred in a physically active college-aged female who injured her ankle when landing from a fall during performance on a military obstacle course.
METHODS: A 19 year old female United States Military Academy cadet presented to a direct access physical therapy clinic. She was limping, not using any assistive device, and was wearing an ace bandage around her right ankle/foot. Two days earlier she fell from a \"10 foot high\" structure while performing the military obstacle course. She did not recall details of impact, but she was told by several bystanders that it appeared that she landed on her right foot followed immediately by a transition to her buttocks and then to her back.
RESULTS: Ottawa Ankle Rules and ligamentous testing were negative; however, she was tender to palpation just anterior to the achilles tendon and lateral to the posterior edge of the medial malleolus. Based on mechanism of injury and tenderness of the posterior ankle, a potential posterior ankle fracture was suspected and subsequently confirmed by radiographic studies of the ankle including standard radiographs and computerized tomography.
CONCLUSIONS: While the Ottawa Ankle Rules are generally effective in detecting many types of ankle fractures, clinicians should not rely solely on such prediction rules. This
case highlights the importance of completing a thorough history and performing a thorough physical examination. This
case report focuses on differential diagnosis. It is important to consider all aspects of the patient evaluation process collectively instead of examination pieces individually.