Impingement Exostoses of the Talus and Fibula Secondary to an Inversion Sprain A case report

Impingement exostoses of the talus and fibula following an inversion sprain is an uncommon sequela to the initial injury. Although a high frequency of symptomatic tibial and talar impingement exostoses have been reported, changes on the lateral side of the ankle are more subtle with significant roentgenographic findings rarely seen. The authors present a rare case of impingement exos-toses involving both the talus and fibula simultaneously. Arthroscopy visualized the tibiotalar and talomalleolar articulations. It revealed opposing exostoses of the talus and fibula, necessitating surgical resection. Arthroscopy is recommended for difficult diagnostic problems of the ankle and an awareness of the condition of post-traumatic impingement exostoses of the talus and f ibula. Impingement exostoses of the talus and fibula fol-lowing an inversion sprain is an uncommon seq uela to the initial injury. O'Donoqhue " in 19 57 reported on a co ndi tion he fou nd in athl etes of osteochondral rid ges or exostoses above the anterior lower art icul ar surface of the tib ia and on the opposing area of the neck of the talus. He called this finding " impingement exos-toses " of the talus and tibia. Nicholas " proposed that impingement exostoses may result from avulsion frac-tures of the rims of the talus and tibi a with talot ibi al spurs occurring anteriorly as well as anterom edially. King et et? in reporting on unusual ankle lesions in athletes found tha t one-half of the 50 memb ers of the Houston Astro baseball team had developed talot ib ial exostoses. Similar ly, Blazina and Westover ' repor ted a high frequency of symptomatic tibial and talar im-pingement exostoses in college athl etes. However, they found that changes on the lateral side of the ankle were more subtle, with sign if ican t roentgeno-graphic changes in th is reg ion rarely seen. ' Kleiger3 noted that with ligamentous injury for months local tenderness may be the only physical finding, althoug