Os subtibiale: Mimicking medial malleolar fracture

Topal, Murat; Köse, Ahmet; Dinçer, Recep; Baran, Tuncay; Köse, Mehmet; Engin, Muhammed Çağatay

doi:10.1016/j.ajem.2016.12.073

Cited by 8 publications

(4 citation statements)

References 12 publications

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“…It should be differentiated from a fracture of medial malleolus. According to previous reports, the incidence of os subtibiale ranges between 0.2% and 2.1% [17,[29][30][31]. Os subtibiale was observed in 0.1% of our cases.…”

Section: Discussionsupporting

confidence: 49%

Accessory Ossicles in the Region of the Foot and Ankle: An Epidemiologic Survey in a Jordanian Population

et al. 2021

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Background and Objectives: The incidence of accessory bones in the region of foot and ankle is quite variable between studies and are often confused with avulsion fractures in trauma patients with musculoskeletal injuries. The aim of this study was to assess the incidence of accessory ossicles of the foot and ankle according to gender, side and coexistence, and to determine how frequently accessory ossicles were misdiagnosed as avulsion fractures. Materials and Methods: Oblique and/or lateral foot radiographs of 1000 adult patients referred from emergency departments to foot and ankle clinic were retrospectively reviewed for the presence of accessory ossicles. The Kappa statistic was used in order to assess the validity of radiographic interpretation for the presence of these bones. Results: Accessory ossicles were detected in 40.2% of the radiographs. The incidence rates for the accessory ossicles in order of frequency were: Os trigonum (15.4%), accessory navicular (13.7%), os peroneum (11.5%), os vesalianum (1.1%), os supranaviculare (0.7%), os subfibulare (0.6%), os talotibiale (0.4%), os calcaneus secundarius (0.3%), os supratalare (0.3%), os infranaviculare (0.3%), os intermetatarseum (0.2%), and os subtibiale (0.1%). Coexistence of two or three ossicles in the same foot was observed in 4.4% of the cases, mostly coexistence with os peroneum (2.9%), followed by accessory navicular (1.6%). 2.7% of accessory ossicles were initially misdiagnosed as avulsion fractures at emergency departments. Interrater agreement over identification of different accessory ossicles was found to be reasonably reliable, with a Kappa greater than 0.80 for all assessed bones. Conclusions: In clinical practice, a thorough knowledge of normal anatomical variants is essential to facilitate appropriate diagnosis and treatment and can help to prevent diagnostic errors.

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Section: Discussionsupporting

confidence: 49%

Accessory Ossicles in the Region of the Foot and Ankle: An Epidemiologic Survey in a Jordanian Population

et al. 2021

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“…It is a rare incidental accessory bone with an estimated prevalence of 0.2% to 1.2% (Table 2). 8,21,22 The prevalence of the os subtibiale has not been reported in previous studies conducted in the Turkish population, but we found os subtibiale in 0.24% of all patients in this study (Table 2). Os subtibiale can easily be misdiagnosed or treated as a medial malleolus fracture.…”

Section: Discussioncontrasting

confidence: 44%

The Prevalence of Accessory Ossicles, Sesamoid Bones, and Biphalangism of the Foot and Ankle: A Radiographic Study

Candan

Torun

Dikici

2022

Foot & Ankle Orthopaedics

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Background: Accessory ossicles, sesamoid bones, and biphalangism of toes are the most common developmental variations of the foot. These bones may be associated with painful syndromes; however, their clinical importance is not well understood because the reported prevalence varies widely. Therefore, we aimed to investigate these variants in Turkish subjects. Methods: A total of 1651 foot radiographs were retrospectively assessed. Radiographs of feet were examined regarding the prevalence, sex, and bilaterality of accessory ossicles, sesamoid bones, and biphalangism in Turkish subjects. Results: Accessory ossicles (26.1%) and sesamoid bones (8%) were detected. The most common accessory ossicles were os trigonum (9.8%), accessory navicular bone (7.9%), and os peroneum (5.8%). Also, we detected os supratalare (0.48%), os calcanei secundarium (0.42%) os subfibulare (0.42%), os supranaviculare (0.36%), os vesalianum (0.30%), os subtibiale (0.24%), os intermetatarseum (0.12%), and os subcalcis (0.12%). We observed bipartite hallux sesamoid in 1.8% and interphalangeal sesamoid bone of the hallux in 0.7% of radiographs. Incidences of metatarsophalangeal sesamoid bones were found as 0.6%, 0.06%, 0.6%, and 5.8% in the second, third, fourth, and fifth digit, respectively. We observed biphalangeal toe in 0.5%, 1.7%, 3.5%, and 37.6% in the second, third, fourth, and fifth toe, respectively. Conclusion: This study is the first detailed report on the incidence of the most common variants of the foot and ankle in a wide-ranging patients’ series in Turkish subjects. Our study’s findings will contribute to reducing misdiagnosis. Clinical Relevance: The results of this study may provide anatomical data that could help clinicians in the diagnosis and management of disorders that present with pain and discomfort in the feet. Knowledge of these variants is important to prevent misinterpreting them as fractures.

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“…Per this classification, our patient falls under the category of Type II, which they report to be more likely to cause symptoms. Finally, Topal et al [ 12 ] have also reported a three patient case report, in which they were able to accurately identify Os subtibiale in their patients who were referred to them by the emergency department as cases of medial malleolar fractures. In two cases, they were able to treat the patients conservatively, while the third patient also presented with a slightly proximal medial malleolar fracture in addition to the presence of the Os Subtibiale, who was treated with closed reduction and splinting.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic Os Subtibiale Following Injury: A Case Report of Failed Conservative Treatment, Leading to Differential Diagnosis Made Intraoperatively

Bandyopadhyay¹

2021

JOCR

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Introduction: Introduction: Os subtibiale is a rare accessory bone found adjacent to the distal tibia and is mostly asymptomatic. Differentiating it from a medial malleolar fracture is challenging. Most cases of acute ankle trauma that presents with an Os subtibiale are initially diagnosed as fractures by treating physicians at emergency centers. It is therefore critical for an orthopedic surgeon who gets referral for such cases to consider complete history of such patients to understand the cause of their symptoms. The goal is to avoid unnecessary surgical treatment and to realize that a symptomatic Os subtibiale can be successfully managed by conservative means. Nonetheless, certain cases may require surgical treatment if conservative treatment options fail. This is a case report of a patient that was diagnosed as a case of symptomatic Os subtibiale intraoperatively, after conservative options were unsuccessful. Case Presentation: An 18-year-old patient with an injured right ankle was referred to our clinic after failed attempts to resolve his symptoms conservatively. Based on our initial clinical and radiographic examination, the patient was continued on a conservative treatment plan assuming, it was a case of unsuccessful fracture union. After almost a year of failed conservative treatments, surgery was offered to the patient, with the understanding that the bone fragment might either be fused or completely removed based on intraoperative diagnosis. At surgery, it was observed that the bone fragment had the characteristic of an Os subtibiale. It presented as a round, smooth structure with well-formed cortical boundaries, and minimal attachment to the distal tibia. A diagnosis of symptomatic Os subtibiale was made intraoperatively, which was then successfully excised using standard orthopedic instrumentation. The patient healed uneventfully and reported a pain free, normal ankle range of motion at latest follow-up of 18 months. Conclusion: Accurate diagnosis of O

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Os subtibiale: Mimicking medial malleolar fracture

Cited by 8 publications

References 12 publications

Accessory Ossicles in the Region of the Foot and Ankle: An Epidemiologic Survey in a Jordanian Population

Accessory Ossicles in the Region of the Foot and Ankle: An Epidemiologic Survey in a Jordanian Population

The Prevalence of Accessory Ossicles, Sesamoid Bones, and Biphalangism of the Foot and Ankle: A Radiographic Study

Symptomatic Os Subtibiale Following Injury: A Case Report of Failed Conservative Treatment, Leading to Differential Diagnosis Made Intraoperatively

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