距骨外側突起骨折を伴った距骨脱臼骨折の1例

Fracture-Dislocation of the Neck of the Talus Associated with Fracture of the Lateral Process of the Talus : Case Report

　抄録：距骨頚部脱臼骨折治療後に右外果下部の疼痛を呈した34歳男性に対してCTにて距骨外側突起骨折による遊離骨片を認め，同骨片を摘出することで疼痛は消失した．単純X線写真では圧痛部に異所性骨化様所見を認めたが，摘出標本の病理組織診断では軟骨組織を有する骨片であると診断され，確定した．以上の所見より本症例における疼痛の原因として，骨折後の骨壊死に伴う変形性関節症によるものではなく，距骨外側骨折の合併により発生した遊離骨片によるものであり，疼痛を引き起こす原因の1つとして念頭に置く必要がある．

　We report the case of a 34-year-old man with a fracture-dislocation of the neck of the talus and fracture of the lateral process of the talus. His symptoms improved after extraction of the free body at the lateral process, and he has had no symptoms at work since the operation. X-ray examination revealed moderate osteoarthritis of the ankle and osteonecrosis of the talus, and during the physical examination tenderness was elicited over the inforlateral portion of the lateral malleolus, but it resolved after lidocaine injection at the site of tenderness. CT revealed a free body at the site. These findings suggest that fracture of the lateral process of the talus can be a cause of pain in a patients with a fracture of the neck of the talus.