This article is the third and final in a series addressing certain common foot and ankle injuries. Previous articles addressed osteochondral defects, peroneal tendon injuries and tarsal tunnel syndrome. This article will address talus fractures, avulsion fractures and Jones fractures.
Before I focus in on these various types of fractures, I wanted to just go through a refresher of some common terms used when physicians issue reports after examining foot and ankle injuries. It is important that the plaintiffs attorney be aware of these terms in order that his or her cross-examination makes sense.
Examining physicians will refer to pain on either the medial side of the ankle or the lateral side of the ankle. The medial side of the ankle is the inside of the ankle. The lateral side of the ankle is the outside of the ankle where the bony prominence exists (the lateral malleolus). Examining physicians will also refer to pain on either the posterior side of the foot or the anterior side of the foot. The posterior side of the foot is the back of the foot by the Achilles’ tendon.
The anterior side of the foot is the front of the foot. From a biomechanical standpoint, it is important for the plaintiffs attorney to understand that turning your ankle inside will most likely produce an injury on the opposite side — the anterior side — and that turning your ankle out will most likely produce an injury on the opposite side — the medial side. This is because of the greater stresses placed on the opposite side.
With respect to talus fractures specifically, the talus is one of the most important bones that make up the ankle joint. During cross-examination, the plaintiffs attorney should get the defense medical examiner to concede that the talus serves as an important link between the leg and the foot.
The talus moves not only at the ankle joint, but also below the ankle and in the midfoot. Therefore, injuries to the talus can affect motion of the ankle and foot joints. Obviously, affecting this motion can have significant effects on the functional ability of the injured party.
Typically, talus fractures are seen in high-speed car accidents and severe falls. The plaintiffs attorney should be aware of this in the unlikely event the defense medical examiner refuses to concede causation. I do not believe there would be too many scenarios where the defense medical examiner would refuse to concede causation in the event of a talus fracture status post a traumatic event.
From a damages standpoint, the plaintiffs attorney should stress on cross-examination that patients who have a talus fracture have significant ankle pain, difficulty bearing weight on the ankle and swelling around the ankle joint. Plaintiffs attorneys should also be aware there are two major complications that commonly occur with talus fractures: arthritis and osteonecrosis.
Arthritis is common after a talus fracture because so much of the bone is covered with cartilage. Arthritis may occur above the talus at the ankle joint, or below the talus at the subtalar joint. When the cartilage is injured, the normally smooth joint surface can become coarse. This coarseness can lead to accelerated wear in the joint, and ultimately to arthritis. Even with surgical treatment of a talus fracture, the development of arthritis is common. Obviously, this arthritis can be painful and even debilitating.
Other potential complications from a talus fracture include infection, nonunion, foot deformity, chronic pain and others. Therefore, if your client has persistent symptoms, make sure he or she is evaluated for any of these potential complications.
Another common injury to the foot is an avulsion fracture of the fifth metatarsal, also called a “Pseudo-Jones fracture.” The fifth metatarsal is the small toe in the foot sometimes referred to as the “pinky” toe. While this may not seem like a serious injury, an avulsion fracture can cause significant pain. It is important that the plaintiffs attorney understands the biomechanics of an avulsion fracture.
An avulsion fracture of the fifth metatarsal occurs where a tendon attaches to the bone at this point (the peroneus brevis tendon). When an avulsion fracture occurs, the tendon pulls off a tiny fragment of bone. Not surprisingly — because an avulsion fracture is called a “Psuedo-Jones fracture” — an avulsion fracture can be confused with a Jones fracture. A Jones fracture is a completely different injury named for the doctor that first wrote about it in the early 1900s. A Jones fracture is an injury to the fifth metatarsal bone of the foot. The fifth metatarsal bone is at the base of the small toe, and the Jones fracture occurs in the midfoot area (the top of the bone).
Both avulsion fractures and Jones fractures can become chronic conditions if the fracture fails to unite, or heal. If this is the case, surgery will likely be recommended to secure the fracture in place with a screw, and bone graft may be used to stimulate a healing response. Once this occurs, it is the responsibility of the plaintiffs attorney to focus on the chronic nature of the pain that can develop from any chronic orthopedic injury.
Obviously, there are many types of foot and ankle injuries that will be encountered in the personal injury, but I believe we addressed some of the most common and significant in this series of articles. •
Brandon Swartz is a founding partner of Swartz Culleton. His practice focuses on all types of personal injury cases, including wrongful death, medical malpractice, civil rights violations, motor vehicle, premises liability, products liability, trucking accidents and workers’ compensation.