Os Trigonum Case Detected by Direct Radiography and Magnetic Resonance Imaging Methods

Abstract

Os trigonum was first described by Rosenmuller in 1804. Os trigonum is an accessory bone located on the posterolateral side of talus. It usually develops as a separate ossification center next to talus at the age of 8-13 and it is expected to fuse within 12 months. If fusion does not occur, it develops as a separate bone and it is named os trigonum. Os trigonum causes pain in the back of the foot by compressing between talus and calcaneus as a result of excessive plantar flexion of the foot, and thus showing symptoms of an asymptomatic condition is called os trigonum syndrome. Os trigonum was detected with the help of Direct Radiography (DR) and Magnetic Resonance Imaging (MRI) methods in a 15-year-old male patient who was admitted to the emergency trauma unit of our hospital with pain and swelling in his right foot due to a sprain in his ankle while playing football.

Keywords

• os trigonum
• os trigonum syndrome
• Magnetic Resonance Imaging

Direkt Grafi ve Manyetik Rezonans Görüntüleme Yöntemleri ile Tespit Edilen Os Trigonum Olgusu

Öz

Os trigonum ilk kez 1804 yılında Rosenmuller tarafından tanımlanmıştır. Os trigonum talus’un posterolateral tarafında yer alan aksesuar bir kemiktir. Genellikle 8-13 yaşlarında talus’un yanında ayrı bir ossifikasyon merkezi olarak gelişim gösterir ve 12 ay içinde kaynaşması beklenir. Kaynaşma gerçekleşmez ise ayrı bir kemik olarak gelişir ve os trigonum adını alır. Os trigonum ayağın aşırı plantar fleksiyonu sonucu talus ve calcaneus arasında sıkışarak ayak arka kısmında ağrıya neden olur ve böylece asemptomatik olan durumun semptom göstermesine os trigonum sendromu denilmektedir. Hastanemizin acil travma birimine futbol oynarken ayak bileğinde burkulma sonucu sağ ayağında ağrı ve şişlik şikayeti ile başvuran 15 yaşında erkek hastada Direkt Grafi (DG) ve Manyetik Rezonans Görüntüleme (MRG) yöntemleri yardımı ile os trigonum tespit edilmiştir.

Anahtar Kelimeler

• os trigonum
• os trigonum sendromu
• Manyetik Rezonans Görüntüleme

Kaynakça

1. 1. Labs, K, Leutloff, D, Perka, C, Posterior ankle impingement syndrome in dancers—a short-term follow-up after operative treatment, Foot and Ankle Surgery, 2002, 8(1), 33-39.
2. 2. Sarrafian, S.K, Sarrafian’s Anatomy of the foot and ankle, 3th. edition, Philadelphia, Lippincott Williams&Wilkins, a Wolter Kluwer, 2011; pp 100.
3. 3. Mouhsine, E, Crevoisier, X, Leyvraz, P.F, Akiki, A, Dutoit, M, Garofalo, R, Post-traumatic overload or acute syndrome of the os trigonum: a possible cause of posterior ankle impingement, Knee Surgery Sports Traumatol ogy Arthroscopy, 2004, 12, 250-253. Doi 10.1007/s00167-003-0465-5.
4. 4. McDougall, A, Os trigonum, The Journal of Bone and Joint Surgery (Br), 1955, 37, 257-265.
5. 5. Arıncı, K, Elhan, A, Anatomi, 6. Baskı, Ankara Günes Tıp kitabevleri, 2016, s 27.
6. 6. Nault, M.L, Kocher, M.S, Micheli, L.J, Os trigonum syndrome, Journal of the American Academy of Orthopaedic Surgeons, 2014, 22(9), 545-553.
7. 7. Karasick, D, Schweitzer ,M.E, The os trigonum syndrome: Imaging features, American Journal of Roentgenology, 1996, 166, 125-129.
8. 8. Hedrick, M.R, McBryde, A.M, Posterior Ankle Impingement, Foot & Ankle International, 1994, 15(1), 2–8. doi:10.1177/107110079401500102.

9. 9. Wredmark, T, Carlstedt, C.A, Bauer, H, Saartok, T, Os trigonum syndrome: a clinical entity in balet dancers. Foot and Ankle, 1991, 11(6), 404-406.
10. 10. Lee, J.C, Calder, J.D.F, Healy, J, Posterior Impingement Syndromes of the Ankle, Seminars in musculoskeletal radiology, 2008, 12(2), 154-169.
11. 11. Coetzee,J.H, Seybold, J.D, Moser, B.R, Stone, R.M, Management of Posterior Impingement in the Ankle in Athletes and Dancers, Foot & Ankle International, 2015, 36(8), 988-994. DOI: 10.1177/1071100715595504.
12. 12. Bureau, N.J, Cardinal, É, Hobden, R, Aubin, B, Posterior Ankle Impingement Syndrome: MR Imaging Findings in Seven Patients, Radiology, 2000, 215(2), 497–503.doi:10.1148/radiology.215.2.r00ma01497.
13. 13. Lawson, J.P, Symptomatic Radiographic Variants in Extremities, Radiology, 1985, 157, 625-631.
14. 14. Chao, W, Os trigonum. Foot and Ankle Clinics of North America, 2004, 9(4), 787-796.
15. 15. Easley, M.E, Wiesel, S.W, Operative Techniques in Foot and Ankle Surgery. Lippincott Williams&Wilkins, a Wolter Kluwer, 2011. pp. 754-755.
16. 16. Mellado, J.M, Ramos, A, Salvado, E, Camins, A, Danus, M, Sauri, A, Accessory ossicles and sesamoid bones of the ankle and foot: imaging findings, clinical significance and differential diagnosis, European Radiology ,2003, 13, L164-L177. DOI 10.1007/s00330-003-2011-8.
17. 17. Smyth, N.A, Zwiers, R,Wiegerinck, J.I, Hanno, C.P, Murawski, C.D, Dijk, C.N.V, Kennedy, J.G, Posterior Hind foot Arthroscopy, The American Journal of Sports Medicine, 2013, Vol. 42, No. 1. DOI: 10.1177/0363546513491213.
18. 18. Liklater, J, MR Imaging of Ankle Impingement Lesions, Magnetic Resonance Imaging Clinics of North America, 2009, 17, 775–800. doi:10.1016/j.mric.2009.06.006.
19. 19. Walls, R.J, Ross, K.A, Fraser, E.J, Hodgkins, C.W, Smyth, N.A, Egan, C.J, Calder, J, Kennedy, J.G, Football injuries of the ankle: A review of injury mechanisms, diagnosis and management, World Journal of Orthopedics, 2016, 18,7(1), 8-19. DOI: 10.5312/wjo.v7.i1.8.
20. 20. Peace, K.A.L, Hillier, J.C, Hulme, A, Healy, J.C, MRI features of posterior ankle impingement syndrome in balet dancers: a review of 25 cases, Clinical Radiology, 2004, 59(11), 1025–1033. doi:10.1016/j.crad.2004.02.010.
21. 21. Coughlin, M.J, Saltzman, C.L, Anderson, R, Mann’s Surgery of The Foot and Ankle. Ninth edition, Philadelphia, Saunders, an imprint of Elseiver Inc, 2014, pp. 1781.