Letter to the Editor for the article “Osteonecrosis of distal tibia in open dislocation fractures of the ankle”

Abstract

00 uthors have claimed that if patients suffered from Weber type C fibular fracture, total talar dislocation and grade III soft-tissue injury (‘‘necrotic triad’’), then post-traumatic osteonecrosis (PON) of distal tibia developed in 100% of cases. But a patient with type C fibular fracture and total talus dislocation will have wound on the medial side of the ankle [1,2], as has also been shown in the case report presented in the article. The authors have not explained how a medially open ankle will affect the vascularity of the lateral epiphysis of distal tibia. 2. A uthors have not explained why closed fracture dislocations of ankle [2,3] were not included in the study. 3. A uthors found that in 12 patients PON of distal tibia could be verified (10 lateral epiphysis, 1 medial epiphysis, 1 medial and lateral epiphysis). PON was diagnosed between 2 weeks and 18 months (mean 7 months) after the accident. But the authors have not given the MRI findings suggestive of osteonecrosis especially at 2 weeks, when a significant bone oedema and signal changes should be present making it difficult to differentiate from osteonecrosis [4,5].