Are These Fractures Identical?
A 71-year-old woman presents with multiple health concerns, including a history of sick sinus syndrome managed by a pacemaker, rheumatoid arthritis, carefully controlled asthma, and osteopenia, for which she receives Prolia injections. She has also undergone various surgeries on her joints and is currently on a regimen that includes Celebrex, diltiazem, Singulair, Incruse, Dupixent, aspirin, famotidine, calcium with vitamin D3, and Rinvoq. At the end of May, she began experiencing swelling in her right ankle and consulted a podiatrist. X-rays revealed only signs of arthritis, with a diagnosis of osteoarthritis and a cortisone injection that provided temporary relief for two days. Due to persistent tenderness in the heel, a CT scan was ordered. The scan results indicated a vertical fracture on the inner side of the calcaneus, affecting the middle subalar facet. She was fitted with a fracture boot and instructed to avoid putting weight on the injured foot until her follow-up appointment in August. At that time, she was cleared to start bearing weight while still wearing the boot. During a recent check-up, some swelling in the ankle was noted, prompting another CT scan. This new scan revealed a diagnosis of a chronic, unhealed fracture of the sustentaculum tali in relation to the middle facet of the subalar joint. This raises a question: Is this the same fracture that was previously identified, or has the radiologist merely articulated it in a different manner? Her physician is currently on vacation and is not expected to return until next week, leaving her without clarity for the moment.
Answers (1)
9/11/2025, 9:50:38 PM
OpenHealth AI
The situation involves a complex history of fractures and joint issues, and it's understandable to seek clarity on whether the findings from the recent CT scan are the same or different from the initial diagnosis.
Main Points:
- The new CT scan indicates a chronic, unhealed fracture of the sustentaculum tali, while the first CT scan identified a vertical fracture of the calcaneus.
- These are distinct structures within the foot. Therefore, it's likely that the new finding is separate from the initially identified fracture.
Explanation:
- The calcaneus (heel bone) and the sustentaculum tali are different areas. The calcaneus supports heel and foot functions, while the sustentaculum tali is a bony ledge that supports the talus bone in the ankle.
- It is common for misinterpretations to arise when interpreting fractures, especially in older adults or those with multiple health conditions. Without your physician available, the best course of action is to stay proactive in monitoring your symptoms.
Next Steps:
- Keep a Symptom Diary: Document any new symptoms or changes in pain levels. This information will be useful for your doctor once they return.
- Rest & Manage Weight: Continue to follow the advice of bearing no weight on the affected foot as this can prevent further damage.
- Ice & Elevate: If you're experiencing swelling, apply ice to the swollen area for 15-20 minutes several times a day, and elevate your foot to help reduce swelling.
- Follow-Up: Confirm your follow-up appointment for further evaluation. If swelling or pain worsens significantly before your scheduled visit, consider contacting your healthcare provider.
- Patience with Healing: Given the chronic nature of fractures, recovery might take time. Staying engaged with your daily care and following your treatment plan is important.
Feeling uncertain is common in such situations, but note that these steps allow you to take an active role in managing your health until further guidance is provided. If you have any specific symptoms or questions in the meantime, feel free to ask.
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