Fracture of The Sustentaculum Tali: Features and Surgical Management for Fracture Reduction

Abstract

Sustentaculum tali is a horizontal shelf-like projection on the medial part of the calcaneum. The medial facet articulates to the talus and supports the medial column of the foot. The spring ligament originates at the plantar aspect of sustentaculum tali, and flexor hallucis longus passes below it and indirectly supports the longitudinal arch of the foot. Sustentaculum tali is a strong cortical bone, so its isolated fracture is unusual. Therefore, the fracture of the sustentaculum tali is easily misdiagnosed. The patients complain of pain below the medial malleolus and also on passive movement of the flexor hallucis longus tendon. The patient has a history of falls from height with the foot supinated or associated talus fracture. Sustentaculum tali fractures are sometimes considered to be extra-articular fractures. CT scan helps diagnose the intraarticular medial facet involvement in this fracture and is now regarded as intra-articular. Need of the study is to make the clinicians aware that these fractures, even if rare, do happen, if mismanaged, may lead to complications like impingement of flexor hallucis longus, post-traumatic arthritis etc. The study aimed to identify the clinical features and diagnosis of sustentaculum tali fracture and its management to prevent complications. Surgical reconstruction of the sustentaculum tali with a direct medial approach and fixation with cannulated cancellous screws. Ten patients were operated on in the last five years, and seven patients showed up for follow-up and had excellent results per the AOFAS scoring system. All of the fractures had signs of radiological union by the end of the third month. In Conclusion, Sustentaculum tali fracture, when suspected, should not be ignored, and the fracture must be fixed surgically. The current aspect of surgical fixation is befitting and should not be disregarded.