종골 부착부에서 발생한 단독 종비인대 견열 골절의 치료: 3 증례 보고 및 문헌 고찰

Abstract

Isolated injury of the calcaneofibular ligament (CFL) is uncommon, and avulsion from the lateral calcaneal wall is rarely described. We report three patients who sustained lateral ankle inversion sprains after low-energy mechanisms (stepping on a curb, stepping into a pavement gap, and a side-step maneuver). Ultrasound demonstrated CFL disruption with variably sized osseous fragments at the calcaneal footprint in all cases, without associated anterior talofibular, syndesmotic, or deltoid ligament injury on clinical examination and imaging. Initial management consisted of short-leg cast immobilization followed by a criterion-based rehabilitation program emphasizing edema control, protected weightbearing, progressive peroneal strengthening, proprioceptive retraining, and graded return to activity. At final follow-up, plain radiographs confirmed bony union of the avulsion fragments in all three patients. Clinically, patients reported almost complete pain resolution, no subjective instability, and full return to activities of daily living. These cases indicate that calcanealside CFL avulsion can occur after seemingly minor adduction/inversion trauma when the ankle is neutral or dorsiflexed. Early recognition with ultrasound and/or CT is feasible, and when fragment displacement is minimal and mechanical instability is absent, nonoperative treatment combined with structured rehabilitation may yield excellent radiographic and functional outcomes.