A radiology pearl: A subtle orthopedic diagnosis

A man recently presents with knee pain after pivoting and torquing his knee while falling. He complains of concurrent mild ankle pain. He presents with this tib-fib xray.


Realizing that a proximal fibular fracture can present concurrently with a medial malleolus fracture or deltoid ligament rupture, we obtained xrays of the ankle. We were looking for a Maisonneuve fracture.

Do you see an ankle injury?

Answer

• There was no medial malleolus fracture.
• There was no obvious deltoid ligament rupture, because the ankle mortise appears normal.
• Always be sure to look at the lateral ankle view. You need to check for a posterior malleolus fracture.
• This patient indeed had a Maisonneuve fracture, which was splinted and referred to orthopedics for operative repair.

Question: Have you had any interesting radiology findings on your ED shift?