Twisted Ankle

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    Twisted Ankle

    A 32 yo M presents with ankle pain and swelling after forcefully externally rotating it while playing soccer. He is unable to ambulate.  Ankle x ray is shown below.

    What other joint should you image?

    Answer: The knee.  This patient is at risk for a concurrent proximal spiral fibular fracture.  The above xray shows widening of the medial distal tibio-fibular syndesmosis/mortis suggesting a tear in the deltoid ligament, the resulting fracture is called a Maisonneuve.  This combination is usually an unstable injury requiring operative repair.

    Proximal fibular fracture:

     

    References:

    http://www.wheelessonline.com/ortho/maisonneuve_fracture

    http://radiopaedia.org/articles/maisonneuve-fracture

    http://www.healio.com/orthopedics/trauma/journals/ortho/2010-3-33-3/%7B4050b65d-6645-4995-9b19-8891cbb63ef4%7D/the-maisonneuve-injury-a-comprehensive-review

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