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: