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
