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?
Don't forget gravity stress views in medial (deltoid) ankle sprains. These views, obtained by shooting a crosstable "AP" view with the medial malleolus facing skyward and the foot dangling off the bed, can show pathologic widening of the medial mortise, indicating significant deltoid ligament rupture. For LATERAL mallelous fractures, this can be the difference between conservative and operative management as well as immediate versus delayed followup.
ReplyDeleteExcellent point, Eric. Thanks. Way to soak up all the good learning on the Ortho rotation.
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