Question

Patient presents with leg and ankle pain after a fall 3 weeks earlier. Initial ankle Xrays were negative. Patient presents today with persistent leg and ankle pain. What's the diagnosis and what other imaging would you perform and why?

 

Answer

Proximal fibula fracture; have a high-clinical suspicion for a Maisonneuve fracture and consider CT scan of the ankle

Maisonneuve fracture

• Fracture of proximal third of the fibula with associated injury of the tibiofibular syndesmosis and interosseous membrane; there is typically an associated fracture of the medial malleolus or ruptured deltoid ligament.
• This patient had a normal ankle X-ray, but the proximal fibular fracture and the persistent ankle pain lead to an ankle CT scan demonstrating a non-displaced fracture at the medial aspect of the posterior malleolus, extending into the tibiotalar joint (see below). 
• The take home point is to always look for an associated ankle injury when a proximal fibular fracture is discovered and Xray above and below the fracture. If Xrays are negative but there is still high clinical suspicion consider advanced imaging such as CT scan.

References

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