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Case of the Month 04/07

Q: What’s wrong with this picture?

View answer

There is a nondisplaced fracture of the medial malleolus (you can see an interruption in the cortical line and a lucency running through the tibia which begins just below that interruption.)

Q: If you wanted to visualize the uniformity of the mortise joint space for uniformity, which view would you evaluate?

View answer

The mortise view (which is taken AP with the ankle internally rotated 15 to 20 degrees) allows visualization of the entire joint space without any bony overlap. A joint space that is not the same width on all sides of the talus should increase suspicion for ligamentous injury or occult fracture. (In this case the film was read by radiology as having a subtle increase in the medial joint space.)

Q: Other than the other 2 views in a complete ankle x-ray series (AP, lateral, mortise view), which x-ray should you order next?

View answer

With a medial ankle fracture or joint space widening, it is important to evaluate the proximal fibula for a fracture (both by examination and by imaging.)

Q: What is the name of this fracture?

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This is a Maisonneuve fracture. It is defined as a fracture of the proximal fibular shaft associated with a medial malleolar fracture or a deltoid ligament rupture.