Imaging Case of the Week 223 Answer

Mortise view of the right ankle shows a widened medial ankle joint space, which suggests a torn deltoid ligament. The medial malleolus is intact.

There are a few avulsed tiny bone fragments visible within the ankle joint medially.

The x-ray also shows a widened tibiofibular clear space, suggesting a syndesmotic injury.

syndesmotic-injury

This patient had her right leg x-rayed, which revealed a fracture of the upper-third of the fibula, which indicates a Maisonneuve fracture.

maisonneuve-fracture

Maisonneuve fracture is an unstable injury and requires ORIF.

High fibula fracture can be clinically occult. If there is an isolated medial malleolus fracture or deltoid ligament tear, as evidenced by medial ankle joint space widening, make sure to always obtain an x-ray of the affected leg to look for proximal fibula fracture.

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