Imaging Case of the Week 23

This ankle x-ray is from a 19 year old patient who inverted his ankle while running. His ankle is swollen and he is unable to weight-bear. What can you see?

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All you can see is a red dot on the AP and Mortise view of the x-ray and a lot of soft tissue swelling over the medial malleolus. Can you spot the fracture?

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This patient has lateral talar dome fracture which is a missable fracture around the ankle.

Radiographic classification: Berndt and Harty’s

  • Stage I – subchondral bone compression
  • Stage II – partially detached osteochondral fragment
  • Stage III – detached, nondisplaced fragment
  • Stage IV – detached and displaced fragment


  • Stage I & II – non-weight bearing short leg cast for up to 6 weeks.
  • Stage III & IV – surgical management.

This patient was managed conservatively.

A mnemonic for missable fractures around the ankle (off the internet) – FLOAT

  • Fifth metatarsal base
  • Lateral malleolus
  • Os trigonum
  • Anterior process of calcaneum
  • Talar dome

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