Imaging Case of the Week 373 Answer

The AP and mortise views show a spiral fracture of the distal tibial diaphysis. Lateral view confirms the fracture.

With an injury pattern like this, always think of a higher fibular fracture (i.e. Maisonneuve fracture) and obtain a full-length leg x-ray. This patient had a leg x-ray that showed an associated fracture of the fibular neck.

Unfortunately, the leg x-ray also reveals that the foot has completely rotated. This means that the patient should have had a back slab with the foot in neutral position prior to obtaining the x-rays!