Ortho Case of the Week – Ankle ANSWERS

Case 1: A 55-year-old male mechanic presents with pain from his left knee to his foot after slipping on oil.

Source: Radiopaedia

1. What is your interpretation of the x-rays above? What is the eponym for this type of injury?

Mildly displaced distal tibial metaphyseal spiral fracture. From it, a nondisplaced vertical fracture line runs inferiorly to the tibial plafond (seen on lateral X-ray). Associated proximal fibular metaphyseal fracture.

Together, these represent a Maisonneuve fracture.

2. What nerve is most commonly injured with this type of injury?

The common peroneal nerve courses over fibular head, and can be injured with any fracture involving the fibular head.

3. How would you test it?

Weakness of ankle dorsiflexion and foot eversion and/or numbness along the lateral lower leg and dorsum of the foot should raise suspicion for an injury to the common perineal nerve.

4. How would you treat this injury?

Reduction and splinting in a posterior long leg splint (video) with close orthopedics follow-up for likely ORIF.

Case 2: A 35-year-old female presents with left ankle pain and swelling after tripping over her pet corgi.

Source: Radiopaedia

1. What is your interpretation of the x-rays above?

Trimalleolar ankle fracture. There is a lateral malleolar fracture at the level of the syndesmosis, a Weber type B lateral malleolus fracture. There is also a medial malleolar fracture and a posterior malleolar fracture is noticed on the lateral view.

2. How would you manage this patient if you didn’t have orthopedics at your hospital?

Reduction and splinting with a L and U splint (posterior short leg plus stirrup – video) with close follow-up with orthopedics.

PLUS