Orris
attachment
attachment
attachment
attachment

Inversion injury Is there a fracture

Reading File
analyse_media
analyse_media
Finding Sources
I can't confirm or exclude a fracture from these photos. They are phone pictures of a monitor, and I couldn't run the image analysis tool on them (it failed to load the files). This is my own read of the images, not a radiology report.
What I see
  • Ankle mortise and malleoli: I see no clear displaced fracture of the distal tibia, medial malleolus or lateral malleolus. The tibiotalar joint looks reasonably congruent.
  • Circled area, lateral view: The talus and calcaneus around the subtalar joint and sinus tarsi look abnormal. There is a lucent line or step through the talar body/neck region and the posterior subtalar area. This could be a fracture, but a normal sinus tarsi or overlapping bone can look the same on one lateral view.
  • Circled area, AP view: The lateral talus and the bones just below it overlap and look irregular. The AP is slightly rotated, so it isn't a true mortise view, and I can't say if the cortex is broken.
Fractures that are easily missed after an inversion injury
  • Lateral process of the talus ("snowboarder's fracture"): It is often mistaken for a sprain. Miller's Review of Orthopaedics gives the mechanism as axial load, dorsiflexion, inversion and external rotation, and notes the lateral talocalcaneal ligament attaches to this process (Miller's Review of Orthopaedics 9th Ed, Complications). It is best seen on a mortise view and often only on CT.
  • Anterior process of the calcaneus
  • Base of the 5th metatarsal: This needs a foot series.
  • Talar dome osteochondral lesion
  • Distal fibula avulsion fractures
  • Peroneal tendon or syndesmotic injury
Suggested next steps
  1. Get the formal radiologist report from the original images, not a photo.
  2. Request a true mortise view and a foot AP/oblique series.
  3. If pain and swelling are focal over the sinus tarsi or lateral talus, or the patient can't bear weight, get a CT of the ankle and hindfoot. MRI is the alternative if ligament, tendon or osteochondral injury is suspected.
  4. Until a fracture is excluded, keep the patient non-weight-bearing in a splint or boot and arrange orthopaedic review.
How tender is the patient over the sinus tarsi, lateral malleolus, and base of the 5th metatarsal? Can they bear weight? Those findings would help narrow this down.
This is a shared conversation. Sign in to Orris to start your own chat.