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Musculoskeletal Imaging
Emergency Imaging
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Practice Cases
Week 1
6 topics, 11 min.
Practice Cases
Week 2
6 topics, 18 min.
Practice Cases
Week 3
6 topics, 27 min.
Practice Cases
Week 4
6 topics, 7 min.
Practice Cases
Week 5
6 topics, 45 min.
0:00
These are images of a 32-year-old man
0:03
who sustained an injury while at work.
0:06
Axial images demonstrate complete discontinuity
0:10
of the anterior syndesmotic ligament.
0:12
The anterior tibiofibular ligament is
0:16
detached from its insertion at the fibula.
0:20
The injury is outlined by fluid
0:22
propagating from the syndesmotic space,
0:25
demonstrating the retraction of the fibers
0:28
towards the tibial origin.
0:32
On axial images, we also see the presence of a
0:36
slightly displaced posterior malleolar fracture,
0:41
a volarized fracture, with fluid noted at the
0:46
level of the fracture gap and reactive marrow edema.
0:50
Notice made of integrity of the posterior tibial
0:56
ligament with edema of the syndesmotic membrane,
1:00
but no discontinuity or gapping of the tibiofibular
1:06
space noted on these non-weightbearing MRI studies.
Wk 4, Case 3 - Review
HIDEInteractive Transcript
0:00
These are images of a 32-year-old man
0:03
who sustained an injury while at work.
0:06
Axial images demonstrate complete discontinuity
0:10
of the anterior syndesmotic ligament.
0:12
The anterior tibiofibular ligament is
0:16
detached from its insertion at the fibula.
0:20
The injury is outlined by fluid
0:22
propagating from the syndesmotic space,
0:25
demonstrating the retraction of the fibers
0:28
towards the tibial origin.
0:32
On axial images, we also see the presence of a
0:36
slightly displaced posterior malleolar fracture,
0:41
a volarized fracture, with fluid noted at the
0:46
level of the fracture gap and reactive marrow edema.
0:50
Notice made of integrity of the posterior tibial
0:56
ligament with edema of the syndesmotic membrane,
1:00
but no discontinuity or gapping of the tibiofibular
1:06
space noted on these non-weightbearing MRI studies.
Report
Patient History
32-year-old man complaining of left ankle pain following a work injury
Findings
SKELETAL/BONES:
Nondisplaced oblique fracture of the posterior malleolus of the distal tibia, with a fracture fragment measuring 1.8 x 1.8 x 0.8 centimeters. Fracture extends to involve the posterior tibiotalar articular surface, without cortical step-off. Microtrabecular fracture of the dorsal talar neck.
Focal osteoedema involving the medial distal fibula at the interosseous syndesmotic ligament insertion.
No further micro- or macro-trabecular fracture or reactive pattern of marrow edema/contusion.
ARTICULATIONS:
Tibiotalar joint/talar dome: No osteochondral defect of the talar dome or tibial plafond. Moderate capsulitis with a small effusion.
Ankle mortise/syndesmosis: The ankle mortise is in anatomic alignment. No syndesmosis widening.
Chopart joint: Unremarkable.
Midfoot/hindfoot: No fracture or injury of the anterior calcaneal process. No prominent midfoot or hindfoot arthrosis.
LIGAMENTS:
High ankle: Complete full-thickness tear of the lateral aspect of the anterior tibiofibular ligament. Swollen sprained interosseous syndesmotic ligament, without tearing. Posterior tibiofibular ligament intact. No passive syndesmotic diastasis.
Low ankle: Intact. Mild swelling the anterior talofibular ligament.
Subtalar/Chopart: Intact.
TENDONS:
Intact.
GENERAL:
Sinus tarsi: Unremarkable.
Muscles: No traumatic muscle injury. No volumetric muscle atrophy.
Soft tissue: Swollen sprained inferior extensor retinaculum laterally (stem ligament).
Plantar fascia: Intact.
Neurovascular complex/tarsal tunnel: Unremarkable. No evidence of entrapment neuropathy.
Intra-articular/loose bodies: None.
Impressions
Posterior malleolar fracture (Volkmann’s fracture) with two-part high ankle sprain as follows:
1. Complete full-thickness anterior tibiofibular ligament tear.
2. Swollen sprained interosseous syndesmotic ligament.
3. Intact posterior tibiofibular ligament.
4. No passive syndesmotic diastasis.
5. Low ankle ligaments intact.
Case Discussion
Faculty
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
ProScan Imaging
Todd D. Greenberg, MD
Radiologist
ProScan
Tags
Musculoskeletal (MSK)
MRI
Foot & Ankle
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