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Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
Practice Cases
Worklist 1
10 topics, 11 min.
Practice Cases
Worklist 2
10 topics, 18 min.
Practice Cases
Worklist 3
10 topics, 37 min.
Practice Cases
Worklist 4
10 topics, 7 min.
Practice Cases
Worklist 5
10 topics, 46 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
Jenny T Bencardino, MD
Vice-Chair, Academic Affairs Department of Radiology
Montefiore Radiology
Edward Smitaman, MD
Clinical Associate Professor
University of California San Diego
Tags
Musculoskeletal (MSK)
MRI
Foot & Ankle
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