Wk 9, Case 3, Foot/Ankle MR - Review

Patient History

15 F with left ankle pain since volleyball injury

Findings

ARTICULATIONS:

Bones: Incomplete infrasyndesmotic fracture coursing through the anterior aspect of the fibular epiphysis reaching the physis without displacement and surrounded by diffuse osteoedema.

Contusional microtrabecular fractures of the medial malleolus posterior colliculus.

Nondisplaced microtrabecular fractures coursing through the medial aspect of the talar neck.

Contusion microtrabecular osteochondral fractures involving the midline anterior aspect of the tibial plafond.

Nondisplaced microtrabecular fractures or stress injury surrounded by moderate osteoedema at the anterolateral aspect of the cuboid involving the 4th and 5th tarsometatarsal joints.

Tibiotalar Joint: No osteochondral defects.

Hindfoot: No arthropathy.

Midfoot: No arthropathy.

LIGAMENTS:

Full-thickness tear of the anterior talofibular and calcaneofibular ligaments. High-grade sprain of the posterior talofibular ligament. Ill-defined hematoma formation at the anterolateral gutter.

The anterior and posterior tibiofibular and syndesmosis are intact.

Low-grade sprain of the superficial (tibiocalcaneal, tibiospring and tibionavicular ligaments) and the deep components (posterior and anterior tibiotalar ligaments) of the deltoid ligament complex.

High-grade sprain of the interosseous talocalcaneal ligament, cervical ligament, medial, intermediate and lateral root of the inferior extensor retinaculum at the level of the sinus tarsi.

TENDONS:

Peroneus Longus/Brevis: Intact.

Posterior Tibialis: Intact.

Flexor Compartment: Intact.

Extensor Compartment: Intact.

GENERAL:

Muscles: No traumatic muscle injury. No volumetric muscle atrophy.

Soft Tissues: Ill-defined hematoma formation at the anterolateral gutter. Reactive synovitis within the sinus tarsi. Diffuse periarticular soft tissue swelling.

Plantar Fascia: No thickening, inflammation, enthesophyte formation, calcaneal osteitis or heel fat pad edema.

Joint Effusion: Tibiotalar and posterior subtalar effusions/hematoma.

Intraarticular/Loose Bodies: None.

Impressions

1. Incomplete spiral infrasyndesmotic fracture involving the anterior aspect of the fibular epiphysis reaching the physis without displacement (Salter-Harris type 3) with microtrabecular fractures of the medial malleolus posterior colliculus in keeping with a Weber A stage 2 injury.

2. Full-thickness tears of the anterior talofibular and calcaneofibular ligaments with anterolateral gutter hematoma formation.

3. Low-grade sprain of the superficial and deep components of the deltoid ligament complex.

4. High-grade sprain of the sinus tarsi ligaments (talocalcaneal, cervical, medial intermediate and lateral roots of the inferior extensor retinaculum) with reactive synovitis.

5. Nondisplaced microtrabecular fractures coursing through the medial aspect of the talar neck.

6. Contusional osteochondral fractures involving the midline anterior tibial plafond.

7. Nondisplaced microtrabecular fractures or stress injury at the anterolateral aspect of the cuboid involving the 4th and 5th tarsometatarsal joints.

8. Tibiotalar and posterior subtalar effusions/hematoma formation.