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.