Wk 4, Case 3 - Review

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.