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Figure 1: Anteroposterior radiograph of the right ankle.
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Figure 2: Lateral radiograph of the right ankle.
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Figure 3: Coronal computed tomographic imaging of the right ankle.
A 12-year-old girl presents to the office with right ankle pain after an injury sustained 4 days earlier. She was running for a football when her foot slipped on wet grass and she twisted her ankle. Anteroposterior and lateral radiographs (Figures 1 and 2) were taken in the emergency department on the day of injury. Coronal computed tomographic imaging of the right ankle was obtained (Figure 3).
What is the most likely diagnosis?
A Maisonneuve fracture is a combination of a spiral fracture of the proximal fibula and a syndesmotic injury to the ankle. Maisonneuve fractures often require surgical fixation of the unstable ankle. A Weber C fracture is a lateral malleolar fracture...
Submit your diagnosis to see full explanation.
A Maisonneuve fracture is a combination of a spiral fracture of the proximal fibula and a syndesmotic injury to the ankle. Maisonneuve fractures often require surgical fixation of the unstable ankle. A Weber C fracture is a lateral malleolar fracture above the level of the ankle joint or talar dome, a Weber B fracture is a lateral malleolar fracture at the level of the talar dome, and a Weber A fracture occurs below the level of the talar dome. Weber C fractures commonly present with disruptions of the tibiofibular syndesmosis. A pediatric triplane fracture is a Salter-Harris fracture that involves all 3 fracture planes. The epiphysis is fractured in the sagittal plan (like with a Tillaux fracture); the physis is separated in the axial plane, and the metaphysis is fractured in the coronal plane (and only seen on lateral radiograph).
A Tillaux fracture is a Salter-Harris type III fracture of the distal tibial epiphysis. The injury is caused by an external rotation force that causes an avulsion of the anterior inferior tibiofibular ligament off the tibia. The fracture occurs at a specific time during adolescence when the medial physis closes before the lateral physis. Tillaux fractures that displace >2 mm are treated with open or closed reduction with a single screw placed parallel to the physis.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
References
- Blackburn EW, Aronsson DD, Rubright JH, Lisle JW. Ankle fractures in children. J Bone Joint Surg Am. 2012;94(13):1234-1244.
- Yoon R. Ankle fractures-pediatric. Available at: https://www.orthobullets.com/pediatrics/4027/ankle-fractures–pediatric. Accessed September 4, 2018.
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