A radiology pearl: A subtle orthopedic diagnosis

Nov 13, 09
A radiology pearl: A subtle orthopedic diagnosis

A man recently presents with knee pain after pivoting and torquing his knee while falling. He complains of concurrent mild ankle pain. He presents with this tib-fib xray. Realizing that a proximal fibular fracture can present concurrently with a medial malleolus fracture or deltoid ligament rupture, we obtained xrays of the ankle. We were looking for a Maisonneuve fracture.

Do you see an ankle injury in these four images?



  • There was no medial malleolus fracture.
  • There was no obvious deltoid ligament rupture, because the ankle mortise appears normal.
  • Always be sure to look at the lateral ankle view. You need to check for a posterior malleolus fracture.
  • This patient indeed had a Maisonneuve fracture, which was splinted and referred to orthopedics for operative repair.



Author information

Michelle Lin, MD

ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco

The post A radiology pearl: A subtle orthopedic diagnosis appeared first on ALiEM.

Leave a Comment

Like articles like this one?

Join our Email List and get the latest TCCC/TECC/TEMS news bulletins, articles, product releases, and more!

Free Delivery

On all orders over $99 within CONUS and to APO/FPO

Easy Returns

We're here to help! Satisfaction Guaranteed

Knowledgeable Staff

Ready to assist you at a moment's notice

Safe& Secure Checkout

World’s most advanced and secure website encryption.