Presentation
Twisting injury.
Patient Data
Moderate ankle and small posterior subtalar joint effusions. Bone contusion involving the medial talar head, neck and anterior body as well as the medial malleolus and medial navicular. Small focus subchondral marrow edema in the medial tibial plafond.
Syndesmotic ligaments are intact. Complete tear ATFL. Near complete tear in proximal CFL. PTFL is intact. Marked contusion of deep deltoid. Spring ligamentous complex and superficial deltoid show mild surrounding edema but no tear. Dorsal talonavicular and bifurcate ligaments are intact. Mild sprain of long plantar ligament.
Normal sinus tarsi, plantar fascia origin and Achilles tendon.
Moderate sprain of extensor and peroneal retinaculum. Moderate tendon sheath effusion of EDL at the level of the injured extensor retinaculum. Mild peroneal tenosynovitis. Minor sheath effusion of the flexor tendons. No tendon tear.
Small muscle belly of peroneus quartus extends down to the level of peroneal tubercle.
Case Discussion
Patients will normally be able to tell you the position of their foot when injured but the imaging pattern can provide the mechanism of injury. This is a Lauge-Hansen supination adduction stage 2 injury at the ankle consisting of:
- complete ATFL tear
- near complete CFL tear
- contusion/tear of deep deltoid, sprain of superficial deltoid and spring ligaments
- medial talus and medial malleolus bone contusion
An inversion injury also occured at the talonavicular joint accounting for the impaction subchondral fractures in the medial navicular bone and talar head.
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