Presentation
A fall while stepping down the stairs - one month ago. Ankle pain.
Patient Data
Ankle joint anterior recess effusion. Normal anterior inferior tibiofibular ligament. Thick, hypoechoic, and wavy inferior and superior bands of the anterior talofibular ligament. Additional bony avulsion from the talus involving the superior band. No peroneal brevis bony avulsion of the 5th metatarsal base. Normal calcaneofibular ligament. Small effusion in the subtalar joint; deep to the calcaneofibular ligament.
No avulsion of the calcaneal anterior process. Normal dorsal calcaneocuboid and bifurcate ligaments.
Medial malleolus bony avulsion at the attachment site of the medial flexor retinaculum. Deltoid ligament bony avulsion from the tibia involving the tibiotalar component. Normal tibiocalcaneal and tibiospring components of the deltoid ligament.
Cine-loop shows stress scan for anterior talofibuliar ligament. It was done in prone position with patient's foot outside the lower end of the examination table. The forefoot is pulled towards the ground and the ligament was scannedThere is ligament laxity with increased talofibular space on stress.
Case Discussion
The patient with ankle injury presented with persistent bimalleolar ankle region pain; one month after the injury and required immobilization. Radiographs (no copyright, not uploaded) failed to show bony avulsion injury.
Ultrasound shows anterior talofibular ligament bony avulsion, deltoid ligament bony avulsion, and medial flexor retinacular bony avulsion.
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