Lateral malleolus avulsion fracture with os subfibulare

Case contributed by Dr Henry Knipe

Presentation

Twisted right ankle with swelling

Patient Data

Age: 35 years
Gender: Male

Thin bony fragments adjacent to the lateral aspect of tip of the lateral malleolus and cortical irregularity at the lateral talus, likely representing avulsion fractures. Incidental note of os subfibulare and os trigonum. Alignment has been maintained. Soft tissue swelling over the lateral malleolus.

Yellow arrow indicates os subfibulare. Blue arrow indicates avulsion fracture. 

Case Discussion

This case demonstrates why a knowledge of common anatomical variants is essential.

The small bony chips lateral to the tip of the lateral malleolus represent an avulsion fracture while the well-corticated bony fragment adjacent to the medial aspect of the lateral malleolus tip could be mistaken for fracture if this was not the typical appearance and location for an accessory ossicle - the os subfibulare.

On the lateral projection, an os trigonum can be appreciated.

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Case information

rID: 26255
Published: 9th Dec 2013
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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