Presentation
Falling down and twisting her ankle.
Patient Data
There is a transverse avulsion fracture of the medial malleolus.
A slightly displaced linear fracture of the posterior malleolus is seen.
Multiple tiny intraarticular bony fragments are seen.
A comminuted impacted and slightly displaced oblique fracture in the fibular diaphysis is noted (above the level of the syndesmosis).
Widening of the distal tibiofibular syndesmosis.
Ankle joint effusion and soft tissue swelling is noted.
Findings are consistent with Lauge-Hansen pronation-external rotation pattern fracture.
Case Discussion
Sir Niel Lauge-Hansen developed a classification system back in the 1950's for ankle fractures based on the mechanism of injury - position and force direction.
The fracture is then given a stage according to the involved structures.
In this case, involvement of the posterior malleolus, in addition to the avulsed medial malleolus and fractured fibula, is classified as stage IV.
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