Presentation
Mechanical fall with "popping" sound in ankle. Right medial ankle tenderness. Tenderness in right fibula head.
Patient Data
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Undisplaced spiral fracture through the proximal fibula. Undisplaced transverse fracture through the medial malleolus. Distal tibiotalar joint appears intact.
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In addition to the fractures, there is a "stitching line" (indicated by arrows). This causes an artifact in which there appears to be a cortical defect in the fibula, which could be mistaken for a fracture line. There is also linear increased density in the soft tissues adjacent, also an artifact.
Case Discussion
The combination of a proximal-third fibula fracture and medial malleolus fracture has the eponymous name of a Maisonneuve fracture.
This case also demonstrates the importance of two orthogonal views to detect and/or confirm the location of pathology. When reading CR or DR images it is important to be aware that some long-leg views are automatically stitched together and if this is imperfect, artifacts that mimic pathology may occur.
The patient required operative management with two medial malleolus screws and a diastasis screw.