Medial ankle cut injury (ultrasound)

Case contributed by Dr Maulik S Patel

Presentation

History of cut injury by scissors to right ankle medial aspect about 4 weeks earlier. Patient was treated by GP with local dressing without suturing. On day of presentation, there is complete healing of superficial wound. However, there is diffuse swelling locally. Patient's father adds history of profuse bleeding at the time of injury. Patient is referred for evaluation of medial ankle tendon integrity.

Patient Data

Age: 10 years old
Gender: Male
Ultrasound

There is irregular hypoechoic scar at site of injury. Tibialis posterior tendon, flexure digitorum tendon and posterior tibial artery could not be identified in scar region.

Tibialis posterior tendon

  • Complete tendon tear
  • Distance between two ends of tendon about 40 mm
  • Proximal end just cranial to medial malleolus

Flexor digitorum longus tendon

  • Complete tendon tear
  • Distance between two ends of tendon about 23 mm
  • Proximal end just below medial malleolus

Posterior tibial artery

  • Length of about 10 mm of artery not seen at scar level
  • Proximal and distal arterial segments show wall thickening
  • Pre-occlusion type flow is seen proximal to scar, in keeping with complete obstruction
  • There is collateral supply to distal segment

Posterior tibial nerve

  • Nerve is normal, including its three divisions

Flexor hallucis longus tendon

  • Intact with normal echotexture
  • No tear or tenosynovitis

Case Discussion

Boy presented with history of cut injury to medial ankle region about 4 weeks back. Ultrasound showed tendinous and vascular injury, sparing the nerves.

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Case information

rID: 54682
Case created: 22nd Jul 2017
Last edited: 23rd Jul 2017
Inclusion in quiz mode: Excluded

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