Presentation
Motor vehicle collision.
Patient Data
Comminuted fractures of the left tibia and fibula with 90 degrees of rotation of the distal fracture fragments compared to the proximal fragments (note that when the femur/proximal tibia is in the frontal projection, the ankle is in the lateral projection and when the femur/proximal tibia is in the lateral projection, the ankle is in the frontal projection).
Status post intramedullary nail placement with proximal and distal interlocking screws for a comminuted tibial fracture with near anatomic alignment.
Case Discussion
Rotational fracture displacement is usually obvious clinically, but may be difficult to recognize on a radiograph. The best way to identify rotational displacement is to compare the orientation of the joints proximal and distal to the fracture. In this case, when the femur/proximal tibia is in the frontal projection, the ankle is in the lateral projection and when the femur/proximal tibia is in the lateral projection, the ankle is in the frontal projection.