Your colleague at the emergency department calls to ask if you can rule out a fracture. Can you?
Although a fracture at ankle level seems very improbable based on the normal talotibial joint and the absence of joint effusion, a fracture at a lower level can certainly not be excluded. The irregularity medially is another clue that additional imaging may be useful.
Because pain was mainly located at the ankle, standard AP and lateral ankle views were performed.
Normal tibiotalar joint and no joint effusion at this level. Slight irregularity on medial side of navicular, but a fracture cannot be substantiated.
Although no fracture was demonstrated, based on clinical suspicion foot and ankle were casted.