Ankle Trauma 1

Introduction

These cases are intended to be used as education materials. There are intentionally no answers. The objective is to provide teaching and test cases where the radiographers cannot "look up the answers on the Internet ". This case can be answered at different levels from student radiographer to advanced radiographer practitioner or reporting radiographer.

Level of Difficulty

This case is suitable for all levels of radiographers from 1st year students to reporting radiographers. The answers will clearly be different for different levels.

Presentation

This is a 15 year old boy who has presented to the Emergency Department. He has been referred for ankle radiography with the following clinical information

"collision @ football - player fell onto ankle - right pain ankle/lower leg - swollen - UTWB"

Imaging

	There is at least one fracture visible on this image. It is very characteristic of what type of fracture? Is there evidence of soft tissue injury? Does this correlate with the fracture?

	The oblique view reveals a further fracture. Does this correlate with any soft tissue signs of injury?

	There are at least 2 soft tissue signs of ankle injury. There is a potentially confusing feature of this image- what is it? How would you help to clarify the findings?

	The radiographer has assessed the initial 3 routine views and proceeded to deliberately perform a poorly positioned lateral ankle. Why did he/she perform this view? Has this image addressed the issue identified in the first lateral ankle image? Is there an epiphyseal injury and, if so, what type is it? (hint- advanced practitioners- go back and look at the AP image)

Further Reading

Mandell J. Isolated Fractures of the Posterior tibial lip at the ankle as demonstrated by an additional projection, the "poor" lateral view. Radiology 1971;101:319-322

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