The Ankle

1

Radiographic examination

• AP view

• Lateral view

• Internal oblique view

2

Common sites of injury in adults

• Lateral malleolus fibula

• Medial malleolus tibia

• Posterior malleolus tibia

• Pilon fracture of the tibial plafond

• Fractures of tarsus and midfoot mimicking ankle fractures

  • Tarsal avulsion

    • Lateral view

      • Head of talus

      • Anterior cortex navicular

      • Posterior tuberosity of talus

      • Dorsal surface of calcaneal tuberosity

      • Anterior process of calcaneus

      • Tuberosity or proximal shaft of the fifth metatarsal

    • AP view

      • Lateral surface of calcaneus

      • Lateral process of talus

      • Osteochondral fractures of the dome of the talus

3

Common sites of injury in children and adolescents

• Epiphyseal separations of distal tibia

  • Salter-Harris types 1, 2, 3, and 4

  • Triplane fractures of distal tibia

• Epiphyseal separations of distal fibula

  • Salter-Harris types 1 and 2

4

Injuries likely to be missed

• Fracture of the medial malleolus may be missed without oblique view of ankle.

• Maisonneuve fracture (see 5)

• Overlooked because they are not specifically sought by observer

  • Osteochondral fractures of the dome of the talus

  • Fractures of lateral process of talus

• Mistake a secondary center of ossification for an avulsion or vice versa

5

Where else to look when you see something obvious