Rogers LF. Ankle Radiographic Evaluation. Joint widening may be due to fracture or dislocation. size and shape of posterior malleolus fragment. X-rays directly visualise bone injury, but understanding of the anatomical position of ligaments is required to appreciate the presence of ligament injuries which are not directly visualised. For the sake of brevity, we will defer extensive discussion of the technique of the examination, which has already been presented. Ankle Injury Inversion Sprain MOI or Etiology (include anatomy of injury) Symptoms Signs Palpation Findings Special The facility provided by sonography is the dynamic characterization of findings and the high spatial resolution. The Canale view is useful for assessing the degree of comminution and displacement of talar neck fractures and is taken with the foot plantarflexed and pronated to 15 degrees. Triplane fractures are complex fractures wherein the fracture line extends in a vertical plane through the epiphysis, a horizontal plane through the physis, and an oblique plane through the metaphysis. References Access free multiple choice questions on this topic. Conversely, fractures tend to be irregular in appearance, with the absence of a well-defined cortex along the margin of the fragment and the adjacent bone. Inversion-type, lateral ligament injuries represent approximately 85% of all ankle sprains. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ [6] The fracture line extends vertically from the tibial articular surface proximally to the lateral cortex of the distal tibial metaphysis. Epidemiology of ankle fractures. Avulsion fracturestend tobe linear or curvilinear. - Over 3000 Free MCQs: https://geekyquiz.com/ The talar anatomy is complex and is divided into the head, neck, and body. This video was produced in partnership with the University of St Andrews and the Arclight Project. These were A benefit is using DSA is the real-time nature of the examination, allowing selective and sub-selective catheterization of distal arteries and the ability to intervene at the time of the examination. First, have the patient lying down supine with the knee bent on the affected side. Transverse fractures invariably involve injury to the syndesmotic ligament. Ultrasound findings include thickening and hypoechogenicity of the affected ligament in case of a sprain. The Tillaux fracture, an avulsion fracture of the anterior tibial tubercle, occurs with external rotation and abduction of the foot. You have tenderness at the outside of the foot (at the "styloid"). HHS Vulnerability Disclosure, Help You can check out our guide to eye trauma here: COMING SOON It should be approximately equal to the superior clear space (the distance between the articular surfaces of the tibia and the talus). The utility of CT is to evaluate for clinically suspected radiographically-occult fractures, to evaluate displacement of fractures and associated dislocations, and to aid surgical planning. We're excited to see what you do with this new tool - make sure to post examples in the comments! . sharing sensitive information, make sure youre on a federal While all fractures are important to identify, the most concerning for the image interpreter are the ones most likely to be missed. An ankle sprain is an injury to the tough bands of tissue (ligaments) that surround and connect the bones of the leg to the foot. In particular, a delayed phase may be added if hyperdensity adjacent to a vessel is seen, and differentiation between a contained hematoma and active hemorrhage is needed. Unger EC, Schilling JD, Awad AN, McIntyre KE, Yoshino MT, Pond GD, Darkazanli A, Hunter GC, Bernhard VM. Simply put, there are 5 reasons to get an ankle x-ray. An impaction fracture of the anterior tibial plafond with the foot in inversion and dorsiflexion is termed a pilon fracture. Imaging Findings Routine ankle MR imaging is performed in the axial, coronal, and sagittal planes; plantar flexion allows better visualization of the calcaneofibular ligament; sequences include T1 and T2; marrow abnormalities are best evaluated with STIR Bauer M, Bengnr U, Johnell O, Redlund-Johnell I. Supination-eversion fractures of the ankle joint: changes in incidence over 30 years. The ankle joint is one of the most commonly injured joints and the most common type of fracture to be treated by orthopedic surgeons. A fourth phase can be added for greater specificity and is usually performed 24 hours after injection. Additionally, avulsion fractions at the site of attachment of the ligament may occur due to these same patterns. The exquisite soft-tissue contrast resolution of MRI allows the evaluation of the tendinous and ligamentous anatomy of the ankle, which permits the characterization of sprains, tendinosis, tenosynovitis, peritendinosis, entrapment, rupture, and dislocation. In a left ankle x-ray report of even date, she provided an impression of no acute fracture or subluxation. 1 The true incidence of ankle sprains in the general population is unknown because more than half of all ankle injuries go untreated. In: StatPearls [Internet]. The ankle is allowed to lie distal to the edge of the table so that the weight to the foot provides the gravity stress. Unable to load your collection due to an error, Unable to load your delegates due to an error. FOIA The ankle is one of the most common sites for acute musculoskeletal injuries, with sprains accounting for 75% of ankle injuries. X-rays provide images of dense structures, such as bone. When describing an ankle X-ray, use the following structure: Anatomical descriptors of ankle fractures include (but are not limited to): Lateral malleolus fractures can be further classified, as per the Danis-Weber classification (commonly referred to as just the Weber classification), into: Today, were REALLY excited to announce Geeky AI; an intelligent assistant to help you write flashcards. In particular, evaluation for tendinosis, tear, or rupture of the Achilles tendon is easily performed with ultrasound due to its superficial location. Fracture is detected in only 15% of X-rays taken in the setting of acute ankle sprain ( 18 ). 2006 Oct;85(10):785-92. doi: 10.1097/01.phm.0000237875.90254.4e. Weight-bearing images are obtained similarly, though with the patient standing. Radiographs may reveal. http://creativecommons.org/licenses/by/4.0/. Cine images are valuable for evaluating large masses, demonstrating the origin of the mass, and demonstrating spatial relationships to adjacent structures. TikTok: https://www.tiktok.com/@geekymedics 2. TikTok: https://www.tiktok.com/@geekymedics X-Rays The primary purpose of plain films in the setting of acute ankle sprains is to rule out acute fracture. Lateral malleolar Salter-Harris injuries are less common and are most frequently type I injuries with minimal or no displacement. Update on talar fracture patterns: a large level I trauma center study. Foot Xray not needed for mid- Foot Pain if both . As such, the image interpreter should recommend AP and lateral views of the tibia and fibula to evaluate for proximal fibula fractures, the so-called Maisonneuve fracture. Sonography of musculoskeletal soft-tissue masses: techniques, pearls, and pitfalls. MRA is not indicated in the acute setting but is useful in the evaluation of chronic peripheral vascular disease such as in diabetes, especially in those patients for whom exposure to iodinated contrast or ionizing radiation is a concern. Typically, a special stand with steps is used, with a slight cut into the top step used to hold the x-ray cassette. Intravenous or intraarticular contrast is rarely administered in these examinations but may be used when contrast-enhanced magnetic resonance imaging (MRI) cannot be performed. Here are some helpful tips called the Ottawa Ankle rules that can help determine if getting an x-ray is right for you. The radiographic search pattern must include the evaluation of the soft tissues for swelling. A small degree of uniform, symmetric osseous radiotracer activity within the foot and ankle is normal. Fractures of the posterior process of the talus are due to either forced dorsiflexion of the ankle, which causes an avulsion, or a chip fracture when the ankle is severely plantarflexed, causing the lateral tubercle to become wedged between the posterior lip of the tibia and the calcaneus. Frank Smithuis and Robin Smithuis. These ligaments are located above the ankle joint and between the tibia and fibula. Therefore, a spatially incongruent combination of images that have increased activity in the bone on the WBC study and decreased or no activity on the sulfur colloid study is consistent with osteomyelitis.[22]. Ligaments appear similar to tendons, though the linear striations are more compact than those of tendons. Hsu CC, Tsai WC, Chen CP, Chen MJ, Tang SF, Shih L. Am J Phys Med Rehabil. Though the initial evaluation is with radiography, an understanding of further evaluation with more advanced cross-sectional imaging is also important. 1. MRI may be especially valuable for early detection of syndesmotic injury in patients with an unclear clinical history, and with equivocal or difficult clinical examinations. Posterior malleolus fractures are typically either avulsion at the site of the attachment of the posteroinferior tibiofibular ligament (due to external rotation) or fractures involving the joint surface due to impaction of the talus against the posterior aspect of the tibial plafond (secondary to forced plantarflexion of the foot). Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ anonymised list of 6886 sequential ankle X-rays, comprising a standardised anteroposterior and lateral view. Jensen SL, Andresen BK, Mencke S, Nielsen PT. Like sonography of most other joints, sonography of the ankle is performed less commonly than other imaging modalities. The ankle joint allows dorsiflexion and plantarflexion and is one of the weight-bearing joints. The head also articulates with the calcaneus via the anterior facet at its inferior margin (anterior portion of the subtalar joint). Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-50630, Figure 3: AP (straight) view - not standard, ankle trauma with suspicion of bony injury, AP view performed at a slight angle to open up the mortise, specific test looking for isolated tibia/fibula injury, x-ray of the foot only, not including the ankle. Introduction. The conventional bone scan is a collection of planar scintigraphic images that present a two-dimensional picture of the imaged region, analogous to radiograph. If you spot an abnormality on a radiograph, continue to examine the entire area visible before stopping in order not to miss any further abnormalities. Licence: [. A loss in bone or joint alignment may be a result of a fracture, joint subluxation (partial dislocation) or dislocation. The Harris view better evaluates the calcaneus, middle facet of the subtalar joint, and sustentaculum tali. Fractures of the talar dome, termed osteochondral defects (OCDs), may initially be missed on the first evaluation of the ankle and should be sought out if other fractures are not identified. Instagram: https://instagram.com/geekymedics . MRI is not indicated unless unusual features are present,. [9]A significant disruption of the tendon is also visible on radiographs. Combined labeled leukocyte and technetium 99m sulfur colloid bone marrow imaging for diagnosing musculoskeletal infection. Avulsion fractures from the distal tip of the lateral malleolus are also common and result from inversion injuries to the ankle. Should this happen, it is a sign that what the person has could possibly be a high ankle sprain. Ankle fractures in children are relatively less frequent, but when they do occur, they tend to involve the epiphysis (Salter-Harris fractures), as the open physeal plate is a plane of weakness in any bone. An enlarged gap between the tibia and fibula indicates a diastasis (mentioned earlier). [2] It appears that the incidence of these fractures is increasing in developed countries, presumably secondary to the increasing number of people involved in athletic . Using the diagram below we can determine when an ankle series is required. 2009 Jun 25;151(26-29):48-9. [Updated 2022 Apr 28]. Abnormal swelling or clinical ankle instability in an acute sprain may be documented with bilateral stress radiographs of the ankle. The neck is the portion that connects the head and body and does not possess an articular surface or cartilage. 5-10 minutes after injection, the blood pool phase is acquired. When suspected, x-rays of the tibia and fibula should be obtained. Ottawa Ankle Rules. Pain after a Negative X-ray - As we noted above, X-ray images aren't as detailed as an MRI. X-rays are made by using external radiation to produce images of the body, its organs, and other internal structures for diagnostic purposes. A Maisonneuve fracture will show a potentially unstable or a stable injury. Two additional important scintigraphic studies that may be utilized to evaluate osteomyelitis are the tagged white blood cell (WBC) scan and sulfur colloid bone scan. This phase can be helpful in cases of persistent soft tissue radiotracer activity obscuring possible osseous activity, as may be seen with soft tissue infections or in patients with peripheral vascular or renal disease, which prevents prompt radiotracer excretion or if there is a concern for osteomyelitis. The sonographic appearance of normal anatomic structures has been previously described. The .gov means its official. The primary motions of the ankle are external rotation, abduction, and adduction. In these situations, consider asking for additional X-rays. [17] Compression of the abnormality is useful to evaluate for swirling of contents within a complex cystic lesion, as may be seen in a ganglion cyst. The most common ankle fracture involves the lateral malleolus, and the most common injury of this structure is an obliquely oriented fracture in the coronal plane. Symptoms that persists beyond a few days or do not improve. The most common indication for these studies is vascular trauma and is most commonly performed with CT. CTA has been shown to have near 100% sensitivity and high specificity for vascular trauma to the ankle, which is less expensive and less time-consuming than conventional angiography and can be performed concomitantly with the trauma evaluation. A size exceeding 8 mm may represent tendinous pathology from multiple sources, including tendinosis or tearing, post-surgical change, inflammatory arthropathies, or accessory muscles, among others. Additionally, DSA has the highest spatial resolution of these modalities, allowing for the detection of small arterial injuries below the limit of resolution of CT or MR. A fracture in an abnormal bone is termed a pathological fracture. 18 Pre-season practice injury rates were 2.5 to 3 times higher than in-season practice rates and 4 . Flex the knee joint slightly and hold the injured ankle in 10to 15 plantar flexion. The ligaments bind the bones together. For more information, you can read a more in-depth reference article: ankle series. Begin by checking that you are looking at the correct radiograph of the correct patient. For mild to moderate ankle sprains, stress xray films are usually unnecessary. The posterior process of the talar body is composed of medial and lateral tubercles, which form a groove through which the flexor hallucis longus tendon runs. Ankle sprain is a common and painful condition in which . Please enable it to take advantage of the complete set of features! [X-ray follow-up study of conservatively treated ankle sprain]. 8600 Rockville Pike A high ankle sprain involves different ligaments than a common ankle sprain. For more information, see the Geeky Medics guides to the bones of the lower limb and the bones of the foot. These fractures may not be clinically suspected, as the presentation is lateral ankle pain, and physical exam may be more suggestive of an ankle sprain. Diagnosis is suspected clinically with tenderness over the syndesmosis which worsens with squeezing of the tibia and fibula together at the midcalf. [10]In particular, since talar and calcaneal fractures typically imply high energy trauma, a search for additional fractures with CT may be warranted in the emergent or urgent setting.[11][12][13][14]. The radiographs of an uncomplicated ankle sprain should appear normal, or they may show some lateral tilt of the talus on the anteroposterior or mortise projection. The talar tilt stress view is obtained by maintaining the talus in inversion by holding the talus and tibia while obtaining a dorsoplantar projection. Unable to process the form. Pain in the foot or above the ankle. Multiple specialized radiographic views of the ankle have been described for specific purposes. An X-ray, ultrasound, or MRI is often needed to confirm a lateral ligament tear and rule out other injuries. The standard radiographic analysis of the ankle includes three views: the anteroposterior (AP, also sometimes referred to as dorsoplantar or DP) view, the internal oblique (or mortise) view, and the direct lateral view. Magnetic resonance imaging (MRI) provides the highest soft-tissue contrast resolution of any imaging modality and is useful for the evaluation of soft tissue abnormalities and osseous lesions. Ankle and foot injuries: analysis of MDCT findings. Disclaimer, National Library of Medicine Initial management goals are to limit inflammation and swelling and to maintain range of motion. Bookshelf Further, the middle facet articulates with the medial process from the calcaneus (also called the sustentaculum tali). The Ottawa Ankle Rules are highly sensitive tools for detecting fracture in the setting of acute ankle sprain ( 18) ( Table 1 ). Type IV injuries typically occur medially. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ The posterior lip of the distal tibia is often referred to as the posterior malleolus. The Ottawa rules recommend an X-ray in the following cases: Following an ankle injury, if there is pain in the malleolar zone, and one of the following: Inability to bear weight (walk four steps) immediately after the injury and when examined. Early treatment includes RICE (rest, ice, compression, elevation) method for the first two to three days. Appropriate probe positioning to evaluate specific pieces of anatomy is crucial but beyond the scope of this article. Difficulty bending the ankle up or down. Calcaneal Avulsion Fractures: An Often Forgotten Diagnosis. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. MRI has been shown to be the most sensitive and specific evaluation for musculoskeletal infections, including cellulitis, abscesses, and osteomyelitis. If in doubt, always ask for senior input. They form what is known as the syndesmosis (pronounced "SIN-des-MO-sis"). Clipboard, Search History, and several other advanced features are temporarily unavailable. Alternatively, the scintigraphic data can be obtained using single-photon emission computed tomography (SPECT) with the imaging cameras in a gantry that rotates about the patient, analogous to a CT, providing a three-dimensional image of the radiotracer activity. Early JS. Frawley PA, Hart JA, Young DA. Haapamaki VV, Kiuru MJ, Koskinen SK. T1-weighted post-contrast sequences with or without contrast may also be added, depending on the clinical indication. A high-frequency (12 MHz to 17 MHz) linear transducer is used to maximize the evaluation of superficial structures. Radiology department of the Amsterdam University Medical Centre in Amsterdam and Alrijne hospital in Leiderdorp in the Netherlands. #2 - Bone Scan = A bone scan is NOT as common a test. Finally, the Saltzman view has been used to determine the relationship of the hindfoot with the leg to characterize complex hindfoot malalignments and is obtained both with and without weight-bearing, with the beam oriented posteroanterior and craniocaudally, tangential to the hindfoot. Diagnosing traumatic arterial injury in the extremities with CT angiography: pearls and pitfalls. lateral talar shift) suggests syndesmosis disruption and therefore joint instability. The mortise view better evaluates the talus and all margins of the joint space. Numbness, tingling, severe pain, or any other concerning complaint requires more immediate evaluation. Ankle sprain; Ankle fracture; Ankle dislocation; Achilles tendon rupture; Calf strain; . [16] The optimal technique for sonographic evaluation involves light pressure to avoid compressing vascular structures and limiting vascular flow. Schweitzer ME, Karasick D. MR imaging of disorders of the Achilles tendon. Facebook: http://www.facebook.com/geekymedics With the ankle joint held at 10 to 15 of plantar flexion, the examiner grasps around the heel with one hand and stabilizes the tibia from the anterior side with the other. Use an ice pack or slush bath of ice and water for 15 to 20 . MR angiography of the foot and ankle. Muscles appear hypoechoic, and linear hyperechoic striations corresponding to fascial lines are often seen. The anterior drawer test is performed as lateral views are taken. 1998 Dec;39(6):393-445. The talar body articulates with the calcaneus inferiorly at the middle (anteromedial) and posterior (posterolateral) facets. The inferior margin of the talar neck forms the superior margin of the sinus tarsi and tarsal canal.[5]. Join the Geeky Medics community: [15] Ultrasound is also invaluable in the use of image-guided interventions, such as biopsies. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. The distal tibial epiphysis is the second most common epiphyseal fracture in the entire body, following the distal radial epiphysis. A less common fracture type is transversely oriented, extending from the medial corner of the ankle mortise superomedially to the medial cortex of the tibial metaphysis. This injury results from ankle inversion or adduction. Bruising around the ankle, sometimes into the foot and toes. The above fracture patterns are most commonly seen in adults. The principle utility of MRI lies in the evaluation of non-acute osseous and soft tissue lesions. Sonographic confirmation and evaluation of soft tissue masses yield complementary information, but other imaging studies are often needed to fully characterize most masses. Diagram of a mortise (on left) and tenon joint. Vessel narrowing may be subtle and difficult to differentiate from the normal tapering of distal vessels. View Ankle Injury Graphic Org.docx from ANATOMY 101 at Everett Community College. Sonographic evaluation is highly dependent on operator skill and is often performed directly by a musculoskeletal subspecialty-trained radiologist. They are the most commonly due to eversion injuries. The ankle joint is composed of the tibia, fibula, and talus. We will limit this discussion to the appearance of muscles, tendons, and ligaments for the sake of brevity, as these structures are the most commonly investigated structures in the acute or traumatic setting. The ankle joint is formed by the tibia, fibula, and talus. The diagnosis of patellar and quadriceps tendon rupture can be made clinically, based on history and exam findings alone. Excessive swelling or bruising is a common occurrence after an ankle sprain, but this alone does not warrant an X-ray or immediate medical attention. Early venous filling on an appropriately-timed arterial phase, CTA suggests arteriovenous shunting, possibly from a fistula. When describing an ankle X-ray, use the following structure: Details of the radiograph and the patient Site of fracture: which bone, which part of the bone, left or right Type of fracture (e.g. If you have any questions you would like answering regarding our . [Ankle and foot sprains: conventional radiography aspects]. Familiarise yourself with normal radiographs of the ankle, so that you are able to recognise when things dont look quite right. The ankle is a hinge joint formed by three bones: the tibia, the fibula and the talus. [Article in German] Authors H Polzer 1 , B Ockert, S Grote, C Volkering, W Mutschler, K G Kanz. Finally, the anterior drawer stress view is obtained by allowing the leg to suspend from the edge of a table while the ankle lies in a gravity-assisted plantar flexion, and the foot is pulled while stabilizing the tibia. Miller-Thomas MM, West OC, Cohen AM. In both views, trace the cortical outline of all the bones visible on the radiograph. X-rays pass through body structures onto specially-treated plates (similar to camera film) and a "negative . Patients use crutches until they can . You can try out the Geeky Medics Flashcard App here: https://geekyquiz.com/flashcards/create-deck/ - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ ment with ankle injury as their primary complaint, 15% will have an ankle fracture [2]. While many of the ligaments and tendons of the ankle and foot are not well-evaluated by radiography, the Achilles tendon is readily apparent. MRI has emerged as an important adjunct in the evaluation of inflammatory arthritides, for which it is the most sensitive modality to detect early changes. Increased radiotracer activity is due to a combination of blood flow and osteoblastic activity. He continues to complain of ankle pain and instability. Epidemiology An ankle sprain is a common injury. You have tenderness at the outside ankle bone (fibula). Accessibility It is not as severe as a grade 3, but definitely more serious than a grade 1 sprain. Ankle fracture dislocation is a neurovascular and limb threatening emergency: any child with an ankle injury demonstrating neurovascular compromise must be referred immediately to the CED Consultant +/- Orthopaedic Registrar on Bleep 8629. ADVERTISEMENT: Supporters see fewer/no ads. Ankle sprain is frequently seen in certain sports and is best managed by an interprofessional team approach. The AP view is used to evaluate the ankle mortise, though the lateral portions of the talus and tibiotalar joint overlap with the lateral malleolus, obscuring that area from view. The incidence of ankle sprain is highest in sports populations. Rest is achieved by limiting weight-bearing. The patient usually is given appropriate initial . Treatment outcome of major fractures of the talus. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ Many ankle fracture types and fracture patterns have been described. Before Unless a thorough physical examination is carried out and clinical suspicion of an underlying fracture is genuinely considered, x-rays can be a needless expense. Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus. The external oblique is used to view the medial column of the foot, navicular, medial cuneiform, first metatarsal, and its articulationsand is obtained similar to the internal oblique view, except that the ankle is in 45 degrees of external rotation. MRI was performed to evaluate for ankle subtalar joint dislocation. Real-time multiplanar reformations can be performed at the workstation, and 3D surface renderings can now be easily created to further assist the surgeon in planning. Adapted by author. Wechsler RJ, Schweitzer ME, Karasick D, Deely DM, Glaser JB. Hans.Polzer@med.uni-muenchen.de ; PMID: 19739551 . You have tenderness at the bone over the arch (the navicular bone). If an area of increased activity is identified, this may then be followed by the sulfur colloid study. Conventional angiography is invasive, however, requiring direct arterial access. It may be difficult to differentiate between an ankle sprain and an ankle fracture and sometimes requires an X-ray or knee jerk reaction test. This is the widest distance between the medial border of the talar bone and the lateral border of the medial malleolus. You can't walk on the ankle. Routine MRI evaluation of the ankle is performed in the standard axial, coronal, and sagittal planes. Have you sprained your ankle so bad that it hurts or is bruised so badly that you arent sure whether you need to get an x-ray? Treatment of a sprained lateral ligament of ankle Almost all pulled ligaments in the ankle can be treated without surgery. By extension, fractures of all three malleoli are referred to as trimalleolar fractures. Ultrasonographic examination for inversion ankle sprains associated with osseous injuries. It should be noted though, that in some countries, including the UK, only the mortise and lateral are used. An official website of the United States government. Enhancing Healthcare Team Outcomes Ankle sprains remain one of the most common musculoskeletal injuries that present to the emergency department. Department of Trauma & Orthopaedics, Lancashire Teaching Hospitals NHS Foundation Trust. Active and passive movement Active movement refers to a movement performed independently by the patient. [24] Images are typically acquired in the arterial phase only, but additional phases may be added as needed. Ankle fractures are created by the movement of the talus within the ankle mortise, with leverage exerted by the foot. Beware of normal developmental variants such as accessory ossicles which may be mistaken for fractures. Simply enter your prompt on the front of the flashcard and let our intelligent assistant (Geeky AI) do the rest! Algoritm for Ankle Fractures 2.0. Create Flashcards using AI | Geeky Medics AI . Failure to identify such fractures can lead to delayed diagnosis and suboptimal management, including growth plate disturbance (in pediatric patients), persistent pain and instability, fracture nonunion, and accelerated osteoarthrosis. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ Fractures involving the medial and lateral malleoli are termed bimalleolar fractures. The imaging clue that osseous fragments in these locations represent normal variant anatomy as opposed to fractures. Study with Quizlet and memorize flashcards containing terms like Hindfoot, Midfoot (4), Forefoot and more. [23] Further, in those patients who will undergo operative management, the CTA can provide valuable information for planning the vascular intervention. 9 The most common injury was ankle ligament sprains, 2, 14-17 mostly involving the lateral ankle ligaments. Look at the medial clear space. The plantar flexion is important to decrease MRI artifact (magic angle), to accentuate the fat plane between the peroneal tendons, and to allow better visualization of the calcaneofibular ligament.[1]. The third delayed phase is acquired 2-4 hours after injection and provides the greatest signal-to-noise ratio, as soft tissue uptake is minimized following normal excretion of the radiotracer. 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