X-rays of Ankle Fractures

Ankle fractures are very common injuries and have whole spectrum of injuries. Few images of x-rays of ankle fractures are presented below

Image 1 – Bimalleolar Fracture With Tibiofibular Diastasis

Following Xray belongs to a man 29 years old male with motor vehicle accident which got his ankle injured.

Xray of Ankle Fractures - Bimalleolar Fracture With Ankle Subluxation With Tibifibular Diastasis

Bimalleolar Fracture With Ankle Subluxation With Tibifibular Diastasis

Note the separation of tibia and fibula [diastasis] represented by increased space between the two. The fracture of the fibula is quite high.

There is a subluxation of the ankle as well.

Image 2 – Trimalleolar Fracture WIth Tibial Shaft Fracture

33 years old young swelling on the leg male got injured in a motor vehicle accident and presented to emergency with and inability to bear weight on the leg.

On assessment there were no injuries to any other part and his neurovascular status of the injured limb was normal.

The xrays of ankle revealed a trimalleolar fracture and a fracture line that extended up to tibial shaft.

trimalleolar fracture with tibial extension

Trimalleolar Fracture With Tibial Fracture

In above xray, anteroposterior view of the ankle is seen. Fractures are marked. Posterior malleolus cannot be seen in this view but the fractured posterior malleolus has been marked in the lateral view below.

lateral view of trimalleolar fracture

Lateral View of The Fracture

The patient was advised open reduction and internal fixation for the fractures including tibial fracture.

The patient however refused and decided to try some form of alternative therapy instead.

 

Image 3 – Xray of Fracture Talus with Ipsilateral Tibia Lower End Fracture

Xray of fracture Talus with concomitant ipsilateral tibia lower end fracture

Fracture of Talus and Lower End Tibia

Fracture of Talus and Lower End TIbia

Such fractures are difficult to treat and talus is prone to osteonecrosis in spite of reduction.

Image 4 -Xray of Fracture Fibula With Subluxation of Ankle

Subluxation of ankle caused by injury to ankle and fracture of fibula. The Xray that follows shows displaced fracture of fibula with subluxation of ankle joint. On left is anteroposterior view and on right is lateral view.

Xray of Fracture Fibula With Subluxation of Ankle

This patient suffered injury after he tried to get down from moving bus. His ankle got twisted and that resulted in injury. He was taken to the hospital where he was evaluated and a splint was applied. The shadow of splint is visible in Xray.

Anteroposterior View Xray of Fracture Fibula With Subluxation of Ankle

This is view on the left side and shows a fracture in fibula (upper arrow) and subluxation of ankle which is depicted by increased joint space in the ankle (lower arrow). There is no fracture of medial malleolus visible.

Lateral View Xray of Fracture Fibula With Subluxation of Ankle

This is on right side and shows fracture fibula (upper arrow). Joint space cannot be commented upon because the xray does not show it.
But there appears a fracture of cuboid in the foot (lower arrow). This fracture is not visible in the other view because of overlapping shadows of other bones of foot. We need anteroposterior view of the foot to ascertain that.

This injury has resulted from twisting force to ankle. In such cases of injury, the usual result is bimalleolar fracture i.e. Fibula as well as medial malleolus are fractured. However in fewer cases, the deltoid ligament ( Ligament that connects tibia to talus bone on the foot. This ligament is quite important in maintaining stability of the ankle joint.) breaks earlier and medial malleolus is spared.

Because the injury is to lateral as well as medial structures, this has resulted in instability of ankle joint, which is visible as subluxation.

Fracture of the cuboid bone might have resulted from the impact of the foot on the ground as the foot struck it.

Image 5 – Xrays of Bimalleolar Fracture With Ankle Dislocation

 

Bimalleolar fracture is a fracture in which both the malleoli of the ankle are presented.  Bimalleolar fracture with ankle dislocation occur but are not very common.

Following are pre and post treatment xrays of a patient with bimalleolar fracture with ankle dislocation.

This is a case of 40 years old male patient who sustained injury after fall from moving bike. He was presented to emergency with severe pain and swelling in the xray region.

This xray was done immediately after patient came to hospital.

Xrays of Bimalleolar Fracture With Ankle Dislocation

This xray contains anteroposterior view on left side and lateral view on right side.

You can see fracture medial and lateral malleoli along with dislocation of the ankle.

The patient was operated. Fibula was fixed with one third tubular plate and medial malleolus was treated by tension band wiring. The ankle was reduced and was stable.

Xrays of Bimalleaolar Fracture With Ankle Dislocation-Postoperative

The fractures are well reduced in both the views and joint line is well maintained.

Author’s Note

  1. Dislocation occurs with bimalleolar fractures when trauma is quite severe. Because two malleoli provide stability to the ankle joint, fracture of the both with ligamentous disruption causes dislocation of the ankle.
  2. Implant of choice for medial malleolus is malleolar screw but in this case the fragment of medial malleolus is too small for a screw. So kwire fixation and tension band wiring has been performed.

Image 6 – Osteochondral Fracture Of Talus – Anteroposterior Xray

A small fracture line is visible in upper outer part of dome of talus. If you cannot localize it, look at the center of the circle.

fracture-talus-osteochondral

The image has been contributed by Tom Jankowski, a reader of Bone and Spine.

Image 7 – Anteroposterior and Lateral Views Of Bimalleolar Fracture of Ankle

Xrays of bimalleolar fracture, AP and lateral views in 27 years old active male.

Bimalleolar Fracutre In Ankle

AP and Lateral Xrays Showing Bimalleolar Fracture

Fibula was fixed with one third tubular plate using open reduction and internal fixation. Medial malleolus was reduced closed and fixed with malleolar screws under Carm image intensifier.

Image 8 – Xray of Injured Ankle Showing Lateral Malleolus Fracture With Subluxation Of Ankle

Following are anteroposterior and lateral views of an ankle injury showing fracture of lateral malleolus in an adult along with subluxation of ankle..

Here is the anteroposterior xray showing the fracture and increased joint space on the medial side [marked by arrow] indicating subluxation

Fracture of Lateral Malleolus with Ankle Subluxation

Fracture of Lateral Malleolus with Ankle Subluxation

Here is the lateral view

lateral View of Lateral Malleolus fracture With Ankle Subluxation

lateral View of Lateral Malleolus fracture With Ankle Subluxation

Such injuries are best managed by open reduction and internal fixation. Restoration of fibular length would automatically reduce the ankle joint as well.

Image 9 – Operated Bimalleolar Fracture With Malleolar Screws and One Third Tubular Plate

Bimalleolar fracture fixed with malleolar screws for medial malleolus fracture and one third tubular plate for fibular fracture.

 

Bimalleolar Fracture Fixed With Malleolar Screws and One Third Tubular Plate

Bimalleolar Fracture Fixed With Malleolar Screws and One Third Tubular Plate

The xray was taken after 3 weeks of surgery.

Image 10 – Xray of Fracture of Lateral Malleolus

Fracture of Lateral Malleolus. Anteroposterior and lateral views.

Lateral malleolus is extension of fibula beyond the ankle joint.

It can be fractured in direct trauma or twisting injuries of ankle.

It is usuallly accompanied by ligamentous injuries on the medial side or fracture of medial malleolus.

The xray shows an undisplaced fracture of lateral malleolus in 34 year old man which resulted following a twisting injury to the ankle.

One of the concerns in malleolar fractures is subluxation of the ankle joint which may result if the fracture is displaced.

An undisplaced fracture of lateral malleolus is very well treated by non operative methods.

Image 11 – Xray of Dislocation of Ankle

Xray of ankle, lateral view, showing dislocation of ankle.

Dislocation of Ankle

Dislocation of Ankle

The injury occurred following fall from stairs.

The dislocation was reduced under sedation and splint was applied.

Image 12 – Xray of Injured Ankle Showing Lateral Malleolus Fracture With Subluxation Of Ankle

Following are anteroposterior and lateral views of an ankle injury showing fracture of lateral malleolus in an adult along with subluxation of ankle..

Here is the anteroposterior xray showing the fracture and increased joint space on the medial side [marked by arrow] indicating subluxation

Fracture of Lateral Malleolus with Ankle Subluxation

Fracture of Lateral Malleolus with Ankle Subluxation

Here is the lateral view

lateral View of Lateral Malleolus fracture With Ankle Subluxation

lateral View of Lateral Malleolus fracture With Ankle Subluxation

Such injuries are best managed by open reduction and internal fixation. Restoration of fibular length would automatically reduce the ankle joint as well.

Image 13 – Bimalleolar Fracture Ankle Treated with Malleolar Screws and Tension Band Wiring

Xray of bimalleolar fracture of ankle. Here is the xray after the injury that shows fracture of medial malleolus and lateral malleolus.

Bimalleolar Fracture Ankle

Bimalleolar Fracture Ankle

The fracture was operated and fixed using malleolar screw for medial malleolus and tension band wiring for lateral malleolus.

Here is anteroposterior view.

Postoperative Xray AP View Bimalleolar Fracture Ankle

Postoperative Xray AP View

This is lateral view.

Lateral Postoperative View -Postoperative Xray AP View Bimalleolar Fracture Ankle

Lateral Postoperative View

The fractures are well reduced and joint space is well maintained.

 

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