A 28-year-old man twists his ankle playing basketball. Radiographs show an undisplaced fracture of the medial malleolus with widening of the ankle mortise. He also reports pain high up in the calf. The next most appropriate step is:

• A MRI of the ankle to assess the deltoid ligament
• B Ultrasound of the calf to exclude deep vein thrombosis
• C CT scan of the ankle to rule out a Tillaux fracture
• D Radiographs of the full length of the tibia and fibula ✓

Explanation

A medial malleolar fracture or deltoid injury combined with proximal calf pain suggests a Maisonneuve fracture, a pronation external rotation injury with a spiral fracture of the proximal third of the fibula and disruption of the syndesmosis. Imaging must include the entire tibia and fibula because the fibular fracture is often clinically silent. MRI of the deltoid adds nothing once the mortise is widened, and DVT is not the immediate concern in this acute injury pattern.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.