Occult ankle fracture detected by an ankle effusion on plain radiography: A case report

• Published in: The Journal of emergency medicine Vol. 14; no. 4; pp. 455 - 459
• Main Authors: Ho, Kendall, Clark, Timothy W.I., Janzen, Dennis L., Connell, Douglas G., Blachut, Piotr
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-07-1996; Elsevier
• Subjects: acute fracture; Adult; ankle; Ankle Injuries - diagnostic imaging; Ankle Injuries - surgery; Biological and medical sciences; diagnosis; Diagnosis, Differential; Exudates and Transudates - diagnostic imaging; Humans; imaging; Injuries of the limb. Injuries of the spine; Male; Medical sciences; occult fracture; Sprains and Strains - diagnostic imaging; Tibial Fractures - diagnostic imaging; Tibial Fractures - surgery; tomography; Tomography, X-Ray Computed; Traumas. Diseases due to physical agents; diagnosis; acute fracture; ankle; imaging; occult fracture; tomography; Ankle; Case study; Human; Radiography; Radiodiagnosis; Effusion; Diseases of the osteoarticular system; Fracture; Computerized axial tomography; Diagnosis; Trauma
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/0736-4679(96)00084-4

Subtle ankle fractures may escape detection on plain radiography. These occult fractures can cause prolonged disability and pain. We present a case of blunt ankle trauma where plain radiography failed to reveal any bony abnormalities. The recognition of an ankle effusion on plain radiographs prompted us to perform a computed tomography (CT) scan of the ankle. The CT scan demonstrated an anterior plafond fracture of the distal tibia, which required surgical fixation. Had the fracture not been identified, our patient would have been treated inappropriately for a ligament sprain. An occult fracture should be suspected if an ankle is grossly swollen after blunt trauma, and plain radiography demonstrates an effusion. In this circumstance, performance of further imaging studies, such as conventional or CT, are advised to rule out an occult ankle fracture.