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  13b (Ankle) - Answer: 51-year-old female presents with a sprain of the right foot

HISTORY: 

This 51-year-old female presents with a sprain of the right foot. Since falling and twisting her ankle two months ago she has had swelling and sharp pain with specific movements.


(QUIZ ANSWER) THE ANATOMICAL STRUCTURE IS:

Calcaneofibular ligament.


Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.


FINDINGS: 

Two-part ankle tear with scarred thickened anterior talofibular ligament and avulsion detachment at the base or calcaneal origin of the calcaneofibular ligament. Underlying skeletal osteoedema. Consider review of the patient's radiograph to ensure that no cortical avulsion fracture is present.

Peroneus longus and brevis intact.

Medial, anterior and posterior tendon groups normal.

No traumatic post sprain OCD. Trace ankle effusion.

Microtrabecular injury of the cuboid.

High ankle is normal.


CONCLUSION:

Two-part low ankle ligament sprain / tear with detachment of the base or origin of the calcaneofibular ligament from the calcaneus. Radiographic review would allow assessment of cortical avulsion fracture.


ADDITIONAL EDUCATIONAL INFORMATION:

Question 1 - Which components of the lateral ligamentous complex are injured in this case?

Question 2 - Why is it extremely uncommon to injure the posterior talofibular ligament?

Question 3 - What are recognized complications of the injury in this case?




Answer 1 - Grade 3 avulsion detachment of the calcaneal attachment of the calcaneofibular ligament with underlying skeletal osteoedema. Grade 1 anterior talofibular ligament sprain.

Answer 2 - Majority of ankle inversion injuries occur with at least some degree of plantar flexion, exposing the weakest anterior talofibular ligament to initial injury, followed by the stronger calcaneofibular ligament, and lastly the posterior talofibular ligament.

Answer 3 - Chronic lateral ankle instability. Anterolateral impingement syndrome is due to a chronically thickened anterior talofibular ligament, with intra-articular fibrotic synovitis in the lateral gutter. Hyalinized tissue may form in the lateral gutter producing a restrictive lesion that may attach to the anterior talofibular ligament. The peroneal tendon subluxes due to peroneal retinaculum detachment. Talar dome or anterior process of calcaneus fractures. Complex regional pain syndrome.


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430577 1572434 10029938 13b (Ankle) - Answer: 51-year-old female presents with a sprain of the right foot /courses/430577/lectures/10029938 true native_comments
430577 1572434 10029938 13b (Ankle) - Answer: 51-year-old female presents with a sprain of the right foot /courses/430577/lectures/10029938 true text

HISTORY: 

This 51-year-old female presents with a sprain of the right foot. Since falling and twisting her ankle two months ago she has had swelling and sharp pain with specific movements.


(QUIZ ANSWER) THE ANATOMICAL STRUCTURE IS:

Calcaneofibular ligament.


Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.


FINDINGS: 

Two-part ankle tear with scarred thickened anterior talofibular ligament and avulsion detachment at the base or calcaneal origin of the calcaneofibular ligament. Underlying skeletal osteoedema. Consider review of the patient's radiograph to ensure that no cortical avulsion fracture is present.

Peroneus longus and brevis intact.

Medial, anterior and posterior tendon groups normal.

No traumatic post sprain OCD. Trace ankle effusion.

Microtrabecular injury of the cuboid.

High ankle is normal.


CONCLUSION:

Two-part low ankle ligament sprain / tear with detachment of the base or origin of the calcaneofibular ligament from the calcaneus. Radiographic review would allow assessment of cortical avulsion fracture.


ADDITIONAL EDUCATIONAL INFORMATION:

Question 1 - Which components of the lateral ligamentous complex are injured in this case?

Question 2 - Why is it extremely uncommon to injure the posterior talofibular ligament?

Question 3 - What are recognized complications of the injury in this case?




Answer 1 - Grade 3 avulsion detachment of the calcaneal attachment of the calcaneofibular ligament with underlying skeletal osteoedema. Grade 1 anterior talofibular ligament sprain.

Answer 2 - Majority of ankle inversion injuries occur with at least some degree of plantar flexion, exposing the weakest anterior talofibular ligament to initial injury, followed by the stronger calcaneofibular ligament, and lastly the posterior talofibular ligament.

Answer 3 - Chronic lateral ankle instability. Anterolateral impingement syndrome is due to a chronically thickened anterior talofibular ligament, with intra-articular fibrotic synovitis in the lateral gutter. Hyalinized tissue may form in the lateral gutter producing a restrictive lesion that may attach to the anterior talofibular ligament. The peroneal tendon subluxes due to peroneal retinaculum detachment. Talar dome or anterior process of calcaneus fractures. Complex regional pain syndrome.