Radiological Evaluation of a High Ankle Sprain

Abstract

A 42-year-old woman with lateral left ankle pain presented to the orthopaedic clinic. She complained of unrelenting left ankle pain following a fall a week earlier. The plain radiographs of her left ankle revealed no evidence of fracture. Following her visit to the clinic, the orthopaedic surgeon ordered a magnetic resonance imaging (MRI) study of the left ankle. The T1- and T2-weighted images demonstrated an abnormal appearance of the anterior inferior tibiofibular (AITF) ligament as well as the anterior talofibular ligament (Figures ​(Figures11–3). Marked subcutaneous edema was evident over the lateral and anterior left ankle. A small ankle effusion was also visualized. Figure 1 Axial MR images of the left ankle. (a) T1-weighted spin-echo image demonstrates thickening and contour irregularity of the anterior inferior tibiofibular ligament (arrow). (b) Fat-suppressed T2-weighted fast spin-echo image shows intraligamentous edema, ... Figure 3 Axial fat-suppressed T2-weighted fast spin-echo image demonstrates edema within and surrounding the anterior talofibular ligament (arrow). What is the diagnosis and the most common mechanism of injury? DIAGNOSIS: Acute distal tibiofibular syndesmotic injury of the left ankle, frequently referred to as a high ankle sprain. A commonly seen accompanying sprain of the anterior talofibular ligament is also present. The most common mechanisms of injury are external rotation of the ankle and hyperdorsiflexion (1).