Undisplaced Fracture – Distal Tibial Metaphysis | Cases

Female, 45.

• Started running 4 months ago.
• Gradually building distance.
• 3 week ago developed significant ankle swelling, pain and difficulty weight bearing after an 8 mile run.
• No history of injury

X-ray – NAD

Exam

• Ankle swollen
• Tender on palpation over left medial malleolus and along tibial shaft.

MRI

Coronal

Saggital T1

There is an undisplaced fracture through the distal tibia with a hypointense fracture line through the tibial metaphysis and quite marked surrounding marrow oedema. There is a small tibiotalar joint effusion. The tibiotalar joint, subtalar joint, Chopart’s articulation and tarsometatarsal joints are all normal. No evidence of a talar dome osteochondral defect.
Non-specific marrow signal abnormality is seen at the angle of Gissane in the calcaneum.
There is a tiny effusion in the peroneal tendon sheath just distal to the lateral malleolus but no underlying tendinosis or tear is seen. Tiny effusions are also seen in the flexor tendon sheaths.
These are otherwise also normal. The ATFL is thickened and sprained. The lateral ankle ligaments are otherwise intact. Intact syndesmosis. Normal deltoid ligament.
Posteriorly there is non insertional Achilles tendinosis. Normal appearances of the plantar fascia.
CONCLUSION
Undisplaced fracture through the distal tibial metaphysis.
Noninsertional Achilles tendinosis.
Long-standing ATFL sprain

Comparison Slides