• LaCourt S
• Sergent A
• Richardson M
• Carter S

• Adult
• Ankle Injuries
• Male
• Open Access Document
• Orthopedic Tests

Objective: Ankle injuries are common to the lower extremity and present to emergency rooms and physician’s offices frequently. The Ottawa Ankle Rules (OAR) are accepted clinical guidelines to assess a patient’s ankle or foot injury and requires radiographs to rule out a fracture. OAR developed a set of physical examinations and criteria to help determine the need for x-rays following a trauma, most commonly following the sprain/strain involving the ankle. This case report demonstrates the necessity of appropriate physical examination and follow-up diagnostic assessments to ultimately diagnose radiographically-occult ankle fracture.

Clinical Features: The patient was a 43-year-old male who was performing lateral speed and agility exercises with the use of a speed ladder when he suddenly heard a pop and pain from his right ankle, suffering an excessive eversion injury. Following the injury, he was able to weight bear on the ankle, but with a noticeable limp. He presented to a chiropractic clinic 2 days post-injury with moderate to severe swelling and bruising over the ankle and foot area. Physical examination with Ottawa ankle rule criteria produced several positive orthopedic findings suggesting the need for ankle radiographs to rule out fracture. Radiographs (initial and repeat) revealed no evident fracture and only swelling of the ankle and mortise joint effusion.

Intervention and Outcome: An MRI without contrast was ordered and revealed a fracture of the posterolateral tibial plateau along with several soft tissue injury findings. Consultation was made with an orthopedic surgeon within 35 days of the initial injury and reported that the ankle was now stable, did not need brace, boot or surgery at this point. The healing time would take approximately 90 days and patient was cleared to begin rehabilitative exercises.

Conclusion: In conclusion, this case provides example of a fracture not indicated by the OAR and emphasizes the role of clinical follow-up and advanced imaging modalities in the accurate diagnosis of ankle injuries, particularly when initial assessments and radiographs are inconclusive. It also illustrates the importance of a multidisciplinary approach in managing such injuries, where the expertise of radiologists and orthopedic surgeons contributes to a comprehensive understanding and treatment of the injury. Further research into optimizing diagnostic pathways for ankle injuries is warranted to enhance outcomes for patients presenting with these common yet complex conditions.

Author keywords: Ankle; Ankle Fracture; Radiography; Ottawa Ankle Rules

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