How would you interpret these 2 views? Oblique and mortise views were also obtained because of the physical exam findings.

What does this mortise view reveal that may not have be very evident on the 2 previous views?

Radiographic interpretation : There is a moderate amount of soft tissue swelling over the lateral malleolus. The AP and lateral views do not reveal any obvious fractures. However, there is a subtle widening of the medial aspect of the distal fibular growth plate (physis) on the mortise view. Comparative views and/or stress views would confirm that this is a fracture versus a normal growth plate closure.

Questions:

Discussion & Teaching Points: This patient has sustained a nondisplaced Salter-Harris type I fracture of the distal fibula (lateral malleolus). Clinical and or radiographic criteria that would warrant immediate orthopedic intervention include: a) An open fracture. b) Any type of injury with neurovascular compromise. c) Any unstable fracture (which would be difficult to adequately immobilize in a splint). d) Any ankle dislocation (which tends to carry a high risk of neurovascular compromise).

Since this patient does not have an open fracture, dislocation or evidence of neurovascular compromise, his stable fracture does not require an immediate orthopedic intervention. Therefore, this patient may be immobilized in an appropriate splint and sent home with an orthopedic referral for definitive casting. A posterior ankle splint would probably not be adequate immobilization by itself for an ankle fracture.