If all of the above 3 views appear normal in a patient with a high clinical suspicion of a fracture, one should then obtain internal and external oblique views of the ankle to obtain additional views of the distal tibia and distal fibula. To obtain such views, the patient's leg is rotated 45 degrees internally, then 45 degree externally. The epiphyses of the distal tibia and fibula both appear by 2 years of age. The physis of the distal tibia fuses to its adjacent metaphysis by 18 years of age. The physis of the distal fibula fuses to its adjacent metaphysis by 20 years of age. Therefore, growth plate injuries should still be considered as a possibility in any patient up to 20 years of age. If one is unsure if a radiolucent line involving the distal tibia or fibula represents either a physis or an actual fracture, consider obtaining a comparison view of the nonaffected ankle. An x-ray of the patient's ankle was obtained.