Wolfgang Hirsch, S.-O. Höhne (Halle)  

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Leg-Bones  

physical  

After distorsion trauma and pain at the lateral maleolus and in the distal diaphysial region of the tibia.

Lateral maleolus fractures are without the help of MRI often misread. According to v. Laer, this is a 5-Kadi-Lesion (in a misdiagnosis or rather a misreading: down before the Kadi!!)  

Frequent in supination trauma: Tendon lesion and extensive clinical symptoms which lie laterally; Fractures (by the hitting of the medial malleolus onto the talus) are found, however, medially (with less symptoms).  

<- view X-Ray 1

X-Ray 1: Fracture of the medial malleolus is not seen in the a.p. x-ray.







<- view X-Ray 2

X-Ray 2: Lateral: Possible Aitken I Fracture in the dorsal area of the metaphysis of the distal tibial metaphysis.







<- view MRI 1

MRI 1: (T2 with fat supression - coronal) White, horizontal (fluid-filled) line of fracture through the medial malleolus without dislocation = Aitken II (could not be seen in conventional x-ray). Confirmation of the bright Aitken I fracture of the dorsal tibial metaphysis (diagonal in the coronal image). Only a small amount of edema is seen in the marrow = bone-bruise, trabecular fracture. Slight increase in fluid in the joint (T2-weighted fat-suppressed sequence)









<- view MRI 2

MRI 2: (T1 - Sagittal) Dark, strong lines in the dorsal area of the metaphysis (corresponding to the lateral x-ray). The surrounding dark area is comparable to the obvious marrow edema (in T1-SE: dark).




 

Total constellation (Consens)  

In this extreme and patient history - obvious findings.
Otherwise also marrow edema of other cause (inflammation, tumor). Patient history?  

If no step on the joint is seen, no early arthrosis, but danger of a pseudoarthrosis if misdiagnosis.

In cartilage-stepping or damage: Early arthrosis.

!!! - This is one of the 5 Kadi-fractures (according to v.Laer)  

From our experience, fractures of the medial maleolus are often initally detected in MRI. Generally, fractures of the upper ankle joint, due to the complexity of the joint and the strong bone mass, are not detected conventionally.

In case there is no MRI availabe: In suspicion of a medial maleolus fracture, a.p.-image (in addition to the normal image with 30° inner rotation).  

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Aitken, fracture, ankle joint, Salter, Harris, Salter-Harris, Salter-Harris fracture, child, childhood, pediatric radiology  

Wolfgang Hirsch, S-O Höhne. Fracture of the ankle joint / Aitken I distal tibia metaphysis and malleolus medialis fracture. PedRad [serial online] vol 1, no. 11.
URL: www.PedRad.info/?search=20011125215323