43-year-old female with ankle pain and fracture of the lateral malleolus. Assess deltoid competency and for medial talar lesion. TENDONS: The extensor and flexor tendons appear intact. The peroneal tendons appear intact. LIGAMENTS: There is complete rupture of the anterior tibiofibular ligament. There is associated cortical irregularity along the lateral aspect of the tibial plafond which is suspicious for an avulsion fracture of the distal tibia. There is also rupture of the posterior tibiofibular ligament. There is increased signal abnormality within the distal tibiofibular syndesmosis. The deltoid ligament appears intact. The lateral collateral ligament complex appears intact. ARTICULAR SURFACES AND BONE: There is a fracture of the distal fibula at the level of the tibiotalar joint with slight medial displacement of the distal fracture fragment. There is cortical irregularity of the lateral aspect of the tibial plafond suspicious for an avulsion fracture of the distal tibia. There is also a linear focus of signal abnormality traversing the posterior malleolus suspicious for a nondisplaced fracture.Note is made of an osteochondral defect along the medial aspect of the talar dome which measures 1.2 cm in the AP dimension and 0.8 cm in the transverse dimension. There is associated 1 to 2 mm of cortical depression of the talar dome. There is fluid signal intensity surrounding this defect which is consistent with an unstable lesion. The osseous fragment demonstrates low signal intensity on T1 and T2-weighted images suggestive of sclerosis/osteonecrosis. There are cysts within the bone underlying this lesion which suggests that this finding may be chronic in etiology. Focus of increased signal abnormality within the anterior calcaneus appears most consistent with a benign vascular remnant. ADDITIONAL
1. Distal tibia and fibula fractures with associated injury/disruption of the distal tibiofibular syndesmotic complex as described above. The deltoid ligament appears intact, as clinically questioned.2. Findings suggestive of a chronic appearing unstable osteochondral defect along the medial aspect of the talar dome, with reference measurements provided above.