Presentation
Slipped and fell. Inversion injury. Swollen ankle, distally pale with weak pulses.
Patient Data
There is a complex fracture-dislocation of the left tibia, with fractures through the medial and posterior tibial malleoli and anterior displacement of the tibial plafond.
In addition, there is a Weber C fracture of the distal fibular diaphysis with posterior displacement of the distal fracture fragment. No talar or calcaneal fracture is present.
Findings are those of displaced trimalleolar fracture.
Under procedural sedation, reduction of the ankle was achieved without issue.
Distal perfusion and pulses returned to normal.
Plaster of Paris cast in situ.
CT confirms the presence of a trimalleolar fracture.
There is a step deformity involving the articular surface of the tibial plafond at the posterior malleolus measuring up to 3mm.
Multiple small hyperdensities at the medial aspect of the head of the talus may represent bone fragments.
Case Discussion
Trimalleolar ankle fractures are considered unstable and are associated with a high rate of ligamentous injury. CT is key in preoperative planning, allowing detailed evaluation of the size and shape of the posterior malleolar fragment and the extent of articular step deformity.
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