SET T0023 -
Emergency Department

Normal.

Undisplaced intra-articular fracture of the tibia / medial malleolus.

Note: this follow up image was taken the following day with slightly different angulation of the Xray beam. The fracture is now shown very well indeed.

This makes an important point. When the x-ray beam passes down the line / plane of a fracture it become much more obvious.

An undisplaced fracture, when the fracture line is situated more en face to the beam, can be overlooked by the unwary. Subtle findings need to be sought for and detected - as occurred when this fracture was diagnosed on the original radiographs obtained in the ED.

Fracture. In fact two fractures!

Fracture of the distal fibula (lateral malleolus) and a fracture of the base of the 5th metatarsal.

These images make the point that two or more fractures can and do occur at the time of an injury. It is crucial that all of the bones - and the joints - on the radiographs are evaluated.

Detecting one fracture does not mean . . . I can stop looking!

Intra-articular fracture of the calcaneum.

Bohler's angle is very abnormal.

Calcaneal fractures are often thought to be invariably associated with a fall from a height.

But they can occur following a relatively minor twist or fall.

Bohler's angle??

See : Accident & Emergency Radiology : A Survival Guide (3rd edition) : Pages 266,272