A man recently presents with knee pain after pivoting and torquing his knee while falling. He complains of concurrent mild ankle pain. He presents with this tib-fib xray. Realizing that a proximal fibular fracture can present concurrently with a medial malleolus fracture or deltoid ligament rupture, we obtained xrays of the ankle. We were looking for a Maisonneuve fracture.

Do you see an ankle injury in these four images?



  • There was no medial malleolus fracture.
  • There was no obvious deltoid ligament rupture, because the ankle mortise appears normal.
  • Always be sure to look at the lateral ankle view. You need to check for a posterior malleolus fracture.
  • This patient indeed had a Maisonneuve fracture, which was splinted and referred to orthopedics for operative repair.



Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD


Professor of Emerg Med at UCSF-Zuckerberg SF General. ALiEM Founder @aliemteam #PostitPearls at https://t.co/50EapJORCa Bio: https://t.co/7v7cgJqNEn
Michelle Lin, MD