Learning objectives
This study aims to illustrate the possible differential diagnosis of persistent ankle pain after inversion lesions.
Illustrate the image patterns of each differential that may cause persistent pain after inversion lesions,
including marrow contusions,
missed fractures,
syndesmosis injuries,
chondral defects,
osteochondral talar lesions,
intraarticular bodies,
spring ligament damage,
sinus tarsi syndrome,
impingement syndromes and reflex sympathetic dystrophy.
Background
Acute ankle injuries are extremely common,
with one ankle inversion injury per 10,000 people each day and 85% of these injuries are sprains.
MRI may be importanton differentiating the many causes of persistent ankle pain after an ankle sprain.
Images of different methods were selected from digital archive o four institution to illustrate the cases.
Imaging findings OR Procedure Details
1.
OSTEOCHONDRAL FRACTURE
Osteochondral fracture of the talar dome is the commonest missed fracture associated with inversion sprains.
It may be staged in 4 types of injury: from an undislocated compression fractures of the subchondral bone to a complete detachment and displacement of the fibro-osseous fragment.
The main imaging findings in MRi isthe detection of a crescentic fracture line and a focal cartilage lesion,
with adjacent bone marrow edema.
In unstable osteochondral fractures we may find a high signal line demarcating the osteochondral fragment from...
Conclusion
Persistent ankle pain following a sprain is a clinical condition that due to its prevalence and clinical importance,
the radiologist may be aware of all the possible causes and its image patterns,
in order to lead an accurate approach.
MRI is usually the modality of choice when investigating persistent ankle pain following a sprain as both soft tissue and bony abnormalities can be readily detected.