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Snowboard mishap with a twist: an uncommon injury that keeps you on your toes!
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Snowboard mishap with a twist: an uncommon injury that keeps you on your toes!

Authors:


1. Bettina Giran, Akos Jaray, University of Pecs, Department of Diagnostic Imaging
fig_01_AITF_avulsion_right

Fig 1: Anterior view of the right ankle at the level of the talofibular syndesmosis. No ligamentous structure identified. Suspicion of bony avulsion due to the irregularity of the cortical surface.

fig_02_AITF_contralateral_normal

Fig 2: Normal anteroinferior talofibular ligament on the contralateral side.

fig_03AITF_comparison

Fig 3:Comparison on split screen.

fig_04_AITF_comparison_marked

Fig 4:Same image with markers.

fig_05_MRI

Fig 5: AITFL rupture on axial PDFS MRI image.

fig_06_elevated_periosteum

Fig 6: Same image with markers.

fig_07_X-ray

Fig 7: Postoperative anteroposterior X-ray of the right ankle.

1Clinical History
The patient fell forward while snowboarding, with the right foot in front and suffered a right ankle injury. After that, she snowboarded for two more days and then went to work wearing a flexible ankle brace.
2Diagnosis
Anteroinferior talofibular (AITF) ligament rupture.
3Discussion
The AITF injury is an uncommon occurrence following snowboard accidents due to the relatively well-stabilized ankle. In this case, the right foot was facing downhill, and the fall occurred forward, causing hyperextension of the right ankle joint, which led to an AITFL rupture. Ultrasound imaging provides a clear view of the region, showing the absence of intact ligament structures and a small cortical defect. MRI, performed to rule out an osteochondral defect, also reveals the rupture, although with lower resolution. Treatment involves fixation with a locking screw.
4Teaching Points
Superficial ligamentous ankle injuries are adequately visualized by ultrasound.
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