case_images: PMC10898864_01
case_images: Radiographs of the patient. (A) Plain X-ray frontal and lateral views obtained at the time of injury showed that the distal end of the fibula was obliquely fractured, displaced posterior-laterally, and 2.5 mm shorter (arrow), and the lateral joint space was dilated (arrowhead). (B) Plain X-ray frontal and lateral images obtained at the time of arrival showed mild enlargement of the medial joint space (arrowhead).
case_images: cureus-0016-00000053112-i01.jpg
case_images: PMC10898864_01_cureus-0016-00000053112-i01.jpg
case_images: FIG1
case_images: This fracture ran from the level of the joint in the posterior-superior direction with approximately 2.5 mm of shortening, displacement posterolaterally, and widening of the lateral joint space (Figure 1A). The medial joint space was enlarged at the time of referral to our hospital (Figure 1B).
case_images: The patient's CT and MRI scans. (A) A CT scan (coronal section) shows that the medial joint space has expanded (arrow). (B) A CT scan (sagittal section) shows that the peripheral bone fragments were displaced posterior-superiorly, and there was a gap left in the anterior part of the fracture, but the posterior bone was united (arrow). (C) An MRI proton density-weighted image (coronal section) shows a high signal which was observed on the medial articular surface of the talus and the medial malleolus. (D) An MRI short tau inversion recovery (STIR) image of the sagittal section shows a high signal which was observed on the medial articular surface of the talus and the medial malleolus.
case_images: cureus-0016-00000053112-i02.jpg
case_images: PMC10898864_01_cureus-0016-00000053112-i02.jpg
case_images: FIG2
case_images: Computed tomography (CT) scans showed posterior-superior displacement of the peripheral bone fragments, and although there was a gap in the anterior part of the fracture, the posterior part was fused (Figures 2A, 2B). On the MRI, proton density-weighted and short tau inversion recovery (STIR) scans showed a high signal on the articular surface of the medial talus and medial malleolus but no significant damage to the deltoid ligament or anterior tibiofibular ligament (Figures 2C, 2D).
case_images: Findings of the ankle arthroscopy. Panes (A) and (B) show detachment and roughening of the cartilage on the medial malleolar joint surface of the talus, and a part of them was trimmed.
case_images: cureus-0016-00000053112-i03.jpg
case_images: PMC10898864_01_cureus-0016-00000053112-i03.jpg
case_images: FIG3
case_images: Detachment and fibrillation of the cartilage were observed on the medial malleolar surface of the talus, part of which was trimmed (Figure 3).
case_images: Intraoperative findings. (A) The bone fragment was displaced posterior-superiorly and partially fused (arrow). (B) and (C) show that the fracture was freshened and reduced.
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case_images: PMC10898864_01_cureus-0016-00000053112-i04.jpg
case_images: FIG4
case_images: After removing all the fibrous tissue and callus, we were able to see the original fracture and anatomically reduce it relatively easily (Figure 4).
case_images: The patient's postoperative radiographs.  (A) Frontal view; (B) Lateral view
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case_images: PMC10898864_01_cureus-0016-00000053112-i05.jpg
case_images: FIG5
case_images: The patient's imaging results at the time of the final follow-up. (A) Plain X-ray frontal view; (B) Plain X-ray lateral view; (C) MRI short tau inversion recovery (STIR) image coronal section shows that the bone marrow edema of the talus had almost disappeared.
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case_images: PMC10898864_01_cureus-0016-00000053112-i06.jpg
case_images: FIG6
case_images: Plain radiographs indicated that the joint spaces between the medial and lateral sides of the talus were even, and an MRI showed that the bone marrow edema observed before surgery had largely resolved (Figure 6).
case_images: Japanese Society for Surgery of the Foot, Ankle/Hindfoot scale. The score was 65 points before the operation but improved to 100 points six months after the surgery.
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case_images: PMC10898864_01_cureus-0016-00000053112-i07.jpg
case_images: FIG7
case_images: Self-Administered Foot Evaluation Questionnaire. Prior to the operation, deductions were observed in social functioning, especially, but no deductions were observed in any of the categories one year after the operation.
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case_images: PMC10898864_01_cureus-0016-00000053112-i08.jpg
case_images: FIG8