Three-view plain radiography of the right ankle (anterior-posterior, lateral, and mortise views) was obtained. MRI is especially useful for the evaluation for osteochondral injury (e.g., talar dome osteochondral injury), ligamentous injury, acute or chronic physeal injury, and stress fracture. This is not a first-line imaging modality for the evaluation of fractures but can be useful when there are significant symptoms and a strong clinical suspicion of injury with negative plain radiography or equivocal CT. CT has been found to improve detection of talar dome fractures, improve talus fracture classification, and detect fractures of the lateral process of the talus, which can be difficult to visualize with plain radiography. This is especially true as some talus fractures may be occult or not well depicted on plain radiographs, making CT useful in these cases. CT can provide excellent bony detail, and if there is a complex fracture, the diagnosis of a talus fracture is in question, or there is strong clinical suspicion of a talus fracture with negative plain radiography, utilization of CT is appropriate. This imaging modality is often used as a follow-up to plain radiography. Radiography has been shown to have difficulty in detecting talar dome fractures and lateral process fractures. Patients with injuries that are suspected to involve the talus should have anterior-posterior, lateral, and oblique views of the ankle (an ankle series) if the talus head is not fully visualized, consideration should be given to obtaining an anterior-posterior view of the foot. This is the first-line imaging modality in patients with suspected bone injury. He has brisk capillary refill and both the dorsalis pedis and posterior tibial pulses are equal and strong. He has swelling and pain on palpation of the dorsal-lateral aspect of his right foot. His physical examination reveals normal vital signs and is generally unremarkable. He complains of pain to the dorsal aspect of the foot. He states he feels that his right foot “was twisted” and “slammed into the floorboard” of the car. The patient did not lose consciousness and has no complaint of head pain, neck pain, back pain, or abdominal pain. The patient was a restrained front seat passenger in a vehicle that was struck by another car while stopped at a red light. A 14-year-old male is brought to the Emergency Department after being involved in a motor vehicle crash.
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