This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Author contributions: Fischetti A, Zawaideh JP and Orlandi D designed the report; Orlandi D performed the ultrasound examination and reported the MRI scan; Belfiore S performed the orthopedic surgery; all the authors revised the literature, wrote and reviewed the manuscript.
Informed consent statement: The patient was informed and provided written consent for the study.
Conflict-of-interest statement: All the authors report no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Davide Orlandi, MD, PhD, Radiology Department, Ospedale Evangelico Internazionale, Corso Solferino 1A, Genova 16122, Italy. my.davideorlandi@gmail.com
Telephone: +39-333-7880696
Received: February 13, 2018 Peer-review started: February 13, 2018 First decision: April 11, 2018 Revised: April 23, 2018 Accepted: May 23, 2018 Article in press: May 23, 2018 Published online: May 28, 2018
ARTICLE HIGHLIGHTS
Case characteristics
Left ankle pain after an inversion injury, muscle functional impairment.
Clinical diagnosis
Swollen left ankle.
Differential diagnosis
Differential diagnosis includes fibular malleolus fracture.
Laboratory diagnosis
Unremarkable laboratory examination.
Imaging diagnosis
A radiography of the ankle excluded bone fracture but revealed the detachment of an osseous fragment; ultrasound demonstrated a diffuse swelling at the posterolateral aspect of the fibular malleolus and a split lesion of the peroneus (PB); MRI scan confirmed the PB split lesion and detects the avulsion of the fibular insertion of the superior peroneal retinaculum (SPR) and a shallow retro-malleolar groove with associated anterior luxation of the peroneus brevis tendon.
Treatment
RICE treatment consists of rest, ice, compression, and elevation, anti-inflammatory can also be prescribed to reduce inflammation. Surgical treatment involves a side-to-side suture, combined with the reconstruction of SPR and the excision of the degenerative tissue.
Experiences and lessons
This case suggests that integrated imaging is helpful for injury diagnosis and surgical planning. Unclear images, such as small bone detachment at plain films can be precious hints for the detection of underlying tendon pathology.
