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Pediatric Avulsion Fracture of the Ankle
A 17-year-old high school lacrosse player presents to an urgent care center with a painful left ankle. He states that the pain started 2 days earlier when he twisted his left ankle (an inversion injury) while competing in a tournament. He says that he tried to continue to play, but the pain increased. He reports that the ankle swelled over the lateral aspect and that he has pain when he walks. He says that he does not feel any numbness, pain in the medial ankle, or pain in the proximal tibia or fibula, and reports that he does not have any other injuries.

The patient is alert and oriented, and is breathing comfortably. His left ankle is moderately swollen. There are no breaks in the skin. He reports tenderness over the lateral malleolus and has moderate pain as he moves the ankle through the range of motion. He reports no pain with palpation over the proximal fifth metatarsal, and no pain at the proximal tibia or fibula. His dorsal pedal and posterior tibial pulses are 2+.

View the image taken and consider what your diagnosis would be.

17-Year-Old Athlete Twisted His Ankle