Differential Diagnosis for Right Ankle Injury
- Single most likely diagnosis
- Undisplaced Salter-Harris 1 fracture of the distal fibular physis with a vertical component: This diagnosis is most likely due to the presence of bone marrow edema in the distal fibula, a linear region of low signal extending from the physis distally, and minimal bone marrow edema superior to the physis, all of which are consistent with a Salter-Harris 1 fracture.
- Other Likely diagnoses
- Undisplaced fracture of the lateral malleolus: The presence of bone marrow edema and a linear region of low signal in the lateral malleolus suggests a fracture, which is consistent with the patient's symptoms and the findings on the MRI.
- Stress fracture of the distal fibula: The bone marrow edema and linear region of low signal could also be consistent with a stress fracture, although the presence of a physis and the patient's age make a Salter-Harris fracture more likely.
- Do Not Miss diagnoses
- Osteonecrosis of the talus or distal fibula: Although there is no evidence of an osteochondral lesion, osteonecrosis could present with similar symptoms and would be a serious complication if missed.
- Infection (e.g. osteomyelitis): Infection could present with bone marrow edema and would require prompt treatment to prevent serious complications.
- Tumor (e.g. osteosarcoma): A tumor could present with similar symptoms and would be a serious diagnosis if missed.
- Rare diagnoses
- Fracture of the anterior or posterior tuberosity of the calcaneus: Although the calcaneus appears unremarkable on the MRI, a rare fracture of the anterior or posterior tuberosity could present with similar symptoms.
- Ligamentous injury not visualized on MRI: Although the ligaments appear intact on the MRI, a rare ligamentous injury could be present and not visualized, particularly if it is a partial tear or a injury to a smaller ligament.