Ankle Fracture: AI-Powered Imaging Analysis

Plain radiographs (AP, lateral, mortise views) are the first-line modality for ankle fractures. CT is indicated for comminuted fractures, posterior malleolus assessment, pilon fractures, and pre-operative planning of articular reduction. MRI adds value when X-ray and CT are negative but clinical suspicion remains high — particularly for non-displaced stress fractures, syndesmotic ligament integrity (AITFL, PITFL), and associated osteochondral talar dome injury. STIR sequences are the most sensitive for occult fracture marrow edema.

The Lauge-Hansen system predicts injury sequence based on the deforming force. A supination-adduction pattern injures the lateral ligaments (ATFL, CFL) before the medial malleolus, visible on MRI as lateral ligament disruption with a transverse fibular fracture. Supination-external rotation — the most common pattern — progresses from AITFL disruption through distal fibular spiral fracture to posterior malleolus and then deltoid injury. AI-assisted MRI review correlates bone fracture pattern, ligamentous signal, and syndesmotic diastasis to confirm or refine the classification and detect instability missed on stress radiographs.

Medial clear space widening greater than 4 mm on mortise radiographs is the classic surgical threshold, but MRI directly visualises the deep deltoid ligament. Complete deep deltoid disruption on coronal T2-FS — shown as a fluid-filled gap medially — combined with fibular fracture at or above the level of the tibial plafond (Weber B/C) indicates rotational instability requiring operative stabilisation. Intact deep deltoid fibres on MRI may support non-operative management even with equivocal stress-view radiographs.