Right ankle pain after a basketball injury

A 29-year-old man presents with right ankle pain caused by a basketball injury he sustained 1 day earlier. He fell after he had jumped up and landed on another player’s foot. The patient’s foot was “turned in” during the fall; this position indicates an inversion injury. He says he has injured his ankle before but never this severely. The rest of the medical history is noncontributory.

Temperature is 37.2^oC (99^oCF); heart rate, 82 beats per minute; respiration rate, 18 breaths per minute; and blood pressure, 110/82 mm Hg. Heart and lungs are normal. Examination of the right ankle reveals moderate soft tissue swelling and moderate ecchymosis. Pulses in the dorsalis pedis and posterior tibial arteries are strong, and sensation in the right foot is intact. Because of severe tenderness, passive and active range of motion in the ankle is limited.

Top 10 Summer Sports With the Most Injuries
Sports    1. Basketball 2. Bicycles   3. Baseball  4. Soccer  5. Softball  6. Trampolines 7. Inline Skating  8. Horseback riding  9. Weightlifting  10. Volleyball	No. of injuries 1,633,905 1,498,252   492,832 477,647 406,381 246,875 233,806 196,260 189,942 187,391
From the American Academy of Orthopedic Surgeons (2000).

You order conventional radiographs of the right ankle. What abnormalities are evident on these films and what further investigation is warranted?

(Answer on next page.)