The radiographs below demonstrate an isolated undisplaced spiral fracture of the lateral malleolus. This fracture likely occurred when a fast external rotation force was applied to the foot. Note that this fracture is in the area of the sydesmotic ligaments and they are at risk for injury. The AP and mortise views should be carefully inspected for evidence of loss of syndesmotic integrity. In this case, there is not loss of syndesmotic integrity and this patient could be managed with a below knee cast for 6-8 weeks.