Fracture of the lateral malleolus with talar tilt: primarily a calcaneal fracture not an ankle injury.

We report four cases in which radiographic features of a fracture of the lateral malleolus and talar tilt of varying severity were associated with a displaced fracture of the calcaneum. In two cases, the initial diagnosis was of a primary ankle injury which led to inappropriate initial management. Gross fracture subluxation of the posterior subtalar joint had occurred in all four cases but could only be fully appreciated after CT examination of the hindfoot. Operative reduction and internal fixation of the calcaneal fracture led to spontaneous reduction of the talar displacement. The association of a swollen hindfoot, talar tilt and a flake fracture of the lateral malleolus must alert clinicians to this injury.