Nice job everyone. Of course this is a Maisonneuve fracture - ie proximal fibula fracture combined with either an injury to the distal tibiofibular syndesmosis or the deltoid ligament/medial malleolus. Much like the named fractures of the forearm, this is another example of the “ring theory” where if you get a fracture through one half of the ring, you should look closely for a fracture in the other half.

Why is it important? You’ll likely miss it with dedicated ankle X-rays, so you should recommend full a full tib-fib series to exclude it.