The prevalence of bone avulsion from anterior talofibular ligament (ATFL) injury may be higher than previously thought because the avulsed bone fragment may only be faintly visible or not visible at all on ankle radiographs. Operative findings of acute sprained ankles found that 12% of ATFL injury had avulsed bone fragment ¹. Haraguchi et al in an anatomical study suggest two new radiographic projection for evaluating suspected avulsion fractures of the lateral malleolus ². The management of subtle avulsion fracture from ATFL injury is unlikely to be different to an isolated ATFL ligamentous injury.