Executive Editor: Steve Krikler

Authors: Paulo Barbosa, Felix Bonnaire, Kodi Kojima

Malleoli Infrasyndesmotic, lateral isolated ligament rupture/avulsion fracture

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Glossary

General considerations

These injuries usually do well without operative fixation. Immobilization is mainly for patient comfort, and early return to activity should be encouraged.

Functional treatment
Indication summary Skill Equipment
All infrasyndesmotic lateral ligament ruptures and avulsion fractures Basic surgical experience, no specialized skills Basic equipment only

Functional treatment includes elastic bandages, functional braces, and compression stockings.

Indications

  • All isolated lateral infrasyndesmotic rupture and avulsion injuries

Contraindications

  • Severe soft-tissue injury or swelling
  • Excessive pain and discomfort

Advantages

  • Full weight bearing (only if combined with a fracture brace) 
  • Early functional recovery 
  • Patient comfort

Disadvantages

  • Only partial weight bearing allowed if not combined with a brace
Circular cast
Indication summary Skill Equipment
All infrasyndesmotic lateral ligament ruptures and avulsion fractures Basic surgical experience, no specialized skills Basic equipment only

Indications

  • All isolated lateral infrasyndesmotic rupture and avulsion injuries

Contraindications

  • Severe soft-tissue injury or swelling
  • Excessive pain and discomfort

Advantages

  • Full weight bearing
  • Good stability 

Disadvantages

  • Risks of cast complications (eg, pressure ulcer, nerve compression) 
  • Risks of immobilization (eg, muscle wasting, joint stiffness)
  • Longer rehabilitation period than functional treatment
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2015-12-04