Executive Editor: Steve Krikler

Authors: Paulo Barbosa, Felix Bonnaire, Kodi Kojima, Paul Demmer

Malleoli

back to skeleton

Glossary

Infrasyndesmotic, lateral isolated ligament rupture/avulsion fracture

Please select a treatment option:
Treatment Indication summary Skill Equipment
Functional treatment All infrasyndesmotic lateral ligament ruptures and avulsion fractures Basic surgical experience, no specialized skills Basic equipment only
Circular cast All infrasyndesmotic lateral ligament ruptures and avulsion fractures Basic surgical experience, no specialized skills Basic equipment only

Infrasyndesmotic, lateral isolated fracture

Please select a treatment option:
Treatment Indication summary Skill Equipment
Functional treatment Minimally displaced fractures, patients not fit for surgery, soft-tissue compromise, nonambulant patient Basic surgical experience, no specialized skills Basic equipment only
Circular cast Minimally displaced fractures, patients not fit for surgery, soft-tissue compromise, nonambulant patient Basic surgical experience, no specialized skills Basic equipment only
Tension band wiring Higher demand patient, small distal fragment Some specialized surgical experience Simple surgical and imaging resources
Tension band plate Higher demand patient; large distal fragment Some specialized surgical experience Simple surgical and imaging resources

Infrasyndesmotic, medial fracture with LCL rupture

Please select a treatment option:
Treatment Indication summary Skill Equipment
Circular cast Patient not fit for surgery, soft-tissue compromise, nonambulant patient Some specialized surgical experience Basic equipment only
Lag screws (oblique or vertical fractures) Large medial fragment, good bone quality Some specialized surgical experience Simple surgical and imaging resources
Lag screws (transverse fracture) Large medial fragment, good bone quality Some specialized surgical experience Simple surgical and imaging resources
Lag screw and buttress plate Vertical fracture line, large medial fragment, surgeon's preference Some specialized surgical experience Simple surgical and imaging resources
Lag screw through buttress plate Vertical fracture line, large medial fragment, surgeon's preference Some specialized surgical experience Simple surgical and imaging resources

Infrasyndesmotic, medial fracture with lateral fracture/avulsion

Please select a treatment option:
Treatment Indication summary Skill Equipment
Circular cast Undisplaced or reduced fractures, marked soft-tissue swelling, patient not fit for surgery, vascular disease, nonambulant patient Basic surgical experience, no specialized skills Basic equipment only
External fixation Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) Some specialized surgical experience Simple surgical and imaging resources
Triangular external fixation Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) Some specialized surgical experience Simple surgical and imaging resources
ORIF Most fractures when the patient is fit and soft tissues do not preclude surgery Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Infrasyndesmotic, posteromedial fracture with LCL rupture

Please select a treatment option:
Treatment Indication summary Skill Equipment
Circular cast Undisplaced or reduced fractures, marked soft-tissue swelling, patient not fit for surgery, vascular disease, nonambulant patient Basic surgical experience, no specialized skills Basic equipment only
External fixation Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) Some specialized surgical experience Simple surgical and imaging resources
Triangular external fixation Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) Some specialized surgical experience Simple surgical and imaging resources
Lag screw Large posteromedial fragment, good bone quality Highly experienced and skilled surgeon Simple surgical and imaging resources

Infrasyndesmotic, posteromedial fracture with lateral fracture/avulsion

Please select a treatment option:
Treatment Indication summary Skill Equipment
Circular cast Undisplaced or reduced fractures, marked soft-tissue swelling, patient not fit for surgery, vascular disease, nonambulant patient Some specialized surgical experience Basic equipment only
External fixation Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) Some specialized surgical experience Simple surgical and imaging resources
Triangular external fixation Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) Some specialized surgical experience Simple surgical and imaging resources
ORIF Most fractures when the patient is fit and soft tissues do not preclude surgery Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Transsyndesmotic, lateral isolated simple fracture

Please select a treatment option:
Treatment Indication summary Skill Equipment
Circular cast Undisplaced or reduced fractures, marked soft-tissue swelling, medical compromise, vascular disease, nonambulant patient Some specialized surgical experience Basic equipment only
Lag screw and neutralization plate Displaced fractures, loss of initial reduction, good bone qualtiy, anterior tibial tubercle avulsion (fixed with independent lag screw) Some specialized surgical experience Simple surgical and imaging resources
Antiglide plate Displaced fractures, osteoporotic bone, small distal fibular fragment, Le Fort fibular avulsion (fixed independently) Highly experienced and skilled surgeon Simple surgical and imaging resources

Transsyndesmotic, lateral isolated multifragmentary fracture

Please select a treatment option:
Treatment Indication summary Skill Equipment
Circular cast Undisplaced or reduced fractures, marked soft-tissue swelling, medical compromise, vascular disease, nonambulant patient Basic surgical experience, no specialized skills Basic equipment only
External fixation Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) Some specialized surgical experience Simple surgical and imaging resources
Triangular external fixation Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) Some specialized surgical experience Simple surgical and imaging resources
Bridging plate Significant comminution Highly experienced and skilled surgeon Simple surgical and imaging resources
Antiglide plate Displaced fractures, osteoporotic bone, small distal fibular fragment, Le Fort fibular avulsion (fixed independently) Highly experienced and skilled surgeon Simple surgical and imaging resources

Transsyndesmotic, lateral simple fracture with deltoid rupture

Please select a treatment option:
Treatment Indication summary Skill Equipment
Circular cast Marked soft-tissue swelling, medical compromise, vascular disease, nonambulant patient Basic surgical experience, no specialized skills Basic equipment only
External fixation Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) Some specialized surgical experience Simple surgical and imaging resources
Triangular external fixation Damage control in polytrauma, excessive soft-tissue swelling Some specialized surgical experience Simple surgical and imaging resources

Transsyndesmotic, lateral simple fracture with medial fracture

Please select a treatment option:
Treatment Indication summary Skill Equipment
Circular cast Marked soft-tissue swelling, medical compromise, vascular disease, nonambulant patient Basic surgical experience, no specialized skills Basic equipment only
External fixation Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) Some specialized surgical experience Simple surgical and imaging resources
Triangular external fixation Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) Some specialized surgical experience Simple surgical and imaging resources
ORIF Most fractures when the patient is fit and soft tissues do not preclude surgery Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Transsyndesmotic, lateral multifragmentary fracture with medial injury

Please select a treatment option:
Treatment Indication summary Skill Equipment
Circular cast Marked soft-tissue swelling, medical compromise, vascular disease, nonambulant patient Basic surgical experience, no specialized skills Basic equipment only
External fixation Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) Some specialized surgical experience Simple surgical and imaging resources
Triangular external fixation Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) Some specialized surgical experience Simple surgical and imaging resources
ORIF Most fractures when the patient is fit and soft tissues do not preclude surgery Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Transsyndesmotic, posterior, lateral simple fractures, and deltoid rupture

Please select a treatment option:
Treatment Indication summary Skill Equipment
Circular cast Marked soft-tissue swelling, medical compromise, vascular disease, nonambulant patient Basic surgical experience, no specialized skills Basic equipment only
External fixation Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) Some specialized surgical experience Simple surgical and imaging resources
Triangular external fixation Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) Some specialized surgical experience Simple surgical and imaging resources
ORIF Most fractures when the patient is fit and soft tissues do not preclude surgery Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Transsyndesmotic, posterior, lateral simple, and medial fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Circular cast Marked soft-tissue swelling, medical compromise, vascular disease, nonambulant patient Basic surgical experience, no specialized skills Basic equipment only
External fixation Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) Some specialized surgical experience Simple surgical and imaging resources
Triangular external fixation Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) Some specialized surgical experience Simple surgical and imaging resources
ORIF Most fractures when the patient is fit and soft tissues do not preclude surgery Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Transsyndesmotic, posterior, lateral multifragmentary, and medial fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Circular cast Marked soft-tissue swelling, medical compromise, vascular disease, nonambulant patient Basic surgical experience, no specialized skills Basic equipment only
External fixation Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) Some specialized surgical experience Simple surgical and imaging resources
Triangular external fixation Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) Some specialized surgical experience Simple surgical and imaging resources
ORIF Most fractures when the patient is fit and soft tissues do not preclude surgery Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Suprasyndesmotic, simple fibular fracture, medial injury, +/- posterior fracture

Please select a treatment option:
Treatment Indication summary Skill Equipment
Long-leg circular cast Marked soft-tissue swelling, medical compromise, vascular disease, nonambulant patient Basic surgical experience, no specialized skills Basic equipment only
External fixation Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) Some specialized surgical experience Simple surgical and imaging resources
Triangular external fixation Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) Some specialized surgical experience Simple surgical and imaging resources
ORIF Most fractures when the patient is fit and soft tissues do not preclude surgery Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Suprasyndesmotic multifragmentary fibula, medial injury, +/- posterior fracture

Please select a treatment option:
Treatment Indication summary Skill Equipment
Long-leg circular cast Marked soft-tissue swelling, medical compromise, vascular disease, nonambulant patient Basic surgical experience, no specialized skills Basic equipment only
External fixation Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) Some specialized surgical experience Simple surgical and imaging resources
Triangular external fixation Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) Some specialized surgical experience Simple surgical and imaging resources
ORIF Most fractures when the patient is fit and soft tissues do not preclude surgery Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Suprasyndesmotic, proximal fibular fracture, medial injury, +/- posterior fracture

Please select a treatment option:
Treatment Indication summary Skill Equipment
Long-leg circular cast Marked soft-tissue swelling, medical compromise, vascular disease, nonambulant patient Basic surgical experience, no specialized skills Basic equipment only
External fixation Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) Some specialized surgical experience Simple surgical and imaging resources
Triangular external fixation Damage control in polytrauma, excessive soft-tissue swelling (prelude to ORIF) Some specialized surgical experience Simple surgical and imaging resources
ORIF Most fractures when the patient is fit and soft tissues do not preclude surgery Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Special considerations
Principles of management of open fractures
Complications
Infection
Compartment syndrome
*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