Diagnosis

44-B2 Transsyndesmotic fibular fracture, with medial lesion

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The most common injury pattern occurs with axial loading of a maximally supinated foot as described for 44-B1 fractures. Progressive talar external rotation results in further opening of the fibular fracture, with posterior displacement of the lateral malleolus. Finally the talus exits the ankle mortise posteriorly and disrupts the medial collateral structures.

In about 5% of malleolar fractures, the injury cause is a forced abduction of the hind part of the pronated foot (corresponds to Pronation-abduction fractures, stage I-III in the Lauge-Hansen classification).

Options
1. 44-B2.1 Simple, with ruptured medial collateral ligament
2. 44-B2.2 Simple, with fracture of the medial malleolus
3. 44-B2.3 Multifragmentary

1. 44-B2.1 Simple, with ruptured medial collateral ligament

44-B2.1

44-B2.1

Fibula
A simple, oblique fracture occurs at the level of the syndesmotic ligaments, and is displaced.

Medial lesion
A rupture of the medial collateral ligament.

Anterior syndesmosis
A ligamentous rupture, or avulsion fracture, of the anterior syndesmotic ligament, either at its fibular (Le Fort / Wagstaff), or tibial (Tillaux-Chaput) insertion.

44-B2.1 AP view

44-B2.1 AP view

Radiograph taken from Orozco R et al, (1998) Atlas of Internal Fixation. Used with kind permission.

2. 44-B2.2 Simple, with fracture of the medial malleolus

44-B2.2

44-B2.2

Fracture of the fibula
A simple, oblique fracture occurs at the level of the syndesmotic ligaments, and is displaced.

Medial lesion
Transverse, or oblique, fracture of the medial malleolus.

Anterior syndesmosis
A ligamentous rupture, or avulsion fracture, of the anterior syndesmotic ligament, either at its fibular (Le Fort / Wagstaff), or tibial (Tillaux-Chaput) insertion.

44-B2.2 AP and lateral view

44-B2.2 AP and lateral view

3. 44-B2.3 Multifragmentary

44-B2.3

44-B2.3

Fibula
Multifragmentary fracture at the level of the syndesmotic ligaments.

Medial lesion
Rupture of the medial collateral ligament, or transverse or oblique fracture of the medial malleolus.

Anterior syndesmosis
One of the fibular fragments can represent the detachment of the tip of the main proximal fibular fragment. This third fragment usually bears some intact portion of the anterior syndesmotic ligament. It may become entrapped between the other fibular fragments.

44-B2.3 AP view

44-B2.3 AP view

Radiograph taken from Orozco R et al, (1998) Atlas of Internal Fixation. Used with kind permission.