Diagnosis

44-B3 Transsyndesmotic fibular fracture, with medial lesion and fracture of the posterolateral rim (Volkmann)

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The most common injury pattern occurs with axial loading of a supinated foot as described for 44-B1and 44-B2 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 B3 fractures, as the talus dislocates posteriorly out of the mortise, it fractures the posterior tibial rim (Volkmann fracture).

Options
1. 44-B3.1 Simple, with ruptured medial collateral ligament
2. 44-B3.2 Simple, with fracture of the medial malleolus
3. 44-B3.3 Multifragmentary, medial malleolus fractured

1. 44-B3.1 Simple, with ruptured medial collateral ligament

44-B3.1

44-B3.1

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.

Posterior syndesmosis
The fracture of the posterior tibia may be a small cortical avulsion. Much more common is a larger compression fracture, the fragment bearing a variable area of the posterior articular surface.

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

44-B3.1 AP and lateral view

44-B3.1 AP and lateral view

2. 44-B3.2 Simple, with fracture of the medial malleolus

44-B3.2

44-B3.2

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

Medial lesion
A transverse, or oblique, fracture of the medial malleolus.

Posterior syndesmosis
The fracture of the posterior tibia may be a small cortical avulsion. Much more common is a larger compression fracture, the fragment bearing a variable area of the posterior articular surface.

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-B3.2 AP and lateral view

44-B3.2 AP and lateral view

3. 44-B3.3 Multifragmentary, medial malleolus fractured

44-B3.3

44-B3.3

Fibula
A multifragmentary fracture occurs at the level of the syndesmotic ligaments. A third fragment may 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.

Medial lesion
A transverse, or oblique, fracture of the medial malleolus.

Posterior syndesmosis
The fracture of the posterior tibia may be a small cortical avulsion. Much more common is a larger compression fracture, the fragment bearing a variable area of the posterior articular surface.

44-B3.3 AP and lateral view

44-B3.3 AP and lateral view