During re-operation the ankle was found to be in equinus without any motion (Fig. 4) demonstrated a posterior dislocation of an intact fibula behind the posterolateral ridge of the distal tibia. Six weeks later radiographs revealed a laterally and anteriorly subluxated ankle (Fig. Post internal fixation radiographs demonstrate persistent syndesmosis widening despite an apparent anatomical positioning of the talus. This is called talar shift and the ankle joint is unstable.Figure 2. If they are not and the talar dome is not parallel to the tibial plafond, the syndesmosis has been torn. The joint spaces around the talus should be the same all the way around. whether there is another fracture (medial malleolus, talus).whether there is displacement (translocation, angulation, rotation).what type of fracture (transverse, oblique, spiral, comminuted).where the fracture is in the bone (relative to syndesmosis).Once you have seen the fracture, remember to describe: Remember that avulsion injuries may be small, and just involve the tip, or the internal surface of the malleolus. If there is a lot of soft tissue swelling over the lateral malleolus, but no fracture, then there has been a ligamentous injury. The AP and lateral views from an ankle x-ray will almost always allow detection of a lateral malleolar fracture. It is worth noting that fractures may be invisible on one projection. In most cases an ankle x-ray is all that is required for diagnosis and follow up. This results in widening of the distal tibiofibular joint and loss of integrity of the socket. In Weber B and C fractures the syndesmosis may have been torn (partially or completely). Weber C: above the syndesmosis (unstable).Weber B: at the syndesmosis (possibly unstable).Weber A: below the syndesmosis (stable).The commonest classification is the Weber classification that uses the position of the fracture relative to the syndesmosis to group fractures: ClassificationĬlassification of distal fibula fractures attempts to split fractures into groups by severity. The syndesmosis is a strong ligament that pulls the tibia and fibula together just above the distal tibiofibular joint. This socket is only functional because the tibia (medial and posterior malleolus) and fibula (lateral malleolus) are held together tightly by the syndesmosis. The ankle is a pseudo-ball-and-socket joint the talus is the ball and the distal tibia and fibula act as the socket. They tend to cause fractures that are higher up the fibula and the rotational component of the injury may cause syndesmosis tears. In some cases, inversion coupled with rotation leads to a more complex injury. Avulsion injuries do not involve the syndesmosis and the ankle remains stable. This results in either a pure ligamentous injury (complete or partial tear) or avulsion of the tip of the fibula (the lateral malleolus). A pure inversion injury will result in tension being applied to the supporting soft tissues of the lateral ankle, particularly the lateral collateral ligament. Most ankle injuries occur because of an inversion injury.
#Distal fibula series
inability to bear weight both immediately after injury and during clinical examinationĪn ankle x-ray series (AP and lateral views) is usually all that is needed to make a diagnosis.Īnkle fractures may be the result of a vast array of injuries that range from an inversion injury to a complex high energy trauma sporting injury.point tenderness at the posterior edge or tip of the medial malleoulus.point tenderness at the posterior edge or tip of the lateral malleoulus.The Ottawa ankle rules allow evidence-based decision making regarding the need for plain radiographs in patients with a traumatic ankle injury.Ī plain film radiograph is indicated in the setting of trauma if there are any of the following clinical examination findings 1: Most patients present following an episode of trauma with ankle pain, tenderness and an inability to weight bear.
Risk factorsĬigarette smoking and obesity are both risk factors for ankle fractures. motor vehicle accident, sporting injury), while older patients present following minor trauma (e.g. Young patients present following injuries in relatively high-energy trauma (e.g. Ankle injuries, like many fractures have a bimodal distribution.
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