- Discussion:
- usually involves a
supination-adduction injury;
- frequently does well w/ closed reduction;
- if frx in fibula is transverse, it is type I avulsion fibular frx;
- since
syndesmotic ligaments are intact, ankle mortise is also stable;
-
type A:
fibula fracture below syndesmosis (infrasyndesmotic)
A1
Isolated
A2
w/ fracture of
medial malleolus
A3
w/ a posteromedial fracture
- Radiographs: 
- Non Operative Treatment:
- if avulsion frx of fibula is undisplaced or minimally displaced, & if there is no medial lesion (by
exam & x-ray) then, apply a walking cast until fibula has healed (usually 6-8 weeks);
-
DVT prophylaxis for frx trauma
- Surgical Indications:
- displaced, unstable, lateral malleolar avulsion frx w/ soft tissue disruption;
- failure to close the gap may lead to non union;
- displaced frx of medial joint complex, + vertical type
medial malleolus fracture, w/ or w/o a frx of posteromedial aspect of the tibia;
- osteochondral frx of medial articular surface of tibia or talus;
- Implants:
- K wires, 1.6 mm & figure of 8 tension band wires, 1.2 for fibula;
- for larger frag use
one third tubular plate;
-
4.0 mm cancellous bone screws, or 4.5 mm cannulated screws as lag screws for the
medial malleolus;
- Operative Rx of Medial Malleolar Frx:
- exposure of
medial malleolus & careful reflexion of trapped periosteum;
- reduction of any impaction of fracture of the articular surface of tibia and bone grafting of a resulting cancellous bone defect;
- fixation of
medial malleolus by tension band wiring (small transverse avulsion frag), or by 4.0 mm cancellous bone
screws as lag screws (large shear fragment), or 4.5 mm cannulated screws;
- ORIF of lateral malleolus;
- straight or hockey stick incision about 10 cm long is made anteriorly;
- anatomical
Reduction of Fibula and temporary reduction w/ pointed reduction forceps;
- fixation of fibular frx by tension band wiring, or
1/3 tubular plate;
