- Sequence of Injury:
- medial side is injuried first;
-
transverse frx of medial malleolus or disruption of
deltoid ligament;
- anterior tibiofibular ligament disruption;
- external rotation then results in rupture of the anterior tibiofibular
ligament or its bony insertion;
- short oblique or spiral frx of fibula above the level of the joint;
- spiral fibular frx, w/ distal end usually 4 to 7 cm above tibial plafond (and
hence, the frx is above the
syndesmotic ligaments);
- fibular frx is spiral, but runs anterosuperior to posteroinferior, &
interosseous membrane is ruptured up to the level of fibula frx;
- posterior injury:
- tibiofibular ligament rupture or avulsion of
posterior malleolus;
- Treatment: (same as
Weber C):
Mechanical considerations for the syndesmosis screw. A cadaver study.
Instability of the distal tibiofibular syndesmosis after bimalleolar
and trimalleolar ankle fractures.
The effect of fibular malreduction on contact pressures in an ankle fracture malunion model.
DB Thordarson MD et al.
JBJS. Vol 79-A. No 12. Dec 1997. p 1809.
The effect of fibular malreduction on contact pressures in an ankle fracture malunion model.
DB Thordarson MD et al.
JBJS. Vol 79-A. No 12. Dec 1997. p 1809.
