- See:
-
Maisonneuve Fracture:
-
Surgical Approaches for Lateral Malleolar Fracture:
-
Anterolateral Approach
-
Posterolateral Approach
-
Weber A Lateral Malleolar Frx:
-
Weber B Lateral Malleolar Frx:
-
Weber C: Lateral Malleolus:
- Discussion:
- malposition of
lateral malleolus w/ tilting or shortening, will lead to distorted talotibial wt bearing and lead to rapid degenerative arthritis;
- if lateral displacement of talus is not corrected, granulation tissue grows into medial joint space & is converted to fibrous tissue,
which prevents late closed reduction of the displacement;
- for ankle to function satsifactorily, fibula must be:
- normal in length
- correctly positioned in the groove of the tibia
- effectively anchored to tibia thru
Syndesmosis;
- anatomic restoration of distal tibiofibular syndesmosis is needed;
- fibula is primary resistance to external rotation forces on ankle;
- tendons of the long calf muscle controlling
Ankle Joint tend to displace the talus laterally;
- because the lateral collateral ligaments secure the fibula to the talus, the talus follows the fibula after fracture;
- if lateral talar shift is greater than lateral displacement of fibula, there may be an injury the sysdesmosis;
- frx of fibular malleolus, even w/ other structures intact, results in 25 deg of ext rot instability & 1-2 mm of lateral talar displacement;
- 1 mm of talar shift decreases the tibiotalar contact by 50% (in a cadaver model);
-
complications:
- most common complication after fracture of the fibula is malunion;
- this is usually in the form of posterior and external rotation displacement of the maleolus and fibular shortening;
- this disturbs the ankle by allowing external rotation of the talus and lateral talar shift;
- Radiographic Studies
- Operative Treatment:
-
indications:
- w/ medial tenderness, > 5 mm of medial clear space (on static or stress views) diagnosis of injury of the
deltoid ligament can be made;
- treat as bimalleolar frxs, w/ ORIF of
lateral malleolus;
-
surgical approaches:
-
reduction: weber B fractures:
- oblique fractures:
- w/ oblique or spiral frx that is not comminuted, fix it with one or two
Lag Screw
inserted from anterior to posterior to achieve intrafragmentary compression;
- screws should engage the posterior cortex but should not protrude far enough posteriorly to encroach
on the peroneal tendon sheaths;
-
plate position:
The key role of the lateral malleolus in displaced fractures of the ankle.
Reconstruction of malunited fractures of the lateral malleolus.
The Dorsal Antiglide Plate in the Treatment of Danis-Weber Type-B Fractures of the Distal Fibula.
Percutaneous intramedullary fixation of lateral malleolus fractures: technique and report of early results.
