Pronation-External Rotation Injuries of the Ankle

- 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.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, November 26, 2012 12:57 pm