- 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
- 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, or1/3 tubular plate
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