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Pronation – Abduction Ankle Frx


- Discussion:
    - pronation of forefoot is combination of external rotation at ankle, abduction of hindfoot, & eversion of forefoot;
    - in pronation, the medial structures tighten and are injured first;

- Sequence of Injury:
    - avulsion frx of medial malleolus or rupture of deltoid ligament;
          - malleolus will have a transverse frx;
    - abduction force then either ruptures syndesmotic ligaments or avulses their bony attachment sites;
    - lateral force from talus impacts and fractures fibula at or above level of syndesmosis & ruptures interosseous membrane up to level of this frx;
         - fracture is either oblique or partially transverse;
         - occasionally has a butterfly fragment, making it unstable;

- Associated Injuries:
    - dome fractures of the talus are common in this shearing fracture

Results of operative treatment of displaced external rotation-abduction fractures of the ankle.