#Trimalleolar fx how to#

Disregarding the precise details of these fractures can lead to disappointing outcomes. Case Overview BackgroundĪnkle fractures are among the most commonly encountered fractures in orthopedics nevertheless, their frequency should not undermine their seriousness. Weaver discusses the surgical landmarks and approaches to the ankle, the methods of fixing the malleoli and the syndesmosis, and common concerns that arise during the surgical management of ankle fractures. Weaver walks us through the surgical management of a 23-year-old male who sustained a trimalleolar ankle fracture with concomitant dislocation and syndesmotic injury following a motor vehicle collision. Operative management is recommended for most displaced fractures, fractures with dislocations, and open fractures. 1, 2 The goal of management is to restore a stable and congruent joint. de Jong and Gert-Jan Kleinrensink.Ankle fractures are the second most common lower limb fractures after those involving the hip, accounting for 10% of all fractures, with an incidence that has been increasing.

According to Lauge-Hansen this is a SER stage 4.Īnatomy of the distal tibiofibular syndesmosis in adults: a pictorial essay with a multimodality approachīy John J. There is a widened medial clear space, which indicates a rupture of the medial collateral band, i.e. On the lateral view the posterior cortex of the tibia is interrupted indicating a fracture (blue arrow).Įven on the AP-view there are subtle findings that indicate a fracture (red arrows). Normally you probably would not have noticed these. There are subtle findings which indicate a fracture of the posterior malleolus. The fracture is classified according to Weber as a type B fracture.Īccording to Lauge Hansen the oblique fibular fracture indicates that this is a Supination Exorotation injury stage 2 or higher. Sometimes CT is needed to get a better impression of the size of the fracture fragment of the posterior malleolus.įracture of the lateral malleolus starting anteriorly at the level of the joint extending proximally posteriorly. The size of the posterior malleolar fragment is probably less than 25% of the articular AP-diameter and will need no separate repair. This is an unstable fracture with dislocation that needs surgical repair. Only now you notice the posterior malleolar fracture on the lateral view.

Look for stage 3 (posterior syndesmotic rupture or avulsion of the posterior malleolus) and stage 4 (rupture of the deltoid ligament or medial malleolar avulsion). a Weber B fracture.Īccording to Lauge Hansen the oblique fibular fracture indicates Supination Exorotation injury stage 2 or higher. The fracture starts at the level of the ankle joint and extends proximally, i.e. The lateral malleolus is 'pushed off' from anterior to posterior. Avulsion fracture of the medial malleolar. White Matter Lesions - Differential diagnosisĭislocated bimalleolar fracture.

#Trimalleolar fx how to#

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