DefinitionSpiral fracture of the upper third of the fibula with disruption of the distal tibiofibular syndesmosis and associated injuries (e.g., fracture of the medial malleolus, fracture of the posterior malleolus, and rupture of the deltoid ligament).
Mechanism of InjuryResulting from external rotation force to ankle with transmission of the force through the interosseous membrane, which extis through a proximal fibular fracture. There are variations in pattern of fibula fracture reflecting either supination or pronation. The foot may even move from relative pronation to supination during injury.
PathoanatomyThe injury may occur with medial malleolus avulsion fracture or deltoid ligament rupture, rupture of anterior talofibular ligament or avulsion of its insertion, as well as rupture of interosseous ligament, rupture of posterior tibiofibular ligament, or posterior malleolar fracture.
SymptomsThe patient is able to walk due to the pain in the ankle.
SignsInspection: Ankle swelling and echymosis.
X-rayShows high fibula fracture with or without fracture of medial malleolus or diastasis of the mortise.
OverviewExamination of the ankle under anesthesia is advised to evaluate degree of instability.
Nonoperative TreatmentIndication: If the syndesmosis is stable under general anesthesia.
Method: Long leg cast with follow up to look that that reduction is not lost after swelling has subsided.
Operative TreatmentIndication: If the syndesmosis is not stable under general anesthesia.
Method: Reaaproximate syndesmosis and fix with 2 syndesmotic screws or fixation with TightRope.
Post operative treatment: Short leg cast, without weight bearing for 6 weeks.