Focus on malleolar fractures

Heim, Dominik

doi:10.1007/s00068-010-0056-3

Cited by 1 publication

(7 citation statements)

References 5 publications

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“…Except for Bonnin 7 , all authors of the reviewed studies agreed that an MF is always associated with an injury to the ATFL and the interosseous tibiofibular ligament 8,9,31,67,68 . An osseous equivalent to ATFL rupture is an avulsion fracture of the CTT (the “anterior malleolus”) 8,19,35,47 .…”

Section: Pathoanatomymentioning

confidence: 99%

“…Rupture of the IOM up to the level of the fibular fracture has long been considered an essential part of an MF 8,27,30,67-69 . However, this concept has been questioned by several authors 36,70-72 .…”

Section: Pathoanatomymentioning

confidence: 99%

“…The key procedure for an MF is anatomic reduction and fixation of the distal fibula within the FN 8,67,98-100 . This requires an “intact” FN.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Open reduction of the distal fibula under direct visualization of the anterolateral distal tibia and the ATFL requires a short anterolateral approach with the patient in the supine position 52,67,99,100 . Closed reduction of the distal fibula into the FN and percutaneous syndesmotic fixation with transsyndesmotic screws are strongly discouraged because there is a high risk of malpositioning of the fibula in the FN 34,101,102 .…”

Section: Surgical Techniquementioning

confidence: 99%

“…Congruence of the articular surfaces must be confirmed under direct vision 85 . Reduction is typically performed with the use of curved bone forceps, which must be applied along the transmalleolar line in the horizontal plane 49,67,99 . In cadaveric experiments, oblique clamp positioning with respect to the axis of the ankle joint resulted in fibular malreduction 106,107 .…”

Section: Surgical Techniquementioning

confidence: 99%

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Maisonneuve Fractures of the Ankle

2022

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Maisonneuve fractures (MFs), originally described as subcapital (high) fibular fractures with additional injury to the anterior and interosseous tibiofibular ligaments, display a variable injury pattern, ranging from stable to highly unstable fractures.The high incidence of associated fractures of the posterior malleolus, the medial malleolus, and the anterolateral distal tibia (the “anterior malleolus”) as well as the variable position of the fibula in the fibular notch (FN) warrant preoperative examination via computed tomography (CT).The main goal of treatment is anatomic reduction of the distal fibula into the FN, which requires prior reduction of displaced posterior malleolar fractures, if present, to restore the integrity of the FN.Open reduction of the distal fibula into the FN and fixation with 2 transsyndesmotic screws or fixation with a screw(s) and suture-button implant, under direct vision, on the lateral aspect of the ankle joint and anterior tibiofibular alignment are preferred over closed reduction to avoid sagittal or rotational malpositioning, which is associated with an inferior outcome.Intra- or postoperative 3D CT visualization is essential for assessment of the accuracy of the reduction of the distal fibula into the FN.

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