Irreducible Ankle Fracture from an Interposed Chaput Fragment

Abstract

To our knowledge, this rare injury pattern, an interposed Chaput fragment preventing closed reduction of the syndesmosis in a skeletally mature patient, has not previously been described in the literature. An open reduction and internal fixation of the Chaput fragment allowed near-anatomic reduction of the tibiotalar joint.

The rare isolated adult Chaput-Tillaux fracture: two case reports and review of the literature

“…7 In this population, the susceptibility of the anterolateral tibial aspect to a forced supination and external rotation is explained by the well-known asymmetric physiologic physiodesis: it starts to close centrally, fusion then progresses medially with the anterolateral portion fusing last. 6,[9][10][11][12][13] The vulnerable growth plate may not be fused until 14 years in girls and 18 years of age in boys. [6][7][8]11,14,15 The adult Tillaux fracture, also recognized as CTF, has a relative incidence of 12% in transmalleolar fractures but the frequency as isolated bony avulsion remains unknow.…”

“…23 Despite having a sensitivity of only 50-72%, 16 this diagnostic exam plays a dominant role and should always include a mortise or internal oblique view to screen for fractures obstructed by the fibula. 10,13,16,18,19 The established literature recommends advanced imaging (i.e. CT scan) to evaluate all fracture planes, but also to detect other fractures, articular fragments and articular compatibility.…”

“…7 Lee et al reduced an interposed Chaput fragment and made an internal fixation with a T-shape plate along with stabilization of the syndesmosis with screws. 13 The retrospective study of Feng et al described an arthroscopic "all-inside" approach and fixation with Herbert screws (2 children and 17 adults) with excellent results and a rapid recovery. 19 The conservative treatment adopted by some authors, despite satisfactory outcomes, is no longer recommended.…”

Ankle fractures involving the anterolateral distal tibia: medium-term clinical results of 50 cases

“…These fractures are regularly underestimated or overlooked completely in plain radiographs [13][14][15]. Failure to reduce and fix anterolateral distal tibial fractures reportedly results in malpositioning of the distal fibula in the tibial incisura leading to incongruity of the ankle mortise with possible deleterious consequences [15][16][17][18].…”

“…Currently proposed methods include transosseous sutures, suture anchor fixation, screw or plate fixation depending on the size of the fracture and bone quality [11]. Except for case reports and small case series with short-term results, data on outcome are lacking in the literature [16][17][18][19][20][21]. Therefore, the aim of this study was to evaluate the medium-term outcomes of a sizeable number of malleolar fractures involving the AM in adults and to identify possible prognostic factors.…”