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TERMINOLOGY
Definitions
- Fractures (fxs) of distal tibia and fibula are divided into
- Pilon fx: tibial plafond fx due to axial load
- May secondarily involve malleoli
- Malleolus fx: due to shear or twisting forces
- Pilon fx: tibial plafond fx due to axial load
- Maisonneuve fx: fx of proximal fibula due to pronation-external rotation (PER) injury of ankle
- Reflects injury to tibiofibular syndesmosis and interosseous membrane
- Associated with medial malleolus (MM) fx or deltoid ligament injury, and posterior malleolus (PM) fx
- Pott or Dupuytren fx (obsolete): fx of distal fibula above syndesmosis
- Earle (Volkmann) fx: fx of lateral margin of PM
- Due to avulsion of posterior inferior tibiofibular ligament (PITFL)
- Chaput-Tillaux fx: fx of lateral margin of anterior tibia
- Due to avulsion of anterior inferior tibiofibular ligament (AITFL)
- Fractures (fxs) of distal tibia and fibula are divided into
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Relevant Anatomy
CLINICAL ISSUES
Presentation
Natural History & Prognosis
Treatment
Common Complications
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
- Pina G et al: Unstable malleolar ankle fractures: evaluation of prognostic factors and sports return. Arch Orthop Trauma Surg. 141(1):99-104, 2021
- He JQ et al: Pathoanatomy and injury mechanism of typical Maisonneuve fracture. Orthop Surg. 12(6):1644-51, 2020
- Stringfellow TD et al: Management of posterior malleolus fractures: a multicentre cohort study in the United Kingdom. Foot Ankle Surg. Epub, 2020
- Carter TH et al: Medial malleolar fractures: current treatment concepts. Bone Joint J. 101-B(5):512-21, 2019
- Mason LW et al: Pathoanatomy and associated injuries of posterior malleolus fracture of the ankle. Foot Ankle Int. 38(11):1229-35, 2017
- Veltman ES et al: Longterm outcome of 886 posterior malleolar fractures: a systematic review of the literature. Foot Ankle Surg. 22(2):73-7, 2016
- Droog R et al: Incidence and clinical relevance of tibiofibular synostosis in fractures of the ankle which have been treated surgically. Bone Joint J. 97-B(7):945-9, 2015
- Gardner MJ et al: Technical considerations in the treatment of syndesmotic injuries associated with ankle fractures. J Am Acad Orthop Surg. 23(8):510-8, 2015
- Meijer DT et al: Guesstimation of posterior malleolar fractures on lateral plain radiographs. Injury. 46(10):2024-9, 2015
- Crim J et al: CT assessment of the prevalence of retinacular injuries associated with hindfoot fractures. Skeletal Radiol. 42(4):487-92, 2013
- Russo A et al: Ankle fracture: radiographic approach according to the Lauge-Hansen classification. Musculoskelet Surg. 97 Suppl 2:S155-60, 2013
- Lempainen L et al: Medial malleolar stress fracture in athletes: diagnosis and operative treatment. Scand J Surg. 101(4):261-4, 2012
- Sanders DW et al: Operative versus nonoperative treatment of unstable lateral malleolar fractures: a randomized multicenter trial. J Orthop Trauma. 26(3):129-34, 2012
- Gougoulias N et al: Supination-external rotation ankle fractures: stability a key issue. Clin Orthop Relat Res. 468(1):243-51, 2010
- Miller AN et al: Posterior malleolar stabilization of syndesmotic injuries is equivalent to screw fixation. Clin Orthop Relat Res. 468(4):1129-35, 2010
- van den Bekerom MP et al: Is fibular fracture displacement consistent with tibiotalar displacement? Clin Orthop Relat Res. 468(4):969-74, 2010
- Büchler L et al: Reliability of radiologic assessment of the fracture anatomy at the posterior tibial plafond in malleolar fractures. J Orthop Trauma. 23(3):208-12, 2009
- Stufkens SA et al: Long-term outcome after supination-external rotation type-4 fractures of the ankle. J Bone Joint Surg Br. 91(12):1607-11, 2009
- Jowett AJ et al: Medial malleolar stress fracture secondary to chronic ankle impingement. Foot Ankle Int. 29(7):716-21, 2008
- Stark E et al: Syndesmotic instability in Weber B ankle fractures: a clinical evaluation. J Orthop Trauma. 21(9):643-6, 2007
- Shariff SS et al: Lauge-Hansen classification--a literature review. Injury. 37(9):888-90, 2006
- Mulligan ME: Ankle and foot trauma. Semin Musculoskelet Radiol. ;4(2):241-53, 2000
- Brage ME et al: Ankle fracture classification: a comparison of reliability of three x-ray views versus two. Foot Ankle Int. 19(8):555-62, 1998
- Kennedy JG et al: An evaluation of the Weber classification of ankle fractures. Injury. 29(8):577-80, 1998
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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Definitions
- Fractures (fxs) of distal tibia and fibula are divided into
- Pilon fx: tibial plafond fx due to axial load
- May secondarily involve malleoli
- Malleolus fx: due to shear or twisting forces
- Pilon fx: tibial plafond fx due to axial load
- Maisonneuve fx: fx of proximal fibula due to pronation-external rotation (PER) injury of ankle
- Reflects injury to tibiofibular syndesmosis and interosseous membrane
- Associated with medial malleolus (MM) fx or deltoid ligament injury, and posterior malleolus (PM) fx
- Pott or Dupuytren fx (obsolete): fx of distal fibula above syndesmosis
- Earle (Volkmann) fx: fx of lateral margin of PM
- Due to avulsion of posterior inferior tibiofibular ligament (PITFL)
- Chaput-Tillaux fx: fx of lateral margin of anterior tibia
- Due to avulsion of anterior inferior tibiofibular ligament (AITFL)
- Fractures (fxs) of distal tibia and fibula are divided into
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Relevant Anatomy
CLINICAL ISSUES
Presentation
Natural History & Prognosis
Treatment
Common Complications
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
- Pina G et al: Unstable malleolar ankle fractures: evaluation of prognostic factors and sports return. Arch Orthop Trauma Surg. 141(1):99-104, 2021
- He JQ et al: Pathoanatomy and injury mechanism of typical Maisonneuve fracture. Orthop Surg. 12(6):1644-51, 2020
- Stringfellow TD et al: Management of posterior malleolus fractures: a multicentre cohort study in the United Kingdom. Foot Ankle Surg. Epub, 2020
- Carter TH et al: Medial malleolar fractures: current treatment concepts. Bone Joint J. 101-B(5):512-21, 2019
- Mason LW et al: Pathoanatomy and associated injuries of posterior malleolus fracture of the ankle. Foot Ankle Int. 38(11):1229-35, 2017
- Veltman ES et al: Longterm outcome of 886 posterior malleolar fractures: a systematic review of the literature. Foot Ankle Surg. 22(2):73-7, 2016
- Droog R et al: Incidence and clinical relevance of tibiofibular synostosis in fractures of the ankle which have been treated surgically. Bone Joint J. 97-B(7):945-9, 2015
- Gardner MJ et al: Technical considerations in the treatment of syndesmotic injuries associated with ankle fractures. J Am Acad Orthop Surg. 23(8):510-8, 2015
- Meijer DT et al: Guesstimation of posterior malleolar fractures on lateral plain radiographs. Injury. 46(10):2024-9, 2015
- Crim J et al: CT assessment of the prevalence of retinacular injuries associated with hindfoot fractures. Skeletal Radiol. 42(4):487-92, 2013
- Russo A et al: Ankle fracture: radiographic approach according to the Lauge-Hansen classification. Musculoskelet Surg. 97 Suppl 2:S155-60, 2013
- Lempainen L et al: Medial malleolar stress fracture in athletes: diagnosis and operative treatment. Scand J Surg. 101(4):261-4, 2012
- Sanders DW et al: Operative versus nonoperative treatment of unstable lateral malleolar fractures: a randomized multicenter trial. J Orthop Trauma. 26(3):129-34, 2012
- Gougoulias N et al: Supination-external rotation ankle fractures: stability a key issue. Clin Orthop Relat Res. 468(1):243-51, 2010
- Miller AN et al: Posterior malleolar stabilization of syndesmotic injuries is equivalent to screw fixation. Clin Orthop Relat Res. 468(4):1129-35, 2010
- van den Bekerom MP et al: Is fibular fracture displacement consistent with tibiotalar displacement? Clin Orthop Relat Res. 468(4):969-74, 2010
- Büchler L et al: Reliability of radiologic assessment of the fracture anatomy at the posterior tibial plafond in malleolar fractures. J Orthop Trauma. 23(3):208-12, 2009
- Stufkens SA et al: Long-term outcome after supination-external rotation type-4 fractures of the ankle. J Bone Joint Surg Br. 91(12):1607-11, 2009
- Jowett AJ et al: Medial malleolar stress fracture secondary to chronic ankle impingement. Foot Ankle Int. 29(7):716-21, 2008
- Stark E et al: Syndesmotic instability in Weber B ankle fractures: a clinical evaluation. J Orthop Trauma. 21(9):643-6, 2007
- Shariff SS et al: Lauge-Hansen classification--a literature review. Injury. 37(9):888-90, 2006
- Mulligan ME: Ankle and foot trauma. Semin Musculoskelet Radiol. ;4(2):241-53, 2000
- Brage ME et al: Ankle fracture classification: a comparison of reliability of three x-ray views versus two. Foot Ankle Int. 19(8):555-62, 1998
- Kennedy JG et al: An evaluation of the Weber classification of ankle fractures. Injury. 29(8):577-80, 1998
