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Malleolus Fracture
Julia R. Crim, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Definitions

                • Fractures of distal tibia and fibula are divided into
                  • Pilon fractures: Due to axial load
                    • May secondarily involve malleoli
                  • Malleolus fractures: Due to shear or twisting forces
                • Maisonneuve fracture: Fracture of proximal fibula due to pronation injury of ankle
                  • Reflects injury to tibiofibular syndesmosis and interosseous membrane
                • Pott or Dupuytren fracture (obsolete): Fracture of distal fibula above syndesmosis
                • Earle (Volkmann) fracture: Fracture of lateral margin of posterior malleolus (PM)
                  • Due to avulsion of posterior inferior tibiofibular ligament (PITFL)
                • Chaput-Tillaux fracture: Fracture of lateral margin of anterior tibia
                  • Due to avulsion of anterior inferior tibiofibular ligament (AITFL)

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Relevant Anatomy

                                CLINICAL ISSUES

                                • Presentation

                                  • Treatment

                                    • Common Complications

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          • Reporting Tips

                                            Selected References

                                            1. 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
                                            2. 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
                                            3. Meijer DT et al: Guesstimation of posterior malleolar fractures on lateral plain radiographs. Injury. 46(10):2024-9, 2015
                                            4. Crim J et al: CT assessment of the prevalence of retinacular injuries associated with hindfoot fractures. Skeletal Radiol. 42(4):487-92, 2013
                                            5. Russo A et al: Ankle fracture: radiographic approach according to the Lauge-Hansen classification. Musculoskelet Surg. 97 Suppl 2:S155-60, 2013
                                            6. Lempainen L et al: Medial malleolar stress fracture in athletes: diagnosis and operative treatment. Scand J Surg. 101(4):261-4, 2012
                                            7. 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
                                            8. Gougoulias N et al: Supination-external rotation ankle fractures: stability a key issue. Clin Orthop Relat Res. 468(1):243-51, 2010
                                            9. Miller AN et al: Posterior malleolar stabilization of syndesmotic injuries is equivalent to screw fixation. Clin Orthop Relat Res. 468(4):1129-35, 2010
                                            10. van den Bekerom MP et al: Is fibular fracture displacement consistent with tibiotalar displacement? Clin Orthop Relat Res. 468(4):969-74, 2010
                                            11. 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
                                            12. 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
                                            13. Jowett AJ et al: Medial malleolar stress fracture secondary to chronic ankle impingement. Foot Ankle Int. 29(7):716-21, 2008
                                            14. Shariff SS et al: Lauge-Hansen classification--a literature review. Injury. 37(9):888-90, 2006
                                            15. Mulligan ME: Ankle and foot trauma. Semin Musculoskelet Radiol. ;4(2):241-53, 2000
                                            16. 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
                                            17. Kennedy JG et al: An evaluation of the Weber classification of ankle fractures. Injury. 29(8):577-80, 1998
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Definitions

                                                          • Fractures of distal tibia and fibula are divided into
                                                            • Pilon fractures: Due to axial load
                                                              • May secondarily involve malleoli
                                                            • Malleolus fractures: Due to shear or twisting forces
                                                          • Maisonneuve fracture: Fracture of proximal fibula due to pronation injury of ankle
                                                            • Reflects injury to tibiofibular syndesmosis and interosseous membrane
                                                          • Pott or Dupuytren fracture (obsolete): Fracture of distal fibula above syndesmosis
                                                          • Earle (Volkmann) fracture: Fracture of lateral margin of posterior malleolus (PM)
                                                            • Due to avulsion of posterior inferior tibiofibular ligament (PITFL)
                                                          • Chaput-Tillaux fracture: Fracture of lateral margin of anterior tibia
                                                            • Due to avulsion of anterior inferior tibiofibular ligament (AITFL)

                                                        IMAGING

                                                        • General Features

                                                          • Radiographic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Staging, Grading, & Classification

                                                                        • Relevant Anatomy

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Treatment

                                                                              • Common Complications

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  • Image Interpretation Pearls

                                                                                    • Reporting Tips

                                                                                      Selected References

                                                                                      1. 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
                                                                                      2. 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
                                                                                      3. Meijer DT et al: Guesstimation of posterior malleolar fractures on lateral plain radiographs. Injury. 46(10):2024-9, 2015
                                                                                      4. Crim J et al: CT assessment of the prevalence of retinacular injuries associated with hindfoot fractures. Skeletal Radiol. 42(4):487-92, 2013
                                                                                      5. Russo A et al: Ankle fracture: radiographic approach according to the Lauge-Hansen classification. Musculoskelet Surg. 97 Suppl 2:S155-60, 2013
                                                                                      6. Lempainen L et al: Medial malleolar stress fracture in athletes: diagnosis and operative treatment. Scand J Surg. 101(4):261-4, 2012
                                                                                      7. 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
                                                                                      8. Gougoulias N et al: Supination-external rotation ankle fractures: stability a key issue. Clin Orthop Relat Res. 468(1):243-51, 2010
                                                                                      9. Miller AN et al: Posterior malleolar stabilization of syndesmotic injuries is equivalent to screw fixation. Clin Orthop Relat Res. 468(4):1129-35, 2010
                                                                                      10. van den Bekerom MP et al: Is fibular fracture displacement consistent with tibiotalar displacement? Clin Orthop Relat Res. 468(4):969-74, 2010
                                                                                      11. 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
                                                                                      12. 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
                                                                                      13. Jowett AJ et al: Medial malleolar stress fracture secondary to chronic ankle impingement. Foot Ankle Int. 29(7):716-21, 2008
                                                                                      14. Shariff SS et al: Lauge-Hansen classification--a literature review. Injury. 37(9):888-90, 2006
                                                                                      15. Mulligan ME: Ankle and foot trauma. Semin Musculoskelet Radiol. ;4(2):241-53, 2000
                                                                                      16. 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
                                                                                      17. Kennedy JG et al: An evaluation of the Weber classification of ankle fractures. Injury. 29(8):577-80, 1998