M.E.Müller: Atlas: Fracture 44-A2

Tibia/Fibula, malleolar segment,
infrasindesmotic lesion,
with fx medial malleolus 5 % of segment

Rupture lateral collateral ligament +Q Avulsion tip lateral malleolus +Q Transverse fx lateral malleolus +Q

These are infrasyndesmotic lesions of the lateral malleolus, either a ligamentous rupture (A2.1) or a bone fracture, that can be of the avulsion type (A2.2) or transverse (A2.3). They are associated with a fracture of the medial malleolus, which fracture line can be either transverse or vertical. Ref. Manual of Internal Fixation:
595 - 611.
Surgeon. AG, MS, EN.

When dealing with a fracture of both malleoli, the surgical procedure should always begin at the lateral side in order to restore the length of the fibula. In the first case illustrated (A2.1), the lateral collateral ligament was sutured. In the other two cases (A2.3), the fibula was internally fixed with a hook plate in one and with a one-third tubular plate in the other, both properly contoured. The bifid tip of the hook plate must be placed through the ligament and driven into the tip of the malleolus with a small impactor. Once in good position, the hook is better than the distal screw of a regular plate.

Whenever posible, the fractures of the medial malleolus should be fixed with two 4 mm cancellous screws in order to perform interfragmentary compression and block the rotation. When the fracture line is vertical, the screws must be placed perpendicular to the fracture line. Smaller fragments can be fixed with Kirschner wires and a tension band.

preoperative + 4 months + 4 months

preoperative + 4 months + 4 months

preoperative + 5 years + 5 years




						Tibia/Fibula, malleolar segment, infrasindesmotic lesion, with fx medial malleolus	5 % of segment






These are infrasyndesmotic lesions of the lateral malleolus, either a ligamentous rupture (A2.1) or a bone fracture, that can be of the avulsion type (A2.2) or transverse (A2.3). They are associated with a fracture of the medial malleolus, which fracture line can be either transverse or vertical.		Ref. Manual of Internal Fixation: 595 - 611. Surgeon. AG, MS, EN.

When dealing with a fracture of both malleoli, the surgical procedure should always begin at the lateral side in order to restore the length of the fibula. In the first case illustrated (A2.1), the lateral collateral ligament was sutured. In the other two cases (A2.3), the fibula was internally fixed with a hook plate in one and with a one-third tubular plate in the other, both properly contoured. The bifid tip of the hook plate must be placed through the ligament and driven into the tip of the malleolus with a small impactor. Once in good position, the hook is better than the distal screw of a regular plate.	Whenever posible, the fractures of the medial malleolus should be fixed with two 4 mm cancellous screws in order to perform interfragmentary compression and block the rotation. When the fracture line is vertical, the screws must be placed perpendicular to the fracture line. Smaller fragments can be fixed with Kirschner wires and a tension band.