M.E.Müller: Atlas: Fracture 44-B2

Tibia/Fibula, malleolar segment,
transsyndesmotic fibular fracture,
with medial lesion 28 % of segment

Fibular simple with rupture anterior syndesmosis + medial collateral ligament + Q Fibular simple with rupture anterior syndesmosis + fracture medial malleolus +Q Fibular multifragmentary +Q

These are simple fractures of the lateral malleolus at the level of the syndesmosis, associated to a rupture of the anterior syndesmosis and to a medial lesion: a ligamentous rupture in the .1 subgroup and a medial malleolus fracture in the .2 subgroup. Ref. Manual of Internal Fixation:
595 - 611.
Surgeon. MS, AG, MV, MS.

The fractures of both malleoli, medial and lateral, should be repaired in the same way as described for group B1. If the distal fragment is small and the lag screw is solid, the second screw can be substituted by a Kirschner wire to prevent rotation. The bent tip of the wire can be buried into the hexagonal cavity of the screw head.

The syndesmotic lesion may be ligamentous or an avulsion fracture of its tibial insertion (tubercle of Tillaux-Chaput) or of its fibular insertion (tubercle of Le Fort). The ligament rupture is sutured while the tubercle avulsions are fixed with a lag screw, with or without a washer.

preoperative + 1 year

preoperative + 1 year

preoperative + 1 year

preoperative + 1 year

preoperative + 1 year

preoperative preoperative

+ 5 year + 5 year

preoperative preoperative

+ 0 months + 0 months

This subgroup differs from the previous subgroups of group B2 in that the fibular fracture is multifragmentary, associated to a fracture of the medial malleolus. The fractures of group B2 are the most frequent of the segment. Ref. Manual of Internal Fixation:
595 - 611.
Surgeon. CB, LO, RO.

The multifragmentation is responsible for the difficulty of the treatment. The reduction of the fibula must be anatomic, in order to restore its length, and the internal fixation stable with a contoured plate, sometimes only with alignment and buttress functions.

The lesion of the syndesmotic ligament is usually severe and a solid reconstruction may be difficult to obtain; This is why it is useful to add a suprasyndesmotic tibio-fibular screw like in type C fractures, where it is mandatory. This screw also protects the malleolar fracture from the loads and must be removed at 6-8 weeks. In the illustrated case, the syndesmosis, avulsed from the tibia along with a small bone fragment (Chaput), was fixed with Kirschner wires and a tension band.

preoperative + 4 months + 1 year

preoperative postoperative + 2 months

preoperative postoperative + 2 months




						Tibia/Fibula, malleolar segment, transsyndesmotic fibular fracture, with medial lesion	28 % of segment






These are simple fractures of the lateral malleolus at the level of the syndesmosis, associated to a rupture of the anterior syndesmosis and to a medial lesion: a ligamentous rupture in the .1 subgroup and a medial malleolus fracture in the .2 subgroup.		Ref. Manual of Internal Fixation: 595 - 611. Surgeon. MS, AG, MV, MS.

The fractures of both malleoli, medial and lateral, should be repaired in the same way as described for group B1. If the distal fragment is small and the lag screw is solid, the second screw can be substituted by a Kirschner wire to prevent rotation. The bent tip of the wire can be buried into the hexagonal cavity of the screw head.	The syndesmotic lesion may be ligamentous or an avulsion fracture of its tibial insertion (tubercle of Tillaux-Chaput) or of its fibular insertion (tubercle of Le Fort). The ligament rupture is sutured while the tubercle avulsions are fixed with a lag screw, with or without a washer.






This subgroup differs from the previous subgroups of group B2 in that the fibular fracture is multifragmentary, associated to a fracture of the medial malleolus. The fractures of group B2 are the most frequent of the segment.		Ref. Manual of Internal Fixation: 595 - 611. Surgeon. CB, LO, RO.

The multifragmentation is responsible for the difficulty of the treatment. The reduction of the fibula must be anatomic, in order to restore its length, and the internal fixation stable with a contoured plate, sometimes only with alignment and buttress functions.	The lesion of the syndesmotic ligament is usually severe and a solid reconstruction may be difficult to obtain; This is why it is useful to add a suprasyndesmotic tibio-fibular screw like in type C fractures, where it is mandatory. This screw also protects the malleolar fracture from the loads and must be removed at 6-8 weeks. In the illustrated case, the syndesmosis, avulsed from the tibia along with a small bone fragment (Chaput), was fixed with Kirschner wires and a tension band.