M.E.Müller: Atlas: Fracture 44-B3

Tibia/Fibula, malleolar segment,
transsyndesmotic fibular fracture,
with medial lesion and a Volkmann 23 % of segment

Fibula simple, with rupture medial collateral ligament +Q Fibula simple, with fracture medial malleolus +Q Fibula multifragmentary, with fracture medial malleolus +Q

These are fractures of the lateral malleolus at the level of the syndesmosis, associated to a medial lesion and to a fracture of the “posterior malleolus” (Volkmann). The subgroups differ in the involvement of the medial collateral ligament (.1), the simple fracture of the medial malleolus (.2) and the multifragmentation of the fracture of the fibula (.3). Ref. Manual of Internal Fixation:
595 - 611.
Surgeon. JM, RO, CS.

The internal fixation of the medial and lateral malleoli is performed according to the described techniques although, as shown in the second illustrated case, when the fibula has a quite long fracture line it is possible to fix it only with interfragmentary compression screws, without a neutralization plate.

The Volkmann fracture, which characterizes the group, must be reduced and fixed if the fragment is large (more than 20%). The reduction is difficult and usually requires a direct retromalleolar approach. It is fixed with one or two cancellous lag screws.

preoperative + 4 months + 4 months

preoperative + 4 months + 4 months

preoperative + 6 months + 6 months

preoperative + 4 months + 4 months




						Tibia/Fibula, malleolar segment, transsyndesmotic fibular fracture, with medial lesion and a Volkmann	23 % of segment






These are fractures of the lateral malleolus at the level of the syndesmosis, associated to a medial lesion and to a fracture of the “posterior malleolus” (Volkmann). The subgroups differ in the involvement of the medial collateral ligament (.1), the simple fracture of the medial malleolus (.2) and the multifragmentation of the fracture of the fibula (.3).		Ref. Manual of Internal Fixation: 595 - 611. Surgeon. JM, RO, CS.

The internal fixation of the medial and lateral malleoli is performed according to the described techniques although, as shown in the second illustrated case, when the fibula has a quite long fracture line it is possible to fix it only with interfragmentary compression screws, without a neutralization plate.	The Volkmann fracture, which characterizes the group, must be reduced and fixed if the fragment is large (more than 20%). The reduction is difficult and usually requires a direct retromalleolar approach. It is fixed with one or two cancellous lag screws.