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These
are multifragmentary diaphyseal fractures of the fibula, proximal to the
syndesmosis. As for the previous group, subgroup .1 is characterized by
the rupture of the medial collateral ligament, the .2 subgroup by the fracture
if the medial malleolus and the .3 subgroup by the associated fractures
of the medial and posterior (Volkmann) malleoli (Dupuytren´s fracture). |
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Ref.
Manual of Internal Fixation:
595 - 611.
Surgeon. RO, RO, CB. |
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When
associated to a talar dislocation, these serious fractures usually carry
with them chondral lesions that will evolve into degenerative arthritis.
The free fragments must be removed and, if the fragments are osteochondral,
substituted by packed cancellous bone graft.
The bony lesions are reconstructed according to the principles described
for the previous group: anatomic reduction of the fibula, repair of the
syndesmotic lesion,
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protection
of the syndesmosis and interosseous membrane with a tibio-fibular screw,
and anatomic reduction and internal fixation of the medial lesion.
In the illustrated C2.2 case there is no tibio-fibular screw because the
tubercle of Chaput was avulsed as a large fragment with a minor involvement
of the interosseous membrane. In these rare cases, the tibio-fibular screw
is useless.
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