8/25/2023 0 Comments Spiral fracture distal fibulaWeber A fractures occur below the level of the tibial plafond. Type A fractures: These are transverse avulsion (or chip) fractures of the distal fibula.Although this complex classification has limited clinical applications, it is a landmark biomechanical study of ankle fractures. They made an attempt to classify the resulting fracture patterns. adduction) to a cadaver ankle placed in either supination or pronation. During this study, scientists applied a directional force either rotational (internal vs. This classification system resulted from a cadaver study conducted in 1950. Generally, according to the Lauge–Hansen classification, supination and external rotation are the causes of spiral fractures of the fibula. An oblique radiograph demonstrates an acute spiral fracture of the distal right fibula ( arrows) and an avulsion of the lateral aspect of the distal tibia (circled). A 46-year-old man has right ankle pain after playing volleyball. It appears as a small avulsion fracture along the lateral border of the tibia and is appreciated best on an oblique view ( Fig. This injury, which usually occurs in adolescent skate boarders or snow boarders, rarely occurs in adults because the ligaments give way first. These fractures may be associated with tears in the posterior talofibular ligament, which adds to the lack of surrounding structural support.Ī Tillaux fracture is a fracture of the anterolateral process of the tibia. There is not enough bony stirrup support for ankle stability. Therefore, these injuries are unstable.įractures above the tibia plafond (a horizontal line drawn across the distal tibia) are unstable fractures. From a biomechanical standpoint, there are now two breaks in the structural support on each side of the ankle. However, if there is a complete avulsion of either the medial or lateral collateral ligaments associated with a (impaction) fracture of the opposite side, the injury is the equivalent of bimalleolar fracture type of injury. The broad, thick deltoid ligament is stronger than the lateral collateral ligaments. The lateral collateral ligaments are composed of the anterior and posterior talofibular ligaments and the posterior calcaneofibular. The broad-based medial collateral ligament is made up of the deltoid ligament. Marked pain and swelling over the distal fibula.Careful documentation of neurovascular status is essential. Signs of pallor, coldness of the foot and ankle (cold dusky limb), diminished or absent dorsalis pedis or posterior tibial pulses, and diminished or absent sensation are important findings. In addition, it is always necessary to conduct a thorough neurovascular examination. Physicians should also inspect the base of the fifth metatarsal for (associated) fractures. The physician should always check for tenderness of the fibular head and the interosseous region between the distal tibia and fibula and the opposite side for an avulsion fracture of the distal tibia (medial malleolus) or a complete avulsion of the deltoid ligament. With supination, the foot and ankle roll inward.Įvaluation of the patient is essential. Supination is a complex triplanar motion of the foot and ankle consisting of plantar flexion, ankle inversion, and medial adduction of the forefoot. * With pronation, the foot and ankle roll outward. Pronation is a complex triplanar motion of the foot and ankle consisting of dorsiflexion, ankle eversion, and lateral abduction of the forefoot. These injuries are associated with a disruption of the distal tibiofibular complex. Fracture of the proximal fibula associated with a torn interosseous ligaments and membrane. A more severe fracture is the Maisonneuve fracture (Weber C fracture), a spiral fracture of the distal fibula that extends to the proximal fibula. It is an oblique fracture of the lateral malleolus that is commonly associated with rupture of the tibiofibular syndesmosis. The fracture in the introductory case is known as a Weber B fracture by some orthopedic specialists (see subsequent discussion). If a ski breaks or changes direction abruptly, an acutely twisted leg may result. Spiral fractures may occur in downhill skiers, who put their feet into rigid boots that fit firmly onto skis. Pain-limited ambulation with an inability to take four steps is characteristic.Ī spiral fracture is caused by supination of the foot with external rotation force (torsion injuries).Marked tenderness, pain, and swelling occur at the fracture site.
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