The images are from a 21 year old college student and football player who sustained a transverse fractures of his right tibia and fibula. This patient does have an avulsion fracture off the navicular but it is not obvious on this view.Ĭourtesy Ashley Davidoff MD 72585 Fracture of the Shaft of the Tibia and Fibula with Fat Embolism The 3D reconstructed CT scan of the forefoot exemplifies the normal anatomy of the distal tibia, fibula, tibio-talar joint, talo navicular joint, and navicular cuboid. The talus is central to the stability of the jointĬourtesy Ashley Davidoff MD 72583c01 The Normal Distal Fibula The axial section CT scan of the forefoot exemplifies the normal anatomy of the distal tibia, fibula, tibio-talar joint. Normal Tibia and FibulaĪshley Davidoff MD The Normal Ankle in Cross Section Unstable fractures, open fractures, and failure to achieve anatomic alignment by closed reduction requires open reduction and internal fixation (ORIF) surgery.
Often a reduction can reduce the need for surgery. Intramedullary nailing is typically performed.Īnkle fractures are typically given an attempt at closed reduction to try to regain anatomic alignment.
Tibial shaft fractures with displacement or comminution can be treated with intramedullary nailing, flexible nails, external fixation devices, or plates and screws. Tibial shaft fractures can be treated nonoperatively if there is minimal displacement. The fibular shaft fracture in a combination tibia/fibula fracture is treated by repairing the tibial shaft fracture. Isolated fibular shaft fractures are treated nonoperatively with weight bearing as tolerated. Proximal fibula fractures are typically treated non-operatively at the site of the fracture, but may require a surgery to repair the syndesmotic injury distally. Imaging includes the use of plain x-rays, and if indicated CT-scan, or MRI. The diagnosis of this injury is usually made by a combination of physical examination and x-ray imaging. Complications that are specific to the fibula include loss of ankle motion, compartment syndrome, peroneal nerve injury, vascular injury, reflex sympathetic dystrophy, fat embolism, and claw toe deformity. The fracture may be complicated in the acute phase by neurovascular injury, or in the subacute or chronic phases by nonunion, malunion, infection, osteonecrosis, or osteoarthritis. The Lauge-Hansen Classification system describes the injuries that result from four different mechanisms supination-adduction (SA), supination-external rotation (SER), pronation-abduction (PA), and pronation-external rotation (PER). Complex fractures include spiral, segmented, and irregular.Īnkle fractures can contain a tibial and/or fibular component. Wedge fractures include spiral wedge, bending wedge, and fragmented wedge. Spiral, transverse, and oblique fractures are simple. Fractures are described based on the pattern, location, and level of comminution. Fibular shaft fractures can occur in isolation however. Duputren’s fracture is also a high fibular fracture from a similar mechanism to the Maisonneuve fracture.įibular shaft fractures often occur in conjunction with fractures of the tibial shaft. There is syndesmotic injury that leads to the fibula to fracture proximally. Proximal fibula fractures or a Maisonneuve fracture can occur as a result of external rotation of the ankle. The location of the fracture on the fibula varies.
Spiral fracture distal fibula series#
The proximal fibula should be examined in all patients with ankle injury: a case series of missed maisonneuve fractures.
Taweel NR, Raikin SM, Karanjia HN, Ahmad J.Evidence-based treatment of Maisonneuve fractures. Stufkens SA, van den Bekerom MP, Doornberg JN, van Dijk CN, Kloen P.The Maisonneuve injury: a comprehensive review. Kalyani BS, Roberts CS, Giannoudis PV.
Maisonneuve fracture of the fibula: implications for imaging ankle injury. Beware the “simple” fibular fracture (a clue for severe unstable ankle injury).
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