Radiology Teaching Files > Case 9795888

previously visited DISTAL FIBULAR FRACTURE
Contributed by: Fritsch & Thompson, Radiologist, Diagnostic Radiology of Houston, Texas, USA.
Patient: 27 year old male
History: Ankle sprain

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Fig. 4: normal maximum values of 6mm and 4mm for the tibiofibular syndesmosis and medial clear space, respectively

Fig. 5
Findings: Oblique, comminuted fracture of the distal fibular diaphysis with a "butterfly" fragment.  Mild posterior displacement and no gross angulation.  The tibiofibular syndesmosis is widened and the medial mortise joint space is widened due to mild lateral talar shift.
Diagnosis: Oblique distal fibular shaft fracture with distasis of the tibiofibular syndesmosis and lateral talar shift, compatible with deltoid ligament disruption. 
Discussion:  The eponym "Dupuytren fracture" has been used to describe this injury.  Commonly used ankle classification systems include the Danis-Weber system, which is based on the level of fibular fracture relative to the tibio-talar joint level and the Lauge-Hansen system  which is a more complicated system describing position of the foot and direction of force at the time of injury. (see links below for more detailed description of these systems.  This fracture would be a Type C, according to the Weber system (see diagram).  

Malleolar fractures in ankle sprain injuries are frequently the result of force applied by or through the talus.  Tension force to a malleolus results from ligamentous attachments and compression or torsional type force results from to bone-to-bone contact.  Tension forces are more likely to result in a horizontal fracture plane across a malleolus and compression/torsional type force is more likely to create an oblique fracture plane. If the talus has moved sufficiently to cause diastasis of the tib-fib joint and fracture the fibula, then medial side injury in the form of either horizontal medial malleolar fracture or deltoid ligament rupture is very likely (see diagram)
References: referred by Hugo Jaime, DC
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Additional Details:

Case Number: 9795888Last Updated: 07-12-2007
Anatomy: Skeletal System   Pathology: Trauma
Modality: Conventional RadiographAccess Level: Readable by all users
Keywords: fibula; fracture; trauma

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