title: A novel 9-region systematic assessment tool for separated ossicle at the fibular tip effects on lateral ankle ligament complex integrity: a cadaveric study.
abstract: OBJECTIVE
  Fibular tip ossicle separation can cause ligament injury leading to chronic lateral ankle instability. A cadaveric study was conducted to preliminarily assess the effects of fibular tip separated ossicle location and size on lateral ankle ligament complex integrity.
  
  
  METHODS
  X-ray examinations and dissection of the anterior talofibular and calcaneofibular ligaments were conducted in ten radiographically confirmed normal below-knee cadaveric specimens extracted from donated fresh cadavers. Ossicle and bone fragment location and size were recorded, and distal fibula, articular surface, and adjacent ligament effects were determined by a novel 9-region matrix.
  
  
  RESULTS
  Ligament risk varied by region. Anterior talofibular ligament width, perpendicular distance to fibular tip, sagittal width of distal fibula, and coronal width of distal fibula at attachment were 7.45 ± 0.22, 11.75 ± 1.03, 20.56 ± 1.54, and 8.68 ± 0.12 mm, respectively. Sagittal distal fibula and calcaneofibular ligament maximum widths at fibular attachment articular surfaces were 16.81 ± 0.96 and 3.50 ± 0.44 mm, respectively. Anterior talofibular to calcaneofibular ligament distance was 2.35 ± 0.14 mm. Separated ossicles >10 mm in regions 1-3 affected anterior talofibular ligaments, calcaneofibular ligaments, and fibular ankle joints; while those in regions 4, 8, and 7 or 9 affected anterior talofibular or calcaneofibular ligaments or were without impact.
  
  
  CONCLUSIONS
  At the fibular tip, separated ossicles sized >10 mm impact collateral ligaments and articular surfaces, while those 5-10 and <5 mm impact anterior talofibular or calcaneofibular ligaments, potentially impairing the lateral ankle ligament complex. Thus, systematic matric-based assessment of ossicle size and location can potentially improve and standardize ankle fracture care.
authors.affiliation: Orthopedic Department, Huashan Hospital, University of FuDan, Shanghai, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Zhang
authors.forename: Xu
authors.initials: X
authors.lastname: Wang
authors.forename: Xin
authors.initials: X
authors.lastname: Ma
authors.forename: Jiazhang
authors.initials: J
authors.lastname: Huang
authors.forename: Jianyuan
authors.initials: J
authors.lastname: Jiang
mesh_terms: D064386:Ankle Fractures / Q000503:physiopathology; D001696:Biomechanical Phenomena; D002102:Cadaver; D005360:Fibula / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D006801:Humans; D017844:Lateral Ligament, Ankle / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000502:physiology; D011859:Radiography
references.citation: AJR Am J Roentgenol. 1994 Aug;163(2):249-55
references.pmid: 8037009
references.citation: Singapore Med J. 1995 Apr;36(2):136-7
references.pmid: 7676255
references.citation: Knee Surg Sports Traumatol Arthrosc. 2010 Feb;18(2):254-7
references.pmid: 19784633
references.citation: Foot Ankle Int. 2010 Mar;31(3):191-6
references.pmid: 20230696
references.citation: J Anat. 2002 May;200(5):457-65
references.pmid: 12090392
references.citation: Clin Orthop Relat Res. 2002 Jun;(399):197-200
references.pmid: 12011709
references.citation: J Bone Joint Surg Br. 2008 Aug;90(8):1049-54
references.pmid: 18669961
references.citation: J Emerg Nurs. 2006 Feb;32(1):78
references.pmid: 16439296
references.citation: Foot Ankle Int. 2013 Aug;34(8):1128-33
references.pmid: 23471672
references.citation: Clin Orthop Relat Res. 1996 Sep;(330):157-65
references.pmid: 8804286
references.citation: J Bone Joint Surg Br. 1998 Jul;80(4):684-8
references.pmid: 9699838