title: A rare type of ankle fracture: Syndesmotic rupture combined with a high fibular fracture without medial injury.
abstract: High fibular spiral fractures are usually caused by pronation-external rotation mechanism. The foot is in pronation and the talus externally rotates, causing a rupture of the medial ligaments or a fracture of the medial malleolus. With continued rotation the anterior and posterior tibiofibular ligament will rupture, and finally, the energy leaves the fibula by creating a spiral fracture from anterior superior to posterior inferior. In this article we demonstrate a type of ankle fracture with syndesmotic injury and high fibular spiral fractures without a medial component. This type of ankle fractures cannot be explained by the Lauge-Hansen classification, since it lacks injury on the medial side of the ankle, but it does have the fibular fracture pattern matching the pronation external rotation injury (anterior superior to posterior inferior fracture). We investigated the mechanism of this injury illustrated by 3 cases and postulate a theory explaining the biomechanics behind this type of injury.
authors.affiliation: Department of Trauma Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands. Electronic address: kwessem@umcutrecht.nl.
authors.forename: K J P
authors.initials: KJ
authors.lastname: van Wessem
authors.affiliation: Department of Trauma Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: L P H
authors.initials: LP
authors.lastname: Leenen
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D001265:Athletic Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D001696:Biomechanical Phenomena; D002370:Casts, Surgical; D005260:Female; D005360:Fibula / Q000000981:diagnostic imaging / Q000293:injuries / Q000503:physiopathology*; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D008023:Ligaments, Articular / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D011403:Pronation; D012421:Rupture / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D016896:Treatment Outcome
keywords: Ankle fracture; Biomechanics; Syndesmotic injury without medial injury