Best Practice Case Studies-Proximal Fibula Fracture

Video Transcription

This is Barry Bellosis, one of the musculoskeletal radiology fellows at Stanford University.  24 year old with left ankle injury with concern for proximal fibular fracture.  The patient in this case presented with a proximal fibular fracture after an ankle injury.  A follow-up radiograph six weeks later demonstrates bony bridging suggestive of healing. When dealing with ankle injury,  there are things we need to consider. For example, the masonib fracture. This refers to a combination of proximal fibular fracture with  associated ankle injury or an unstable ankle injury.  When we see an isolated medial malleolar fracture such as in this case,  make sure we also check the proximal fibular for any fracture.  An isolated posterior malleolar fracture may also be associated with proximal fibular fracture or  painful or swelling on the medial side such as in this case without fracture,  but we can see widening of the medial clear space. We need to check the proximal fibula for fracture, which this case had.  When imaging the tibiofibular syndesmosis, we look at the incisora tibialis,  we look at the space, and then we also look at the medial clear space, which should be less than five millimeter.  There are different types of ankle fracture classification,  but the most commonly used are the Dennis-Weber and the Logue-Hansen classification. Weber classification takes into account the fibular fracture in relation to the syndesmosis,  whereas Logue-Hansen is based on the mechanism of injury. The first term refers to the position of the foot at the time of injury,  either supination or pronation, and the second term refers to the direction of the deforming force such as either AB duction, AD duction, or external rotation.  This is a simplified version of the Weber and Logue-Hansen classification and not comprehensive.  Weber A refers to infrasyndesmotic or below the syndesmosis fracture and correlates to the Logue-Hansen supination AD duction injury. Weber B  occurs at the level of the syndesmosis and correlates with the Logue-Hansen supination external rotation injury,  whereas Weber C occurs above the syndesmosis and correlates to the Logue-Hansen  pronation external rotation injury.

Video Summary

The video discusses the evaluation of ankle injuries, specifically focusing on proximal fibular fractures. A 24-year-old patient presented with such a fracture after an ankle injury. Healing was suggested by a follow-up radiograph showing bony bridging. Important aspects include checking for proximal fibular fractures in cases with isolated medial or posterior malleolar fractures or medial clear space widening without fracture. The Weber and Lauge-Hansen classifications are used for categorizing ankle fractures. Weber classification relates to the syndesmosis, while Lauge-Hansen focuses on injury mechanism. Proper assessment of the tibiofibular syndesmosis is essential, including checking the incisura tibialis and medial clear space.

Meta Tag

Edition 2nd Edition

Related Case 2nd Edition, CASE 10

Topic Foot and Ankle

Keywords

2nd Edition, CASE 10

2nd Edition

Foot and Ankle

ankle injuries

proximal fibular fractures

Weber classification

Lauge-Hansen classification

tibiofibular syndesmosis