Authors of section

Authors

Paulo Barbosa, Felix Bonnaire, Kodi Kojima

Executive Editors

Steve Krikler, Chris Colton

Open all credits

Infrasyndesmotic, medial fracture with lateral fracture/avulsion

Introduction

If the lateral injury involves an avulsion fracture of the tip or a transverse fracture of the lateral malleolus, with a medial malleolar fracture (oblique or vertical), this is classified as an AO/OTA 44A2.2 or an AO/OTA 44A2.3 fracture.

In these fractures, the superomedial corner of the talus may cause, not only a high oblique or vertical medial malleolar fracture, but also an impaction fracture of the “medial corner” of the tibia, at the junction of its horizontal joint surface (plafond) and the medial malleolar joint surface (see x-ray for 44A2.3 fractures). The impacted “corner” fragment will need to be reduced, prior to reduction and fixation of the medial malleolus.

Avulsion of the tip of the lateral malleolus

If the lateral injury involves an avulsion fracture of the tip of the lateral malleolus, with a medial malleolar fracture (oblique or vertical), this is classified as an AO/OTA 44A2.2 fracture.

Avulsion of the tip of the lateral malleolus (AO/OTA 44A2.2)
Complete radiological evaluation (AP, lateral and AP with internal rotation) is crucial for correct classification and decision making.
definition

Transverse fracture of the lateral malleolus

If the lateral injury involves a transverse fracture of the lateral malleolus, with a medial malleolar fracture (oblique or vertical), this is classified as an AO/OTA 44A2.3 fracture.

In these fractures, the superomedial corner of the talus may cause, not only a high oblique or vertical medial malleolar fracture, but also an impaction fracture of the “medial corner” of the tibia, at the junction of its horizontal joint surface (plafond) and the medial malleolar joint surface. This is effectively a “split depression” injury, analogous to that of the tibial plateau. The impacted “corner” fragment will need to be reduced, prior to reduction and fixation of the medial malleolus.

Transverse fracture of the lateral malleolus (AO/OTA 44A2.3)
Transverse fracture of the lateral malleolus (AO/OTA 44A2.3)
Complete radiological evaluation (AP, lateral and AP with internal rotation) is crucial for correct classification and decision making.
definition