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Paulo Barbosa, Felix Bonnaire, Kodi Kojima

Executive Editors

Steve Krikler, Chris Colton

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Transsyndesmotic, lateral simple fracture with deltoid rupture

When there is a simple, displaced, oblique fracture at the level of the syndesmotic ligaments, associated with a rupture of the medial collateral ligament, this is classified as an AO/OTA 44B2.1 fracture.

The anterior syndesmotic ligament is ruptured, or it may be avulsed, either at its fibular (Le Fort / Wagstaff), or tibial (Tillaux-Chaput) insertion.

The most common injury pattern occurs with axial loading of a maximally supinated foot. Progressive talar external rotation results in further opening of the fibular fracture, with posterior displacement of the lateral malleolus, corresponding to Lauge-Hansen supination external rotation stage III. Finally the talus exits the ankle mortise posteriorly and disrupts the medial collateral structures, corresponding to Lauge-Hansen supination external rotation stage IV.  In about 5% of malleolar fractures, the injury cause is a forced abduction of the hind part of the pronated foot (corresponds to Pronation-abduction fractures, stage I-III in the Lauge-Hansen classification).

Simple, with ruptured medial collateral ligament (AO/OTA 44B2.1)
Complete radiological evaluation (AP, lateral and AP with internal rotation) is crucial for correct classification and decision making.
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