Authors of section

Author

Alan Ruggles

Executive Editor

Jörg Auer

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Lateral malleolar fractures

Fracture characteristics and clinical signs

Lateral malleolar fractures of the tibia can vary in size from relatively small to the entire lateral malleolus.
Usually lameness is mild to moderate, but not severe.
Typically a moderate soft-tissue swelling is present over the distal lateral aspect of the tibia.

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Etiology

Tibial fractures usually develop as a result of trauma, such as kicks or falls. The exception to this are tibial stress fractures, which are an accumulation of cyclic loading and bone fatigue.

Fracture types overview

The most common types of tibial fractures are:

  1. Salter Harris Type II
  2. Tibial crest fractures
  3. Simple diaphyseal fractures
  4. Comminuted diaphyseal fractures
  5. Diaphyseal stress fractures
  6. Medial malleolus fractures
  7. Lateral malleolus fractures
  8. Distal physeal fractures
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Radiography

Radiography provides the most meaningful information as to location and configuration of the fracture(s).
In most cases 4 views at 45 degree intervals provide adequate information for an exact diagnosis. For the evaluation of the proximal tibia typically a lateromedial and a caudocranial projection each is enough.
Nuclear scintigraphy is useful in the identification of tibial stress fractures, which may be radiographically inapparent.

Craniocaudal and lateromedial views
Craniolateral to caudomedial and craniomedial views

Imaging for lateral malleolar fractures

The fragment is best seen on a dorsal to plantar radiographic projection.
Ultrasonographic evaluation of the lateral collateral ligaments is recommended prior to surgical intervention.

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