Marginal Fractures of the Lateral Malleolus in Association with other Fractures in the Ankle Region

Eight cases of avulsion-type fracture of the distal fibula associated with fracture of the calcaneus, talus, or ankle region were identified. This avulsion fracture can be identified on routine radiographs as well as on CT scans of the ankle and is pathognomonic of rupture of the superior peroneal retinaculum with or without peroneal tendon displacement. Recognition of this avulsion fracture, with subsequent proper management of the underlying peroneal tendon pathology by immobilization or surgery, may prevent future tendon dysfunction. It may also alter the treatment of other associated injuries.

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T2* Mapping of Peroneal Tendons Using Clinically Relevant Subregions in an Asymptomatic Population

Foot & Ankle International ◽

10.1177/1071100717693208 ◽

2017 ◽

Vol 38 (6) ◽

pp. 677-683 ◽

Cited By ~ 4

Author(s):

Katharine J. Wilson ◽

Rachel K. Surowiec ◽

Nicholas S. Johnson ◽

Carly A. Lockard ◽

Thomas O. Clanton ◽

...

Keyword(s):

T2 Mapping ◽

Lateral Malleolus ◽

Peroneal Tendon ◽

Peroneal Tendons ◽

Peroneus Longus ◽

Mapping Sequence ◽

Asymptomatic Volunteers ◽

Peroneus Brevis ◽

Magnetic Resonance Imaging Mri ◽

Tendon Pathology

Background: Peroneal tendon evaluation is particularly demanding using current magnetic resonance imaging (MRI) techniques because of their curving path around the lateral malleolus. Quantifiable, objective data on the health of the peroneal tendons could be useful for improving diagnosis of tendon pathology and tracking post-treatment responses. The purpose of this study was to establish a method and normative T2-star (T2*) values for the peroneal tendons in a screened asymptomatic cohort using clinically reproducible subregions, providing a baseline for comparison with peroneal tendon pathology. Methods: Unilateral ankle scans were acquired for 26 asymptomatic volunteers with a 3-Tesla MRI system using a T2* mapping sequence in the axial and sagittal planes. The peroneus brevis and peroneus longus tendons were manually segmented and subregions were isolated in the proximity of the lateral malleolus. Summary statistics for T2* values were calculated. Results: The peroneus brevis tendon exhibited a mean T2* value of 12 ms and the peroneus longus tendon was 11 ms. Subregions distal to the lateral malleolus had significantly higher T2* values ( P < .05) than the subregions proximal in both tendons, in both the axial and sagittal planes. Conclusion: Peroneal tendon regions distal to the inferior tip of the lateral malleolus had significantly higher T2* values than those regions proximal, which could be related to anatomical differences along the tendon. Clinical Relevance: This study provides a quantitative method and normative baseline T2* mapping values for comparison with symptomatic clinically compromised peroneal tendon patients.

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The Use of Modern Intramedullary Nailing in Distal Fibula Fracture Fixation

Foot & Ankle Specialist ◽

10.1177/1938640018803734 ◽

2018 ◽

Vol 12 (4) ◽

pp. 322-329 ◽

Cited By ~ 1

Author(s):

Joseph Tracey ◽

Tyler J. Vovos ◽

Danny Arora ◽

Samuel Adams ◽

Selene G. Parekh

Keyword(s):

Case Series ◽

Lateral Malleolus ◽

Wound Complications ◽

Peroneal Tendon ◽

Syndesmotic Injury ◽

Fixation Device ◽

Distal Fibula ◽

Minimal Incision ◽

Lateral Incision ◽

Incision Wound

Background. Lateral malleolus (LM) fixation is necessary for unstable ankle fractures. Traditional fixation relies on the use of plates through a lateral incision, wound healing can be an issue for such incisions. A novel intramedullary (IM) fixation device has been developed that can be placed through a minimal incision. The purpose of this study was to demonstrate the clinical efficacy of this device. Methods. A retrospective analysis was performed on patients who received IM fixation for isolated fibula, bimalleolar (BM), and trimalleolar (TM) fractures. Pertinent demographic information, operative factors, complications, and clinical outcomes were recorded. Results. Sixteen patients were included in the study with an average age of 59 years (range 35-86 years). Six patients presented with isolated LM fractures, four patients had a BM fracture with a syndesmotic injury, 2 patients sustained a LM fracture with an associated syndesmotic injury, 2 patients had a BM fracture, and 2 patients had a TM fracture with a syndesmotic injury. There was a 100% healing rate of the lateral malleolus without any cases of malunion or shortening. There were no cases of sural nerve or peroneal tendon injuries, nor any wound complications found. Conclusion. These findings demonstrate the safe and efficacious use of a novel intramedullary fixation device for fibula fractures with lower wound complications compared with published outcomes found with lateral fibular plating. The features of this device allow for reliable fixation of the fibula, maintaining length and minimizing wound issues. Levels of Evidence: Level IV: Case series

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The Use of Modern Intramedullary Nailing in Distal Fibula Fracture Fixation

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00493 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0049

Author(s):

Joseph Tracey ◽

Tyler Vovos ◽

Samuel Adams ◽

Selene Parekh

Keyword(s):

Wound Complication ◽

Lateral Malleolus ◽

Wound Complications ◽

Peroneal Tendon ◽

Syndesmotic Injury ◽

Fixation Device ◽

Distal Fibula ◽

Minimal Incision ◽

Lateral Incision ◽

Incision Wound

Category: Trauma Introduction/Purpose: Lateral malleolus (LM) fixation is necessary for unstable ankle fractures. Traditional fixation relies on the use of plates through a lateral incision, wound healing can be an issue for such incisions. A novel intramedullary (IM) fixation device has been developed that can be placed through a minimal incision. The purpose of this study was to demonstrate the clinical efficacy of this device. Methods: A retrospective analysis was performed on patients who received IM fixation for isolated fibula, bimalleolar (BM), and trimalleolar (TM) fractures. Pertinent demographic information, operative factors, complications, and clinical outcomes were recorded. Results: Sixteen patients were included in the study with an average age of 59 (Range of 35 to 86). Six patients presented with isolated LM fractures, four patients had a BM fracture with a syndesmotic injury, two patients sustained a LM fracture with an associated syndesmotic injury, two patients had a BM fracture, and two patients had a TM fracture with a syndesmotic injury. There was a 100% healing rate of the lateral malleolus without any cases of malunion or shortening. There were no cases of sural nerve or peroneal tendon injuries, nor any wound complications found. Conclusion: These findings demonstrate the safe and efficacious use of a novel intramedullary fixation device for fibula fractures with a lower wound complication and infection rates compared to published outcomes found with lateral fibular plating. The features of this device allow for reliable fixation of the fibula, maintaining length and minimizing wound issues.

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An Alternate Technique of Applying Lag Screw for Fixation of Distal Fibula Fracture: Posterior to Anterior Interfragmentary Compression Screw

Foot & Ankle Specialist ◽

10.1177/1938640017729495 ◽

2017 ◽

Vol 10 (6) ◽

pp. 555-559

Author(s):

Suganth Jayaraman Vijimohan ◽

Syed Haque ◽

David Ellis

Keyword(s):

Lateral Malleolus ◽

Peroneal Tendon ◽

Compression Screw ◽

Distal Fibula ◽

Lag Screw ◽

Lower Limb Fractures ◽

Choice Of Treatment ◽

Limb Fractures ◽

Interfragmentary Compression ◽

Anterior Posterior

Ankle fractures are one of the most common lower limb fractures, representing a significant portion of the trauma workload. Marked proportion of these is isolated intraarticular lateral malleolus fractures. Anatomical reduction and rigid internal fixation using lag screw (interfragmentary screw) to provide interfragmentary compression has remained the choice of treatment in selected lateral malleolus fractures. Applying interfragmentary compression screw from anterior to the posterior surface of the fibula has been the traditional method of performing this. In this article, we describe an alternate method of applying posterior-anterior interfragmentary compression screw to the fibula fractures. We will also discuss the benefits it provides such as minimizing the chances of hardware-related peroneal tendon irritation. Further argument will focus on the mechanical benefit this will render while providing equal clinical outcome of the time tested anterior-posterior interfragmentary compression screw. Levels of Evidence: Level V: Therapeutic comparison

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