1. Case for small group discussion
Ankle fracture
Case for small group discussion
AOTrauma—Foot & Ankle
Module 1a: Ankle trauma—ankle fractures
Stefan Rammelt, DE

2. Case description 43-year-old man Soccer injury Closed fracture
Mild swelling

3. Case description
CT scan shows shell-like avulsion of the posterior tibia
No impaction
What is the type of fracture?
Reduction and fixation?

4. Internal fixation—postoperative x-rays
Supination external rotation 4 (SER 4)
B2-type according to AO/OTA Fracture Classification
Syndesmotic avulsions should be recognized and fixed appropriately—in this case from the fibula
Mention Wagstaffe fragment

5. Take-home messages
Even in simple B-type fractures, anatomic reduction is paramount
No need to stabilize deltoid ligament
Lateral neutralization plate or posterior antiglide plate for fibular fixation
Fix syndesmotic avulsions
References:
Rammelt S, Grass R, Zwipp H. [Ankle fractures]. Unfallchirurg Jun;111(6):421–437.
Rammelt et al. Unfallchirurg. 2008;111:421–437