Distal fibula fracture…

August 20, 2013

Ankle XR, Orthopedics, Trauma, XR


Distal fibula fractures are very common.  Here is a mid-50s female who twisted her ankle:

Distal Fib fx 1 Distal fib fx 2 Gravity stress mortis 1

The first two images show a minimally displaced spiral-type fracture of the distal fibula without mortis widening.  However, when the patient is placed in “gravity stress” view (third image) you can see the medial part of the mortis (red arrow) widens quite significantly (5.4mm).  Orthopedic literature has classified this type of fracture as a Danis-Weber B fracture (1).  With stress on the ankle joint, medial widening of the mortis beyond 5mm is highly suggestive of deltoid ligament disruption (1).   Essentially this is similar to a bimalleolar fracture.  Operative stabilization and ligamentous repair may help this patient in the long-term.

Consider gravity stress views in all of your distal fibular fractures, especially those above the level of the mortis (Weber B).  For a comprehensive review article on these types of fractures please read reference #1 below.

Author:  Russell Jones, MD

References

1.  van den Bekerom MPJ, Mutsaerts ELAR, Niek van Dijk C.  Evaluation of the integrity of the deltoid ligament in supination external rotation ankle fractures: a systematic review of the literature.  Arch Ortho Traum Surg 129 (2); 227-235.

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