3/11/2023 0 Comments Ankle fracture![]() ![]() Lauge-Hansen fracture patterns and observations were made based on cadaveric models. The posterior talofibular ligament restricts foot posterior displacement and is the strongest lateral ankle ligament ( 32). The calcaneofibular ligament, deep to the peroneal tendons, helps to stabilize the subtalar joint and restricts inversion ( 30, 31, 32, 33 and 34). The anterior talofibular ligament restricts foot anterior displacement, internal rotation, and talar inversion and is the weakest of the lateral ankle ligaments ( 14, 30, 31 and 32). The apex of the lateral malleolus is rounded and may contribute to the origin of the calcaneofibular ligament. The posterior border of the lateral malleolus presents a shallow groove, called lateral malleolus sulcus, which permits the passage of the peroneal tendons. The anterior border of the lateral malleolus is the origin of the anterior talofibular and the calcaneofibular ligaments. Posterior to the articular fossa is the malleolar fossa, which is a rough depression for the origin of the posterior talofibular ligament and inferior transverse ligament. The medial surface of the distal fibula presents an articular facet placed anteriorly for the lateral surface of the body of the talus. ![]() The distal fibula includes the origin of the three lateral ankle ligaments. Direct varus inversion of the ankle forces the talus against the medial malleolus, which may cause a vertical supracollicular fracture pattern ( 25, 26, 27, 28 and 29). Fracture patterns may vary due to the deltoid ligament complex ( 22, 23). Similarly, excessive dorsiflexion stresses the posterior deep deltoid at the posterior colliculus. Anterior colliculus fractures contribute 15% to 20% of medial malleolar ankle fractures ( 20, 21, 22, 23 and 24). Excessive plantarflexion and eversion of the foot may cause rupture of the superficial deltoid at the anterior colliculus ( 5, 17). Talar external rotation is prevented by the deep deltoid ligament, and hindfoot eversion is prevented by the superficial deltoid ligament ( 19). The superficial deltoid originates from the anterior colliculus and attaches to the anterior talar neck, the navicular tuberosity, spring ligament, and the sustentaculum tali of the calcaneus ( 16, 17 and 18). The deep deltoid ligament inserts just distal to the medial talar surface on the central and posterior aspects. The posterior component originates from the intercollicular groove and posterior colliculus. The deep deltoid ligament has an intermediate and posterior component ( Fig. The deep deltoid ligament originates in the intercollicular groove between the colliculi ( 15, 16). Medially, the distal tibia extends into the medial malleolus that consists of the anterior and posterior colliculi. The talus has medial and lateral articular surfaces that articulate with its respective malleoli. It proceeds anteriorly to the syndesmosis to the anterior aspect of the lateral malleolus and assists in stabilizing the hindfoot to the forefoot during push-off in gait ( 14). The anterior inferior tibiofibular ligament starts 5 mm above the articular surface and descends obliquely between the tibia and fibula ( 13). Loading of a plantarflexed talus may cause fracture of the posterior malleolus (Volkmann fracture) due to excessive tension to the posterior ligaments ( 5, 11, 12). Lateral talar rotation in the transverse plane may injure the posterior tubercle. The posterior inferior transverse ligament also originates from the posterior tubercle. The posterior inferior tibiofibular ligament originates from the posterior tubercle laterally on the posterior tibial surface. The tubercle at the anterior border of the fibular notch, tubercle of Tillaux-Chaput, and the posterior malleolus, at the posterior border of the fibular notch, assist to stabilize the posterior ankle joint ( 5, 6, 7, 8, 9, 10 and 11). Superior to the notch is the interosseous tibiofibular ligament. ![]() The lateral surface of the tibia includes the fibular notch, which articulates with the fibula. Posteriorly, the distal tibia has a shallow groove for the flexor hallucis longus tendon. The talar dome is wider anteriorly than posteriorly and has a central indentation that separates two crests ( 4). The talar dome and distal tibial plafond create a congruent and stable articular joint that is able to withstand four times the body weight during the stance phase of gait. The syndesmotic ligaments permit the distal fibula to rotate approximately 12 degrees relative to the tibia ( 3). The tibia and fibula are held together by the syndesmotic ligaments that comprise the anterior and posterior inferior tibiofibular ligaments, interosseous ligament, and the inferior transverse ligament. The talus rests within the framework of the distal tibia and fibula ( Fig. The ankle joint is simply not a hinged joint that gives uniplanar motion, but the complex anatomy of the ankle joint permits triplanar motion ( 1, 2). ![]()
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