Acute Fixation of Distal Fibula Avulsion

Fractures after Ankle Sprains

Jasmin Diallo

Joe Wagener

Christine Schweizer

Beat Hintermann

Lukas Zwicky

Tamara Horn Lang

AOFAS Meeting, July 15-18, 2015, Long Beach, California

Acute Fixation of Distal Fibula Avulsion Fractures after

Ankle Sprains

Jasmin Diallo

My disclosure is in the

Final AOFAS Mobile App.

I have no potential conflict with

this presentation.

The Issue Avulsion fracture of the distal fibula causes…

- …elongation of the lateral ligaments due to dehiscence

between the avulsed fragment and the fibula

The Issue

We believe this elongation might result in chronic ankle

instability

open reconstruction of acute bony avulsion of lateral

ligaments with fixation of the fragment prevents chronic

ankle instability

The Idea

Patients and Methods

- between 2010 and 2013

- 10 patients with an acute avulsion fracture of the fibula

involving the ATFL and FCL

– mean age 34 [15 - 64] years

– 5 females, 5 males

- open reconstruction of the lateral ligaments and fixation

of the avulsed fragment

- postoperative walking boot for 6 weeks with weight

bearing as tolerated

- clinical and radiological follow-up controls 6 weeks, 3

months and one year postoperative

Patients and Methods

- Objective

– x-ray for reduction control

– “Anterior Drawer Test”

- Subjective

– pain (VAS)

– reuptake of sports activities

– patient satisfaction (modified Coughlin-Score)

– stability/ recurrence of ankle sprain

Outcome measures included:

Technique and Surgeries

Local debridement of the fragment and the fibula with a

chisel

Technique and Surgeries

Reduction and fixation first with Kirschner-wire(s),

then with 1-2 cannulated screw(s)

- Objective

– in all cases good reduction an bony integration of the fragment

on the x-ray

– none of the cases had a positive anterior drawer test in

comparison to the contralateral side

Results

- Subjective

– mean pain on VAS 1,5 [0 - 4]

– all patients returned to their pre-injury sport activities

– no subjective instability

– 6 patients are very satisfied, 4 patients are satisfied with the

result

After a mean follow up 2 years [1 - 4]

Conclusion

These promising results encourage us to further treat

patients presenting acute avulsion fractures involving the

ATFL and FCL using open reconstruction of the lateral

ligaments with fixation of the osseous avulsion fragment.

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