Double fractures of the fibula in bimalleolar fractures

ABSTRACT

Study of eight cases of displaced ankle fractures with double fracture of the fibula showed that these fractures constitute a separate entity with special characteristics. For the second fibular fracture to occur, it is thought that a change in the position of the foot, or a change in the direction of the injuring force or a change in both should occur. These fractures, although rare, are very serious. Closed reduction of the fibular fractures, in spite of internal fixation of the medial malleolus, is difficult and proved unstable in plaster immobilization. Open reduction and internal fixation, especially, of both fibular fractures is necessary if permanent disability is to be avoided. Ankle fractures are unpredictable in presentation. This is especially true concerning the fibular component of these fractures. Lauge-Ha-nsen classification[1], although it gives precise and detailed description of ankle fractures including ligamentous injuries, did not include all possible fractures at the ankle. Large series, classified according to it, showed that between one to seven percent of the fractures could not be classified according to Lauge-Hansen classification[2,6]. Isolated fractures of the posterior tibial edge [Bosworth][7] and Maisonneuve [1840] fracture[8] are examples. Many questions concerning especially the mechanism of injury and the pathological anatomy of the ankle injuries are still unanswered and require more investigations and considerations In this report we present eight patients with ankle fractures where the fibular fracture was double. In the available literature we could not find a report dealing with this entity. This fracture, although rare, is serious. Closed reduction of the fibular fracture proved unstable in spite of internal fixation of the medial malleolus. If permanent disability is to be avoided then proper reduction and internal fixation of medial malleolus and both fibular fractures should be performed