Fracture of medial malleolus with lateral talar shift and diastasis of syndesmosis

From: Dr Iain Nixon

What type of fracture is shown and what other area of the leg should be imaged?
What is the definitive treatment for this fracture
What complications may occur in the short term

Click here for answer
(See below for more details)

There is a fracture of the medial malleolus with lateral talar shift and diastasis of the syndesmosis. It is important to xray the entire length of the tibia and fibula. This may demonstrate fractures proximal to the site of injury. Best treatment is open reduction with internal fixation. Medial skin necrosis is a common problem. The patient has a small risk of compartment syndrome.

The fracture can be classified as a Weber type C. Weber's classification depends on the site of the fibular fracture. Fracture at the level of the syndesmosis or below is type A. Type B runs obliquely up from the ankle joint and type C is proximal to the syndesmosis.
Diastasis is treated with a syndesmosis screw above the level of the syndesmosis in plane 25 degrees postero-anterior to the normal coronal plane of the tibia. The ankle should be fully dorsiflexed to ensure there is no narrowing of the ankle mortise and the screw should be placed without compression. The malleolar fracture should be treated with two AO screws.
Compartment syndrome is characterised by an increase in compartment pressure within an enclosed space. Compartment syndrome should be suspected if there is pain out of proportion to that expected from the injury. There will be pain on active or passive stretching of the muscles involved in the compartment. Sensory alteration, motor weakness and loss of peripheral pulses are late signs and carry a poor prognosis.