Clinical Details

Clinical and radiological findings:  A mixed bag injury sustained by a middle-aged female motor vehicle accident. This was a GA type 2 open injury which was provisionally debrided and stabilised in an external fixator. Definitive fixations was performed around 7 to 10 days post injury following consolidation of soft tissue. Initially categorised as a simple distal tibial spiral fracture with concomitant fibula fracture preoperative CT planning demonstrated plafond extension together with a Weber A bony avulsion of the distal fibula. This is more in fitting with two isolated injuries: that of the tibial shaft and fibula at the same level and a supination adduction ankle injury resulting in vertical shear of the medial malleolus and avulsion of the fibula apex. This is a little different to the classical occult posterior malleolus fracture associated with distal tibial spiral fractures (for which there is good evidence for the use of CT scanning to plan plafond stabilisation0.