![]() 2 The tibiotalar short component, a stout ligament passing plantarodistally from the malleolus to the medial trochlea of the talus, is taut in flexion but somewhat lax in extension. The MCL of the tarsal joint is a complex structure consisting of 3 distinct components. 1 Pronation stress on the flexed tarsal joint applies tension to an isolated (tibiotalar short) component of the MCL. Physical examination findings were the authors' rationale for obtaining dorsoplantar flexed pronation and supination stressed radiographic views. The radiographic diagnosis was oblique fracture of the talus with subluxation of the talocalcaneal joint and avulsion fracture of the lateral malleolus. Dorsoplantar flexed pronation and supination stressed radiographic views confirmed the presence of fractures of the talar neck and lateral malleolus and suggested that the medial collateral ligament (MCL) was intact ( Figure 3). If isolated medial malleolar fractures and isolated posterior malleolar or Volkmann fractures are not associated with a lateral malleolar injury or a fibular fracture they are classified and coded as partial articular distal tibial end segment fractures 1.Traditional varus and valgus stressed radiographic views with the tarsal joint held in extension were not helpful. C3 fractures can be additionally subdivided concerning proximal fibular injury (fracture/tibiofibular joint dislocation) and medial injury (deltoid ligament rupture/malleolar fracture).C3.3 medial injury and posterior malleolar (Volkmann) fracture.C3.2 fibular shortening and medial injury.C3.1 medial injury: deltoid ligament rupture or medial malleolar fracture.C3: proximal suprasyndesmotic injury with the following:.C1 and C2 lesions can be additionally subcategorised regarding syndesmotic stability.C2.3 medial malleolar and posterior malleolar (Volkmann) fracture.C2: wedge or multifragmentary suprasyndesmotic fibular diaphyseal fracture with the following:.C1.3 medial malleolar and posterior rim (Volkmann) fracture.correspond to pronation-eversion injury – Lauge-Hansen stage I-IV.C1: simple suprasyndesmotic fibular diaphyseal fracture with one of the following:.all but type B1.1 transsyndesmotic fibular fractures can be associated with Tillaux-Chaput tubercle fractures or Wagstaffe-Le Fort avulsions. ![]()
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