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MEDICINA E CHIRURGIA DELLA CAVIGLIA E DEL PIEDE

A Journal on Physiopathology and Surgery of the Foot


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Chirurgia del Piede 2009 December;33(3):135-43

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: Italian

Problems after fracture of the distal fibula

Pisani G., Pisani P. C., D’arrigo A.

1 Centro di Chirurgia del Piede “Prof. G. Pisani”, Clinica Fornaca di Sessant, Torino, Italia 1 Università degli Studi di Catania, Dottorato di Ricerca in Traumatologia, XXI Ciclo (2006-2008)


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An outline is given of fibula ontomorphogenesis, anatomy and biomechanics, highlighting the importance of the fibula in the tibiotarsal joint and in the adaptation of the ankle mortise to the trochlea tali: the fibula rises, turns and moves away from the tibia on dorsiflexion, whereas the opposite occurs on plantar flexion. As the fibula also plays an important role in weight bearing, distal fibular fractures often require surgical repair of bone axis, length and rotational movement. Failure to undergo anatomic reconstruction may lead to secondary pain and stiffening of the tibiotarsal joint, particularly on dorsiflexion. Synthesis should be stabilized with compression screws or modelled plaques. Intramedullary nailing (Rush) may not ensure adequate joint stability or rotation. Rotational osteotomy, realignment and lengthening may be indicated in a variety of cases, or resection of tibiofibular synostosis with interpositioning of inert material (silastic) to prevent recurrence.

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