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. 2023 Sep 22;18(1):714.
doi: 10.1186/s13018-023-04194-6.

The safe zone of distal fibula was determined based on the classification of lateral malleolus fossa

Gui-Xuan You #  1 , Lei Huang #  1 , Ming-Hui Li #  1 , Bin Xiong  2 , Wan-Lin Peng  3 , Hou-Yin Shi  4 , Lei Zhang  5   6
Affiliations

The safe zone of distal fibula was determined based on the classification of lateral malleolus fossa

Gui-Xuan You et al. J Orthop Surg Res. .

Abstract

Background: Lateral malleolus fractures are very common, and the distal fibular geometry is complex. This study aimed to classify the lateral malleolus fossa (MF) into different types by characterizing the lateral MF imaging morphology and exploring the relationship between the lateral MF and internal fixation position after distal fibula fractures.

Methods: Anteroposterior CT reconstruction was performed on 248 subjects. After reconstruction, the deepest point of the lateral MF was located, and then, the cross-sectional shape of the lateral MF was observed and classified.

Results: According to the morphology of the CT cross section, the lateral MF was divided into three types: type C (43.1%), type V (32.2%), and type Flat (24.7%). Type V (3.98 ± 0.82) was significantly longer than type C(2.83 ± 0.54) and type Flat (1.84 ± 0.42) in cd. Similarly, in ∠α, Type Flat(136.31 ± 9.63) was the largest, followed by type C (116.51 ± 8.79), and type V (89.31 ± 9.07) was the smallest. Other measurements were not found any significant differences between the above.

Conclusion: According to the morphology of the CT cross section, the lateral MF was divided into three types: type C, type V and type Flat. Type V is most likely to be invaded when fixing the distal fibula. Screws less than 9 mm should be selected when fixing, and screws no more than 10 mm should be selected when there are type C and type Flat of MF.

Keywords: Ankle; Fibular fracture; Internal fixation; Lateral malleolar fossa.

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Conflict of interest statement

The authors declare they have no competing interests. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article.

Figures

Fig. 1
Fig. 1
Lateral MF map after three-dimensional reconstruction. a The frontal plane of the lateral MF location. b The horizontal plane of the lateral MF location. c The sagittal plane of the lateral MF location. d Three-dimensional reconstruction of the location of the lateral MF
Fig. 2
Fig. 2
Cross-sectional data measurement diagram. a and d The deepest point of lateral malleolus fibula thickness. b and e The depth of lateral MF. c and f The angle of the MF
Fig. 3
Fig. 3
Localization and measurement of lateral MF area. 3a)The starting point of frontal area measurement. b The starting point of cross-sectional area measurement. c The starting point of sagittal area measurement. d ef: the length of the upper and lower surfaces of the lateral MF. gh: The left and right surface length of the outer lateral MF. s: Area size of lateral MF
Fig. 4
Fig. 4
The classification of lateral MF. a and d Type C of the lateral MF. b and e Type V of the lateral MF. c and f Type Flat of the lateral MF
Fig. 5
Fig. 5
Simulate the three types of different safety zones when the screw is placed from the outside to the inside. a Three types in a unified cross section on their safe area. b F type safety zone. c C safety zone. d V type safety zone
See this image and copyright information in PMC

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