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Anterior Colliculus Fracture with Lateral Fibular Plate Fixation in a Complex SER Ankle Injury
Score and Comment on this Case
Clinical Details
Clinical and radiological findings: A 51-year-old female presented following a trip and fall, resulting in an ankle injury. Radiographic evaluation revealed a complex supination-external rotation (SER) pattern fracture, including a failed anterior colliculus in tension, a complex fibular fracture with a direct lateral apex, and small posterior malleolar and Wagstaffe-Le Fort tubercle fractures. The initial clinical examination was unremarkable for neurovascular compromise.
Preoperative Plan
Planning remarks: The preoperative plan involved addressing the anterior colliculus fracture using tension band plating techniques, given the small fragment size unsuitable for large screw fixation. A lateral fibular plate was planned due to the complexity of the fibular fracture. Syndesmotic stabilization was considered essential, with options including anatomical reduction of the posterior malleolus and Wagstaffe-Le Fort tubercle or direct syndesmotic screw fixation.
Surgical Discussion
Patient positioning: The patient was positioned supine on the operating table with the affected limb externally rotated to facilitate lateral and anterior access to the ankle.
Anatomical surgical approach: A lateral approach to the fibula was performed, involving an incision over the lateral malleolus. Subperiosteal dissection exposed the fibular fracture site. For the anterior colliculus, an anteromedial approach was utilized to allow for tension band plating. The syndesmosis was accessed through the lateral incision for potential screw placement.
Operative remarks:The anterior colliculus fragment was stabilized using a 2.0mm straight plate with 2.4mm screws, applying tension band principles. The distal screw was inserted as a lag screw before tensioning the plate. A lateral fibular plate was applied due to the complex nature of the fibular fracture. Despite personal preference against lateral plating, it was deemed necessary for this fracture pattern. Syndesmotic stability was achieved with a syndesmotic screw, as anatomical reduction of the posterior malleolus and Wagstaffe-Le Fort tubercle was not pursued.
Postoperative protocol: Postoperatively, the patient was placed in a splint with non-weight bearing status for six weeks, followed by progressive weight bearing as tolerated. Range of motion exercises were initiated at two weeks post-surgery.
Follow up: Not specified.
Orthopaedic implants used: 2.0mm straight plate, 2.4mm screws, lateral fibular plate, syndesmotic screw.
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26 Jul 2025
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Full Citation
Cite this article:
Surname, Initial. (2025). Anterior Colliculus Fracture with Lateral Fibular Plate Fixation in a Complex SER Ankle Injury. Journal of Orthopaedic Surgery and Traumatology. Case Report 5251706 Published Online Jul 26 2025.