Presentation
Patient presents to the ED after slipping on ice and injuring her right ankle.
Patient Data
Two views right ankle and two views right knee were obtained.
There is an acute displaced avulsion fracture of the medial malleolus. There is an acute comminuted oblique distal fibular fracture. There is an acute minimally displaced posterior malleolus fracture. There is widening of the tibiofibular clear space. There is lateral, posterior, and superior talar dislocation.
CT was performed after casting and reduction of the tibiotalar dislocation.
CT demonstrates improved alignment of the joint and displaced fracture fragments.
Case Discussion
Distal fibular fracture with syndesmotic diastasis, medial malleolus avulsion fracture, and posterior malleolus fracture, as well as outward and upward dislocation of the talus with respect to the tibia, compatible with a Dupuytren fracture.
This was first described by French surgeon Baron Guillaume Dupuytren and published by Dr. Thompson in 1880:
"In his chapter on fracture of the fibula, Dupuytren refers to the injury as one of the complications of fracture of the fibula, and describes it as a dislocation of the foot outwards and upwards."
""This form of displacement", he observes, "is so rare that I have only seen it once in nearly two hundred cases of fractured fibula which have fallen under my observation during the last fifteen years. It involves not only fracture of the fibula, but also laceration of the strong tibio-peroneal ligaments, which generally resist a force to which the osseous tissue itself yields.""
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