Fractures of the fibula at the distal tibiofibular syndesmosis.

Two basic fracture types are found at the level of the syndesmosis, supination-external rotation (SE) and pronation-abduction (PA), reflecting the mechanism of injury. The SE-type fracture of the fibula extends from the anterior edge in a posterosuperior direction, and the PA-type fracture extends from the medial surface either transversely or obliquely in a laterosuperior direction, and are often comminuted. The SE-types exist in 2 locations above and below the anterior fibular tubercle. All 3 types exist also in atypical forms. Treatment of the initial stages is by cast immobilization, and advanced lesions are treated by open reduction and internal fixation of the medial and lateral lesions of the ankle. The most common type of Wagstaffe fracture was type 2 which represents fractured anterior spike of the proximal fragment of the fibula.