Influence of unstable ankle fracture (type Weber C), osteosynthesis and syndesmotic transfixation on position of fibula in tibiofibular notch: a cadaveric study



The aim of the cadaveric study was to determine the effects of an unstable ankle fracture on the position of the fibula in the incisural notch and subsequently to evaluate the alterations resulting from the individual steps of a guideline-based osteosynthesis.


In a specimen model with 20 uninjured fresh-frozen lower legs with induced unstable fracture of the fibula (type Weber C), a guideline-based osteosynthesis was performed. The distances between the anterior and posterior edges of the tibia and fibula and in the center of the incisural notch, as well as the rotation angle of the fibula, were measured in the acquired 3D image data sets and were compared with the intact condition of the ankle mortise.


The dissection of the syndesmosis and osteotomy of the fibula results in an external rotation the fibula by 3.6° (p = 0.000), while the distance between the anterior edge of the tibia and the fibula widens by 1.86 mm (p = 0.000). After osteosynthesis of the fibula and transfixation of the syndesmotic region using a positioning screw, the posterior distance is no longer substantially increased by 0.22 mm (p = 0.103) but also reduced by 0.1 mm (p = 0.104) in the tibiofibular notch. The external rotation of the fibula remains slightly increased by just 0.45° (p = 0.009).


The results indicate that there is a tendency for over-compression when adjusting the tibiofibular distance and that the fibula in the tibiofibular notch tends to remain slightly rotated externally.

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Corresponding author

Correspondence to Sven Vetter.

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Conflict of interest

The authors declare the following potential conflicts of interest concerning the research, authorship, and publication of this article. The BG Trauma Center Ludwigshafen and Siemens Healthcare AG in Erlangen, Germany cooperate in the field of medical imaging and image-guided surgery. This cooperation influenced neither the outcome of the study nor the manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the institutional and/or national research committee’s ethical standards and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The ethics committee of the Medical Faculty of Heidelberg approved the study. The application was submitted on 13 January 2014 and was accepted on 17 February 2014 with the registration number S-013/2014.

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Privalov, M., Swartman, B., Beisemann, N. et al. Influence of unstable ankle fracture (type Weber C), osteosynthesis and syndesmotic transfixation on position of fibula in tibiofibular notch: a cadaveric study. Eur J Trauma Emerg Surg (2021).

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  • Ankle fracture
  • Ankle mortise
  • Syndesmotic injury
  • Positioning screw
  • Intraoperative 3D imaging