Rammelt Stefan, Bartoníček Jan, Neumann Annika Pauline, Kroker Livia
UniversitätsCentrum für Orthopädie, Plastische und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
1. Medizinische Fakultät der Karls-Universität und Militärkrankenhaus Prag, Prag, Tschechien.
Unfallchirurg. 2021 Mar;124(3):212-221. doi: 10.1007/s00113-021-00959-y. Epub 2021 Feb 12.
The anterolateral tibial rim with the anterior tibial tubercle (Tubercule de Tillaux-Chaput) serves as an insertion site of the anterior inferior tibiofibular ligament (AITFL). It can also be termed the anterior malleolus or fourth malleolus. Fractures of the anterolateral tibial rim typically result from an external rotation or abduction mechanism of the talus within the ankle mortise. They are frequently overlooked in plain radiographs. Computed tomography (CT) is needed for an exact visualization of the fracture anatomy and treatment planning. A total of three main types can be differentiated: (1) extra-articular avulsion fracture of the AITFL, (2) fracture of the anterolateral distal tibia with involvement of the joint and tibial incisura and (3) impaction fracture of the anterolateral tibial plafond. Surgical fixation of displaced anterolateral distal tibial fractures aims at bone-to-bone stabilization of the anterior syndesmosis, restoration of the tibial incisura for the distal fibula and joint surface. Displaced extra-articular avulsion fractures (type 1) are fixed with a suture anchor or transosseal suture. Larger fragments involving the tibial incisura and plafond (type 2) are mostly fixed with screws. Impression fractures of the anterolateral tibial plafond (type 3) necessitate elevation with restoration of the joint surface, bone grafting of the impaction zone as needed and anterior buttress plating. Only a few studies have reported the treatment results of anterolateral tibial rim fractures in adults. Conservative treatment of dislocated fragments reportedly leads to non-union and malposition of the distal fibula with incongruence of the ankle mortise requiring revision. Impaction fractures (type 3) can lead to secondary avascular necrosis of the anterolateral tibial plafond.
带有胫骨前结节（蒂洛-沙普氏结节）的胫骨前外侧缘是下胫腓前韧带（AITFL）的附着点。它也可被称为前踝或第四踝。胫骨前外侧缘骨折通常由距骨在踝关节窝内的外旋或外展机制引起。它们在普通X线片上常被忽视。需要计算机断层扫描（CT）来精确显示骨折的解剖结构并进行治疗规划。总共可分为三种主要类型：（1）AITFL的关节外撕脱骨折；（2）累及关节和胫骨切迹的胫骨远端前外侧骨折；（3）胫骨前外侧平台的嵌插骨折。移位的胫骨远端前外侧骨折的手术固定旨在实现前联合的骨对骨稳定，恢复胫骨切迹以容纳腓骨远端和关节面。移位的关节外撕脱骨折（1型）用缝线锚钉或经骨缝线固定。累及胫骨切迹和平台的较大骨折块（2型）大多用螺钉固定。胫骨前外侧平台的嵌压骨折（3型）需要抬高并恢复关节面，根据需要对嵌压区进行植骨并进行前侧支撑钢板固定。仅有少数研究报道了成人胫骨前外侧缘骨折的治疗结果。据报道，对脱位骨折块进行保守治疗会导致腓骨远端不愈合和错位，踝关节窝不协调，需要进行翻修。嵌压骨折（3型）可导致胫骨前外侧平台继发性缺血性坏死。
