Tibia/Fibula

BONE: TIBIA/FIBULA (4) Location: Proximal segment (41)

Types: A. Extra-articular (41-A) B. Partial articular (41-B) C. Complete articular (41-C)

Groups: Tibia/fibula, proximal, extra-articular (41-A) Tibia/fibula, proximal, partial articular (41-B) Tibia/fibula, proximal, complete articular (41-C) 1. Avulsion 2. Metaphy- 3. Metaphyseal 1. Pure split 2. Pure de- 3. Split de- 1. Articular 2. Articular 3. Articular (41-A1) seal simple multifragmen- (41-B1) pression pression simple, meta- simple, meta- multifrag- (41-A2) tary (41-A3) (41-B2) (41-B3) physeal simple physeal multi- mentary (41-C1) fragmentary (41-C3) (41-C2)

Subgroups and Qualifications: Tibia/fibula, proximal, extra-articular, avulsion (41-A1) 1. Of fibular head (41-A1.1) 2. Of tibial tuberosity (41-A1.2) 3. Of cruciate insertion (41-A1.3) (1) anterior (2) posterior

Tibia/fibula, proximal, extra-articular, simple metaphysis (41-A2) 1. Oblique in frontal plane (41-A2.1) 2. Oblique in sagittal plane (41-A2.2) 3. Transverse (41-A2.3)

Tibia/fibula, proximal, extra-articular, multifragmentary metaphysis (41-A3) 1. Intact wedge (41-A3.1) 2. Fragmented wedge (41-A3.2) 3. Complex (41-A3.3) (1) lateral (1) lateral (1) slightly displaced (2) medial (2) medial (2) significantly displaced

Tibia/fibula, proximal, partial articular, split (41-B1) 1. Of lateral surface (41-B1.1) 2. Of medial surface (41-B1.2) 3. Oblique, involving the tibial spines (1) marginal (1) marginal and 1 of the surfaces (41-B1.3) (2) sagittal (2) sagittal (1) lateral (3) frontal anterior (3) frontal anterior (2) medial (4) frontal posterior (4) frontal posterior

Tibia/fibula, proximal, partial articular, depression (41-B2) 1. Lateral total (41-B2.1) 2. Lateral limited (41-B2.2) 3. Medial (41-B2.3) (1) 1 piece (1) peripheral (1) central (2) mosaic-like (2) central (2) anterior (3) anterior (3) posterior (4) posterior (4) total

Tibia/fibula, proximal, partial articular, split depression (41-B3) 1. Lateral (41-B3.1) 2. Medial (41-B3.2) 3. Oblique involving the tibial spines (1) antero-lateral depression (1) antero-lateral depression and 1 of the surfaces (41-B3.3) (2) postero-lateral depression (2) postero-lateral depression (1) lateral (3) antero-medial depression (3) antero-medial depression (2) medial (4) postero-medial depression (4) postero-medial depression

Tibia/fibula, proximal, complete articular, simple articular, simple metaphysis (41-C1) (1) intact anterior tibial tubercle and intercondylar eminence (2) anterior tibial tubercle involved (3) intercondylar eminence involved 1. Slight displacement (41-C1.1) 2. 1 condyle displaced (41-C1.2) 3. Both condyles displaced (41-C1.3)

Tibia/fibula, proximal, complete articular, articular simple, metaphysis multifragmentary (41-C2) 1. Intact wedge (41-C2.1) 2. Fragmented wedge (41-C2.2) 3. Complex (41-C2.3) (1) lateral (1) lateral (2) medial (2) medial

Tibia/fibula, proximal, complete articular, articular multifragmentary (41-C3) (1) metaphyseal simple (2) metaphyseal lateral wedge (3) metaphyseal medial wedge (4) metaphyseal complex (5) metaphysio-diaphyseal complex 1. Lateral (41-C3.1) 2. Medial (41-C3.2) 3. Lateral and medial (41-C3.3)

BONE: TIBIA/FIBULA (4) Location: Diaphyseal segment (42)

Types: A. Simple (42-A) B. Wedge (42-B) C. Complex (42-C)

Groups: Tibia/fibula, diaphyseal, simple (42-A) Tibia/fibula, diaphyseal, wedge (42-B) Tibia/fibula, diaphyseal, complex (42-C) 1. Spiral (42-A1) 2. Oblique 3. Transverse 1. Spiral wedge 2. Bending 3. Frag- 1. Spiral 2. Segmented 3. Irregular Ն ( 30°) (42-A2) (Ͻ30°) (42-B1) wedge (42-B2) mented (42-C1) (42-C2) (42-C3) (42-A3) wedge (42-B3)

Subgroups and Qualifications: Tibia/fibula, diaphyseal, simple, spiral (42-A1) (1) proximal zone (2) middle zone (3) distal zone 1. Fibula intact (42-A1.1) 2. Fibula fracture at different level 3. Fibula fracture at same level (42-A1.2) (42-A1.3)

Tibia/fibula, diaphyseal, simple, oblique (Ն30°) (42-A2) (1) proximal zone (2) middle zone (3) distal zone 1. Fibula intact (42-A2.1) 2. Fibula fracture at different level 3. Fibula fracture at same level (42-A2.2) (42-A2.3)

Tibia/fibula, diaphyseal, simple, transverse (<30°) (42-A3) (1) proximal zone (2) middle zone (3) distal zone 1. Fibula intact (42-A3.1) 2. Fibula fracture at different level 3. Fibula fracture at same level (42-A3.2) (42-A3.3)

Tibia/fibula, diaphyseal, wedge, spiral (42-B1) (1) proximal zone (2) middle zone (3) distal zone 1. Fibula intact (42-B1.1) 2. Fibula fracture at different level 3. Fibula fracture at same level (42-B1.2) (42-B1.3)

Tibia/fibula, diaphyseal, wedge, bending (42-B2) (1) proximal zone (2) middle zone (3) distal zone 1. Fibula intact (42-B2.1) 2. Fibula fracture at different level 3. Fibula fracture at same level (42-B2.2) (42-B2.3)

Tibia/fibula, diaphyseal, wedge fragmented (42-B3) (1) proximal zone (2) middle zone (3) distal zone 1. Fibula intact (42-B3.1) 2. Fibula fracture at different level 3. Fibula fracture at same level (42-B3.2) (42-B3.3)

Tibia/fibula, diaphyseal, complex, spiral (42-C1) (1) pure diaphyseal (2) proximal diaphysio-metaphysis (3) distal diaphysio-metaphysis 1. With 2 intermediate fragments 2. With 3 intermediate fragments 3. With more than 3 intermediate (42-C1.1) (42-C1.2) fragments (42-C1.3)

Tibia/fibula, diaphyseal, complex segmental (42-C2) 1. With an intermediate segmental 2. With an intermediate segmental 3. With 2 intermediate segmental fragment (42-C2.1) and additional wedge fragment(s) fragments (42-C2.3) (1) pure diaphyseal (42-C2.2) (1) pure diaphyseal (2) proximal diaphysio-metaphyseal (1) pure diaphyseal (2) proximal diaphysio-metaphyseal (3) distal diaphysio-metaphyseal (2) proximal diaphysio-metaphyseal (3) distal diaphysio-metaphyseal (4) oblique lines (3) distal diaphysio-metaphyseal (5) transverse and oblique lines (4) distal wedge (5) 3 wedges, proximal and distal

Tibia/fibula, diaphyseal, complex, irregular (42-C3) 1. With 2 or 3 intermediate fragments 2. Limited shattering (Ͻ4cm) 3. Extensive shattering (Ͼ4cm) (42-C3.1) (42-C3.2) (42-C3.3) (1) 2 intermediate fragments (1) pure diaphyseal (2) 3 intermediate fragments (2) proximal diaphysio-metaphyseal (3) distal diaphysio-metaphyseal

BONE: TIBIA/FIBULA (4) Location: Distal segment (43)

Types: A. Extra-articular (43-A) B. Partial articular (43-B) C. Complete articular (43-C)

Groups: Tibia/fibula, distal, extra-articular (43-A) Tibia/fibula, distal, partial articular (43-B) Tibia/fibula, distal, complete articular (43-C) 1. Metaphyseal 2. Metaphy- 3. Metaphy- 1. Pure split 2. Split de- 3. Multifragmen- 1. Articular 2. Articular 3. Articular simple (43-A1) seal wedge seal complex (43-B1) pression tary depression simple, meta- simple, meta- multifragmen- (43-A2) (43-A3) (43-B2) (43-B3) physis simple physis multi- tary (43-C3) (43-C1) fragmentary (43-C2)

Subgroups and Qualifications: Tibia/fibula, distal, extra-articular, simple (43-A1) (1) fibula intact (2) simple fracture of fibula (3) multifragmentary fracture of fibula (4) bifocal fracture of fibula 1. Spiral (43-A1.1) 2. Oblique (43-A1.2) 3. Transverse (43-A1.3)

Tibia/fibula, distal, extra-articular, wedge (43-A2) (1) fibula intact (2) simple fracture of fibula (3) multifragmentary fracture of fibula (4) bifocal fracture of fibula 1. Posterolateral impaction (43-A2.1) 2. Anteromedial wedge (43-A2.2) 3. Extending into diaphysis (43-A2.3)

Tibia/fibula, distal, extra-articular, complex (43-A3) (1) fibula intact (2) simple fracture of fibula (3) multifragmentary fracture of fibula (4) bifocal fracture of fibula 1. With 3 intermediate fragments 2. More than 3 intermediate frag- 3. Extending into diaphysis (43-A3.3) (43-A3.1) ments (43-A3.2)

Tibia/fibula, distal, partial articular, pure split (43-B1) (1) fibula intact (2) simple fracture of fibula (3) multifragmentary fracture of fibula (4) bifocal fracture of fibula 1. Frontal (43-B1.1) 2. Sagittal (43-B1.2) 3. Metaphyseal multifragmentary (5) anterior (5) lateral (43-B1.3) (6) posterior (Volkmann) (6) medial (medial malleolus)

Tibia/fibula, distal, partial articular, split depression (43-B2) (1) fibula intact (2) simple fracture of fibula (3) multifragmentary fracture of fibula (4) bifocal fracture of fibula 1. Frontal (43-B2.1) 2. Sagittal (43-B2.2) 3. Of the central fragment (43-B2.3) (5) anterior (5) lateral (6) posterior (6) medial

Tibia/fibula, distal, partial articular, depression (43-B3) (1) fibula intact (2) simple fracture of fibula (3) multifragmentary fracture of fibula (4) bifocal fracture of fibula 1. Frontal (43-B3.1) 2. Sagittal (43-B3.2) 3. Metaphyseal, multifragmentary (5) anterior (5) lateral (43-B3.3) (6) posterior (6) medial

Tibia/fibula, distal, complete articular, articular simple, metaphyseal simple (43-C1) (1) fibula intact (2) simple fracture of fibula (3) multifragmentary fracture of fibula (4) bifocal fracture of fibula 1. Without impaction (43-C1.1) 2. With epiphyseal depression 3. Extending into diaphysis (43-C1.3) (5) frontal plane (43-C1.2) (6) sagittal plane

Tibia/fibula, distal, complete articular, articular simple, multifragmentary metaphysis (43-C2) (1) fibula intact (2) simple fracture of fibula (3) multifragmentary fracture of fibula (4) bifocal fracture of fibula 1. With asymmetric impaction 2. Without asymmetric impaction 3. Extending into diaphysis (43-C2.3) (43-C2.1) (43-C2.2) (5) frontal plane split (6) sagittal plane split

Tibia/fibula, distal, complete articular, articular multifragmentary (43-C3) (1) fibula intact (2) simple fracture of fibula (3) multifragmentary fracture of fibula (4) bifocal fracture of fibula 1. Epiphyseal (43-C3.1) 2. Epiphysio-metaphyseal (43-C3.2) 3. Epiphysio-metaphysio-diaphyseal (43-C3.3)

BONE: TIBIA/FIBULA (4) Location: Malleolar segment (44)

Types: A. Infrasyndesmotic lesion (44-A) B. Transsyndesmotic fibula fracture (44-B) C. Suprasyndesmotic lesion (44-C)

Groups: Tibia/fibula, malleolar, infrasyndesmotic lesions Tibia/fibula, malleolar, transsyndesmotic fibula frac- Tibia/fibula, malleolar, suprasyndesmotic (44-C) (44-A) ture (44-B) 1. Isolated 2. With me- 3. With 1. Isolated 2. With me- 3. With me- 1. Simple dia- 2. Multifrag- 3. Proximal (44-A1) dial malleolar postero-medial (44-B1) dial lesion dial lesion physeal fibular mentary frac- fibula (44-C3) fracture fracture (44-B2) and fracture (44-C1) ture of fibular (44-A2) (44-A3) Volkmann diaphysis (fracture of (44-C2) the posterolateral rim) (44-B3)

Subgroups and Qualifications: Tibia/fibula, malleolar, infrasyndesmotic, isolated (44-A1) 1. Rupture of lateral collateral 2. Avulsion of tip of lateral malleolus 3. Transverse fracture of lateral malle- ligament (44-A1.1) (44-A1.2) olus (44-A1.3)

Tibia/fibula, malleolar, infrasyndesmotic lesion with medial malleolar fracture (44-A2) (1) transverse (2) oblique (3) vertical 1. Rupture of lateral collateral 2. Avulsion of tip of lateral malleolus 3. Transverse fracture of lateral malle- ligament (44-A2.1) (44-A2.2) olus (44-A2.3)

Tibia/fibula, malleolar, infrasyndesmotic lesion with postero-medial fracture (44-A3) 1. Rupture of lateral collateral 2. Avulsion of tip of lateral malleolus 3. Transverse fracture of lateral malle- ligament (44-A3.1) (44-A3.2) olus (44-A3.3)

Tibia/fibula, malleolar, transsyndesmotic, isolated (44-B1) 1. Simple (44-B1.1) 2. Simple with rupture of anterior 3. Multifragmentary (44-B1.3) syndesmosis (44-B1.2) (1) in substance (2) Chaput (anterior tibia) (3) Lefort (anterior fibula)

Tibia/fibula, malleolar, transsyndesmotic fracture with medial lesion (44-B2) 1. Simple, rupture of medial collateral 2. Simple with fracture of medial 3. Multifragmentary (44-B2.3) and anterior syndesmosis (44-B2.1) malleolus and rupture of anterior syn- (1) rupture of medial collateral ligament (1) in substance desmosis (44-B2.2) (2) fracture of medial malleolus (2) Chaput (1) in substance (3) Lefort (2) Chaput (3) Lefort

Tibia/fibula, malleolar, transsyndesmotic with medial lesion and a Volkmann (fracture of posterolateral rim) (44-B3) (1) extra-articular avulsion (2) peripheral articular fragment (3) significant articular fracture 1. Fibula simple with medial collateral 2. Simple fibula fracture with fracture 3. Multifragmentary with fracture of ligament rupture (44-B3.1) of medial malleolus (44-B3.2) medial malleolus (44-B3.3)

Tibia/fibula, malleolar, susprasyndesmotic, simple diaphyseal fracture of fibula (44-C1) 1. Rupture of medial collateral 2. With fracture of medial malleolus 3. With fracture of medial malleolus ligament (44-C1.1) (44-C1.2) and a Volkmann (Dupuytren) (44-C1.3) (1) extra-articular avulsion (2) peripheral articular fragment (3) significant articular fragment

Tibia/fibula, malleolar, suprasyndesmotic, multifragmentary fibular diaphyseal fracture (44-C2) 1. With rupture of medial collateral 2. With fracture of medial malleolus 3. With fracture of medial malleolus ligament (44-C2.1) (44-C2.2) and a Volkmann (Dupuytren) (44-C2.3) (1) extra-articular avulsion (2) peripheral articular fragment (3) significant articular fragment

Tibia/fibula, malleolar, suprasyndesmotic, proximal fibular lesion (44-C3) (1) fracture through neck (2) fracture through head (3) proximal tibiofibular dislocation (4) rupture of medial collateral ligament (5) fracture of medial malleolus (6) articular fragment 1. Without shortening, without 2. With shortening, without 3. Medial lesion and a Volkmann Volkmann (44-C3.1) Volkmann (44-C3.2) (44-C3.3)