Beyond the Malleoli: Part 1—Avulsion Fractures of the Tibia and Fibula

Avulsion fractures of the ankle and hindfoot are a diverse group of injuries occurring at level of retinacular, capsuloligamentous, and tendinous attachments. Even small fracture fragments have the potential to cause serious complications (such as ankle instability and accelerated osteoarthritis in the context of avulsion fractures of the surrounding capsuloligamentous supporting structures), if not treated appropriately. This article describes the relevant anatomy, injury mechanisms, classification, nomenclature, imaging, treatment, and complications of ankle and hindfoot avulsion fractures, with the exception of fractures occurring at and in the vicinity of the medial and lateral malleolar tips. In this part 1 of a two-part series, we provide a review of ankle retinacular and distal tibiofibular syndesmotic avulsion fractures.