An avulsion fracture of the fibula at the insertion of the AITFL is called what?

• A. Weber fracture
• B. Tillaux fracture
• C. Maisonneuve fracture
• D. Wagstaffe fracture

Answer: (B)

Recognize that this is a Wagstaffe fracture: an avulsion of a small piece of the distal fibula at the insertion of the anterior inferior tibiofibular ligament. The AITFL pulls on the distal fibula during ankle external rotation, and sometimes this traction causes a fragment to break off anterolaterally. This injury is often associated with syndesmotic injury and can occur as part of the Wagstaffe-Le Fort spectrum if a proximal fibula fracture accompanies it (Maisonneuve-type scenario).

This is distinct from a Weber fracture, which is a fibular fracture at the level of the ankle joint (distal to the syndesmosis) rather than an avulsion at the ligament insertion. It is also different from a Tillaux fracture, which involves the distal tibial epiphysis in adolescents, and from a Maisonneuve fracture, which centers on a proximal fibular fracture with distal ankle instability.