Wagstaffe-Le Fort Fracture
The fracture of the distal fibula caused by avulsion from the distal tibia is called a Wagstaffe-Le Fort fracture, which represents an avulsion of the anterolateral distal fibula at the attachment of the anterior inferior tibiofibular ligament (AITFL).
Fracture Mechanism and Classification
This injury occurs when the distal tibia causes an avulsion fracture of the anterolateral aspect of the distal fibula through tension forces transmitted via the AITFL during external rotation or supination-external rotation ankle injuries 1, 2.
The Wagstaffe-Le Fort fracture is also referred to as the "anterior malleolus" fracture and represents a component of the broader spectrum of ankle fracture-dislocations involving syndesmotic injury 2.
This fracture pattern is frequently associated with Maisonneuve fractures, where injury to the anterior and interosseous tibiofibular ligaments occurs alongside proximal fibular fractures 1, 2.
Associated Injuries and Diagnostic Considerations
The American College of Radiology recommends standard radiographic protocols including anteroposterior, lateral, and mortise views to properly assess fracture stability 3, 4.
CT examination is essential for comprehensive assessment, as the Wagstaffe-Le Fort fragment may be part of a complex injury pattern that includes posterior malleolar fractures (77% incidence), medial malleolar fractures (39% incidence), or complete deltoid ligament disruption (51% incidence) 1, 2.
Weight-bearing radiographs can detect dynamic abnormalities such as joint malalignment and syndesmotic instability that may not be apparent on non-weight-bearing films 3.
Clinical Significance
The presence of a Wagstaffe-Le Fort fracture indicates disruption of the anterior tibiofibular ligament and potential syndesmotic instability, which requires careful assessment of the medial clear space (stability confirmed if <4mm) 3, 4.
Intra- or postoperative 3D CT visualization is essential for assessment of the accuracy of reduction of the distal fibula into the fibular notch when surgical management is pursued 2.