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Internal Rotation of the Proximal Fibular Fragment Producing Symptomatic Tibiofibular Impingement after an SER-II Ankle Fracture: A Case Report

The Lauge-Hansen classification of ankle fractures originally characterized the displacement of the distal fibula in a supination-external rotation stage II (SER-II) fracture as external rotation.6 More recent studies using CT suggest that the distal fibular fragment is not actually displaced but in its anatomic position relative to the talus in this stable fracture pattern3,9 and that it is internal rotation of the proximal fibular fragment relative to the tibia that produces the appearance of distal fibular displacement. Michelson7 and others1,5,9 proposed that this proximal fibular internal rotation results in no change in normal ankle biomechanics and, at least in part, explains the excellent prognosis with nonoperative treatment of SER-II ankle fractures. The current report suggests that internal rotation of the proximal fibular fragment in an SER-II fracture may not always be a benign finding. We describe a case of symptomatic tibiofibular impingement that resulted from proximal fibular internal rotation after an SER-II ankle fracture. The patient improved significantly after tibiofibular decompression.