Wagstaffe–Le Fort avulsion fracture

Wagstaffe–Le Fort avulsion fracture is a specific type of ankle fracture characterized by an avulsion fracture of the anterolateral aspect of the distal fibula. This injury is less common than other ankle fractures and is named after the surgeons who first described it, William Warwick Wagstaffe and René Le Fort. The Wagstaffe–Le Fort avulsion fracture is often associated with ligament injuries due to the mechanism of injury, which typically involves a forceful inversion of the foot.

Etiology

The Wagstaffe–Le Fort avulsion fracture occurs when there is a forceful inversion of the foot, leading to tension on the lateral ligaments of the ankle, particularly the anterior talofibular ligament (ATFL). This tension can cause a fragment of the fibula to avulse (or pull away) from the main bone. This type of injury is often seen in athletes and individuals who experience a twisting injury to the ankle.

Clinical Presentation

Patients with a Wagstaffe–Le Fort avulsion fracture typically present with pain, swelling, and tenderness over the lateral aspect of the ankle. The pain is exacerbated by movement, especially inversion and dorsiflexion of the foot. Physical examination may reveal bruising and an inability to bear weight on the affected limb.

Diagnosis

Diagnosis of a Wagstaffe–Le Fort avulsion fracture is primarily based on the clinical presentation and radiographic findings. X-rays of the ankle in various projections (anteroposterior, lateral, and mortise views) are essential to identify the avulsion fracture and assess its size and displacement. In some cases, advanced imaging techniques such as Computed Tomography (CT) scans or Magnetic Resonance Imaging (MRI) may be required to evaluate the extent of the injury and associated ligamentous damage.

Treatment

The treatment of Wagstaffe–Le Fort avulsion fractures depends on the size of the avulsed fragment and the degree of displacement. Non-displaced or minimally displaced fractures can often be managed conservatively with immobilization in a cast or boot for a period of 4 to 6 weeks, followed by physical therapy to restore range of motion and strength. Surgical intervention may be necessary for fractures with significant displacement or those involving a large portion of the articular surface. Surgical options include open reduction and internal fixation (ORIF) to realign and stabilize the fracture fragments.

Prognosis

The prognosis for patients with Wagstaffe–Le Fort avulsion fractures is generally good, especially with early diagnosis and appropriate treatment. Most patients are able to return to their normal activities within a few months. However, complications such as post-traumatic arthritis, stiffness, and chronic pain can occur, particularly in cases with delayed diagnosis or inadequate treatment.

Prevention

Prevention of Wagstaffe–Le Fort avulsion fractures involves measures to reduce the risk of ankle injuries, such as wearing appropriate footwear, engaging in exercises to strengthen the muscles around the ankle, and improving proprioception and balance.