The anatomy and insertion of the anterior inferior tibiofibular ligament and the wagstaffe fracture

M. Philpott, A. Fisher, L. Jayatilaka, L.-A. Lambert, L. Fisher, A. Bond, A. Molloy, L. Mason

Introduction: Our aim in this study was to identify the fibular footprint of the Anterior Inferior Tibiofibular Ligament (AITFL) and its relation to Wagstaffe fracture fragment size.

Methods: We examined 25 cadaveric lower limbs that had been preserved in a solution of formaldehyde. The lower limbs were carefully dissected to identify the ligamentous structures on the anterolateral aspect of the ankle. The AITFL anatomy was compared to Wagstffe fractures identified from our ankle fracture database. All ankles which had undergone CT imaging were included in the study.

Results: There were 13 right and 12 left feet used for dissection. The AITFL origin was from the anterior fibular tubercle with an average length of 21.49 mm (95% CI 20.14, 22.85). The average distance of the distal aspect of the AITFL footprint to the distal fibula margin was 11.60mm (95% CI 10.49, 12.71). 40 ankle fractures with Wagstaffe fracture fragments were identified from our database. The average age of the patients was 52.2 years. On average the length of the Wagstaffe fragment was 10.28mm (95% CI 8.12, 12.44). The average distance from the distal tip of the fibula to the Wagstaffe fracture fragment was 9.58mm (95% CI 20.14, 22.85)
In total there were 22 syndesmosis injuries, The average length of the Wagstaffe fragment associated with syndesmotic instability on testing was 11.25 (95% CI 7.66, 14.84). The average Wagstaffe fracture length in syndesmotic stable ankle fractures was 9.21 (95% CI 6.81, 11.61). The difference was not statistically significant p=0.462 (Mann-Whitney test).

Conclusion: The AITFL fibular origin was almost twice the length of the Wagstaffe fracture fragments seen in our institution. Therefore, this suggests that a ligamentous failure.