Wagstaffe-Le Fort Fracture

Description

Wagstaffe-Le Fort Fracture: vertical avulsion fracture of the medial aspect (anteromedial) of the distal fibula due to avulsion of the anterior tibiofibular ligament attachment (ATFL). See also: Tillaux-Chaput avulsion fracture – anterolateral tibia avulsion

History of the Wagstaffe-Le Fort Fracture

1875 – William Warwick Wagstaffe reviewed 62 ankle fractures sustained between 1866-1868 following direct and indirect violence. He recorded 2 cases in which he could find ‘no parallel instance to the two which are subjoined‘. Wagstaffe original description:

I find in none of the standard works to which I have able to refer any mention of cases in which the fracture was of the character found in the two cases here recorded. The peculiar feature of these cases was the existence of a vertical fracture of the fibula in its lower end, with a displacement of the fractured portion in such a way that it was twisted round on its long axis.

Wagstaffe 1875

1886 – Léon Clément Le Fort described the same vertical fracture of the anteromedial portion of the fibula (Wagstaffe tubercle) suggesting it was at the site of the anterior inferior tibiofibular ligament (AITFL) insertion. He observed and described 3 clinical cases of isolated fracture of the anterior margin of the lateral malleolus corresponding to the attachment of the ligamentum malleoli lateralis anterius. In his opinion the fracture was produced by forced supination-adduction of the foot.

2002 – Park et al reviewed AITFL avulsion fracture classification. The Wagstaffe fracture (isolated vertical fracture of the distal fibula avulsed by the anterior tibiofibular ligament) was classified as type I, or primary Wagstaffe fracture)

Types of Wagstaffe fractures. (A) Type I, displaced avulsion fracture of the distal end of the fibula. (B) Type II, fracture of the anterior spike of the proximal fibular fragment. (C) Type III, fractures of the anterior tubercles from both of the tibia and fibula

Park et al 2002

2019 – Birnie et al proposed a new AITFL avulsion fracture classification system

Associated Persons

• William Warwick Wagstaffe (Sr) (1843-1910)
• Léon Clément Le Fort (1829–1893)

Alternative names

• Wagstaffe-Le Fort Fracture
• Le Fort-Wagstaffe Fracture
• Wagstaffe Ankle Fracture
• Le Fort Ankle Fracture

References

Original articles

• Wagstaffe W. An unusual form of fracture of the fibula. St. Thomas’s Hospital reports. 1875; 6: 43-49
• Le Fort LC. Note sur une variété non decrite de fracture verticale de la malleole externe par arrachement. Bulletin général de thérapeutique médicale, chirurgicale, obstétricale et pharmaceutique. 1886; 110: 193-199 [Note on an undescribed variety of vertical fracture of the lateral malleolus by avulsion.]

Historical review

• Park JW, Kim SK, Hong JS, Park JH. Anterior tibiofibular ligament avulsion fracture in weber type B lateral malleolar fracture. J Trauma. 2002; 52(4): 655-9.
• Somford MP, Wiegerinck JI, Hoornenborg D, van den Bekerom MPJ. Ankle fracture eponyms. JBJS 2013; 95(24): e198
• Birnie MFN et al. Anterior inferior tibiofibular ligament avulsion fractures in operatively treated ankle fractures: a retrospective analysis. Arch Orthop Trauma Surg. 2019; 139(6): 787-793
• Fisher A et al. The anatomy of the anterior inferior tibiofibular ligament and its relationship with the Wagstaffe fracture. Foot Ankle Surg. 2021 Apr;27(3):291-295.
• Kikuchi S et al. Characteristic features of the insertions of the distal tibiofibular ligaments on three-dimensional computed tomography- cadaveric study. J Exp Orthop. 2020 Jan 23;7(1):3
• Eponymythology: Eponymous Foot, ankle and talus injuries. LITFL