2 A short history of ankle fractures
3 Development of radiological classifications Although the first attempts at classifying ankle fractures date back to the preradiological era, these classification schemes were based exclusively on experiments. Only after the introduction of radiological examination was it possible to open a clinically relevant debate about this issue.
3.1
Chaput classification
The first classification of ankle fractures reflecting radiographic findings was published by Chaput in 1907 [13]. He based it on experimental studies of his predecessors, particularly Tillaux, and distinguished between four basic groups of fractures: • Abduction fractures • Adduction fractures • Supramalleolar fractures caused by adduction or abduction • Comminuted fractures
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The first classification of ankle fractures reflecting radiographic findings was published by Chaput in 1907.
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The first two groups are fracture dislocations, while the third and fourth groups include pilon fractures. Ample drawings used in the text show that Chaput had a good knowledge of all types of fibular fractures in terms of the level of fracture line. He described in great detail the fractures of the medial malleolus and fractures of the posterior rim of the distal tibia, distinguishing between different sizes of the avulsed fragment. He repeatedly mentioned Tillaux experimental studies and the fragment of anterior tubercle of the distal tibia described by him (Tillaux’s fragment externe) known today as the Tillaux-Chaput tubercle or fragment. 3.2
Destot classification
In 1911, Destot [14] introduced a concept which remains relevant today, consisting in division of ankle fractures into those compromising the stability of fracture dislocations, ie, fractures which involve only the mortise and disturb the equilibrium of the foot, versus those involving the “pilon tibial” or the tibial “pestle”, ie, the support of the body. Both groups were subdivided into individual patterns (Fig 2-5). 3.3
Tanton classification
Another classification of ankle fractures was published in 1916 by Tanton [10] who based it on the Destot’s concept, ie, distinguishing between malleolar and pilon fractures. Malleolar fractures were subdivided into the isolated (medial or lateral malleolus) and the associated ones. The latter group included four fracture patterns, according to the level of the fibular fracture in relation to the syndesmosis (Fig 2-6): • Fractures bi-malléolaires basses (Weber A type) • Fractures de Dupuytren basses (Weber B type) • Fractures de Dupuytren types (low Weber C type) • Fractures de Maisonneuve (high Weber C type) Pilon fractures were divided into total and partial ones. In the latter group, he distinguished between isolated fractures and fractures combined with malleolar fractures. Therefore, pilon fractures included also fractures of both malleoli with
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The Foot: Arts, Myths, and Secrets Stefan Rammelt, Hans Zwipp
