A New Classification Framework for Distal Fibula Avulsion Fractures Utilizing Arthroscopy-Assisted Assessment and Its Implications for Surgical and Rehabilitation Approaches

By
Linguo He
Qiang Teng
Wenrui Wu
Fangling Wang
Boyuan Zheng
Dahai Hu
Xiaofei Zheng
Huige Hou
September 10, 2026

Frontiers In Medicine

Objective:

To develop a novel classification system for distal fibular avulsion fractures and provide guidance for surgical management and rehabilitation strategies.

Approach:

Patient Data: Included 152 patients diagnosed with distal fibular avulsion fractures from February 1, 2019, through April 30, 2023.
Arthroscopic Assessment: Utilized arthroscopic observations to identify fracture characteristics and document concomitant intra-articular pathology.
Classification System: Fractures categorized based on bone-fragment size and its relationship with ligaments into types A1, A2, B1, B2, C1, and C2.

Key Findings:

Cohort comprised 45 females and 107 males.
Fractures categorized as A1 (n = 9 [6.0%]), A2 (n = 31 [20.3%]), B1 (n = 62 [40.8%]), B2 (n = 33 [21.7%]), C1 (n = 13 [8.6%]), C2 (n = 4 [2.6%]).
82.9% of avulsion fractures were located in the anterior and junctional areas.
Fracture type associated with pathological soft tissue in the anterior compartment (p < 0.001) and osteochondral defects (p = 0.035).

Interpretation:

A novel classification system for distal fibular avulsion fractures was established.

Limitations:

Study limited to a single institution.
Potential selection bias in patient enrollment.

Conclusion:

The classification system provides a structured approach for managing distal fibular avulsion fractures.

A New Classification Framework for Distal Fibula Avulsion Fractures Utilizing Arthroscopy-Assisted Assessment and Its Implications for Surgical and Rehabilitation Approaches

Objective:

Approach:

Key Findings:

Interpretation:

Limitations:

Conclusion:

Original Source(s)

A novel classification system for avulsion fractures of the distal fibula based on arthroscopy-assisted measurement and significance to surgery and rehabilitation

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