Wagstaffe-Le Fort骨折とTillaux-Chaput骨折の病態，診断，治療法

Etiology, Diagnosis, and Treatment of Wagstaffe-Le Fort Fractures and Tillaux-Chaput Fractures

　背景：前下脛腓靱帯裂離骨折の腓骨側はWagstaffe-Le Fort骨折(WF骨折)，脛骨側はTillaux-Chaput骨折(TC骨折)と呼ばれ，その発生頻度，病態，治療法は明確でない．

　対象と方法：足関節果部骨折190例を後ろ向きに調査した．

　結果：Orthopaedic Trauma Association(OTA)分類44-A，B，CにおけるWF骨折の発生頻度は2％，10％，0％，TC骨折は0％，9％，32％だった．小骨片や損傷靱帯の処置は行われていなかったが，臨床的不安定性は生じていなかった．

　まとめ：WF骨折は主にOTA分類44-Bに，TC骨折は主にOTA分類44-Cに発生する．診断にはCTが必須である．当骨折に対する手術適応は転位した巨大骨片，関節内陥入などに限られるべきと考える．

　Background：The purpose of this study was to clarify the incidence, etiology, and treatment of anterior inferior tibiofibular ligament avulsion fractures of the anterior fibular tubercle (Wagstaffe-Le Fort fractures) and of the anterior tibial tubercle (Tillaux-Chaput fractures).

　Methods：We performed a retrospective study of 190 ankle malleolar fractures in adults.

　Results：The incidence of Wagstaffe-Le Fort fractures in Orthopaedic Trauma Association classification (OTA) 44-A, 44-B, and 44-C type fractures was 2%, 10%, and 0%, respectively, and the corresponding incidence of Tillaux-Chaput fractures was 0%, 9%, and 32%, respectively.　No invasive procedures to treat small avulsion fragments and ruptured ligaments resulted in any clinical instability of the ankle.

　Conclusions：The prevalence of Wagstaffe-Le Fort fractures and Tillaux-Chaput fractures was high in OTA 44-B and 44-C type fractures, respectively.　Computed tomography was essential to demonstrating the severity of the avulsion fractures.　Open reduction and internal fixation with a lag screw is useful for treating fractures with large displaced fragments.