NAVIGATE:
Pronation-Abduction

Hallmark:
- Short, oblique fracture of the fibula AT the level of the syndesmosis

Stage I
- Rupture of the deltoid ligament OR
- Fracture of the medial malleolous

Stage II
- Rupture of the anterior/posterior tibio-fibular ligament with possible avulsion

Stage III
- Short, oblique fracture of the fibula AT the level of the syndesmosis

Complete syndesmosis diastasis
Stage II has the possibility of having no fracture and is often mistaken as a high ankle sprain.

Stage II-III injuries are unstable.

Syndesmosis screw(s) is necessary.

Prefer one 4.5mm fully threaded cortical screw involving four cortices.

Short, oblique fibular fracture

No fracture seen

Stress external rotation

Syndesmosis screw