3%), victims of motorcycle accidents used protective boots at the time of the accident. This information is not available for our patients, but since it is especially a statistical data of this city, it is quite likely that the frequency of use of protective boots is similar. The Brazilian Traffic Code considers a violation only not wearing the helmet, not referring to other protective equipment. The use of boots with high torsional stiffness could prevent ankle fractures. New studies specifically studying malleolar fractures in motorcycle accidents are needed to a better understanding of the injury mechanics in order to support the creation of laws regarding motorcyclists’ self-protection equipment. The distribution of lesions according to the AO classification, which is the Danis-Weber rating added with subtypes, shows a predominance of type B (56.

2%), which is most often studied type of injury in Brazilian literature. We found no epidemiological studies of malleolar fractures that show the relative distribution of the three different types of classification. The finding that 37.0% of fractures of type C is important because it is the fibula fracture with syndesmosis injury, which treatment is more complex than type B. This fact is due to the difficulty in reducing the fibula fracture, particularly in C2 and C3 types, and to the need for perfect restoration of the t��bio-fibular conexion at the syndesmosis level. It is important to point out the high incidence of fractures in our series. There were 21 cases, 28% of the total, a much higher rate than that found by Baptista et al.

11 of 5.7% and by Santin et al. 12 of 8.8%. Besides the highest index, most of the fractures are of type III according to Gustilo and Anderson classification, nine cases or 42.9%. Of these, five cases were type IIIB, which were ought to be treated by local flaps or microsurgical flaps, through a highly complex procedure only available in few public hospitals. Even when it is possible to obtain adequate skin coverage, the prognosis of this type of fracture is usually not good. We have observed that many of these cases progress to a degeneration of the tibiotalar articulation of multifactor etiology, involving cartilage damage at the time of trauma, therefore, the bone destruction that cannot be adequately reconstructed, resulting sometimes in infection and adhesions of periarticular soft tissues.

It is quite common that an equinus contracture and a rigid ankle are the end result of a severe open malleolar fracture, regardless how adequate has been the therapeutic conduct, requiring additional procedures as tibiotalar arthrodesis or prosthetic ankle. Twenty two patients had associated injuries in other parts of the musculoskeletal system (30.1%). In total, 34 different lesions were found, the most Dacomitinib frequent injury of the ipsilateral foot of the ankle fracture found in 11 patients, i.e. 50.0% of patients had associated injuries.