Journal of Foot and Ankle Surgery (Asia Pacific)

Register      Login

VOLUME 4 , ISSUE 2 ( July-December, 2017 ) > List of Articles

RESEARCH ARTICLE

Management of Fracture of Posterior Malleolus, Trimalleolar Fracture, Fracture Dislocations, and Syndesmosis Injury of Ankle Joint

Satish R Gawali, Raman O Toshniwal, Shashikant B Kukale,, Pramod V Nirvane,

Citation Information : Gawali SR, Toshniwal RO, Kukale, SB, Nirvane, PV. Management of Fracture of Posterior Malleolus, Trimalleolar Fracture, Fracture Dislocations, and Syndesmosis Injury of Ankle Joint. J Foot Ankle Surg Asia-Pacific 2017; 4 (2):90-96.

DOI: 10.5005/jp-journals-10040-1077

License: CC BY 3.0

Published Online: 01-04-2009

Copyright Statement:  Copyright © 2017; The Author(s).


Abstract

Background

Malleolar fractures of ankle are usually complex injuries, as they are associated with significant ligament and soft tissue injury—injury to syndesmosis and injury to medial and lateral collateral ligaments. The open reduction and internal fixation is not feasible until recovery of significant soft tissue injury and subsidence of edema. Malleolar fractures are articular fractures and have associated subluxation and dislocation of talus. The aims of treatment are to restore normal anatomy and provide sufficient stability for early movements.

Malleolar fractures more often require open reduction. Our study aimed to know efficacy and outcome of operative management of them.

Materials and methods

From January 2013 to March 2015, 35 patients with syndesmotic ankle injury and trimalleolar ankle fractures admitted to the Government Medical College, Latur, India, were operated and followed up prospectively.

Results

Mean age of patients is 35 years (25–60 years). Fracture union was seen radiologically in 3 to 4 months depending on fracture geometry. We achieved good to excellent results of 90%.

Conclusion

We conclude that malleolar fractures encountered in clinical practice need thorough assessment and meticulous surgical intervention, as they are associated with injury to ligament complex, i.e., ligament is a key structure in the stability of ankle mortise. Abduction and external rotation types of injuries are the most common types to be seen. We achieved stable fixation and performed early mobilization of the ankle joint, which limits the complications of mainly ankle stiffness. Each malleolus has got its inherent associated complications and calls for special attention for identifying associated conditions, such as syndesmotic injury, talus dislocation in posterior malleolar fractures, irreducible ankle dislocation with trimalleolar fracture, and entrapped fibula behind tibia with irreducible dislocation.

How to cite this article

Gawali SR, Kukale SB, Nirvane PV, Toshniwal RO. Management of Fracture of Posterior Malleolus, Trimalleolar Fracture, Fracture Dislocations, and Syndesmosis Injury of Ankle Joint. J Foot Ankle Surg (Asia-Pacific) 2017;4(2):90-96.


HTML PDF Share
  1. Complication of fractures and dislocation of the ankle. In: EPPS, Charles H, editors. Complications in orthopaedic surgery. Chap. 23. 3rd ed. Vol. 1. Philadelphia (PA): J.B. Lippincott Company; 1994. p. 595-648.
  2. Surgical treatment of malleolar fractures–a review of 144 patients. Clin Orthop Relat Res 1997 Aug;341:90-98.
  3. Ankle fractures and dislocations. In: Chapman MW, Madison M, editors. Operative orthopaedics. Chap. 50. 2nd ed. Vol. 3. Philadelphia (PA): J.B. Lippincott Company; 1993. p. 731-748.
  4. Fractures and dislocations of the ankle. In: Rockwood CA, Green DP, editors. Fractures in adults. Chap. 18. 2nd ed. Vol. 2. Philadelphia (PA): J.B. Lippincott Company; 1991. p. 1983-2040.
  5. Fractures and dislocations about the ankle. In: Gustilo RB, Kyle RF, Templeman D, editors. Fractures and dislocations. Chap. 30. Vol. 2. St. Louis (MO): Mosby Year book Inc.; 1993. p. 997-1043.
  6. The key role of the lateral malleolus in displaced fractures of the ankle. J Bone Joint Surg 1977 Mar;59(2):169-173.
  7. Ankle fractures. In: Scurran BL, editor. Foot and ankle trauma. Chap. 28. New York: Churchill Livingstone; 1989. p. 579-638.
  8. ; Savoie, FH.; Hughes, JL. Fractures of the ankle. In: Rockwood CA, Green DP, Bucholz RW, editors. Rockwood and Green's fractures in adults. Chap. 23. 3rd ed. Vol. 2. Philadelphia (PA): J.B. Lippincott Company; 1991. p. 1983-2040.
  9. Displaced ankle fractures in patients over 50 years of age. J Bone Joint Surg Br 1983 May;65(3):329-332.
  10. Fitzpatrick T, Van Herpe LB. Quantitative criteria for prediction of the results after displaced fracture of the ankle. J Bone Joint Surg 1983 Jun;65(5):667-677.
  11. The timing of ankle fracture surgery and the effect on infectious complications; a case series and systematic review of the literature. Int Orthop 2013 Mar;37(3):489-494.
  12. Clinical outcomes following ankle fracture: a cross-sectional observational study. J Foot Ankle Res 2014 Nov;7(1):50.
  13. Prediction of outcome after ankle fracture. J Orthop Sports Phys Ther 2005 Dec;35(12):786-792.
  14. Functional outcome after operative treatment for ankle fractures in young athletes: a retrospective case series. Foot Ankle Int 2008 Sep;29(9):887-894.
  15. Surgical techniques of open reduction and internal fixation for ankle fracture. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2008 Apr;22(4):456-458.
  16. Surgical treatment of pronation and supination external rotation trimalleolar fractures. Zhongguo Gu Shang 2008 Apr;21(4):300-301.
  17. Operative treatment of ankle fracture-dislocations. Clin Orthop Relat Res 1985 Oct;199:28-38.
  18. Open ankle fractures. The indications for immediate open reduction and internal fixation. Clin Orthop Relat Res 1993 Jul;292:118-127.
  19. Outcomes of operative treatment of unstable ankle fractures: a comparison of metallic and biodegradable implants. J Bone Joint Surg Am, 2012 Nov;94(22):e166.
  20. Minimally invasive osteosynthesis of ankle fractures. Pol Orthop Traumatol 2012 Nov;77:145-150.
  21. Laterally comminuted fracture-dislocation of the ankle. J Bone Joint Surg Am 1987 Jul;69(6):881-885.
  22. Malleolar fractures: nonoperative versus operative treatment. Clin Orthop Relat Res 1985 Oct;199:17-27.
  23. Total dislocation of the talus. J Bone Joint Surg Am 1980 Dec;62(8):1370-1372.
  24. Early complications in the operative treatment of ankle fractures. Influence of delay before operation. J Bone Joint Surg (Br) 1991 Jan;73(1):79-82.
  25. Early postoperative ankle exercise: a study of postoperative lateral malleolar fractures. Clin Orthop Relat Res 1994 Mar;300:193-196.
  26. A prospective randomised control study comparing early mobilisation versus immobilization of surgically treated ankle fractures (abstract). J Bone Joint Surg Br 1997 Sep;79(Suppl 3):367-368.
  27. Early weight bearing following ORIF of posterior malleolar fractures of the ankle joint. J Bone Joint Surg Br 1999;81-B(Suppl II):181.
  28. ; Tsao, AK.; Hughes, JL. Fractures and injuries of ankle. In: Rockwood CA, Green DP, bucholz RW, Heckman JD, editors. Rockwood and Green's fractures in adults. Chap. 31. 4th ed. Vol. 2. Philadelphia (PA): Lippincott Raven; 1996. p. 2201-2266.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.