The Medial Malleolus in Ankle Fractures

Aim: To evaluate the surgical outcomes and complications of patients over 65 years of age, with unstable ankle fractures. Material and Method: The study included 111 patients (73F/38 M) operated on between January 2015 and February 2019 and followed up for a mean of 21.2 months (range, 6-62 months).Demographic characteristics, comorbidities, fracture type, and mechanisms of injury were evaluated. Relationships between postoperative complications and comorbidities were examined. In the postoperative functional evaluations, the AOFAS score was used and pre and postoperative mobilization (eg, use of assistive devices) was assessed. Results: The mean age of the patients was 70.5 ± 6.1 years (range, 65-90 years). The mechanism of trauma was low-energy trauma in 90.1% of the fractures and high-energy trauma in 9.9%. The fractures were formed with a SER injury (supination external rotation) in 83.7% of cases and bimalleolar fractures were seen most frequently (85/111, 76%).Complications developed in 16 (14.4%) patients and a second operation was performed in 11 (9.9%) patients with complications. Plate was removed and debridement was performed in 5 of 6 patients due to wound problems. Nonunion was developed in the medial malleolus in 4 patients. Revision surgery was performed because of implant irritation in 2 patients and early fixation loss in the medial malleolus fracture in one patient. Calcaneotibial arthrodesis was performed in 3 patients because of implant failure and ankle luxation associated with non-union. A correlation was determined between ASA score and DM and complications, but not with osteoporosis. The mean follow-up AOFAS score was 86.7 ± 12.5 (range, 36-100).A total of 94 (84.7%) patients could walk without assistance postoperatively and 92 (82.9%) were able to regain the preoperative level of mobilization. Conclusion: Although surgery can be considered an appropriate treatment option for ankle fractures in patients aged >65 years, care must be taken to prevent potential complications and the necessary precautions must be taken against correctable comorbidities.

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Functional outcome of bimalleolar ankle fractures treated with fibular plate for lateral malleolus and C.C. screws for medial malleolus

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2020.v6.i1o.1970 ◽

2020 ◽

Vol 6 (1) ◽

pp. 1126-1132

Author(s):

Dr. Sachin Kale ◽

Dr. Pratik Tank ◽

Dr. Rahul Ghodke ◽

Dr. Pankaj Singh ◽

Dr. Abhiraj Patel

Keyword(s):

Functional Outcome ◽

Lateral Malleolus ◽

Ankle Fractures ◽

Medial Malleolus

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Treatment of Medial Malleolus or Pure Deltoid Ligament Injury in Patients with Supination-External Rotation Type IV Ankle Fractures

Orthopaedic Surgery ◽

10.1111/os.12318 ◽

2017 ◽

Vol 9 (1) ◽

pp. 42-48 ◽

Cited By ~ 9

Author(s):

Xu Wang ◽

Chao Zhang ◽

Jian-wen Yin ◽

Chen Wang ◽

Jia-zhang Huang ◽

...

Keyword(s):

External Rotation ◽

Ankle Fractures ◽

Ligament Injury ◽

Deltoid Ligament ◽

Medial Malleolus ◽

Type Iv ◽

Deltoid Ligament Injury ◽

Supination External Rotation

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Result of Ankle Fracture Fixation, Our Hospital Experience

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i36b31959 ◽

2021 ◽

pp. 120-125

Author(s):

Ghazanfar Ali Shah ◽

Nizam Ahmed ◽

Aftab Alam Khanzada ◽

Tanveer Afzal ◽

Muhammad Rafique Joyo ◽

...

Keyword(s):

Internal Fixation ◽

Fracture Fixation ◽

Functional Outcomes ◽

Functional Result ◽

Ankle Fractures ◽

Medial Malleolus ◽

Grading System ◽

Prospective Analysis ◽

The World ◽

Cancellous Screws

Aims and Objectives: The goal of this study was to see the outcome of open reduction and internal fixation for ankle fractures. Methods: A prospective analysis of 40 ankle fractures of adult patients handled surgically using diverse approaches in the period from January 2019 to January 2020 at the Orthopedic department of SMBBIT, Dow University of Medical and Health Sciences. Karachi Pakistan. The ankle grading system developed by Baird and Jackson was used to assess the functional result. Results: We achieved 87.5 percent outstanding to good outcomes, 6.3 percent fair outcomes, and 6.2 percent bad outcomes in our study. The findings were comparable to those of other researchers around the world. Interpretation and Conclusion: In 87.5 percent of patients, the operational results were satisfactory, with good to outstanding functional outcomes. With stable fracture fixation, excellent outcomes are attained. Cancellous screws are better for internal fixation of the medial malleolus, while Malleolar screws are superior for that task. For ankle fractures treated surgically, patients may expect to have satisfactory function thereafter.

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Polyglycolide Bioabsorbable Screws in the Treatment of Ankle Fractures

Foot & Ankle International ◽

10.1177/107110079701800303 ◽

1997 ◽

Vol 18 (3) ◽

pp. 128-131 ◽

Cited By ~ 47

Author(s):

W. David Hovis ◽

Robert W. Bucholz

Keyword(s):

Functional Results ◽

Sinus Tract ◽

Ankle Fractures ◽

Medial Malleolus ◽

Wound Infections ◽

Inflammatory Reactions ◽

Malleolar Fractures ◽

Metallic Implants ◽

Bioabsorbable Screws

Twenty-one patients with unstable medial malleolar, bimalleolar, or trimalleolar ankle fractures underwent open reduction and internal fixation of the medial malleolus with 4.5-mm polyglycolide screws. All lateral malleolar fractures were internally fixed with standard metallic implants. Radiographic and clinical follow-up results were available on 16 of 21 patients. All fractures healed at an average of 3.4 months (range, 3–6 months), and there were no medial wound infections. Eight of 16 patients developed an inflammatory reaction to the biodegradable polyester at 3 to 4 months after implantation, including one who developed a sterile draining sinus tract. No surgical or nonsurgical treatment was required in those eight patients. We conclude that whereas polyester screws yield union rates and functional results similar to those of metallic screws in the treatment of medial malleolar fractures, the use of polyglycolide screws is associated with an unacceptable rate of inflammatory reactions.

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Prevalence of Osteochondral Lesions in Rotational Type Ankle Fractures With Syndesmotic Injury

Foot & Ankle International ◽

10.1177/1071100718804818 ◽

2018 ◽

Vol 40 (2) ◽

pp. 159-166 ◽

Cited By ~ 6

Author(s):

Kaj T. A. Lambers ◽

Aimane Saarig ◽

Hayley Turner ◽

Sjoerd A. S. Stufkens ◽

Job N. Doornberg ◽

...

Keyword(s):

Cohort Study ◽

Open Reduction ◽

Stage Iv ◽

Ankle Fractures ◽

Osteochondral Lesions ◽

Medial Malleolus ◽

Syndesmotic Injury ◽

Level Of Evidence ◽

Medial Side ◽

Medial Malleolus Fracture

Background: The aim of this study was to report the incidence of associated osteochondral lesions (OCLs) on postop CTs, which may benefit from arthroscopic treatment, in patients with rotational type ankle fractures with syndesmotic injury. The diagnosis and treatment of associated OCLs may be an additional benefit of the use of arthroscopy in the management of rotational type ankle fractures with syndesmotic injury. Methods: We retrospectively reviewed data of a prospective cohort study of patients who underwent open reduction and surgical fixation of an ankle fracture with syndesmotic injury. These patients underwent routine bilateral postoperative CT assessment. Two independent observers classified ankle fractures according to Weber and OCLs according to the classification system by Berndt and Harty. Fifty-nine patients were included. There were 19 (32%) Weber B type ankle fractures and 39 (66%) Weber C type fractures. One patient (2%) had fixation for a medial malleolus fracture and syndesmotic rupture without fibula fracture. Results: Talar OCLs were present in 8 patients (14%). In one patient, 2 OCLs were found, which resulted in a total of 9 lesions. Two lesions were found on the medial side, both anterior. The other 7 were located laterally, of which 1 was anterior, 3 central, and 3 posterior on the talus. According to the Berndt and Harty classification, 1 was classified as stage I, 4 as stage III, and 4 as stage IV. Conclusion: The prevalence of OCLs in ankle fractures with syndesmotic instability was 14%. We believe that lesions were arthroscopically accessible in 6 patients (10%). Moreover, most lesions were located on the lateral dome, and thus also potentially approachable through an anterolateral arthrotomy during open reduction and internal fixation. The majority of OCLs found in this series were Berndt and Harty type III or IV, and so likely would preferably have been addressed during the index procedure. Level of Evidence: Level III, diagnostic cohort study.

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BIMALLEOLAR ANKLE FRACTURE: A SIMPLE FRACTURE?

Acta Ortopédica Brasileira ◽

10.1590/1413-785220172501166234 ◽

2017 ◽

Vol 25 (1) ◽

pp. 48-51 ◽

Cited By ~ 2

Author(s):

JUNJI MILLER FUKUYAMA ◽

ROBINSON ESTEVES SANTOS PIRES ◽

PEDRO JOSÉ LABRONICI ◽

JOSÉ OCTÁVIO SOARES HUNGRIA ◽

RODRIGO LOPES DECUSATI

Keyword(s):

Ankle Fracture ◽

Fragment Size ◽

External Rotation ◽

Ankle Fractures ◽

Ligament Injury ◽

Deltoid Ligament ◽

Medial Malleolus ◽

Level Of Evidence ◽

Deltoid Ligament Injury ◽

Supination External Rotation

ABSTRACT Objective: To evaluate the frequency of deltoid ligament injury in bimalleolar supination-external rotation type fractures and whether there is a correlation between the size of the fractured medial malleolus and deltoid ligament injury . Methods: Twenty six consecutive patients underwent magnetic resonance exams after clinical and radiographic diagnosis of bimalleolar supination-external rotation type ankle fractures . Results: Thirteen patients (50%) presented deltoid ligament injury associated to bimalleolar ankle fracture. Partial injury was present in seven (26.9%) patients and total injury in six (23.1%). Regarding medial fragment size, the average was 2.88 cm in the absence of deltoid ligament injury. Partial injuries presented 1.93 cm and total 2.1 cm on average . Conclusion: Deltoid ligament injury was present in 50% of bimalleolar ankle fractures. Smaller medial malleolus fragments, especially concerning the anterior colliculus, presented greater association with partial deltoid ligament injuries. Level of Evidence IV, Cross Sectional Study.

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Weightbearing Radiography and MRI Findings in Ankle Fractures

Foot & Ankle Specialist ◽

10.1177/1938640020921571 ◽

2020 ◽

pp. 193864002092157

Author(s):

Henrik C. Bäcker ◽

J. Turner Vosseller ◽

Harald Bonel ◽

Jennifer Cullmann-Bastian ◽

Fabian Krause ◽

...

Keyword(s):

Structural Integrity ◽

External Rotation ◽

Stress Test ◽

Ankle Fractures ◽

Deltoid Ligament ◽

Medial Malleolus ◽

Mri Findings ◽

Partial Tear ◽

Complete Rupture ◽

Significant Difference

Background. Static weightbearing radiography can be used to assess stability in ankle fractures by measuring lateral talar shift (medial clear space; MCS). However, the correlation of a stable ankle joint under weightbearing load and the structural integrity of the deltoid ligament has not been shown. In this study, we assessed deltoid ligament integrity on magnetic resonance imaging (MRI) and correlated that with weightbearing and gravity stress test radiography. Methods. Thirty-four patients with supination external rotation II-IV (SER) fractures underwent MRI, weightbearing radiography, and gravity stress test. On MRI, the deep anterior and posterior tibiotalar deltoid, tibionavicular and tibiocalcaneal ligaments, as well as the syndesmosis were assessed as intact, partial rupture, or complete rupture. The MCS was measured as the distance between the lateral border of the medial malleolus and the medial border of the talus at the level of the talar dome on the mortise view. Results. Twenty-three patients suffered a deep anterior tibiotalar ligament rupture (16 partial; 7 complete) and 2 a deep posterior tibiotalar ligament tear (1 partial; 1 complete). For MCS on weightbearing radiography, no statistically significant differences were identified between any of the individual groups. With gravity stress radiography, only a complete tear of the tibiocalcaneal ligament showed a significantly higher MCS than a partial tear or intact tibiocalcaneal ligament ( P < .005). No other ligament disruption showed a significant difference between the complete rupture versus intact or partial tear. Conclusion. Weightbearing radiography does not show much variation in terms of MCS even with ligamentous disruption and fibula fracture. The talus often centers itself underneath the tibia with weightbearing radiography. Levels of Evidence: Level III: Retrospective cohort study

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