![]() In such cases, the patient is fitted with either a short-leg or a long-leg non-weight-bearing cast, depending on the stability of the fixation. However, if skin conditions, bone quality, or other factors impede secure fixation, the fracture requires extended protection. After this period, partial weight bearing can commence if the fracture is healing properly and progress accordingly. Range of motion exercises are initiated, while weight bearing is limited for 6 weeks. If the bone quality is satisfactory and the fixation is secure, the splint can be replaced with a removable splint or fracture boot during the first postoperative visit. To immobilize the ankle after lateral malleolus fracture surgery, a posterior plaster splint is applied in a neutral position and elevated. In cases involving osteoporotic patients or those with poor soft tissue coverage, reduce and stabilize the fracture with Kirschner wires placed obliquely through the distal fibular fragment and into the tibia. Although commercially available precontoured fixed angle distal fibular locking plates provide alternative fixation options distally, they often result in increased hardware prominence. If placed posterolaterally, the plate acts as an antiglide plate. Unicortical cancellous screws are placed below the level of the plafond. Generally, place three cortical screws in the shaft of the fibula above the fracture and two or three screws distal to the fracture. Plates can supplement lag screw fixation or span a comminuted segment. In larger individuals or for more proximal fractures, a 3.5-mm dynamic compression plate can be used. These wires can be further secured with a tension band wire.Īnatomical reduction and maintenance of fibular length are crucial aspects of the procedure.įor fractures above the level of the syndesmosis, use a small fragment, one-third tubular plate for fixation after achieving anatomical reduction. In patients with poor bone quality, Kirschner wires can be placed obliquely from lateral to medial through the distal and proximal fibular fragments. Alternatively, orient the malleolar screw slightly obliquely to engage the medial cortex of the fibula proximal to the fracture. In larger patients, a 4.5-mm lag screw can be used. If the fracture is below the level of the plafond, the distal fragment is small, and the patient has good bone stock, use an intramedullary 3.5-mm malleolar screw for fixation. Contour the intramedullary pin to prevent this mistake. Avoid tilting the lateral malleolus toward the talus as it can lead to narrowing of the ankle mortise and reduced motion. Insert a Rush rod, interlocking fibular rod, or other intramedullary device across the fracture line into the medullary canal of the proximal fragment. Split the fibers of the calcaneofibular ligament longitudinally to expose the tip of the lateral malleolus. įor transverse fractures, an intramedullary device can be used. The length of the screws is crucial, ensuring engagement with the posterior cortex for secure fixation without protruding far enough posteriorly to encroach on the peroneal tendon sheaths. Place the screws approximately 1 cm apart. If the fracture is sufficiently oblique, has good bone stock, and no comminution, fix the fracture with two lag screws inserted from anterior to posterior for interfragmentary compression. See Also: Posterolateral Approach to Ankle Joint Lateral Malleolus Fracture Surgery Options See Also: Approach to the Lateral Malleolus Alternatively, a posterolateral incision can be used, and the plate can be inserted with a posterior antiglide technique. To expose the lateral malleolus and the distal fibular shaft, make a lateral longitudinal incision while taking care to protect the superficial peroneal nerve. In such cases, it may be advisable to proceed with medial malleolar fixation initially. In severe cases of comminution, the lateral malleolus may be over-reduced, hindering the anatomical reduction of the medial malleolar component. If the fractured fibula is part of a bimalleolar fracture pattern, the lateral malleolar or fibular fracture is usually reduced and internally fixed before fixing the medial malleolar component, except in the case of a comminuted lateral malleolus as part of a bimalleolar or trimalleolar pattern. ![]() See Also: Ankle Anatomy Lateral Malleolus Fracture Treatment Surgery Steps Lateral malleolus fracture treatment options include Kirschner wires, tension band, screws, intramedullary rods or plate. ![]()
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