Functional outcome of surgical management of Bimalleolar ankle fractures

Background: Ankle fracture ranks second among lower limb fractures, accounting for about 10% of all fractures. It occurs in about 137 per 1 lakh people each year. Bimalleolar fractures are the most common fracture in outpatient as well as in emergency department which accounts for 1/4th of all ankle fractures. Treatment of this fracture is complicated and challenging as the outcome will influence the locomotive power. Improper and inadequate fixation will cause long term disability as the body weight is transmitted through the ankle joint. This study was conducted to evaluate the functional outcome of bimalleolar ankle fractures treated with various surgical modalities. We also try to delineate the types of fractures occurred and its outcome after surgical fixation and also to understand the advantages and disadvantages of various implants used along with its complications. Aims and Objectives: To determine the functional outcome of surgical management of bimalleolar ankle fractures and to know the risks and complications associated with surgical fixation of bimalleolar ankle fractures. Subjects and Methods: A prospective study is conducted among 40 patients who came to the Emergency Department and to Orthopaedics Outpatient Department in Sree Mookambika Institute of Medical Sciences between April 2021 and September 2022 were analyzed. We have included bimalleolar ankle fractures with Lauge–Hansen classification (SER4, SAD 2, PER 3, PAB 3), Danis–Weber Type (A2, B2, C2, C3) in this study and we have excluded patients with Lauge–Hansen classification (SER1,2,3, SAD1, PER1,2,4, PAB1,2), Danis-Weber Type (A1, A3, B1, B3, C1), Systemic infections, open injury, fracture with dislocation, skin diseases over the incision site Trimalleolar ankle fracture, previous arthrodesis at target level. Based on the fracture pattern, the patients were planned for surgical fixation with appropriate implants. Results: In our present study of 40 patients, we assessed the functional outcome based on Baird and Jackson’s scoring system. Based on which 21 patients (52.5%) had excellent outcome, 14 patients (35%) had good outcome, 3 patients (7.5%) had fair outcome, and 2 patients (5%) had poor outcome. Out of total population, 35 patients (87.5%) had no complications followed by 3 patients (7.5%) had superficial infection and 2 patient (5%) who had ankle stiffness. Conclusion: Medial malleolus fracture can be effectively treated by various modalities such as Screw fixation, tension band wiring (TBW) and K-wire fixation, giving excellent to good results. Among which TBW and Screw fixation are relatively better than K-wire fixation for medial malleolus fracture. Similarly, lateral malleolus fracture can be treated with plate fixation, screw fixation and K-wire fixation which gives excellent to good results. Among which plate fixation (locking compression plate) is better than K-wire and screw fixation for lateral malleolus fracture. Superficial skin infection is the most common complication we encountered in our study.

Background: Malleolar injuries are the most common significant lower extremity fractures. These injuries gain importance, because the whole body weight is transmitted through the ankle, and locomotion depends on the stability of the ankle. Open reduction and internal fixation have become the mainstay of treatment for most of the unstable bimalleolar fractures, as these operative methods restores the anatomy, biomechanics and contact loading characteristics of the ankle. Objectives: To study the functional outcome of surgically managed bimalleolar fractures of ankle in adults. Methods: A prospective study of 30 cases of bimalleolar fractures of ankle in adults, managed surgically by various techniques in During the period from December 2014 to May 2016 were studied, satisfying the inclusion and exclusion criteria were studied. The functional outcome was evaluated using the Biard and Jackson’s ankle scoring system. Results: In our study we achieved 86.6% excellent to good results, 6.6% fair results, 6.6% poor results. The results were comparable to other studies. Interpretation & Conclusion: The operative results were satisfactory in 86.6% cases, with good to excellent functional outcome. Excellent results are obtained with stable fixation of fracture. Cancellous screws or malleolar screws are far better in internal fixation of medial malleolus compared to Kirschner -wire fixation and lateral plating was the best for fibular fractures. Good functional results are obtained by surgical management of bimalleolar ankle fractures. Early weight bearing and mobilisation is achieved in these patients. Anatomical reduction with restoration of the articular congruence is essential in all intra articular fractures, more so, if a weight bearing joint like ankle is involved. Open reduction and internal fixation restores the articular congruity of the ankle joint. TBW done for many PER and PA injuries showed promising results comparable to that with screw fixation and also lesser reports of skin irritation at the wound site. It is the method preferred for small transverse fragments and osteoporotic bones of both malleoli especially in the elderly.

Background: The movement around ankle joint is very important because of the cultural practices, which involve squatting and sitting cross-legged. Bimalleolar Pott’s fractures are very common in ankle joint injuries because of increased incidence of road traffic accidents and industrial trauma. Accurate reduction of fractures around ankle joint is important for a painless ankle joint. Objective: To study the functional outcome of surgically managed closed bimalleolar fractures of ankle in adults; to evaluate restoration of the anatomy of malleoli and ankle perfectly by operative treatment with internal fixation; to assess the union of fractures after surgical management; and to achieve stable fixation and early mobilization of the ankle. Materials and Methods: We have evaluated clinical, radiographic, and functional outcomes of 40 patients treated with a combination of different treatment modalities, which involve the combination of tension band wiring (TBW), Kirschner (K)-wire, Rush pin, cortical and cancellous screws, and one-third tubular plates for lateral and medial malleolus fixation. Results: In this prospective study, 40 cases of bimalleolar fractures of ankle were treated by surgical methods. Road traffic accident was the most common mode of injury. Majority [16 (40%)] of the cases showed supination–external rotation injury, followed by 11 (27.5%) cases with pronation–external rotation injury. Majority [29 (72.5%)] of the medial malleolus fractures were fixed with TBW. In the remaining cases, cancellous screws and K-wire were used. Most [20 (50%)] of the lateral malleolar fractures were fixed with K-wire. In the rest of the cases, one-third tubular plate and Rush pin were used. In our study, the average time taken for union was 10.4 weeks. Excellent results were achieved in 23 cases (57.5%), good in 10 cases (25%), fair in five cases (12.5%), and poor in two cases (5%). Excellent results were observed in most bimalleolar fractures. Of the two cases with poor results, one developed superficial infection and the other showed delayed union. Conclusion: Unstable bimalleolar ankle fractures are common because of road traffic accidents. Understanding the mechanism of injury is essential for anatomical reduction and fixation. Fibular alignment (length and rotation) has to be maintained for lateral stability of the ankle. Anatomical reduction with restoration of the articular congruence is essential in all intra-articular fractures, more so, if a weight-bearing joint such as ankle is involved. Open reduction and internal fixation restores the articular congruity of the ankle joint. Excellent results are obtained with stable fixation of fracture. TBW is better in internal fixation of medial malleolus compared with K-wire fixation, and lateral plating was the best for fibular fractures. Hence, we conclude that surgical management of bimalleolar ankle fractures provides good functional outcome. By stable surgical fixation of fracture, early mobilization can be done with good functional outcome.

Background: With the advent of A.O principles of management, the results of bimalleolar ankle fractures are better with emphasis on anatomical reduction of fracture, stable internal fixation, regaining full length of fibula and early active pain free mobilization. This study was done to analyse the results of surgical management of bimalleolar ankle fractures in a tertiary care hospital. Materials and Methods: A prospective study was done in a tertiary care hospital in the year 2020 for 6 months. Cases with bimalleolar ankle fractures in the age group of 20-60 years were included in the study. Cases with systemic infection, open injury with dislocation, skin diseases and previous arthrodesis at target level. The Lauge-Hansen classification and AO classification were used to evaluate the fractures radiologically. The patients who were presented in the casualty and out-patient department were examined clinically and radiologically. Outcome was assessed subjectively and objectively with scoring system and graded accordingly. Post-op complications were also noted. Results: In our study, 30 cases of bimalleolar ankle fractures were analysed. Classification used was Lauge-Hansen and A.O. classification. Road traffic accident was major mode of injury. Average injury surgery interval was 6 days. Malleolar screw for medial malleolus and plate and screws for fibula was common mode of fixation. Results were analysed using Olerud and Molendar subjective and objective scoring. The subjective scoring was excellent and good in 80% of cases and objective scoring was good in 22 cases. Conclusion: Accurate anatomical reduction and fixation results in good functional outcome.

Background: Malleolar injuries are the most common significant lower extremity fractures. These injuries gain importance, because the whole body weight is transmitted through the ankle, and locomotion depends on the stability of the ankle. Open reduction and internal fixation have become the mainstay of treatment for most of the unstable bimalleolar fractures, as these operative methods restores the anatomy, biomechanics and contact loading characteristics of the ankle.Objectives:1.To study the functional outcome of surgically managed bimalleolar fractures of ankle in adults.2.To restore the anatomy of malleoli and ankle perfectly by operative treatment with internal fixation Methods: A prospective study of 50 cases of bimalleolar fractures of ankle in adults, managed surgically by screw for medial malleolus and plate for lateral malleolus during the period from june 2018-feb 2020 at Dr. D.Y. Patil hospital, Navi Mumbai.Inclusion Criteria•All closed fractures.•Open type 1, 2, 3a (Gustillo-Anderson).•Above 18 years.Exclusion Criteria•With associated Pilon fracture.•Patients unfit for surgery.•Patients with minimally displaced mono-malleolar fractures, avulsion fractures and stable fracturesFollow-up was taken at 1month, 3 months, and 6 months post-operatively. At every visit check radiographs were taken to assess the radiological union.Results: In our study we achieved 86% excellent to good results, 8% fair results, 6% poor results. The results were comparable to other studies.Conclusions: The operative results were satisfactory in 86% cases, with good to excellent functional outcome.•Excellent results are obtained with stable fixation of fracture. Cancellous screws or malleolar screws are better in internal fixation of medial malleolus and lateral plating was the best for fibular fractures.•Good functional results are obtained by surgical management of bimalleolar ankle fractures. Early weight bearing and mobilisation is achieved in these patients.Anatomical reduction with restoration of the articular congruence is essential in all intra articular fractures, more so, if a weight bearing joint like ankle is involved. Open reduction and internal fixation restores the articular congruity of the ankle joint.

Background: Ankle joint is hinged synovial joint. Ankle is a close fitting hinge-like joint of which two parts interlock like mortise (the box formed by the distal end of Tibia and Fibula) and the tenon (upward projecting Talus). Ankle fractures are very common. The various surgical modalities include fixation with cancellous lag screws, malleolar screw, tension band wiring, semi-tubular plating, fixation with rush pin. These operative methods restore the anatomy and contact loading characteristic of the ankle including easier rehabilitation, early mobilization and earlier weight bearing. Aims: To evaluate the functional outcome of surgical management of the bimalleolar fractures of ankle. Material and Methods: Present study was prospective study, carried out among patients with bimalleolar fractutes of the ankle coming to Orthopaedic department of Tertiary health care centre for duration of November 2020-22. Data analysis: Following the above procedure, the findings were recorded in the proforma. These findings were entered in Microsoft Excel 2010. The results were compiled by using suitable tables and graphs wherever necessary. The variations were analysed as a percentage of the total and reported. Data analysis was done with the help of openepi software version 2.3.1. Results: The mean age of the patients was 39.86 ± 10.67 years. Majority of the patients 24 (80%) included in the study were male. Almost 15 (50 %) patients had pain score of 1 and 9(30%) patients had zero score. On range of movement 93.3% had zero score and 6.7% had score 2. On final objective scoring majority 73.3% had good, 20% had fair and 6.7%had poor outcome. Conclusion: Supination-external rotation injury is the most common type of bimalleolar ankle fracture and also common type associated with dislocations and complications. Good functional outcome was achieved by restoring sufficient stability and providing good mobility at the ankle joint. Anatomical reduction of the fracture is associated

Introduction: Of all the lower limb fractures ankle fractures are one of the most common accounting for almost 9% with the annual incidence being 107-187 per 1 lakh population. Treatment of this fracture is complicated and challenging as the outcome will influence the locomotive power. Improper and inadequate fixation can cause long term disability as body weight is transmitted through it. Aim of study: To assess the functional and radiological outcome of displaced bimalleolar ankle fractures and to assess the rate of complications.Materials and Methods: This prospective study was done at the Department of orthopaedics in K.R. Hospital, Mysuru after obtaining informed consent from patients. A total of 50 patients between the age of 18-50 years were treated with Open Reduction and Internal Fixation with various methods for bimalleolar fracture between August 2017- January 2018; These patients were followed for 12 months and evaluated based on union rate, complications (Infections, Nonunion) and functionally by Baird and Jackson ankle scoring system. Results: In our study of 50 patients, bimalleolar ankle fractures treated by ORIF by various methods were followed up for 12 months. In our study, majority were males (72%). Mean age group included in the study was 33 years. In majority of patients, the mode of injury was RTA (72%) and most common fracture type being AO Type 44 A (56%). As per Baird and Jackson scoring system excellent to good functional outcome was seen in 78.3% individuals with fair outcome in 17.9% and poor outcome in 5.6%. Complications were seen in 9 patients and only two underwent re surgery for non-union.Conclusion: We found that ORIF yielded good results in terms of anatomical reduction, stability and post-operative functional outcome. Hence as per our study we can safely conclude that open reduction and internal fixation should be the treatment of choice for all unstable ankle fractures.

Bimalleolar injuries are the most common significant lower extremity fractures. Open reduction of fracture and internal fixation methods have become the good option of treatment for bimalleolar fractures. The aim of the study is to assess the outcome following surgical management of ankle fracture. Classifications used is Danis-Weber. The outcome is assessed using olerud and molander scoring system. We performed a narrative review to assess the functional outcome of surgically managed bimalleolar ankle fractures. Extensive search of articles was done electronically using databases like PUBMED, Google scholar, reference checking. We concluded that internal fixation for bimalleolar ankle fractures gives better reduction, and functional outcome showing significant improvement in function of the ankle joint.

Patient: Male, 37Final Diagnosis: Talar neck fracture dislocation combined with bimalleolar ankle fractureSymptoms: Mild ankle painMedication: —Clinical Procedure: Open reduction and internal fixationSpecialty: Orthopedics and TraumatologyObjective:Rare co-existance of disease or pathologyBackground:Fractures of the talus are uncommon injuries that usually involve the talar neck, rather than the talar body. This report is of a rare case of combined left talar neck fracture and adjacent joint dislocation with an ipsilateral bimalleolar ankle fracture.Case Report:A 37-year-old man presented with an injury to his left foot following a motor vehicle accident. When he presented to the hospital emergency department, his left foot and ankle were swollen, the overlying skin was intact but badly contused, and there was no neurovascular deficit. Radiographs of the left ankle showed a fracture of the talar neck and bimalleolar fracture. An initial closed reduction under anesthesia failed. Therefore, open reduction and rigid stabilization of all fractures were achieved surgically, followed by the application of an external fixator spanning the ankle and the subtalar joints. The external fixator was removed at six weeks, range of motion (ROM) exercises were commenced, and a non-weight-bearing mobilization protocol was continued for 12 weeks. At four-year follow-up, radiographs confirmed solid union of all fractures, and although avascular necrosis (AVN) of the talus and secondary ankle arthritis developed, the functional outcome was satisfactory.Conclusions:The immediate management of talar neck fracture with dislocation combined with a bimalleolar fracture is important to prevent soft tissue complications and to improve the functional ROM of the ankle. However, AVN and post-traumatic osteoarthritis at both the ankle and the subtalar joints are still common sequelae of talus fracture.

The incidence of talar fractures is relatively low affecting usually young patients, while recent epidemiological studies have shown that talar body fractures represent a significant proportion of the total number of talar fractures. Talar body fractures are usually high-energy injuries and often a combined talar neck and body fracture is noted. An association between talar body fractures and ankle fractures has also been recorded involving the medial or lateral malleolus. The only report of a talar fracture combined with a bimalleolar ankle fracture that was found in the literature is referred to a talar neck fracture. In this report, a combination of a talar body fracture and bimalleolar ankle fracture in a polytraumatised young patient is presented. This combined injury pattern seems to be very rare, since a similar case was not found in the literature. An open reduction and internal fixation of the talar body fracture as well as the bimalleolar fracture, followed by a prolonged non-weight bearing, led to a fracture healing with no evidence of osteonecrosis. Minimal osteoarthritic changes of the tibiotalar joint were noted at 3 years follow-up with satisfactory functional results.

Ankle fractures combined with a talar body fracture imply either the medial or the lateral malleolus. The only report of a talar fracture combined with a bimalleolar ankle fracture found in the literature is referred to a talar neck fracture. We report a case of a simultaneous talar body fracture and bimalleolar ankle fracture in a young patient. This combined injury pattern appears to be very rare; one similar case was reported in the literature. An open reduction and internal fixation of the talar body fracture as well as the bimalleolar fracture, followed by a prolonged non-weight bearing, led to a fracture healing with no evidence of osteonecrosis. At the last follow-up, the functional result was satisfactory.

Objectives: According to the Lauge-Hansen classification, supination external-rotation (SER) type 4 fractures should be accompanied by medial malleolar fracture or deltoid ligament injury. The aim of the study was to investigate medial insufficiency rates in postoperative weight-bearing radiographs in SER type 4 bimalleolar fractures. Methods: The files of the patients who were operated with the diagnosis of SER type 4 bimalleolar ankle fracture between 2017-2020 were evaluated retrospectively. Thirty-seven cases (15 males and 22 females) were included in the study. The data based on the evaluation of the weight-bearing radiographs of the patients taken in the postoperative 1st year were examined statistically. Results: The injury mechanism was sports injury in 17 (45.9%) cases, traffic accidents in 8 (21.6%) cases, falling in 9 (24.3%) cases, and falling from height in 3 (8.2%) cases. The preoperative tibiofibular distance was 6.05 ± 1.86 mm, and the postoperative tibiofibular distance was 4.19 ± 0.40 mm (p = 0.001). The preoperative tibiofibular overlap was 5.03 ± 2.93 mm, and the postoperative tibiofibular overlap was 8.62 ± 1.04 mm (p = 0.001). The postoperative medial clear space was 4.11 ± 0.57 mm. Postoperative medial clear space of 5 mm and higher was determined in 7 (18.9%) cases. Conclusions: In SER type 4 bimalleolar fractures with a large medial malleolar fragment fracture, weight-bearing radiographs may show an increase in medial clear space. This means that a medial malleolar fracture in bimalleolar fractures may be also accompanied by deltoid ligament injury. The Lauge-Hansen classification system may be insufficient to identify a medial ligament injury.

Ankle fractures account for about 9% of all fractures in adults. Open reduction and internal fixation is the preferred treatment for such injuries. However, surgery is not free of complications, and outcomes following surgery are not always satisfactory. Therefore, this study aimed to estimate the functional outcomes of bimalleolar ankle fractures treated by open reduction and internal fixation. This descriptive, cross-sectional study was carried out at a tertiary care center in the western region of Nepal among the patients with bimalleolar ankle fractures from March 2017 to August 2020 after approval from the Institutional review committee. Convenience sampling was done to reach the sample size. Twenty-nine cases were included in the study. Data were recorded in proforma and data analysis was done in the statistical package for social sciences (SPSS 16.0). The American Orthopedic Foot and Ankle Society (AOFAS) ankle-handfoot score was used to assess the final outcome. At the final evaluation mean AOFAS ankle-handfoot score score was 89.86 (±7.95). According to the AOFAS ankle-hindfoot score, there were 19 excellent (65.51%), six good (20.68%), and four fair (13.79%) results. Complications in the form of superficial infection were seen in four (13.79%) cases. Functional outcomes following surgical treatment of bimalleolar ankle fractures are mostly excellent to good and complications following surgery are few, therefore, surgery is a better option of treatment in bimalleolar ankle fractures.

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