Surgical treatment of Bi- and trimalleolar ankle fractures: Should the medial collateral ligament be sutured or not?

Abstract

In Weber type A, B, and C fractures there is no census or whether or not to suture the ruptured medial collateral ligament. From May 1990 to December 1994, operations were performed on 48 patients with such lesions. Thirty-three cases were reviewed, 29 males and four females, with an average age of 39 years (range, 15-73 years). In 22 cases there was an isolated fracture of the lateral malleolus, and in 11 cases the fracture was associated with a posterior malleolus fracture. There were tibiotalar dislocations in nine cases. Fifty-eight percent of the injuries were caused by sports activities and 27% by an ordinary fall. After a preoperative external reduction, the lateral and posterior (if necessary) fractures were anatomically and rigidly fixed (plate, pins, and wire) without any suture of the medial ligament. Medial tibiotalar and tibiofibular diastasis were totally reduced as shown during intraoperative radiographs. The follow-up at time of review was 27 months on average (range, 9 months-5 years). Functional results were excellent and good in 82.5% of cases, with a return to sports activities at a mean time of 4.3 months. X-rays were considered as normal in 73% of cases, with an anterior impingement syndrome in 15% and calcifications of the medial collateral ligament in 12%. Stress radiographs in valgus talar tilt (n = 24) were normal in all cases. The authors suggest new surgical guidelines in ankle fractures with a medial collateral rupture, based on fracture stabilization, with ligament tears left unexplored (medial, tibiofibular, and syndesmotic ligaments), and early mobilization.