Bimalleolar Fractures Research Articles (Page 1)

Perioperative outcomes following open vs closed geriatric ankle fractures: A large, propensity-matched cohort study.

Background: Bimalleolar fractures, which often necessitate surgery due to instability, are linked to considerable postoperative pain. Selective cyclooxygenase-2 (COX-2) inhibitors, like celecoxib, have demonstrated potential in alleviating pain and decreasing the need for opioids. However, the optimal dosing regimen remains unclear. This study compares the efficacy of two celecoxib regimens in reducing postoperative pain after ankle fracture surgery. Methods: A double-blind, randomized controlled trial was carried out with 240 patients undergoing bimalleolar fracture surgery under spinal anesthesia. The participants were split into three groups: a placebo group, a group receiving 400 mg of celecoxib (Group 400), and a group receiving 600 mg of celecoxib (Group 600). Pain levels were evaluated using the Visual Analog Scale (VAS) at specific time points (0, 6, 24, and 72 hours after surgery). Additionally, total morphine consumption, the time until first analgesic use, patient satisfaction, and side effects were documented. Results: Patients in Group 600 experienced significantly lower pain scores and delayed morphine use compared to the placebo group (P < 0.05). Both celecoxib groups consumed less morphine overall, with higher patient satisfaction scores reported in Group 600. Adverse events were minimal and comparable across all groups. Conclusion: The preemptive use of celecoxib, particularly at a 600 mg dose, significantly reduces postoperative pain and opioid use while enhancing patient satisfaction with minimal side effects. These results suggest that COX-2 inhibitors are a practical alternative to opioids for managing pain after ankle fracture surgery.

Several publications have suggested that elderly patients with open ankle fractures may have grave prognosis in terms of mortality, similarly to elderly patients with hip fractures. In this study we evaluated the effect of open ankle fractures on patient mortality in elderly population, including octogenarians and nonagenarians. This retrospective cohort included all patients above the age of 60 treated in Japan public emergency care hospitals between the years 2010 and 2018. Patients with lateral malleolus, medial malleolus, bimalleolar, trimalleolar and pilon fractures were included. The outcomes were mortality, length of hospital stay, surgical site infections and readmissions within one year. There was a total of 6766 patients ages above 60, of whom 6062 had closed fractures and 704 had open fractures. Open fractures were not associated with higher mortality than closed fractures. Patients with open fractures stayed in the hospital for longer time (median of 51 vs 37 days, p < 0.001), had higher rate of surgical site infections (5.3 % vs 1.7 %, p < 0.001) and a lower rate of readmissions (2.6 % vs 6.2 %, p < 0.001). The study shows that elderly patients with open ankle fractures are hospitalized for longer time and experience a higher rate of surgical site infections. However, they do not experience excess short-term mortality in this study setting. IV (non-experimental study).

Background:Despite considerable improvements in surgical treatment strategies for unstable ankle fractures, long-term follow-up studies on conventional treatment strategies are missing. The aim of the study was to assess the patient-reported long-term outcome (≥15 years) following surgically treated ankle fractures.Methods:Retrospective, single-center, outcome study with a current follow-up. Identified were all patients treated surgically for an unstable ankle fracture between January 2003 and October 2009. Treatment was performed according to the AO principles. General demographics, injury-, fracture- and treatment details, as well as the current patient-reported outcome (Olerud-Molander Ankle Score [OMAS], the Foot and Ankle Ability Measure [FAAM], the European Foot & Ankle Society Score [EFAS], and the EuroQoL–5 dimensions, 5 levels [EQ-5D-5L]) were assessed.Results:Of 398 eligible patients, 125 patients (31.4%; 54% female, 48% left side) were included. The average age at trauma was 43.1 ± 11.8 years, and the mean follow-up 17.8 ± 2.0 years. Overall, 43%, 22%, and 34% sustained a unimalleolar, bimalleolar, and trimalleolar fracture, respectively. In addition, 53% had a fracture to the posterior malleolus. The overall median outcome for the OMAS, FAAM daily, and EFAS daily were 100 (interquartile range [IQR] 15), 99 (IQR 7), and 96 (IQR 16), respectively. The EQ-5D-5L scored at a median of 1.00 (IQR 0.09). The number of malleoli fractured was the only factor affecting all outcome scores. A moderate or poor outcome was reported for 5% of unimalleolar, 18% of bimalleolar, and 30% of trimalleolar fractures.Conclusion:Although the overall functional outcome was good, about 15% of patients had considerable impairment. The only factor associated with the patient-reported outcomes was the number of malleoli fractured, with 30% of patients with a trimalleolar ankle fracture presenting inferior outcomes.

The purpose of this study was to identify the incidence and risk factors associated with surgical site infection (SSI) after open reduction and internal fixation of bimalleolar ankle fractures. Bimalleolar ankle fractures are one of the most common subtypes of ankle fractures, accounting for 15% to 20% of all ankle fractures. Recent studies have shown that 4.37% of patients undergoing ORIF of ankle fractures develop an SSI postoperatively. The literature detailing the risk factors for the development of SSI after open reduction and internal fixation (ORIF) of bimalleolar ankle fractures is sparse. Therefore, the purpose of this study was to determine the risk factors that predispose patients to SSI after the index procedure. Patients who underwent bimalleolar ankle fracture repair between January 1, 2010, and December 31, 2021, were identified using the PearlDiver Mariner Database. Demographics and comorbidities between SSI and non-SSI cohorts were compared through chi-square analysis. Multivariate logistic regression was used to analyze risk factors for SSIs. A P value less than 0.001 was determined to be statistically significant. The incidence of SSI after ORIF of bimalleolar ankle fractures was 3.1%. Age, sex, and a higher total Elixhauser Comorbidity Index were associated with an increased incidence of SSI (P < 0.0001). Risk factors for the development of SSI included male sex (OR = 1.17; P < 0.0001), chronic kidney disease (odds ratio [OR] = 1.233; P < 0.001), diabetes (OR = 1.27; P < 0.0001), drug abuse (OR = 1.22; P < 0.0001), fluid and electrolyte disorders (OR = 1.42; P < 0.0001), hypertension (OR = 1.29; P < 0.0001), peripheral vascular disease (OR = 1.62; P < 0.0001), tobacco use (OR = 1.25; P < 0.0001), and weight loss (OR = 1.25; P < 0.0001). Peripheral vascular disease was the most highly correlated risk factor for the development of SSIs in this study. These findings underscore the importance of preoperative risk stratification and optimization to minimize SSIs in this population. This is the first study to delineate the risk factors for the development of SSI in patients undergoing ORIF for bimalleolar ankle fractures. Physicians can use these results to counsel patients before undergoing the index procedure to minimize postoperative infections. IV.

Background:Bimalleolar ankle fractures, particularly those resulting from supination–external rotation (SER) mechanisms, are common injuries. This study evaluates the short-term clinical outcomes and quality of life following surgical treatment of these fractures.Matеrials and Methods:This prospective cohort study was conducted at two trauma centers in Isfahan, Iran. A total of 34 adults, with SER-type bimalleolar ankle fractures, underwent open reduction and internal fixation. Additionally, a matched control group comprising 34 healthy individuals was included in the study. Functional outcomes were evaluated using the Foot and Ankle Outcome Score (FAOS) and the Short Form-36 (SF-36) in the control group, as well as at three and six months post-surgery for the patient group.Results:The study included 24 males (70.6%) and 10 females (29.4%) in the case group, with a mean age of 32.8 years (SD ± 9.7) and a mean BMI of 26.01 kg/m² (SD ± 1.91). Significant improvements were observed in the patient group from three to six months post-surgery across multiple FAOS and SF-36 domains. FAOS pain scores increased from 67.8 ± 7.5 to 83.9 ± 8.3 (P < 0.001), and activities of daily living improved from 75.3 ± 8.0 to 88.7 ± 8.5 (P < 0.001), approaching control levels. SF-36 physical functioning scores rose from 63.5 ± 8.2 to 81.3 ± 7.9 (P < 0.001). However, domains, like symptoms, sports/recreation, social functioning, and role-emotional, remained lower than controls at six months (P > 0.05).Conclusions:Surgical treatment of bimalleolar ankle fractures leads to significant short-term functional improvements, with a low complication rate. While promising, continued rehabilitation beyond six months may be necessary for complete functional restoration.

Is systematic deltoid ligament repair necessary in bimalleolar equivalent ankle fractures? A bi-centric case-control study.

BackgroudThe effectiveness of deltoid ligament complex repair in bimalleolar equivalent fractures remains controversial. While direct repair of the superficial ligamentous structures is feasible, the necessity of primary repair for the deep component and the optimal approach for achieving this remain unclear. This study aimed to determine whether anterior deltoid ligament repair (ADLR; tibionavicular and tibiospring ligaments) can stabilize the ankle joint following a complete deltoid ligament rupture (cDLR).MethodsSeventeen ankles from nine fresh-frozen cadavers were dissected from the knee downward and divided into 3 groups: normal (intact ankle ligaments), cDLR, and ADLR. The medial clear space and torque failure after ADLR were evaluated. Medial clear space was measured under non-weight-bearing conditions and during 8-lb (35 N) external rotation and gravity stress tests across the 3 groups. The medial clear space was measured using Adobe Photoshop's length measurement function.ResultsSignificant differences (p < 0.001) were observed in the medial clear space measurements across the normal, cDLR, and ADLR groups during all test conditions. Torque failure occurred after ADLR at a mean of 73.3 lb (standard deviation, 28.5).ConclusionsThe stability observed in stress tests following ADLR and the results of torque failure testing suggest that ADLR alone is sufficient to restore ankle stability. Initial stability was achieved using ADLR, which can be performed relatively easily even in cases of cDLR.

This study aimed to evaluate the stability of bimalleolar ankle fracture fixation techniques (bicortical and unicortical lag screw) in simulated progressive rehabilitation with a walking boot. Five matched pairs of lower extremities underwent simulated bimalleolar ankle fracture and were randomly assigned into these 2 repair groups. Each specimen was tested under an axial compression cyclic load test for 10000 cycles at a rate of 1 Hz while the ankle was held in 30° inclination. Radiographic assessments (screw attached lengths [length from screw head to far cortex], fracture gap, and joint clear space [medial, superior, and lateral]) by 3 examiners were performed at 0th, 5000th, and 10000th cycles. Three repeated measurements by each examiner. The overall level of intra-rater reliability for all 3 raters and all measurements were found to be within "moderate" to "excellent" agreement. For radiographic screw loosening and fracture displacement, evaluation found that at no time point did either the bicortical group or the unicortical group meet the minimal threshold of clinical failure which defined as 2-mm of screw displacement or 2-mm of fracture displacement. Both bicortical and traditional unicortical lag screw fixation techniques provide equivalent stability for medial malleolar fractures in a bimalleolar ankle fracture during simulated progressive rehabilitation with a walking boot. This could potentially have clinical benefits in patient care with earlier return to function, prevention of stiffness and loss of range of motion, and decreased muscle atrophy during the postoperative rehabilitation period.Level of Evidence: Level V: bench top testing.

To investigate the impact of diabetic neuropathy on operative bimalleolar or trimalleolar ankle fracture outcomes when compared with both non-diabetic and diabetic patients without neuropathy. Design: Retrospective comparative study. TriNetX research network, a global health-collaborative clinical research platform comprising de-identified electronic health records from healthcare organizations across the United States. The TriNetX research network was queried for all patients with an operative bimalleolar or trimalleolar ankle fracture (OTA/AO 44) from 2005 to 2022. From this population, subgroups were formed based on diabetes status and the presence of diabetic neuropathy. Patients with diabetic neuropathy were compared to both non-diabetics and patients with diabetes. Propensity score matching (1:1) was performed to match patients based on demographics and comorbidities across groups, including severity of diabetes by A1C. Following matching, logistic regression was performed to calculate risk ratios and assess differences in postoperative medical and surgical complications between neuropathic and non-diabetic patients, as well as between neuropathic and diabetic patients. Included were 115,162 ankle fracture patients; 94,111 (81.7%) patients without diabetes, 13,741 (12%) patients with diabetes but without diabetic neuropathy, and 7,310 (6.3%) patients with diabetic neuropathy. When compared to patients without diabetes, patients with diabetic neuropathy had increased risk of two-year malunion/nonunion (Risk ratio (RR) 1.79; p<0.001), implant infection (RR 2.12; p<0.001) and amputation (RR 8.01; p<0.001). When compared to patients with diabetes, but without neuropathy, patients with diabetic neuropathy again had significantly higher odds of implant failure (RR 2.00; p<0.001), malunion/nonunion (RR 2.35; p<0.001), and infection (RR 2.25; p<0.001). This study found that patients with diabetic neuropathy had higher odds of postoperative complications, such as malunion/nonunion, infection, and amputation, following surgical fixation of ankle fractures than non-diabetic patients and diabetic patients without neuropathy. Level III; Retrospective Cohort Study.

Introduction The involvement of the posterior malleolus (PM) in dislocated bimalleolar ankle fractures is associated with inferior clinical outcomes. There is no consensus on whether and when a computed tomography (CT) scan should be performed in the case of an inconspicuous X-ray of the PM. How high is the risk of missing a posterior malleolus fracture (PMF) without a CT scan? The aim of this study was hence to analyze the rate of correctly performed assessments of the PM in bimalleolar ankle fractures based on X-rays and to correlate this with surgical therapy. Materials and Methods In total, 100 bimalleolar ankle fractures, 50% with and 50% without PMF visible on the basis of a CT scan, were analyzed by 4 observers at 2 different time points 30 days apart (d1 and d2). The observers had to decide on the basis of X-rays whether a PMF was present or not. This was followed by a correlation with the operative treatment. Results Analyzing each observer independently, the correct diagnoses of a present PMF were made in an average of 83% of cases, with no significant difference between seniors and residents. In 22 of 50 cases (44%) with a PMF confirmed on a CT scan, it was missed by at least one of the observers based on plain radiographs. For those PMF that required fixation (24 of the 50 PMF), in 25% of cases, at least 2 observers missed the diagnosis of a PMF. Conclusions Based on our results, there are deficits in the detection of PMF in bimalleolar ankle fractures only on the basis of X-rays, even in PMF that were later fixed surgically. This study aids the awareness that PMF can be easily missed on X-rays and raises the question of whether a CT scan might become mandatory in distal fibula fractures that involve the upper ankle joint. Levels of Evidence: Level III: Retrospective study

ABSTRACTBACKGROUND:Ankle fractures are common injuries that often require surgical intervention to restore proper alignment and stability. Traditional anesthesia methods, such as general and spinal anesthesia, may not be suitable for patients with significant comorbidities. The wide-awake local anesthesia no tourniquet (WALANT) technique has emerged as a viable alternative, particularly for patients with cardiovascular or pulmonary conditions. This study aimed to compare the clinical outcomes of WALANT and spinal anesthesia in the surgical treatment of ankle fractures.METHODS:This prospective, randomized study included patients with bimalleolar fractures who underwent surgery between June 2022 and November 2023. Patients were randomly assigned to one of two groups: the WALANT group (n=16) or the spinal anesthesia group (n=19). Preoperative demographic data, intraoperative parameters (including surgical time), and postoperative outcomes, such as pain scores assessed using the Visual Analogue Scale (VAS), patient-controlled analgesia (PCA) morphine consumption, and American Orthopaedic Foot and Ankle Society (AOFAS) scores at 12 months postoperatively, were evaluated.RESULTS:Both groups had similar demographic characteristics (p>0.05). There was no significant difference in operating room time between the groups (WALANT: 180.47 minutes vs. Spinal: 190.94 minutes, p=0.30). Postoperative pain, assessed using VAS scores at 12 and 24 hours, did not significantly differ between groups. Morphine consumption via PCA was also similar (WALANT: 19.57 mg vs. Spinal: 22.8 mg, p=0.291). At the 12-month follow-up, AOFAS scores were similar between groups (WALANT: 80 vs. Spinal: 83.1, p=0.388). However, preoperative anxiety levels were higher in the WALANT group (p=0.001).CONCLUSION:The WALANT technique provides comparable postoperative pain control and functional outcomes to spinal anesthesia in ankle fracture surgery. Although preoperative anxiety was higher in the WALANT group, no significant differences were observed in postoperative pain or long-term recovery. WALANT represents a feasible and cost-effective alternative to traditional methods, especially in settings with limited access to anesthesiologists, such as during natural disasters or pandemics. It may be particularly advantageous for patients with cardiovascular or pulmonary comorbidities, helping to avoid the risks associated with systemic anesthesia.

Ankle fractures are injuries caused by rotational forces, commonly resulting in deltoid ligament damage. Disruption of the deltoid ligament is associated with medial ankle instability, which might require repair. Historically, these repairs have been through an open approach, which is more difficult to visualize the deep deltoid ligament due to overlying structures. Utilizing arthroscopy alongside suture tape augmentation may enhance postoperative outcomes. A retrospective analysis of 12 deidentified patients from 2 hospital systems examined 12 patients with bimalleolar equivalent, trimalleolar equivalent, or Maisonneuve-type ankle fractures of the ankle with increased medial clear space widening. Variables such as age, weight, body mass index (BMI), sex, side, history of previous ankle surgery, preoperative ambulatory status, length of hospital stay, and disposition were documented. A technique guide was also developed using 2 expert surgeons’ experience and opinions for using suture tape augmentation with the Arthrex InternalBrace system. We present a novel technique for the reconstruction of the deep deltoid ligament complex using our experience from these cases. Included in this guide are details on indications, setup, technique, postoperative protocol, and radiographic assessment. Following surgery with the technique, all patients exhibited reduced medial clear space, regained ambulation without assistance, and returned to full weight bearing. Arthroscopically assisted deep deltoid ligament reconstruction utilizing suture tape augmentation appears to be a successful procedure for restoring ankle function and radiographic parameters when used in conjunction with accepted open reduction and internal fixation (ORIF) techniques for bimalleolar or trimalleolar ankle fracture equivalents. Level of Evidence: Expert Opinion Level V.

Functional orthoses offer comparable outcomes to traditional casting in function and symptom relief after ankle fracture surgery, with the potential benefit of improved patient comfort and mobility. Even though early functional treatment after ankle fracture surgery shows promise, uncertainties about functional outcomes, symptom relief, and wound complications remain. (1) Are the functional outcomes 12 weeks after injury of patients treated with functional bracing (2 weeks of cast immobilization followed by 4 weeks of functional bracing) superior to those of patients who undergo 6 weeks of cast immobilization after ankle fracture surgery? (2) Are the functional outcomes 2 years after injury of patients treated with functional bracing as described above superior to those of patients who undergo 6 weeks of cast immobilization after ankle fracture surgery? (3) Are adverse events, particularly wound complications, more common in patients treated with functional bracing than those treated with cast immobilization? Between November 2005 and December 2012, a total of 134 patients (mean [range] age 40 years [18 to 59], 51% women) with an ankle fracture were enrolled in a randomized trial at one institution. Because of organizational changes, data collection and analysis were delayed. However, the study questions remain relevant, as most patients had bimalleolar or trimalleolar fractures, which are still treated surgically, and the postoperative protocols from the original study that were evaluated in this report remain widely used today. The indications for surgery were acute displaced lateral malleolar ankle fracture with > 2 mm of displacement (31% [42 of 134]), bimalleolar fracture (49% [65]), or trimalleolar fracture (20% [27]). After surgery and an initial 2-week period of cast immobilization, participants were randomized into functional bracing (n = 73) using a prefabricated ankle orthosis and cast immobilization (n = 61) with a custom-made below-knee fiberglass cast for an additional 4 weeks. In the bracing group, 3% (2 of 73) were lost to follow-up at 12 weeks and 14% (10) at 2 years, with 86% (63) fully analyzed. In the casting group, 2% (1 of 61) were lost to follow-up at 12 weeks and 20% (12) at 2 years, with 80% (49) fully analyzed. There were no differences in the baseline characteristics between the study groups. The primary outcome measure was the patient-reported Olerud-Molander Ankle Score (OMAS; scale from 0 to 100, with higher scores indicating better outcomes and fewer symptoms), assessed at 12 weeks (minimum clinically important difference [MCID] 15.0) and at 2 years (MCID 9.5). We also assessed the frequency of postoperative adverse events, including wound infections. A repeated-measures mixed model was used for statistical analyses of the primary outcome. At 12 weeks, we found no clinically important difference between the bracing group (mean ± SD 58 ± 23) and the casting group (50 ± 19) in OMAS score (mean difference 8 [95% confidence interval (CI) 2 to 14]; p = 0.008). At 2 years, we found no difference between the bracing group (91 ± 11) and the casting group (88 ± 14) in OMAS score (mean difference 3 [95% CI -3 to 9]; p = 0.29). The frequency of treatment-related adverse events, particularly wound complications, likewise did not differ between the groups and was 26% (19 of 73) in the bracing group and 23% (14 of 61) in the casting group (p = 0.68). Given these findings, surgeons can consider either treatment strategy based on patient preferences, clinical context, and resource availability without compromising clinical outcomes. However, functional bracing may enhance comfort and mobility during recovery while requiring fewer resources. Future studies should identify specific patient subgroups that may benefit more from either strategy and evaluate factors such as cost-effectiveness and patient satisfaction. Level I, therapeutic study.

Evaluation of functional outcome in closed bimalleolar fracture treated with open reduction &amp; internal fixation

Posterior malleolus (PM) fracture in trimalleolar fractures is closely associated with syndesmosis stability and affecting functional outcomes in comparison to bimalleolar fractures of the lateral and medial malleolus. The purpose of this study was to explore the role of posterior malleolus fixation for maintaining of the distal tibiofibular joint stability and intermediate-term outcomes on functional recovery and radiological appearances. In the last 7 years (2015-2022) we did ORIF for 98 consecutive trimalleolar ankle fractures which were evaluated retrospectively in patients with and without transsyndesmotic fixation. Group I consisted of sixty-four patients, in whom transsyndemotic fixation was performed. Thirty-four patients in Group II, no syndesmotic fixation was carried out in trimalleolus fractures. There were 58 male (59%), 40 female (41%) patients who had trimalleolus fractures with mean age 42 years (range 23-75)0 The mean follow up was 14 to 48 months with a mean of 16 months. American Orthopedic Foot and Ankle Society score was not significantly between two groups. Therefore, transyndesmotic screw fixation may not be needed in the cases where the posterior malleolar fracture is appropriately fixed, however, in our series, majority of the triamalleolus fractures were fixed with trans syndesmotic screws based on intra operatively radiological fluoroscopy screening with ankle in forced external rotation (ER) or Hook test after fixation PM fractures. The reduction of lateral malleolus fractures are critical for reduction of the PM fragments including maintaining correct length of the distal fibula, correction of the mal-rotation and centralization of the talus. PM fractures are reduced anatomically in intraoperatively fluoroscopic images, we may either fixing PM or trans syndesmotic fixation to maintain stability distal tibiofibular joint based on intraoperatively fluoroscopic screening assessments. The order of fixation trimalleolus fracture is critical for surgical management. For a trimalleolus fracture, firstly reduction of the lateral malleolus fractures then posterior malleolus, the last for medial malleolus fractures. Keywords : Ankle fracture, ankle malleolar fracture, posterior malleolus, syndesmosis, internal fixation

A Rare Case of Iatrogenic Flatfoot Following Minimally Invasive Fixation of Bimalleolar Ankle Fracture

Tillaux-Chaput tubercle fractures in adults often go unnoticed on standard radiographs in the setting of other malleolar fractures. This study aimed to identify clinical and radiologic factors associated with these fractures to develop a decision aid for computed tomographic (CT) diagnosis. This case-control study included 72 patients with bimalleolar fractures who underwent both radiography and CT scans. The case group consisted of 28 patients with Tillaux-Chaput fractures, and 44 served as control. Sociodemographic, clinical data, and injury mechanisms were compared using univariate and multivariate analysis to identify predictive factors. Tillaux-Chaput fractures were undetected on standard radiographs in 60% of cases. In multivariate analysis, only age >60 years and injury mechanisms with Lauge-Hansen pronation-external rotation stage III or IV injuries were found to be highly associated with Tillaux-Chaput tubercle fractures. We recommend routine CT scan evaluation for patients >60 years old with stage III or IV pronation-external rotation ankle fractures. Level III, case-control study.

Talar fractures are relatively uncommon, with an incidence of 0.1% to 0.85% of all fractures and 3% to 6% of all foot fractures. Among these, talar neck fractures are more common than those of the talar body, typically occurring in the coronal plane. Restoration of joint congruency is necessary to reduce the incidence of osteonecrosis and post-traumatic osteoarthritis. Most fractures occur in the talar neck or body in the coronal plane. In the present case report, authors present a sagittal plane fracture of the talar body in combination with a bimalleolar fracture in a 45-year-old female, managed with open reduction and internal fixation using screws. In the present case, the dual approach, which is ideal, could not be performed due to the condition of the wound over the lateral aspect of the ankle. Proper planning regarding the timing of surgery, considering the swelling and soft tissue status, alongside proper anatomic reduction and rigid fixation with good surgical technique and postoperative rehabilitation, are key to achieving favourable clinical outcomes.

Sir Percivall Pott (1714-1788) was a prominent English surgeon renowned for his substantial contributions to surgery and orthopedics. His career began with the preparation of cadavers for dissection under Edward Nourse, where he studied anatomy. Among his many significant contributions, Pott advocated for limb-preserving techniques over radical methods such as amputation. He was the first to identify an environmental carcinogen and link it to cancer. His well-known account of sustaining a bimalleolar ankle fracture from a horse fall, which was managed conservatively without any residual deformity and later became known as Pott's fracture. Additionally, his research on spinal tuberculosis, now referred to as Pott's disease, is widely recognized in the medical community. Pott authored numerous publications that encompass both surgical and orthopedic advancements. This review aims to pay tribute to this eminent figure, highlighting his groundbreaking discoveries that have laid the foundation for several concepts in surgical sciences.