- Post-Procedure: Fixation of the Lateral Malleolus
- Post-Procedure: Repair of the Deltoid Ligament and Internal Fixation of the Lateral Malleolus
Post-Procedure: Fixation of the Lateral Malleolus
POST-PROCEDURE CARE
- Immobilize the ankle in a posterior plaster splint in neutral position.
- Remove the splint 2 to 4 days after surgery and replace with a removable splint or fracture boot if the bone stock is good and fixation is secure.
- Protect the ankle in a short or long leg non-weight-bearing cast for 8 to 12 weeks if skin condition, poor bone quality, or tenuous fixation is present.
- Begin range-of-motion exercises when the splint is removed.
- Restrict weight bearing for 6 weeks, then allow 50% weight bearing with full weight bearing restricted until 12 weeks.
- Use a 5-mm heel wedge for 4 to 6 months if the deltoid ligament was repaired.
COMPLICATIONS
- Infection
- Delayed union or nonunion
- Hardware failure
- Painful hardware
ANALYSIS OF RESULTS
Studies have demonstrated very high rates of success for bony union of lateral malleolar fractures using the techniques described here. The most common complication was symptomatic hardware because of the superficial nature of fixation on the lateral side of the ankle.
OUTCOMES AND EVIDENCE
- Brown, Dirschl, and Obremsky: 31% of patients had lateral hardware pain after plate and screw fixation of unstable ankle fractures; 23% required hardware removal, with only half of those obtaining pain relief.
- Tornetta and Creevy: lag screw versus lateral plate and screw fixation; the lag screw group had no nonunions, loss of reduction, or soft-tissue complications; 2% complained of lateral pain compared to 17% in the plate/screw group.
- Kim and Oh: 93% satisfactory results in noncomminuted Danis-Weber type B fractures with lag screw only fixation.
- Koval et al: 89% healing in osteopenic fibular fractures treated with plate fixation augmented with intramedullary Kirschner wires; biomechanical testing showed that the augmented plates had 81% greater resistance to bending.
- Breederveld et al: equally good functional results with immediate and delayed open reduction and internal fixation, but shorter hospital stays and less immediate post-op pain in the group treated with immediate surgery.
- Konrath et al: no difference in complications, reduction, motion, or operative time between early (less than 5 days) and delayed surgery for closed Danis-Weber type B bimalleolar or bimalleolar-equivalent fractures.
Procedure: Fixation of the Lateral Malleolus
Post-Procedure: Repair of the Deltoid Ligament and Internal Fixation of the Lateral Malleolus
POST-PROCEDURE CARE
- Immobilize the ankle in a posterior plaster splint in neutral position.
- Remove the splint 2 to 4 days after surgery and replace with a removable splint or fracture boot if the bone stock is good and fixation is secure.
- Protect the ankle in a short or long leg non-weight-bearing cast for 8 to 12 weeks if skin condition, poor bone quality, or tenuous fixation is present.
- Begin range-of-motion exercises when the splint is removed.
- Restrict weight bearing for 6 weeks, then allow 50% weight bearing with full weight bearing restricted until 12 weeks.
- Use a 5-mm heel wedge for 4 to 6 months if the deltoid ligament was repaired.
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COMPLICATIONS
- Infection
- Delayed union or nonunion
- Hardware failure
- Painful hardware
ANALYSIS OF RESULTS
Studies have demonstrated very high rates of success for bony union of lateral malleolar fractures using the techniques described here. The most common complication was symptomatic hardware because of the superficial nature of fixation on the lateral side of the ankle.
OUTCOMES AND EVIDENCE
- Brown, Dirschl, and Obremsky: 31% of patients had lateral hardware pain after plate and screw fixation of unstable ankle fractures; 23% required hardware removal, with only half of those obtaining pain relief.
- Tornetta and Creevy: lag screw versus lateral plate and screw fixation; the lag screw group had no nonunions, loss of reduction, or soft-tissue complications; 2% complained of lateral pain compared to 17% in the plate/screw group.
- Kim and Oh: 93% satisfactory results in noncomminuted Danis-Weber type B fractures with lag screw only fixation.
- Koval et al: 89% healing in osteopenic fibular fractures treated with plate fixation augmented with intramedullary Kirschner wires; biomechanical testing showed that the augmented plates had 81% greater resistance to bending.
- Breederveld et al: equally good functional results with immediate and delayed open reduction and internal fixation, but shorter hospital stays and less immediate post-op pain in the group treated with immediate surgery.
- Konrath et al: no difference in complications, reduction, motion, or operative time between early (less than 5 days) and delayed surgery for closed Danis-Weber type B bimalleolar or bimalleolar-equivalent fractures.
Procedure: Fixation of the Lateral Malleolus
