- See:
-
Radiographic Studies
-
Verticle Fractures of Medial Malleolus:
- Discussion:
- transverse frx of fibula occuring below
Syndesmosis;
- usually there is enough remaining butress of fibula to prevent lateral
talar tilt or displacement;
- avulsion frx of distal fibula c/w
supination/adduction frx;
- Treatment:
- consider fixation w/ screw or with a tension band wire;
- may require operative treatment if assoc w/
medial malleolus Frx;
-
tension band wire;
- 2 parallel K wires (0.045 inch) are inserted at distal end of fibula and
engage the proximal medial cortex above fracture site;
- 20 gauge wire is then passed thru transverse drill hole above frx site &
placed in a figure of 8 fashion around bent tips of protruding K wires;
-
screw fixation:
- if frx is transverse or distal frag is small, consider insertion of a long screw
across the fracture line into the meduallary canal of the proximal fragment;
- expose tip of malleolus by splitting
calcaneofibular ligament longitudinally;
- avoiding tilting
lateral malleolus toward the talus;
- insertion point for meduallary fixation is at lateral surface of malleolar tip;
-
4.0 mm cancellous screw or
malleolar screw is inserted into
proximal medial cortex of fibula above the fracture site;
- avoid rotation or displacement of distal fragment as screw is inserted;
- since the medullary device (screw) is straight, the lateral malleolus may be
inadvertently tilted toward the talus;
- this will result in narrowing of ankle
Mortise & reduced motion;
Percutaneous intramedullary fixation of lateral malleolus fractures:
technique and report of early results.
