Are Outcomes of Bimalleolar Fractures Poorer Than Those of Lateral Malleolar Fractures with Medial Ligamentous Injury?

Nirmal C. Tejwani; McLaurin, Toni M.; Walsh, Michael; Bhadsavle, Siraj; Koval, Kenneth J.; Egol, Kenneth A.
July 2007
Journal of Bone & Joint Surgery, American Volume;Jul2007, Vol. 89-A Issue 7, p1438
Academic Journal
Background: Recommendations for surgical treatment and expected outcomes differ for two unstable patterns of supination-external rotation ankle injuries. We compared the demographic characteristics and functional outcome following surgical stabilization between the two types of supination-external rotation type-4 fractures: distal fibular fracture with a deltoid ligament rupture and bimalleolar fracture. Methods: Demographic data on 456 patients in whom an unstable fracture of the ankle was treated surgically were entered into a database and the patients were prospectively followed. Two hundred and sixty-six of these patients sustained either a bimalleolar fracture or a lateral malleolar fracture with insufficiency of the deltoid ligament and widening of the medial clear space. No medial fixation was used in the patients with a deltoid ligament injury. All patients followed a similar postoperative protocol. The patients were followed clinically and radiographically at three, six, and twelve months after the surgery. Function was assessed with the Short Musculoskeletal Function Assessment and the American Orthopaedic Foot and Ankle Society score. Results: Bimalleolar fractures were more commonly seen in female patients, in those older than sixty years of age, and in patients with more comorbidities. There was no significant association between the fracture pattern and either diabetes or the length of the hospital stay. At a minimum of one year postoperatively, the patients with a bimalleolar fracture had significantly worse function, even after we controlled for all other variables. The overall complication rate, including elective hardware removal, was also higher in the group with a bimalleolar fracture (seventeen compared with nine patients). Conclusions: At one year after surgical stabilization of an unstable ankle fracture, most patients experience little or mild pain and have few restrictions in functional activities. However, the functional outcome for those with a bimalleolar fracture is worse than that for those with a lateral malleolar fracture and disruption of the deltoid ligament, possibly because of the injury pattern and the energy expended. Level of Evidence: Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • Stability Assessment of the Ankle Mortise in Supination-External Rotation-Type Ankle Fractures: Lack of Additional Diagnostic Value of MRI. Nortunen, Simo; Lepojärvi, Sannamari; Savola, Olli; Niinimäki, Jaakko; Ohtonen, Pasi; Flinkkilä, Tapio; Lantto, Iikka; Kortekangas, Tero; Pakarinen, Harri // Journal of Bone & Joint Surgery, American Volume;11/19/2014, Vol. 96 Issue 22, p1855 

    Background: This prospective diagnostic study assessed the utility of MRI (magnetic resonance imaging) findings for the deep aspect of the deltoid ligament in evaluating the stability of the ankle mortise in patients who have an SER (supination-external rotation)-type lateral malleolar fracture...

  • A comparison of ankle block and spinal anesthesia for foot surgery. Urfalioglu, Aykut; Gokdemir, Onur; Hanbeyoglu, Onur; Bilal, Bora; Oksuz, Gozen; Toker, Melike; Gungor, Leyla // International Journal of Clinical & Experimental Medicine;2015, Vol. 8 Issue 10, p19388 

    Regional anesthesia methods in the lower extremity include central blocks where spinal and epidural anesthesia are performed as well as peripheral nerve blocks, which are performed by injecting anesthetics locally to nerves. The study aimed to provide a retrospective comparison of unilateral...

  • Competence of the Deltoid Ligament in Bimalleolar Ankle Fractures After Medial Malleolar Fixation. Tornetta III, Paul // Journal of Bone & Joint Surgery, American Volume;Jun2000, Vol. 82-A Issue 6, p843 

    Background: The stability of the ankle joint is provided by the medial and lateral malleoli and ligaments. Recent studies of cadaveric ankles have demonstrated that injury to the medial structures of the ankle is necessary to allow lateral subluxation of the talus after fracture. However,...

  • Ankle fractures in diabetics. Parikh, M.; Slater, N.; Walker, C. // Journal of the Royal College of Surgeons of Edinburgh;Dec98, Vol. 43 Issue 6, p415 

    Describes the treatment of ankle fractures in insulin-dependent diabetics. Deficits in all sensory modalities; Description of the development of neuroarthropathy after ankle and foot injuries in diabetics; Recommendation for the identification of diabetic patients in fracture clinics.

  • Tibiofibular syndesmosis in acute ankle fractures: additional value of an oblique MR image plane. Hermans, John; Beumer, Annechien; Hop, Wim; Moonen, Adrianus; Ginai, Abida // Skeletal Radiology;Feb2012, Vol. 41 Issue 2, p193 

    Objective: To evaluate the additional value of a 45° oblique MRI scan plane for assessing the anterior and posterior distal tibiofibular syndesmotic ligaments in patients with an acute ankle fracture. Materials and methods: Prospectively, data were collected for 44 consecutive patients with...

  • Management of adult ankle fractures. Sarraf, Khaled M.; Shearman, Alexander D.; Houlihan-Burne, David; Thevendran, Gowreeson // British Journal of Hospital Medicine (17508460);Mar2013, Vol. 74 Issue 3, pC41 

    The article discusses the treatment and management of adult ankle fractures. It presents two treatment methods: non-operative, in which surgery can be replaced by exercise or is simply avoided to prevent abnormal contact pressures in the ankle joint or to reduce risk of post-traumatic...

  • You ain't no chris meyers!  // Ride BMX;Aug2003, Vol. 12 Issue 8, p46 

    CHRIS MYERS broke/dislocated his ankle and broke his fibula on a spine 360 in Escondido, California. He immediately put his foot back into place, but the doctors are telling him that there's some ligament damage, so he will be off his bike for three months. All of this happened a week before...

  • Complications of Ankle Fractures in Persons with Diabetes. Bevilacqua, Nicholas J.; Rogers, Lee C. // Podiatry Management;Nov/Dec2008, Vol. 27 Issue 9, p127 

    The article discusses the treatment of ankle fractures in diabetic patients. The treatment depends on the fracture pattern and its effect on joint stability. Anatomic restoration of the ankle joint is required for patients presenting with displaced or unstable fracture patterns. Factors such as...

  • Evaluation of the integrity of the deltoid ligament in supination external rotation ankle fractures: a systematic review of the literature. van den Bekerom, Michel P. J.; Mutsaerts, Eduard L. A. R.; van Dijk, C.Niek // Archives of Orthopaedic & Trauma Surgery;Feb2009, Vol. 129 Issue 2, p227 

    Review the literature concerning modalities to evaluate the integrity of the deltoid ligament in patients with supination external rotation ankle fractures. The electronic databases Pubmed/Medline, CINAHL and Embase were searched from 1987 to November 2007 to identify all published original...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics