1. Case for small group discussion
Ankle fracture
Case for small group discussion
Ankle fracture in a pregnant woman
AOTrauma—Foot & Ankle
Module 1a: Ankle trauma—ankle fractures
Stefan Rammelt, DE

2. Case description 21-year-old woman
8 weeks after malleolar fracture treated nonoperatively
Week 12 of gestation
Pain in left foot, increasing after weight bearing
This is the fourth x-ray showing same displacement as the first one

3. Case description Full weight bearing Mild pain Treatment options?
Timing?

4. Correction at 10 weeks postinjury
Avulsion of anterior syndesmosis noted and fixed with screw

5. 9-month follow-up
Healthy baby
No follow-up x-rays

6. 1-year follow-up Patient satisfied Sends follow-up x-ray
Plans plate removal

7. 3-year follow-up Patient satisfied New baby on the way
No follow-up x-rays

8. 5-year follow-up Patient satisfied No restriction
Occasional pain during sports
Stable ankle
No deformity
2 healthy babies

9. 5-year follow-up

10. 5-year follow-up

11. Take-home messages
Early correction of malleolar malunions or malreductions to prevent posttraumatic arthritis
Respect the radiographic landmarks for reduction and correction
Exact reduction of syndesmotic avulsions is essential for correction
Biomechanical and clinical studies indicate correction of displacement ≥2mm is necessary
References:
Rammelt S, Marti RK, Zwipp H. [Joint-preserving osteotomy of malunited ankle and pilon fractures]. Unfallchirurg Sep;116(9):789–796. German.
Rammelt S, Obruba P. An update on the evaluation and treatment of syndesmotic injuries. Eur J Trauma Emerg Surg Dec;41(6):601–614.
Rammelt et al. Unfallchirurg. 2013;116:789–796.
Thordarson DB, Motamed S, Hedman T, et al. The effect of fibular malreduction on contact pressures in an ankle fracture malunion model. J Bone Joint Surg Am. 1997;79:1809–1815.