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

2. Case description 48-year-old woman
Sports injury, mild soft-tissue swelling
CT-scan shows no impaction
Type of fracture?
Options for reduction and fixation?

3. Weber’s trick

4. Fibular fixation
Show that there is not much displacement but there is osseous stabilization of the posterior and anterior syndesmotic ligaments. Syndesmotic stability should be checked at the end of the fixation. If stable no additional syndesmotic fixation required.

5. Discussion points
Insertion of the screws from anterior to posterior or vice versa?
When to use posterior antiglide plates?
Posterolateral or medial approach?
Need for syndesmotic stability?

6. Take-home messages
Large posterior malleolar fragments can be fixed from the front with lag screw
Direct vision possible through fibular fracture
For assessment of reduction, fix posterior malleolus first
Be aware of hyperflexion mechanism of the injury
Check syndesmotic stability in all cases
References:
Rammelt S, Zwipp H, Mittlmeier T. [Operative treatment of pronation fracture--dislocations of the ankle]. Oper Orthop Traumatol Jun;25(3):273–291; quiz
Rammelt et al. Oper Orthop Traumatol. 2013;25:273–291
Weber BG. Die Verletzungen des oberen Sprunggellenkes. Bern: Hans Huber; 1966