Operation after an external malleolus fracture

Surgical therapy for an external malleolus fracture

Any displaced ankle fractures or those with an unstable injury to the syndesmosis must be operated on. An exact restoration of the axis, length and rotation of the ankle bones is crucial for the success of the therapy.
An emergency indication for immediate operation of the lateral malleolus fracture exists in the case of open fractures, vascular and nerve injuries and manifest compartment syndrome.

The treatment of the lateral ankle fracture should generally be sought within the first 6 hours after the accident.

However, if the ankle is too swollen, you have to wait because the risk of infection increases significantly with swollen soft tissues and wound closure is more difficult. The injured lower leg is put up in a plaster cast in the following days and the ankle is cooled. In addition, anti-inflammatory drugs (NSAIDs) can be given, which have an analgesic effect and also promote decongestion. The operation can usually take place after 3-5 days. Disadvantages in the treatment of fractures due to the waiting time do not have to be expected.

The operative stabilization of the external malleolus fracture always follows the sequence of external malleolus, internal malleolus, and posterior Volkmann fragment.

Read more about the external ankle fracture without surgery.

Surgical method

Displaced fractures of the outer malleolus tip can be repaired with a screw (Cancellous screw) be refixed. Otherwise, a tension belt with wires is recommended, in which the fragment is securely attached to its place of origin via an eight-turn twisted wire loop.

If the fibular fracture is higher up at the level of the syndesmosis or above (Weber B + C), a plating (Plate fixation) of the fracture. The plate should be placed so that at least 3 screws come to rest above and below the fracture zone. Via an additional screw (interfragment lag screw) the fracture can be contracted, which has a positive effect on bone healing. To stabilize a torn syndesmosis, one or two syndesmosis adjustment screws (Cortex screw) inserted from the fibula into the shin to stabilize the ankle joint.
It is essential to ensure that the natural ankle conditions are restored exactly (to the millimeter). Even small remaining irregularities (Incongruences) can later severely damage the ankle. The result is premature wear of the ankle cartilage (Post-traumatic ankle arthrosis).

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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
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Outer malleolus fracture after osteosynthesis

  1. Shin / tibia
  2. Adjusting screw
  3. free lag screw
  4. upper ankle
  5. Talus / talus
  6. Third pipe plate with screws (Cortical bone screw above, cancellous bone screw below)
  7. Fibula / fibula
  • Inner malleolus fractures: After exact set-up, inner ankle fractures areCancellous pull screw if necessary with washer), optionally also supplied by a tension strap.
  • Rear Volkmann fragment (triangle): The indication for re-fixation of a rear Volkmann fragment is given if its size is more than a quarter of the joint surface. Usually, after an operation, the fragment is grasped from the front with 2 screws (cortical or cancellous tension screws) after it has been set up.

Aftercare

After a successful operation of the lateral ankle fracture, an early functional follow-up treatment can take place, i.e. While relieving the operated leg, the mobility of the ankle can be trained. A lower leg plaster cast is only necessary for extensive fractures.

The inserted wound tubes (Redon drainage) will be on 2nd postoperative day away. This is followed by a first X-ray control instead of. The thread is pulled on the 12th postoperative day after the end Wound healing.

For a total of at least 6 weeks the mobilization has to take place on two forearm crutches while relieving the operated leg. (Some authors see the possibility of partial weight bearing of 10-20 kg or full weight bearing in a special shoe (e.g. Variostabil)).

At the end of the 6th postoperative week, after removing any set screw that may have been inserted, and depending on the radiological follow-up, you can begin to build up the load up to full load. It is recommended to carry out physiotherapeutic exercise treatments to promote strength and mobility.

The metal removal (Plate, screws) takes place after approx. 1 year.