Bi-Malleolar Ankle Fracture Fixed


This is a case from last year—

A seemingly innocuous bi-malleolar ankle fracture in a 24 yo female that fell down stairs at a belated Halloween party.

Patient was so excited to be done with his surgeries/recovery he brought brand new, custom, Nike Blazers in the box to wear out of the office.

On closer inspection you can see her fibula broke in a less typical pattern at joint level with mild fragmentation in to the lateral gutter. Fibula almost broke in Salter Harris pattern we’ve seen in adolescents where physis is just closing, or has recently closed.

We used a pin distractor to span fracture and pull fibula out to length, and then rotate it anteriorly. We then used a lag screw and washer to better distribute pressure across a softer than expected anterior cortex.

Her medial malleolus, or rather anterior colliculus fracture was badly displaced. We were able to reduce it with very anterior lag screws.

We did use Nano arthroscopy to clean out the lateral gutter, and inspect joint surfaces.

Except for the 1 fluoro shot, the other post-op images are full weight bearing at 10 weeks. Pt left this visit in sneakers, and completed PT by 16 weeks with no complaints or bracing.