Bi Malleolar fracture
Definition
Medial Malleolus and Lateral Malleolus fractured
Management
Superior results with operative management
Surgery
1. Weber B + medial malleolus fracture
Fibula
- interfragmentary lag screw
- derotation 1/3 tubular plate
Medial malleolus (dependant on fragment size)
- 2 partially threaded lag screws
- 1 screw and one k wire
- TBW
Screen syndesmosis
- should be stable with Weber B
- stress view (ER and dorsiflexion)
- cotton test (clamp on fibula and attempt to open syndesmosis under II)
2. Fibular fracture + posterior malleolus
Fibular plate versus nail
Walsh et al Foot Ankle Surg 2022
- meta-analysis of RCTs of plate versus fibular nail
- no difference in outcome or healing rates
- reduction in complications with nail
Tri-Malleolar Fracture
Definition
Lateral malleolus + medial malleolus + posterior malleolus