Executive Editor: Steve Krikler

Authors: Paulo Barbosa, Felix Bonnaire, Kodi Kojima

Malleoli Transsyndesmotic, lateral isolated simple fracture

back to skeleton

Glossary

General considerations

In these fractures there is no injury to the medial side and in many cases nonoperative treatment will give a satisfactory result.

Circular cast
Indication summary Skill Equipment
Undisplaced or reduced fractures, marked soft-tissue swelling, medical compromise, vascular disease, nonambulant patient Some specialized surgical experience Basic equipment only

General considerations
Nonoperative treatment of ankle fractures is usually reserved for inherently stable fractures, which is typical of B1 fractures, but may be indicated for unstable fractures in the presence of local, or general, contraindications to surgery.

Indications

  • Undisplaced or reduced fractures
  • Severe soft-tissue swelling 
  • Poor general condition of the patient (high anesthetic risk)
  • Peripheral vascular disease

Contraindications

  • Dislocated or unstable joint 
  • Inadequate reduction 
  • Shortening, malrotation and axis deviation of the fibula
  • Open fractures with severe soft-tissue injury

Advantages

  • Full weight bearing possible
  • Good stability

Disadvantages

  • Risks of cast complications (eg, pressure ulcer, nerve compression) 
  • Risks of immobilization
  • Risk of secondary displacement and post-traumatic arthrosis 
  • Risk of malunion 
  • Possible longer period of rehabilitation
Lag screw and neutralization plate
Indication summary Skill Equipment
Displaced fractures, loss of initial reduction, good bone qualtiy, anterior tibial tubercle avulsion (fixed with independent lag screw) Some specialized surgical experience Simple surgical and imaging resources

Indications

  • Good bone quality 
  • Tillaux-Chaput lesion
  • Open fractures with severe soft-tissue injury 
  • Loss of reduction after nonoperative treatment

Contraindications

  • Poor general condition of the patient (high anesthetic risk, poor limb vascularity) 
  • Severe osteoporosis 
  • Severely compromised local soft tissues
  • Low demand patient 
  • Peripheral vascular diseases

Advantages

  • Anatomical reduction of the joint 
  • Absolute stability 
  • Early weight bearing
  • Early functional recovery 
  • Good long-term functional results

Disadvantages

  • Skin irritation through bulky implant
  • Risk of wound infection 
  • Risk of soft-tissue breakdown 
Antiglide plate
Indication summary Skill Equipment
Displaced fractures, osteoporotic bone, small distal fibular fragment, Le Fort fibular avulsion (fixed independently) Highly experienced and skilled surgeon Simple surgical and imaging resources

Indications

  • Displaced, unstable fractures 
  • Osteoporotic bone
  • Open fractures with severe soft-tissue injury 
  • Loss of reduction after nonoperative treatment

Contraindications

  • Tillaux-Chaput or Le Fort / Wagstaff lesion
  • Poor general condition of the patient (high anesthetic risk) 
  • Low demand patient
  • Poor state of soft tissues 
  • Peripheral vascular diseases

Advantages

  • Less dissection (compared to neutralization plate)
  • Indirect reduction through the plate
  • Less skin irritation because of posterolateral plate position
  • Early weight bearing
  • Anatomical reduction of the joint 
  • Early functional recovery 
  • Good long-term functional results

Disadvantages

  • Skin irritation through bulky implant
  • Risk of wound infection 
  • Risk of soft-tissue breakdown
  • Distal positioning of the plate on the distal fragment limited by peroneal tendons 
  • Risk of injury to peroneal tendons
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2015-12-04