The Treatment For Vertical Fracture Of Internal Malleolus With Severe Injury Of Lateral Ligament

Objectives: To explore the therapeutic efficacy in patients with vertical fracture ofinternal malleolus complicated with severe injury of lateral ligament.Methods: A retrospective analysis was conducted on23patients with verticalfracture of internal malleolus complicated with severe injury of lateral ligamentadmitted from April2005to June2012in our hospital. After exposing the verticalfracture line of internal malleolus via anteromedial approach, internal articular surfaceof the distal tibia was explored during surgery. Selection of fixation hardwares such asKirschner wires, screws and steel plates depended on the size of fracture fragments.Whether implantation with bone graft was needed based on the compression degree ofarticular surface. Injury of lateral ligament was repaired with anchors. X rays wereperformed to assess the postoperative healing of fracture, internal fixation, occurrenceof osteoarthritis and the range of ankle motion. Evaluation of ankle function was doneaccording to Ankle and Hindfoot scores system (American Orthopaedics Foot andAnkle Society, AOFAS).Results: Seventeen out of these23cases were followed up, with a mean follow-upof15months (8-24months). There were no wound infections, necrosis, deep venousthrombosis, pulmonary infections and other complications. The mean healing time offracture was2.9months (2.7-4.1months). All patents recovered well, without nonunion.During follow-ups, neither looseness nor rupture of internal fixation was found inpatients, without any manifestations of osteoarthritis. The range of ankle motion was asfollows：the angle of dorsal extension ranged from8°to17°,averaged14°; and plantarflexion ranged from18°-43°,averaged37°. The score of ankle function was89.3±5.2according to Ankle and Hindfoot scores system (AOFAS).Conclusions: It requires comprehension and attention to the injury mechanism ofankle fracture. The diagnosis and management also should be intensified for the damage of internal articular surface in distal tibia. Repair of severe lateral ligament with surgerycan effectively reduce the postoperative complications such as instability of ankle andposttraumatic arthritis.