Bimalleolar Ankle Fracture: Open Reduction and Internal Fixation
Bimalleolar Ankle Fracture ORIF
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Sign in to watchCreate a free accountAssess the mechanism of injury and neurovascular status, and document the soft-tissue envelope — fracture blisters and swelling determine the timing of surgery. Obtain AP, mortise, and lateral radiographs of the ankle. A medial clear space wider than the superior clear space suggests deltoid incompetence and an unstable injury. CT is useful where posterior malleolar involvement or articular comminution is suspected.
Implants & Instruments
One-third tubular plate or distal fibular locking plate; 3.5 mm cortical and 4.0 mm partially threaded cancellous screws; 2.0 mm K-wires; pointed reduction and Weber clamps; small fragment set. An antiglide plate should be available for vertical shear medial patterns.
Post-operative Protocol
Below-knee splint with elevation for 10–14 days. Non-weight-bearing for 6 weeks in a removable boot, beginning active ankle range of motion at 2 weeks once wounds are dry. Progressive weight-bearing from 6 weeks with radiographic confirmation of union. Thromboprophylaxis per institutional protocol.
Selected Educational References
- 1.Lauge-Hansen N. Fractures of the ankle: combined experimental-surgical and experimental-roentgenologic investigations. Arch Surg. 1950.
- 2.Tornetta P. Competence of the deltoid ligament in bimalleolar ankle fractures after medial malleolar fixation. J Bone Joint Surg Am. 2000.
- 3.Weber M, Krause F. Peroneal tendon lesions caused by antiglide plates used for fixation of lateral malleolar fractures. Foot Ankle Int. 2005.
- 4.SooHoo NF, et al. Complication rates following open reduction and internal fixation of ankle fractures. J Bone Joint Surg Am. 2009.
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