Bimalleolar Ankle Fracture: Open Reduction and Internal Fixation
Bimalleolar Ankle Fracture ORIF
Procedure video is being prepared. Faculty upload and transcoding complete before publication.
Assess 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.
Discussion
Sign in to join the discussionNo questions yet
Be the first to ask the faculty about this procedure.
Open reduction and internal fixation (ORIF) remains the standard of care for displaced bimalleolar ankle fractures to restore anatomic alignment, maintain stability and allow early mobilisation. This guide outlines a safe, stepwise approach to fixation of the fibula followed by the medial malleolus.
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.
Safety & Quality
Confirm site marking and administer prophylactic antibiotics within 60 minutes of incision. Document the soft-tissue assessment that justified the timing of surgery. Record intra-operative syndesmotic stress testing. Wound complications and superficial peroneal nerve symptoms should be captured in follow-up audit.
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.