Vertical Frx of Medial Malleolus

- Discussion:
    - results from supination-adduction fracture (Weber A)
    - adduction forces result in a vertical fracture of the medial malleolus at the junction of the plafond and malleolus;
           - transverse fibular frx or tear of lat collat occurs concomitantly;
           - medial soft tissues are intact so that interpostion is not problem;
    - main problem is comminution at medial corner of mortise;
           - plafond may be comminuted w/ impacted fragments, leading to varus tilt of mortise & post traumatic arthritis;

- Surgical Technique:

                         

    - vertical frx of medial malleolus are fixed w/ cancellous screws placed perpendicular to the fracture site;
           - usually 2 cancellous screws are required;
    - washers may be needed because of thinner medial cortex;
    - when choosing site of screw insertion, avoid areas likely to produce further comminution of the fragment;
    - screws should be seated in dense bone of the central distal tibial metaphysis and thus should be approximately 40 mm long;
           - do not attempt to anchor them in the far cortex, which is too thin to provide much purchase;

- Comminution:
    - medial surface should be inspected for articular crush of tibial surface or talar dome;
    - w/ joint congruity, impacted fragments need to be reduced w/ bone graft applied to metaphyseal defects;
    - if proximal portion of vertical frx is comminuted, butress plate may be required;
           - w/o use of butress plate a varus deformity of talus may develope;
           - plate may be small DC plate, one third, a T or clover leaf plate will suffice



Vertical Shear Fractures of the Medial Malleolus: a biomechanical study of five internal fixation techniques. 

Bicortical fixation of medial malleolar fractures: a review of 23 cases at risk for complicated bone healing.

Comparison of Surgical Techniques of 111 Medial Malleolar Fractures Classified by Fracture Geometry.




Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, February 18, 2014 11:16 am