A lamina spreader was used to obtain fibular length. A screw was then placed proximal to the plate in the fibular shaft. A precontoured lateral fibular plate was affixed to the distal segment of the fibula with 3.5mm locking screws (Zimmer, Warsaw, IN) ( Figure 5). Next, we turned our attention back to the lateral side. Intraoperative fluoroscopy showing an oscillating saw that was used to create an oblique osteotomy through the previous fracture site. The authors have obtained the patient’s informed written consent for print and electronic publication of the case report. This serves as a reminder of the principles of treatment which he first described, and which universally dictate care. Treatment included a distal fibular osteotomy to correct fibular length and rotation, as was first described by Yablon. We present a review of the literature and a case of a non-operatively treated, displaced ankle fracture with lateral malleolus malunion, ankle subluxation, and residual pain. 6 Thus, the goal of treating ankle fractures is to restore an anatomic tibio-talar reduction to prevent future ankle arthritis. 5 The importance of an anatomic tibio-talar joint reduction was further elucidated by Ramsey, who showed that even 1mm of residual tibio-talar misalignment increased contact pressure by 42%. 3, 4 Yablon originally described that late posttraumatic degenerative ankle arthritis was due to ongoing tibio-talar joint incongruity, and more importantly that anatomic reduction of the lateral malleolus was key to anatomic reduction of the ankle joint, as the talus “faithfully followed that of the lateral malleolus”. Rotational ankle injuries, most of which involve a significant injury to the lateral malleolus, are the most common subgroup of ankle fractures and the most common subgroup to lead to posttraumatic arthritis. 2 These injuries can lead to posttraumatic ankle arthritis, which is the leading cause of ankle arthritis. 1 They are the fourth most common fracture type, accounting for approximately 7% of all fractures. This implant offers several advantages, including easy application, less soft tissue dissection, less palpable instrumentation, stable fixation, and a short operating time.Ankle fractures are common injuries, with an incidence of 187 fractures per 100,000 person years. Knowles pin fixation for displaced lateral malleolar fractures is a useful and effective method. Three complications occurred, but resolved with nonoperative therapy. No instrumentation problems were encountered. The average satisfactory outcome of the 4 groups was 88.1%. Open reduction and internal fixation with a Knowles pin fixation of the lateral malleolus.įunctional results were evaluated using the Baird and Jackson ankle scoring system. Patients were assigned into 4 groups according to the Orthopedic Trauma Association classification of ankle fractures. All the patients had a stable syndesmosis, less than 50% comminution, and had no other operations in the same extremity. The senior surgeons were all orthopedic trauma subspecialists.Ī total of 168 patients meeting our inclusion criteria, an isolated displaced lateral malleolar fracture surgically treated by a Knowles pin between 19, were studied. The study was carried out at a municipal teaching hospital. To assess the use of Knowles pin fixation for isolated displaced lateral malleolar fractures and to present our surgical experience using this method.
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