Background: The movement around ankle joint is very important because of the cultural practices, which involve squatting and sitting cross-legged. Bimalleolar Potts fractures are very common in ankle joint injuries because of increased incidence of road traffic accidents and industrial trauma. Accurate reduction of fractures around ankle joint is important for a painless ankle joint.
Objective: To study the functional outcome of surgically managed closed bimalleolar fractures of ankle in adults; to evaluate restoration of the anatomy of malleoli and ankle perfectly by operative treatment with internal fixation; to assess the union of fractures after surgical management; and to achieve stable fixation and early mobilization of the ankle.
Materials and Methods: We have evaluated clinical, radiographic, and functional outcomes of 40 patients treated with a combination of different treatment modalities, which involve the combination of tension band wiring (TBW), Kirschner (K)-wire, Rush pin, cortical and cancellous screws, and one-third tubular plates for lateral and medial malleolus fixation.
Results: In this prospective study, 40 cases of bimalleolar fractures of ankle were treated by surgical methods. Road traffic accident was the most common mode of injury. Majority [16 (40%)] of the cases showed supinationexternal rotation injury, followed by 11 (27.5%) cases with pronationexternal rotation injury. Majority [29 (72.5%)] of the medial malleolus fractures were fixed with TBW. In the remaining cases, cancellous screws and K-wire were used. Most [20 (50%)] of the lateral malleolar fractures were fixed with K-wire. In the rest of the cases, one-third tubular plate and Rush pin were used. In our study, the average time taken for union was 10.4 weeks. Excellent results were achieved in 23 cases (57.5%), good in 10 cases (25%), fair in five cases (12.5%), and poor in two cases (5%). Excellent results were observed in most bimalleolar fractures. Of the two cases with poor results, one developed superficial infection and the other showed delayed union.
Conclusion: Unstable bimalleolar ankle fractures are common because of road traffic accidents. Understanding the mechanism of injury is essential for anatomical reduction and fixation. Fibular alignment (length and rotation) has to be maintained for lateral stability of the ankle. Anatomical reduction with restoration of the articular congruence is essential in all intra-articular fractures, more so, if a weight-bearing joint such as ankle is involved. Open reduction and internal fixation restores the articular congruity of the ankle joint. Excellent results are obtained with stable fixation of fracture. TBW is better in internal fixation of medial malleolus compared with K-wire fixation, and lateral plating was the best for fibular fractures. Hence, we conclude that surgical management of bimalleolar ankle fractures provides good functional outcome. By stable surgical fixation of fracture, early mobilization can be done with good functional outcome.
Key words: Bimalleolar Potts fractures, TBW, K-wire, rush pin, CC screw, one-third tubular plates
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