Surgical therapy for an external ankle fracture
All displaced ankle fractures or those with unstable injury of the syndesmosis must be operated. An exact restoration of the axis, length and rotation of the ankle bones is crucial for the success of the therapy. An emergency indication for immediate surgery of the external ankle fracture exists in cases of open fractures, vascular and nerve injuries and manifest compartment syndrome.
The treatment of the external ankle fracture should generally be attempted within the first 6 hours after the accident. However, if the ankle joint is too swollen, the patient must first wait because the risk of infection increases considerably with swollen soft tissue and wound closure is more difficult. In the following days, the injured lower leg is put up in a plaster splint and the ankle joint is cooled.
In addition, anti-inflammatory drugs (NSAIDs) can be administered, which have an analgesic effect and also promote decongestant swelling. After 3-5 days, the operation can usually take place. Disadvantages in fracture treatment due to the waiting period are not to be expected. Surgical stabilization of the external ankle fracture always follows the sequence external ankle, internal ankle, posterior Volkmann fragment.
Method of operation
Displaced fractures of the tip of the outer ankle can be refixed with a screw (cancellous bone screw) if the fragment size is sufficient. Otherwise, a tension belt with wires is recommended, in which the fragment is stably fixed to its original location by means of a wire loop wound in a figure-eight direction. If the fibula fracture is higher at the level of the syndesmosis or above (Weber B+C), plating (plate osteosynthesis) of the fracture is performed.
The plate should be positioned so that at least 3 screws are positioned above and below the fracture zone. An additional screw (interfragmentary lag screw) can be used to contract the fracture, which has a positive effect on bone healing. For stabilization in case of torn syndesmosis, one or two syndesmosis set screws (corticalis screw) are inserted from the fibula into the tibia to stabilize the ankle bifurcation.
It is essential to ensure that the natural conditions of the ankle joint are restored exactly (to the millimetre). Even small remaining irregularities (incongruities) can later cause severe damage to the ankle joint. The result is premature wear and tear of the ankle cartilage (post-traumatic ankle arthrosis).
- Set screw
- Free traction bolt
- Upper ankle joint
- Hock leg/talus
- Third-tube plate with screws (top corticalis screw, bottom cancellous bone screws)
- Internal ankle fractures: After exact adjustment, internal ankle fractures are treated with a screw connection (cancellous bone traction screw with washer if necessary), or optionally with a tension belt. – Posterior Volkmann fragment (triangle): The indication for refixation of a posterior Volkmann fragment is given if its size is more than a quarter of the joint surface. Usually, the fragment is grasped from the front with 2 screws (cortical or cancellous bone screws) during an operation after its setup.