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Medial Malleolus Osteosynthesis: Surgery & Recovery

Medial malleolus osteosynthesis is a surgical procedure to stabilise a fractured medial malleolus using screws, wires, or plates to restore ankle joint stability.

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Things worth knowing about "Medial malleolus osteosynthesis"

Medial malleolus osteosynthesis is a surgical procedure to stabilise a fractured medial malleolus using screws, wires, or plates to restore ankle joint stability.

What is Medial Malleolus Osteosynthesis?

Medial malleolus osteosynthesis is a surgical procedure in trauma surgery and orthopaedics used to stabilise a fractured medial malleolus (the inner bony prominence of the ankle) using implants such as screws, Kirschner wires, or plates. The primary goal is to restore the anatomical alignment and mechanical stability of the upper ankle joint (talocrural joint).

Causes and Indications

Surgery is indicated when the medial malleolus fracture is displaced or unstable, making conservative treatment such as casting insufficient. Common causes of a medial malleolus fracture include:

Ankle inversion or supination injuries (rolling the ankle inward)
Falls from height
Sports injuries, especially in football, basketball, and skiing
Road traffic accidents

Medial malleolus fractures often occur as part of a combined ankle fracture pattern, such as bimalleolar or trimalleolar fractures. The surgical indication is based on fracture type, degree of displacement, and ankle joint stability.

Diagnosis

Before surgery, a thorough diagnostic work-up is performed:

X-rays of the ankle in two planes to assess fracture type and extent
Computed tomography (CT) for complex or unclear fracture patterns
Clinical examination to assess soft tissue damage, neurovascular status, and joint stability

Fractures are commonly classified using the Weber classification (Weber A, B, or C) or the AO classification system.

Surgical Technique

The procedure is typically performed with the patient in the supine position under regional or general anaesthesia. Key steps include:

Reduction: The displaced bone fragments are repositioned into their correct anatomical alignment.
Fixation: Depending on the fracture type, stabilisation is achieved using one or two lag screws, a plate-and-screw construct, or Kirschner wires with a tension band wire (tension band osteosynthesis).
Wound closure: After placement of a drain, the wound is closed in layers.

Tension band osteosynthesis using two parallel Kirschner wires and a wire loop is a well-established method for transverse fracture patterns. Larger or more complex fragments are typically fixed with lag screws or small-fragment plates.

Postoperative Care and Rehabilitation

Structured postoperative rehabilitation is essential for full recovery:

Immobilisation and partial weight-bearing for several weeks, depending on fracture complexity and surgical outcome
Thromboprophylaxis with low-molecular-weight heparin
Physiotherapy to restore range of motion, muscle strength, and proprioception
Gradual increase in weight-bearing under medical supervision
Follow-up X-rays to monitor bone healing

Full weight-bearing is generally achievable within 6 to 12 weeks, depending on the severity of the injury and the course of healing.

Possible Complications

As with any surgical procedure, certain risks exist:

Wound or bone infection (osteitis)
Implant loosening or failure
Impaired wound healing, particularly in patients with diabetes or smokers
Nerve or vascular injury
Post-traumatic osteoarthritis of the ankle joint if reduction is incomplete
Deep vein thrombosis or pulmonary embolism

In some cases, implant removal may be necessary after complete fracture healing, particularly if implants are palpable or cause discomfort.

References

Rommens PM, Hessmann MH (eds.): Intramedullary Nailing. Springer, Berlin/Heidelberg, 2015.
Müller ME et al.: The Comprehensive Classification of Fractures of Long Bones. Springer, Berlin, 1990.
Court-Brown CM et al.: Rockwood and Green's Fractures in Adults. 8th edition. Wolters Kluwer, Philadelphia, 2015.

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