Krishna Bhargavevem, Anvesh Kumar Kondlapudi, Sai Pavan Kumar Murari, Srinivasa Murthy



 Objectives: Appropriate management of malleolar injuries is crucial as the ankle is an important weight-bearing joint, and locomotion is determined by and dependent on joint stability. We studied the functional outcome of surgically managed bimalleolar fractures of the ankle.

Methods: Fractures were classified anatomically and as per Lauge–Hansen, arbeitsgemeinschaft für osteosynthesefragen (AO)/orthopedic trauma association classification. The stability of the structures at the fracture site, the extent of damage, mechanism of injury was assessed. Radiologically, tibiofibular clear space of >6 mm and widening of the medial clear space of >4 mm were indicators of syndesmotic instability.

All underwent open reduction and internal fixation under spinal and/epidural anesthesia. We used tension band wiring, malleolar screw, Kirschner wires (K-wires), cancellous screws for fixing medial malleolus; one-third tubular plate and K-wires for lateral malleolus. Patients were followed up at 6 weeks for 6 months, evaluated using Biard and Jackson’s ankle scoring system.

Results: Of 30 patients, 25 (83.3%) were men. The right ankle was involved in 56.6%. Road traffic accident was the cause in 83.3%. 14 (46.6%) had supination external rotation injuries. The AO Type B was the most common (66.6%). All had a complete union, with a mean time for union 10.6 weeks (8-14 weeks). Functional scores were categorized into excellent (60%), good (26.6%), fair and poor (n=02 each). Superficial and deep infection (n=02 each), delayed union (n=01) were the complications.

Conclusion: ORIF restores the articular congruity of the ankle joint. Cancellous or malleolar screws are better for fixation of the medial malleolus and lateral plating for fibular fractures.


Bimalleolar fracture, Biomechanics, Cancellous screw, Malleolar screws, Open reduction and internal fixation, Plating, Tension band wiring.

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About this article




Orthopedics; bimalleolar fracture


Bimalleolar fracture, Biomechanics, Cancellous screw, Malleolar screws, Open reduction and internal fixation, Plating, Tension band wiring.





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Asian Journal of Pharmaceutical and Clinical Research
Vol 10 Issue 11 November 2017 Page: 252-256

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Authors & Affiliations

Krishna Bhargavevem
Department of Orthopaedics, Apollo Institute of Medical Sciences and Research, Hyderabad - 500 096, Telangana, India.

Anvesh Kumar Kondlapudi
Department of Orthopaedics Sri Devaraj Urs Medical College, Kolar - 563 101, Karnataka, India.

Sai Pavan Kumar Murari
Department of Orthopaedics, Apollo Institute of Medical Sciences and Research, Hyderabad - 500 096, Telangana, India.

Srinivasa Murthy
Department of Orthopaedics, Apollo Institute of Medical Sciences and Research, Hyderabad - 500 096, Telangana, India.

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