Malleolar Fractures: Guidelines and Tips for Surgical Fixation

  • Mahmut Nedim Doral
  • Onur Bilge
  • Gazi Huri
  • Egemen Turhan
  • Hande Guney
  • João Espregueira-Mendes


The ankle joint is the most commonly injured weight-bearing joint in the human body. A spectrum of injuries is possible from stable simple soft tissue injuries to unstable, complex open ankle fractures or fracture dislocations. The most common ankle joint fracture patterns are lateral malleolar, bimalleolar, and trimalleolar fractures. Malleolar fracture management can be summarized into three general approaches: nonsurgical, staged, and surgical. In general, stable and unstable ankle fractures can be managed nonsurgically or surgically, respectively. Staged treatment with external fixation and delayed internal fixation is reserved for high-energy fractures/fracture dislocations with compromised surrounding soft tissues. The two main lateral malleolar fracture fixation categories are plating and intramedullary fixation. Various surgical fixation methods have been described for the treatment of lateral malleolar fractures, but the best method is still to be determined. Anatomical reduction and stable fixation of medial malleolar fractures are important in order to restore ankle mortise stability, to obtain healthy bony union and early ankle motion. Although a nonsurgical approach is applicable in non-displaced fractures, surgical management has been favored for more than 40 years. In contrast to well-established management of lateral and medial malleolar fractures, the management of posterior malleolar fractures is still controversial. As the importance of minimally invasive fracture surgery has increased in order to minimize complications such as non-union and soft tissue injuries, the concordant evolution of the use of arthroscopy in “joint-related fracture” surgery has developed. This chapter presents guidelines and tips for the surgical management of ankle malleolus fractures (lateral, medial, posterior), including clinical comparison of a variety of surgical fixation methods.


  1. Abdelgawad AA, Kadous A, Kanlic E (2011) Posterolateral approach for the treatment of posterior malleolus fracture of the ankle. J Foot Ankle Surg 50:607–611PubMedCrossRefGoogle Scholar
  2. Ahn J, Kim S, Lee JS, Woo K, Sung KS (2016) Incidence of peroneal tendinopathy after application of a posterior antiglide plate for repair of supination external rotation lateral malleolar fractures. J Foot Ankle Surg 55:90–93PubMedCrossRefGoogle Scholar
  3. Amanatullah DF, Wolinsky PR (2010) An alternative fixation technique for small medial malleolus fractures. Orthopedics 33:888–889PubMedCrossRefGoogle Scholar
  4. Amendola A, Petrik J, Webster-Bogaert S (1996) Ankle arthroscopy: outcome in 79 consecutive patients. Arthroscopy 12:565–573PubMedCrossRefGoogle Scholar
  5. Ansari U, Adie S, Harris IA, Naylor JM (2011) Practice variation in common fracture presentations: a survey of orthopaedic surgeons. Injury 42:403–407PubMedCrossRefGoogle Scholar
  6. Asloum Y, Bedin B, Roger T, Charissoux JL, Arnaud JP, Mabit C (2014) Internal fixation of the fibula in ankle fractures. A prospective, randomized and comparative study: plating versus nailing. Orthop Traumatol Surg Res 100:255–259CrossRefGoogle Scholar
  7. Atesok K, Doral MN, Whipple T et al (2011) Arthroscopy-assisted fracture fixation. Knee Surg Sports Traumatol Arthrosc 19:320–329PubMedPubMedCentralCrossRefGoogle Scholar
  8. Bankston AB, Anderson LD, Nimityongskul P (1994) Intramedullary screw fixation of lateral malleolus fractures. Foot Ankle Int 15:599–607PubMedCrossRefGoogle Scholar
  9. Barnes H, Cannada LK, Watson JT (2014) A clinical evaluation of alternative fixation techniques for medial malleolus fractures. Injury 45:1365–1367PubMedCrossRefGoogle Scholar
  10. Bartonicek J, Rammelt S, Tucek M (2017) Posterior malleolar fractures: changing concepts and recent developments. Foot Ankle Clin 22:125–145PubMedCrossRefGoogle Scholar
  11. Boggs LR (1986) Isolated posterior malleolar fracture. Am J Emerg Med 4:334–336PubMedCrossRefGoogle Scholar
  12. Bonasia DE, Rossi R, Saltzman CL, Amendola A (2011) The role of arthroscopy in the management of fractures about the ankle. J Am Acad Orthop Surg 19:226–235CrossRefGoogle Scholar
  13. Bostman O, Vainiopaa S, Hirvensalo E et al (1987) Bioabsorbable internal fixation for malleolar fractures. A prospective randomized trial. J Bone Joint Surg 67B:615–619CrossRefGoogle Scholar
  14. Braunstein M, Baumbach SF, Böcker W, Mutschler W, Polzer H (2016a) Arthroscopically assisted treatment of ankle fractures. Unfallchirurg 119:92–98PubMedCrossRefGoogle Scholar
  15. Braunstein M, Baumbach SF, Regauer M, Böcker W, Polzer H (2016b) The value of arthroscopy in the treatment of complex ankle fractures – a protocol of a randomized controlled trial. BMC Musculoskeletal Disord 17:210CrossRefGoogle Scholar
  16. Brown OL, Dirschl DR, Obremseky WT (2001) Incidence of hardware-related pain and its effect on functional outcomes after open reduction and internal fixation of ankle fractures. J Orthop Trauma 15:271–274PubMedCrossRefGoogle Scholar
  17. Brunner CF, Weber BG (1982) The anti-glide plate. In: Special techniques in internal fixation. Springer-Verlag, New York, pp 115–133CrossRefGoogle Scholar
  18. Bucholz RW, Henry S, Henrey B (1994) Fixation with bioabsorbable screws for the treatment of fractures of the ankle. J Bone Joint Surg Am 76:319–324PubMedCrossRefGoogle Scholar
  19. Bugler KE, Watson CD, Hardie AR et al (2012) The treatment of unstable fractures of the ankle using the Acumed fibular nail: development of a technique. J Bone Joint Surg Br 94:1107–1112PubMedCrossRefGoogle Scholar
  20. Cansu E, Unal MB, Gurcan S, Parmaksizoglu F (2016) Surgical treatment of lateral malleolar fractures using the compression cerclage system. J Am Podiatr Med Assoc 106:313–318PubMedCrossRefGoogle Scholar
  21. Chan KB, Lui TH (2016) Role of ankle arthroscopy in management of acute ankle fractures. Arthroscopy 32(11):2373–2380PubMedCrossRefGoogle Scholar
  22. Choi CH, Choi YA, Kim JH, Sung IH (2007) Posterior plating in distal fibular fracture. J Korean Fracture Soc 20:161–165CrossRefGoogle Scholar
  23. Choi JY, Kim JH, Ko HT, Suh JS (2015) Single oblique posterolateral approach for open reduction and internal fixation of posterior malleolar fractures with an associated lateral malleolar fracture. J Foot Ankle Surg 54:559–604PubMedCrossRefGoogle Scholar
  24. Chung KJ, Huang B, Choi CH, Park YW, Kim HN (2015) Utility of 3D printing for complex distal tibial fractures and malleolar avulsion fractures: technical tip. Foot Ankle Int 36:1504–1510CrossRefGoogle Scholar
  25. Clyde J, Kosmopoulos V, Carpenter B (2013) A biomechanical investigation of a knotless tension band in medial malleolar fracture models in composite Sawbones. J Foot Ankle Surg 52:192–194PubMedCrossRefGoogle Scholar
  26. Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37:691–697PubMedPubMedCentralCrossRefGoogle Scholar
  27. Court-Brown CM, McBirnie J, Wilson G (1998) Adult ankle fractures: an increasing problem. Acta Orthop Scand 69:43–47Google Scholar
  28. Davidovitch RI, Egol KA (2009) The medial malleolus osteoligamentous complex and its role in ankle fractures. Bull NYU Hosp Jt Dis 67:318–324Google Scholar
  29. De Vries JS, Wijgman AJ, Sierevelt IN, Schapp GR (2005) Long term results of ankle fractures with a posterior malleolar fragment. J Foot Ankle Surg 44:211–217PubMedCrossRefGoogle Scholar
  30. Deml C, Eichinger M, van Leeuwen WF, Erhart S, Eulder SA, Brunner A (2017) Does intra-articular load distribution change after lateral malleolar fractures? An in vivo study comparing operative and non-operative treatment. Injury 48:854–860PubMedCrossRefGoogle Scholar
  31. Dumigan RM, Bronson DG, Early JS (2006) Analysis of fixation methods for vertical shear fractures of the medial malleolus. J Orthop Trauma 20(10):687–691PubMedCrossRefGoogle Scholar
  32. Ebraheim N, Weston JT, Ludwig T, Moral MZ, Carroll T, Liu J (2014) The association between medial malleolar geometry, injury mechanism, and syndesmotic disruption. Foot Ankle Surg 20:276–280Google Scholar
  33. Evans JM, Gardner MJ, Brennan ML, Phillips CJ, Henley MB, Dunbar RP (2010) Intramedullary fixation of fibular fractures associated with pilon fractures. J Orthop Trauma 24:491–494PubMedCrossRefGoogle Scholar
  34. Fermino JE, Gruber BF, Karunakar MA (2007) Safe zone for the placement of medial malleolar screws. J Bone Joint Surg 89A:133–138CrossRefGoogle Scholar
  35. Fitzpatrick EP, Kwon JY (2014) Use of a pointed reduction clamp placed on the distal fibula to ensure proper restoration of fibular length and rotation and anatomic reduction of the syndesmosis: a technical tip. Foot Ankle Int 35:943–948PubMedCrossRefGoogle Scholar
  36. Fowler TT, Pugh KJ, Litsky AS, Taylor BC, French BG (2011) Medial malleolar fractures: a biomechanical study of fixation techniques. Orthopedics 34:349–355Google Scholar
  37. François N, Inal N, Nassar E, Benrahho A, Moujawaz B (1998) The “epiphysa” fibular nail-45 cases during 30 months. Technical note. Eur J Orthop Surg Traumatol 8:81–83CrossRefGoogle Scholar
  38. Freeman AL, Tornetta P III, Schmidt A, Bechtold J, Ricci W, Fleming M (2010) How much do locked screws add to the fixation of “hybrid” plate constructs in osteoporotic bone? J Orthop Trauma 24:163–169PubMedCrossRefGoogle Scholar
  39. Frigg R (2003) Development of the locking compression plate. Injury 34(Suppl 2):6–10CrossRefGoogle Scholar
  40. Fuchs DJ, Ho BS, LaBelle MW, Kelikian AS (2016) Effect of arthroscopic evaluation of acute ankle fractures on PROMIS intermediate-term functional outcomes. Foot Ankle Int 37:51–57PubMedCrossRefGoogle Scholar
  41. Gardner M, Brodsky A, Briggs SM, Nielson JH, Lorich DG (2006) Fixation of posterior malleolar fractures provides greater syndesmotic stabilization. Clin Orthop Relat Res 447:165–171PubMedCrossRefGoogle Scholar
  42. Gardner MJ, Streubel PN, McCormick JJ, Klien SE, Johnson JE, Ricci WM (2011) Surgeon practices regarding operative treatment of posterior malleolus fractures. Foot Ankle Int 32:385–393PubMedCrossRefGoogle Scholar
  43. Gausepohl T, Mohring R, Pennig D, Abarquel A, Eldad A (2001) Fine thread versus coarse thread. A comparison of the maximum holding power. Injury 32:1–7CrossRefGoogle Scholar
  44. Georgiadis GM, White DB (1995) Modified tension band wiring of the medial malleolar ankle fractures. Foot Ankle Int 16:64–68PubMedCrossRefGoogle Scholar
  45. Gonzalez TA, Watkins C, Drummond R, Wolf JC, Toomey EP, DiGiovanni CW (2015) Transfibular approach to posterior malleolus fracture fixation: technique Tip. Foot Ankle Int 37:440–445PubMedCrossRefGoogle Scholar
  46. Gonzalez T, Chien B, Ghorbanhoseini M, Kwon JY (2017) Minimally invasive surgical approach to distal fibula fractures: a technical tip. Arch Bone Jt Surg 5:39–45Google Scholar
  47. Gu W, Shi Z, Mei G, Xue J, Zou J (2014) Dual plating fixation for distal fibular comminutes fractures. Zhongguo Xiu Fu Chong Jian WaiKe Za Zhi 28:56–59Google Scholar
  48. Halm JA, Schepers T (2012) Damage to the superficial peroneal nerve in operative treatment of fibula fractures: straight to the bone? Case report and review of the literature. J Foot Ankle Surg 51:684–686PubMedCrossRefGoogle Scholar
  49. Handolin L, Kiljunen V, Arnala I et al (2005a) No long-term effect of ultrasound therapy on bioabsorbable screw-fixed lateral malleolar fractures. Scand J Surg 94:239–242PubMedCrossRefGoogle Scholar
  50. Handolin L, Kiljunen V, Arnala I, Pajarinen J, Partio EK, Rokkanen P (2005b) The effect of low-intensity ultrasound and bioabsorbable self-reinforced poly-L-lactide screw fixation on bone in lateral malleolar fractures. Acta Orthop Trauma Surg 125:317–321PubMedCrossRefGoogle Scholar
  51. Haraguchi N, Haruyama H, Toga H, Kato M (2006) Pathoanatomy of the posterior malleolar fracture of the ankle. J Bone Joint Surg Am 88:1085–1092PubMedCrossRefGoogle Scholar
  52. Heim D, Niederhauser K (2007) One-third tubular hook plate. Oper Orthop Traumatol 19:305–309PubMedCrossRefGoogle Scholar
  53. Hepple S, Guha A (2013) The role of ankle arthroscopy in acute ankle injuries of the athlete. Foot Ankle Clin 18:185–194PubMedCrossRefGoogle Scholar
  54. Herscovici D Jr, Scaduto JM, Infante A (2007) Conservative treatment of isolated fractures of the medial malleolus. J Bone Joint Surg Br 89:89–93PubMedCrossRefGoogle Scholar
  55. Hess F, Sommer C (2011) Minimally invasive plate osteosynthesis of the distal fibula with the locking compression plate: first experience of 20 cases. J Orthop Trauma 25:110–115PubMedCrossRefGoogle Scholar
  56. Hirakawa N, Uchino M, Naruse K et al (2016) Treatment of 1/3 tubular plate with the hooks for lateral malleolar fracture. J Jpn Soc Fracture Repair 38:452–458Google Scholar
  57. Hoelsbrekken SE, Kaul-Jensen K, Morch T et al (2013) Nonoperative treatment of the medial malleolus in bimalleolar and trimalleolar ankle fractures: a randomized controlled trial. J Orthop Trauma 27:633–637PubMedCrossRefGoogle Scholar
  58. Hovis WD, Bucholz RW (1997) Polyglycolide bioabsorbable screws in the treatment of ankle fractures. Foot Ankle Int 18:128–131PubMedCrossRefGoogle Scholar
  59. Ikuta T, Kuga F, Yo M, Tome Y (2006) Plate osteosynthesis for lateral malleolar fracture using proceed 1/3 tubular plate. Orthop Traumatol 55:459–462CrossRefGoogle Scholar
  60. Irwin TA, Lien J, Kadakia AR (2013) Posterior malleolus fracture. J Am Acad Orthop Surg 21:32–40PubMedCrossRefGoogle Scholar
  61. Isik C, Tecimel O, Akmese R, Firat A, Tahta M, Bozkurt M (2013) The comparison of plate-screw and tension band techniques in the osteosynthesis of Danis-Weber type A and B lateral malleolar fractures. Acta Orthop Traumatol Turc 47:27–31PubMedCrossRefGoogle Scholar
  62. Jeong ST, Hwang SC, Kim DH, Nam DC (2015) A new surgical technique for traumatic dislocation of posterior tibial tendon with avulsion fracture of medial malleolus. Acta Orthop Traumatol Turc 49:690–693PubMedGoogle Scholar
  63. Johnson BA, Fallat LM (1997) Comparison of tension band wire and cancellous bone screw fixation for medial malleolar fractures. J Foot Ankle Surg 36:284–289PubMedCrossRefGoogle Scholar
  64. Johnson EE, Davlin LB (1993) Open ankle fractures. The indications for immediate open reduction and internal fixation. Clin Orthop Relat Res 292:118–127CrossRefGoogle Scholar
  65. Kabukcuoglu Y, Kucukkaya M, Eren T, Gorgec M, Kuzgun U (2000) The ANK device: a new approach in the treatment of the freactures of the lateral malleolus associated with the rupture of the syndesmosis. Foot Ankle Int 21:753–758PubMedCrossRefGoogle Scholar
  66. Kara AN, Esenyel CK, Sener BT, Merih E (1999) A different approach to the treatment of the lateral malleolar fractures with syndesmosis injury: the ANK Nail. J Foot Ankle Surg 38:394–402PubMedCrossRefGoogle Scholar
  67. Karachalios T, Roidis N, Karoutis D, Bargiotas K, Karachalios GG (2001) Trimalleolar fracture with a double fragment of the posterior malleolus: a case report and modified operative approach to internal fixation. Foot Ankle Int 22:144–149PubMedCrossRefGoogle Scholar
  68. Keene DJ, Mistry D, Nam J et al (2016) The Ankle Injury Management (AIM) trial: a pragmatic, multicenter, equivalence randomized controlled trial and economic evaluation comparing close contact casting with open surgical reduction and internal fixation in the treatment of unstable ankle fractures in patients aged over 60 years. Health Technol Assess 20:1–158PubMedPubMedCentralCrossRefGoogle Scholar
  69. Koslowsky TC, Mader K, Kirschner S, Gausepohl T, Pennig D (2007) Treatment of medial malleolar fractures using fin-threaded K-wires: a new operative technique. J Trauma 62:258–261PubMedCrossRefGoogle Scholar
  70. Kosuge DD, Mahadevan D, Chandrasenan J, Pugh H (2010) Managing type II and type IV Lauge-Hansen supination external rotation ankle fractures: current orthopaedic practice. Ann R Coll Surg Engl 92:689–692PubMedPubMedCentralCrossRefGoogle Scholar
  71. Kupcha P, Pappas S (2008) Medial malleolar fixation with a bicortical screw: technique tip. Foot Ankle Int 29:1151–1152PubMedCrossRefGoogle Scholar
  72. Kusnezov NA, Eisenstein ED, Diab N, Thabet AM, Abdelgawad A (2017) Medial malleolar fractures and associated deltoid ligament disruptions: current management controversies. Orthopedics 40(2):e216–e222PubMedCrossRefGoogle Scholar
  73. Lamontagne J, Blachut PA, Broekhuyse HM, O’Brien PJ, Meek RN (2002) Surgical treatment of a displaced lateral malleolus fracture: the antiglide technique versus lateral plate fixation. J Orthop Trauma 16:498–502PubMedCrossRefGoogle Scholar
  74. Lareau CR, Bariteau JT, Paller DJ, Koruprolu SC, DiGiovanni CW (2015) Contribution of the medial malleolus to tibiotalar joint contact characteristics. Foot Ankle Spec 8:23–28PubMedCrossRefGoogle Scholar
  75. Latif G, Al-Saadi H, Zekry M, Hassan MA, Al Mulla J (2013) The effect of percutaneous screw fixation of lateral malleolus on ankle fracture healing and function. Surg Sci 4:365–370CrossRefGoogle Scholar
  76. Lauge-Hansen N (1950) Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations. Arch Surg 60:957–985CrossRefGoogle Scholar
  77. Lauge-Hansen N (1953) Fractures of the ankle V pronation-dorsiflexion fractures. AMA Arch Surg 67:813–820PubMedCrossRefGoogle Scholar
  78. Lee HJ, Kang KSK, Kang SY, Lee JS (2009) Percutaneous reduction technique using a Kirschner wire for displaced posterior malleolar fractures. Foot Ankle Int 30:157–159PubMedCrossRefGoogle Scholar
  79. Lee YS, Chen SW (2009) Lateral fixation of open AO type-B2 ankle fractures: the Knowles pin versus plate. Int Orthop 33:1135–1139PubMedCrossRefGoogle Scholar
  80. Lee YS, Hsu TL, Huang CR, Cheng SH (2010) Lateral fixation of AO type-B2 ankle fractures: the Acutrak plus compression screw technique. Int Orthop 34:903–907PubMedPubMedCentralCrossRefGoogle Scholar
  81. Lee YS, Huang CC, Chen CN, Lin CC (2005) Operative treatment of displaced lateral malleolar fractures: the Knowles pin technique. J Orthop Trauma 19:192–197PubMedCrossRefGoogle Scholar
  82. Leontaritis N, Hinojosa L, Panchbhavi VK (2009) Arthroscopically detected intra-articular lesions associated with acute ankle fractures. J Bone Joint Surg Am 91:333–339PubMedCrossRefGoogle Scholar
  83. Lesic A, Bumbasirevic M (2004) Ankle fractures. Curr Orthop 18:232–244CrossRefGoogle Scholar
  84. Loukachov VV, Birnie MFN, Dingemans SA, de Jong VM, Schepers T (2017) Percutanous intramedullary screw fixation of distal fibula fractures: a case series and systematic review. J Foot Ankle Surg 56:1081–1086. CrossRefPubMedGoogle Scholar
  85. Macko VW, Matthews LS, Zwirkoski P, Goldstein SA, Arbor A (1991) The joint-contact area of the ankle: the contribution of the posterior malleolus. J Bone Joint Surg Am 73:347–351PubMedCrossRefGoogle Scholar
  86. Mandracchia DM, Mandracchia VJ, Buddecke DE (1999) Malleolar fractures of the ankle. A comprehensive review. Clin Podiatr Med Surg 16:679–723PubMedGoogle Scholar
  87. Maniar H, Kempegowda H, Tawari AA et al (2017) Medial malleoli fractures: clinical comparison between newly designed sled device and conventional screws. Foot Ankle Spec 10:296–301CrossRefGoogle Scholar
  88. McKenna PB, O’shea K, Burke T (2007) Less is more: lag screw only fixation of lateral malleolar fractures. Int Orthop 31:497–502PubMedCrossRefGoogle Scholar
  89. Mendelhall S (1998) Trauma update. Orthopedic Network News 9:1–7Google Scholar
  90. Michelson JD (2003) Ankle fractures resulting from rotational injuries. J Am Acad Orthop Surg 11:403–412PubMedCrossRefGoogle Scholar
  91. Michelson JD (1995) Current concepts review: fractures about the ankle. J Bone Joint Surg Am 77:142–152PubMedCrossRefGoogle Scholar
  92. Michelson JD, Clarke HJ, Jinnah RH (1990) The effect of loading on tibiotalar alignment in cadaver ankles. Foot Ankle Int 10:280–284CrossRefGoogle Scholar
  93. Miersch D, Wild M, Jungbluth P, Betsch M, Windolf J, Hakimi A (2011) A transcuneiform fracture-dislocation of the midfoot. Foot 21:45–47CrossRefGoogle Scholar
  94. Milner BF, Mercer D, Firoozbakhsh K, Larsen K, Decoster TA, Miller RA (2007) Bicortical screw fixation of distal fibula fractures with a lateral plate: an anatomical and biomechanical study of a new technique. Foot Ankle Surg 46:341–347PubMedCrossRefGoogle Scholar
  95. Minihane KP, Lee C, Ahn C, Zhang LQ, Merk BR (2006) Comparison of lateral locking plate and antiglide plate for fixation of distal fibular fractures in osteoporotic bone: a biomechanical study. J Orthop Trauma 20:562–566PubMedCrossRefGoogle Scholar
  96. Mirza A, Morartry AM, Probe RA, Ellis TJ (2010) Percutaneous plating of the distal tibia and fibula: risk of injury to the saphenous and superficial peroneal nerves. J Orthop Trauma 24:495–498PubMedCrossRefGoogle Scholar
  97. Mizel MS, Temple HT (2004) Technique tip: revisit to a surgical approach to allow direct fixation of fractures of the posterior and medial malleolus. Foot Ankle Int 25:440–442PubMedCrossRefGoogle Scholar
  98. Mont MA, Sedlin ED, Weiner LS (1992) Postoperative radiographs as predictors of clinical outcome in unstable ankle fractures. J Orthop Trauma 6:352–356PubMedCrossRefGoogle Scholar
  99. Noh KC, Hong DY, Kim YT, Kadakia AR, Park YW, Kim HN (2015) Arthroscopic transfibular approach for removal of bone fragments in posterior malleolar fracture: technical tip. Foot Ankle Int 36:108–111PubMedCrossRefGoogle Scholar
  100. Nuney JA (1999) Fracture and fracture dislocations of the ankle. In: Coughlin MC, Mann RA (eds) Surgery of the foot and ankle, 7th edn. Mosby, St. Louis, MO/Baltimore, MD/Boston/MA, pp 1389–1421Google Scholar
  101. Odak S, Ahluwalia R, Unnikrishnan P, Hennessy M, Platt S (2016) Management of posterior malleolar fractures: a systematic review. J Foot Ankle Surg 55:140–145PubMedCrossRefGoogle Scholar
  102. Ogilvie-Harris DJ, Reed SC, Hedman TP (1994) Disruption of the ankle syndesmosis: biomechanical study of the ligamentous restraints. Arthroscopy 10:558–560PubMedCrossRefGoogle Scholar
  103. Ono A, Nishikawa S, Nagao A, Irie T, Sasaki M, Kouno T (2004) Arthroscopically assisted treatment of ankle fractures: arthroscopic findings and surgical outcomes. Arthroscopy 20:627–631PubMedPubMedCentralCrossRefGoogle Scholar
  104. Ostrum RF (1996) Posterior plating of displaced Weber B fibula fractures. J Orthop Trauma 10:199–203PubMedCrossRefGoogle Scholar
  105. Ostrum RF, Litsky A (1992) A tension band fixation of medial malleolus fractures. J Orthop Trauma 6:464–468PubMedCrossRefGoogle Scholar
  106. Pettrone FA, Gail M, Pee D, Fitzpatrick T, Van Herpe LB (1983) Quantitative criteria for prediction of the results after displaced fractures or the ankle. J Bone Joint Surg Am 65:667–677PubMedPubMedCentralCrossRefGoogle Scholar
  107. Porter DA, May BD, Berney T (2008) Functional outcome after operative treatment for ankle fractures in young athletes: a retrospective case series. Foot Ankle Int 29:887–894CrossRefGoogle Scholar
  108. Pot JH, van Wensen RJA, Olsman JG (2011) Hardware related pain and hardware removal after open reduction and internal fixation of ankle fractures. Foot Ankle Online J 4:1CrossRefGoogle Scholar
  109. Pugh KJ (2002) Fractures and soft tissue injuries about the ankle. In: Fitzgerald RH, Kaufer H, Malkani AL (eds) Orthopaedics. Mosby, St. Louis, pp 419–431Google Scholar
  110. Rajeev A, Senevirathna S, Radha S, Kashayap NS (2011) Functional outcomes after fibula locking nail for fragility fractures of the ankle. J Foot Ankle Surg 50:547–550PubMedCrossRefGoogle Scholar
  111. Ramsey PL, Hamilton W (1976) Changes in tibiotalar area caused by lateral talar shift. J Bone Joint Surg 59:169–173Google Scholar
  112. Redfern DJ, Sauve PS, Sakellariou A (2003) Investigation of incidence of superficial peroneal nerve injury following ankle fracture. Foot Ankle Int 24:771–774PubMedCrossRefGoogle Scholar
  113. Rehman H, McMillan T, Reman S, Clement A, Finlayson D (2015) Intramedullary versus extramedullary fixation of lateral malleolus fractures. Int J Surg 22:54–61PubMedCrossRefGoogle Scholar
  114. Reinherz RP, Granoff SR, Henning KE, Ross BS (1991) Characteristics and operative management of supination external rotation ankle fractures. J Foot Surg 30:356–363PubMedGoogle Scholar
  115. Ricci WM, Tornetta P, Borrelli J (2012) Lag screw fixation of medial malleolar fractures: a biomechanical, radiographic, and clinical comparison of unicortical partially threaded lag screws and bicortical fully threaded lag screws. J Orthop Trauma 26(10):602–606PubMedCrossRefGoogle Scholar
  116. Rovinsky D, Haskell A, Liu Q, Paiement GD, Robinovitch S (2000) Evaluation of a new method of small fragment fixation in a medial malleolus fracture model. J Orthop Trauma 14:420–425PubMedCrossRefGoogle Scholar
  117. Ruedi TP, Buckley R, Moran C (2007) AO principles of fracture management, 2nd edn. Thieme Publishing Group, New YorkGoogle Scholar
  118. Saini P, Aggrawal A, Meena S, Trikha V, Mittal S (2014) Miniarthrotomy assisted percutaneous screw fixation for displaced medial malleolus fractures – a novel technique. J Clin Orthop Trauma 5:252–256PubMedPubMedCentralCrossRefGoogle Scholar
  119. Sakai R, Uchino M, Yoneo T et al (2017) Influence of hooks and a lag screw on internal fixation plates for lateral malleolar fracture: a biomechanical and ergonomic study. J Orthop Surg Res 12:34PubMedPubMedCentralCrossRefGoogle Scholar
  120. Salter RB, Simmonds DF, Malcolm BW, Rumble EJ, MacMichael D, Clements ND (1980) The biological effect of continuous passive motion on the healing of full thickness defects in articular cartilage: an experimental investigation in rabbits. J Bone Joint Surg Am 62:1232–1252CrossRefGoogle Scholar
  121. Sanders DW, Tieszer C, Corbett B, Canadian Orthopedic Trauma Society (2012) Operative versus nonoperative treatment of unstable lateral malleolar fractures: a randomized multi-center trial. J Orthop Trauma 26:129–134PubMedCrossRefGoogle Scholar
  122. Schaffer JJ, Manoli A (1987) The antiglide plate for distal fibular fixation. J Bone Joint Surg Am 69:596–603PubMedCrossRefGoogle Scholar
  123. Schiedts D, Fleurat E, Bouger D, Bastaraud H (1997) Osteosynthesis of internal malleolar fracture by staplers. Rev Chir Orthop Reparatrice Appar Mot 83:70–73PubMedGoogle Scholar
  124. Shi H, Chen Y, Wang J et al (2017) Comparison of the direct and indirect reduction techniques during the surgical management of posterior malleolar fractures. BMC Musculoskelet Disord 18:109Google Scholar
  125. Specchiulli F, Mangialardi R (2004) The surgical treatment of malleolar fractures: long-term results. Chir Organi Mov 89:313–318Google Scholar
  126. Strenge KB, Idusuyi OB (2006) Technique tip: percutanous screw fixation of posterior malleolar fractures. Foot Ankle Int 27:650–652PubMedCrossRefGoogle Scholar
  127. Stufkens SAS, van den Bekerom MPJ, Kerkhoffs GMMJ, Hintermann B, van Dijk CN (2011) Long-term outcome after 1822 operatively treated ankle fractures: a systematic review of the literature. Injury 42:119–127PubMedCrossRefGoogle Scholar
  128. Sudmann E (1974) Compression osteosynthesis of lateral malleolar fractures with a figure-of-eight cerclage. Acta Chir Scand 140:37–40Google Scholar
  129. Takao M, Uchio Y, Naito K, Fukazawa I, Kakimaru T, Ochi M (2004) Diagnosis and treatment of combined intra-articular disorders in acute distal fibular fractures. J Trauma 57:1303–1307CrossRefGoogle Scholar
  130. Tejwani NC, McLaurin TM, Walsh M, Bhadsavle S, Koval KJ, Egol KA (2007) Are outcomes of bimalleolar fractures poorer than those of lateral malleolar fractures with medial ligamentous injury? J Bone Joint Surg Am 89:1438–1441PubMedGoogle Scholar
  131. Tekin AC, Cabuk H, Dedeoglu SS et al (2016) Anterograde headless cannulated screw fixation in the treatment of medial malleolar fractures: evaluation of a new technique and its outcomes. Med Princ Pract 25:429–434PubMedPubMedCentralCrossRefGoogle Scholar
  132. Tenenbaum S, Shazar N, Bruck N, Bariteau J (2017) Posterior malleolus fractures. Orthop Clin North Am 48:81–89PubMedCrossRefGoogle Scholar
  133. Thevendran G, Young A (2012) Arthroscopic reduction and fibula nailing high-risk diabetic ankle fractures: case reviews and technical tip. Foot Ankle Spec 5:124–127Google Scholar
  134. Thordarson DB, Bains R, Shepherd LE (2001) The role of ankle arthroscopy on the surgical management of ankle fractures. Foot Ankle Int 22:123–125PubMedPubMedCentralCrossRefGoogle Scholar
  135. Thordarson DB, Motamed S, Hedman T, Ebramzadeh E, Bakshian S (1997) The effect of fibular malreduction on contact pressures in an ankle fracture malunion model. J Bone Joint Surg Am 79:1809–1815PubMedCrossRefGoogle Scholar
  136. Toolan BC, Koval KJ, Kummer FJ, Sanders R, Zuckerman JD (1994) Vertical shear fractures of the medial malleolus: a biomechanical study of five internal fixation techniques. Foot Ankle Int 15:483–489CrossRefGoogle Scholar
  137. Tornetta P III (2000) Competence of deltoid ligament in bimalleolar ankle fractures after medial malleolar fixation. J Bone Joint Surg Am 82:843–848Google Scholar
  138. Treadwell JR, Fallat LM (1993) The antiglide plate for Danis-Weber type B fibula fractures: a review of seventy-one cases. J Foot Ankle Surg 32:573–579PubMedGoogle Scholar
  139. Tsukada S, Otsuji M, Shiozaki A et al (2013) Locking versus non-locking neutralization plates for the treatment of lateral malleolar fractures: a randomized trial. Int Orthop 37:2451–2456Google Scholar
  140. Turhan E, Doral MN, Demirel M et al (2013) Arthroscopy-assisted reduction versus open reduction in the fixation of medial malleolar fractures. Eur J Orthop Surg Traumatol 23:953–959CrossRefGoogle Scholar
  141. Veltman ES, Halma JJ, de Gast A (2016) Longterm outcome of 886 posterior malleolar fractures: a systematic review of the literature. Foot Ankle Surg 22:73–77PubMedCrossRefGoogle Scholar
  142. Verheyen CC (2006) Clinical tip: distraction technique for restoring length of the fibula in ankle fractures. Foot Ankle Int 27:867–868Google Scholar
  143. Wei SY, Okereke E, Winiarsky R, Lotke PA (1999) Nonoperatively treated displaced bimalleolar and trimalleolar ankle fractures: a 20-year follow-up. Foot Ankle Int 20:404–407PubMedCrossRefGoogle Scholar
  144. Weinraub GM, Levine P, Shi E, Flowers A (2017) Comparison of medial malleolar fracture healing at 8 weeks after open reduction internal fixation versus percutaneous fixation: a retrospective cohort study. J Foot Ankle Surg 56:277–281PubMedCrossRefGoogle Scholar
  145. Wendsche P, Drac P (2012) Are malleolar fractures easy to treat? Acta Chir Orthop Traumatol Cech 79:540–548Google Scholar
  146. White TO, Bugler KE, Appleton P, Will E, McQueen MM, Court-Brown CM (2016) A prospective randomized trial of the fibular nail versus standard open reduction and internal fixation for fixation of ankle fractures in elderly patients. Bone Joint J 98B:1248–1252CrossRefGoogle Scholar
  147. Winkler B, Weber BG, Simpson LA (1990) The dorsal antiglide plate in treatment of Danis-Weber type B fractures of the distal fibula. Clin Orthop Relat Res 259:204–209Google Scholar
  148. Yablon JG, Heller FG, Shouse L (1977) The key role of the lateral malleolus in displaced fractures of the ankle. J Bone Joint Surg Am 59:169–173CrossRefGoogle Scholar
  149. Yeo ED, Kim HJ, Cho WI, Lee YK (2015) A specialized fibular locking plate for lateral malleolar fractures. J Foot Ankle Surg 54:1067–1071PubMedCrossRefGoogle Scholar
  150. Young KW, Kim JS, Cho JH, Kim HS, Cho HK, Lee KT (2015) Paratrooper’s ankle fracture: posterior malleolar fracture. Clin Orthop Surg 7:15–21PubMedPubMedCentralCrossRefGoogle Scholar
  151. Yufit P, Seligson D (2010) Malleolar ankle fractures. A guide to evaluation and treatment. Orthop Trauma 24:286–297CrossRefGoogle Scholar
  152. Zahn RK, Frey S, Jakubietz RG et al (2012) A contoured locking plate for distal fibular fractures in osteoporotic bone: a biomechanical cadaver study. Injury 43:718–725PubMedCrossRefGoogle Scholar
  153. Zhenhua F, Waizy H, Ming X, Wusheng K (2013) Lateral malleolus hook plate for comminuted Weber A and B fractures: a retrospective study. Indian J Orthop 47:364–369PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Mahmut Nedim Doral
    • 1
  • Onur Bilge
    • 2
    • 3
  • Gazi Huri
    • 4
  • Egemen Turhan
    • 4
  • Hande Guney
    • 5
  • João Espregueira-Mendes
    • 6
    • 7
    • 8
  1. 1.Faculty of Medicine, Department of Orthopaedics and TraumatologyUfuk University Dr. Rıdvan Ege HospitalAnkaraTurkey
  2. 2.Meram Faculty of Medicine, Department of Orthopaedics and TraumatologyKonya Necmettin Erbakan UniversityKonyaTurkey
  3. 3.Meram Faculty of Medicine, Department of Sports MedicineKonya Necmettin Erbakan UniversityKonyaTurkey
  4. 4.Faculty of Medicine, Department of Orthopaedics and TraumatologyHacettepe UniversityAnkaraTurkey
  5. 5.Faculty of Health Sciences, Department of Physiotherapy and RehabilitationHacettepe UniversityAnkaraTurkey
  6. 6.Clínica do Dragão—Espregueira-Mendes Sports Centre—FIFA Medical Center of Excellence, F.C. Porto StadiumPortoPortugal
  7. 7.ICVS/3B’s Research Group—Biomaterials, Biodegradables and Biomimetics, University of MinhoHeadquarters of the European Institute of Excellence on Tissue Engineering and Regenerative MedicineGuimarãesPortugal
  8. 8.Department of OrthopaedicsMinho UniversityBragaPortugal

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