Ankle Fracture Fixation: Medial or Lateral First?

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Radiology

Background:

• The standard surgical dogma for unstable ankle fractures emphasizes lateral malleolus reduction first for accurate talar alignment.
• Current surgical practices sometimes deviate from this established protocol, exploring alternative fixation sequences.

Purpose of the Study:

• To compare the outcomes of medial malleolus-first fixation versus lateral malleolus-first fixation in unstable ankle fractures.
• To assess radiographic parameters and complications associated with each fixation approach.

Main Methods:

• A retrospective cohort study involving 280 adult patients with operative bimalleolar ankle fractures.
• Analysis of patient demographics, injury characteristics, and radiographic metrics (talocrural angles, medial clear space, tibiofibular overlap).
• Review of intraoperative findings and postoperative complications.

Main Results:

• The medial-first group had a higher incidence of open fractures and less isolated injuries.
• Intramedullary screw placement for the lateral malleolus was more frequent in the medial-first group.
• No significant differences were observed in fluoroscopy times or radiographic outcomes between the two groups.

Conclusions:

• Medial-first fixation demonstrates equivalent radiographic outcomes to lateral-first fixation in unstable ankle fractures.
• This approach may be a viable alternative in select patient populations, warranting consideration in surgical planning.