[Osteosynthesis of internal malleolar fracture by staplers]

Rigid medial and lateral fixation should stabilize the syndesmosis without further additional supplementation. We used Titanium staples for medial malleolar fixation.

This study included 21 medial malleolar fractures (6 isolated medial malleolar fractures). Ankle fractures were classified according to Weber's system for lateral malleolar fracture. TECHNICAL: Tension band was used for Weber A lateral malleolar fracture and a plate for Weber B and C. One Weber A fracture was stabilized by staples. After reduction with clamps, three staples are placed perpendicular to the fracture line. All medial malleolar fractures were treated by staples including comminutive fractures or fractures who extended proximally into the tibia pilon. Only three transversal fractures of the anterior rim were treated by staples. Closure was made without any drainage. A below the knee cast was placed for 6 weeks.

All fractures healed without further displacement. According to Weber Score, eleven ankle had an excellent result, seven a good result and three a bad result. We never removed the staples except in one case of technical error.

Titanium staple present an attractive alternative for medial malleolar fixation. Plaster cast don't impair ankle function. Titanium staples are easy to use, are of little bulk and removal is not necessary. Skie et al. described three types of anterior rim fracture: one transversal and two oblique. The small size of the fragment makes reduction difficult to maintain, and impacted staple tends to displace laterally this small fragment. In this series we stapled only transverse fracture of the anterior rim (three times). But even in this case, it is difficult to maintain reduction during stapling. In case of lass of reduction, removal of the staple is responsible for fragmentation of the small fragment. Excluding the anterior rim fracture, other fractures, including T fractures and fractures who extend to the tibial pilon can be treated by this technique.

Titanium staple is easy to use in medial malleolar fractures excluding anterior rim fractures.