Surgical Discussion

Preoperative CT imaging suggested only minimal objective plafond impaction associated with this vertical medial malleolar fracture. A standard anteriomedial surgical approach was used and the fragments were primarily distracted allowing antegrade view through the fracture to the tibiotalar joint space. There was no objective indication of significant joint surface impaction. Accordingly no disimpaction was done. Following reduction of the fragment and temporary fixation a polyaxial fluoroscopic examination did not demonstrate an appreciable zone of impaction. Fixation of the medial malleolus was achieved primarily with the transverse lag screws with supplementary anti glide plate fixation overlapping the proximal fracture apex. Despite intraoperative clinical and radiological assessment, post-operative imaging does suggest some local impaction of the articular surface in this marginal medial region. I remain on the fence however given the corresponding shape of the medial talus shoulder and the apparent congruency of the joint space, I would consider the congruent curvature curvature demonstrated to be likely physiological.

Orthopaedic implants used:   Stryker VariAx Distal Fibula