Bimalleolar and Trimalleolar Fractures

 

Bimalleolar fractures Trimalleolar fractures

Fibular + medial malleolus

Fibular + posterior malleolus

Fibular + Medial malleolus + Posterior malleolus

Bimall Trimall

Bimalleolar fractures

 

Medial malleolus + Weber B lateral malleolus

 

Weber BWeber B

 

Fibula Medial Malleolus Syndesmosis

Interfragmentary lag screw

Derotation plate

2 partially threaded lag screws

Tension band wire

Plate

Should be stable with Weber B

Cotton test

Clamp on fibula and attempt to open syndesmosis under II)

 

Ankle Fracture Bimalleolar ORIFAnkle Fracture Bimalleolar ORIF

 

Medial malleolus + Weber C lateral malleolus

 

Ankle Fracture BimalleolarAnkle Fracture Clear Syndesmotic Injury

 

Fibula Medial Malleolus Syndesmosis

Interfragmentary lag screw

Derotation plate

2 partially threaded lag screws

Tension band wire

Plate

Open reduction of syndesmosis

Stabilized with screws / tightrope

 

Fibular fracture

 

Fibular fracture + posterior malleolus

 

BimallBimallBimallBimall

 

Postero-lateral approach

Fibula Posterior Malleolus Syndesmosis

Interfragmentary lag screw

Derotation plate

Buttress plate +/- screws

Usually stable with fixation of posterior malleolus

Screen +/- stabilize

 

bimallbimall

 

Tri-Malleolar Fracture

 

Definition

 

Lateral malleolus + medial malleolus + posterior malleolus

 

Posterolateral approach

- prone or lateral

- ORIF fibula + posterior malleolus

- move patient to supine to ORIF medial malleolus

 

trimallTrimallTrimallTrimall

 

TrimalltrimalltrimallTrimall