Tuesday, March 15, 2011
In honor of Ms. Marianne Clark, our Senior Account Executive here at Medical Legal Art who recently suffered a slip and fall on the ice with a resulting trimalleolar ankle fracture, I thought it apropos to dedicate this article to these common orthopedic injuries that we so often see in personal injury litigation. Ms. Clark is back in the office now recovering from her fixation surgery, but you may have noticed that I was too busy to post an article last month while she was away. It's good to have her back with us.
When involved in litigation regarding an ankle fracture, you may be confronted with terms such as medial malleolus, lateral malleolus, bimalleolar, trimalleolar and syndesmosis. It is important to understand the anatomy of the ankle before we can fully understand the terms describing the various injuries. The ankle is a joint where the tibia and fibula of the lower leg articulate with the talus bone in the upper portion of the foot. The tibia is on the medial (inner/toward the midline) aspect of the ankle and the fibula is on the lateral (outer/away from the midline) aspect of the ankle. The ends of these bones form knobs or projections that you can easily see or feel on either sides of the ankle. These protuberances are called the lateral malleolus (fibula) and the medial malleolus (tibia). Each malleolus can be fractured independently (lateral malleolus fracture, medial malleolus fracture) but if both are fractured, it is called a bimalleolar fracture. There is also a posterior projection of the tibia called the posterior malleolus. If all three regions are involved in the injury it is called a trimalleolar fracture.
The syndesmosis is the articulation between the lower portions of the tibia and fibula where they come together and touch just above the ankle joint. This articulation is held in place with a variety of ligaments and a stable syndesmosis is important for proper pain-free weight bearing. In many cases involving fractures or severe sprains of the ankle, the syndesmosis becomes separated or unstable if the ligaments are stretched or torn.
Fractures of the various malleoli can often be treated conservatively with immobilization or casting of the ankle. Internal fixation surgery is also common when metal hardware is required to secure and stabilize the fragments while the fractures heal. A variety of screws or plates and screws may be employed based on the nature of the fractures and the preferences of the surgeon. This hardware is often left in place permanently although it is not uncommon for the hardware to be removed in a subsequent procedure if it causes any difficulties after the fractures have healed. Disruptions of the syndesmosis can also be repaired surgically. These procedures can include repair or reconstruction of the ligaments or the placement of long screws that traverse both the tibia and fibula to hold the distal ends of these bones together in proper alignment.