Fracture: use of a new implant design
56
yr old male patient suffered fracture bimalleolar right ankle after falling
from motorcycle. The patient was
diabetic and alcoholic. The medial malleolus fracture was grade 1 compound. The
lateral malleolus had comminuted fracture. The compounding wound was washed
thoroughly and sterile dressing was applied. The ankle was reduced and below
knee plaster was given. The patient was prepared and taken to operation
theatre. The compounding wound was debrided and necrotic margins removed.
Fracture medial malleolus was reduced and fixed with 2 partially threaded
cannulated cancellous screws and washers. The fracture lateral malleolus was
exposed laterally and all care was taken to preserve the soft tissues. The
fracture wad badly comminuted and no contact between two main ends was there to
guide fracture reduction. The fracture was bridged using a lateral malleolus
locking plate and alignment confirmed under image intensifier. This implant is
a relatively new design which allows fixation of comminuted fractures in a difficult
zone like lateral malleolus. The flare of plate is also has a thinned profile to
reduce implant impingement on skin and allow wound closure safely. The ankle
was kept in a plaster post operatively to allow wound healing and swelling to
decrease.
