Abstract: Background: Bimalleolar ankle fractures with ankle subluxation forms the type of fractures difficult to treat and causes long term sequelae of complications if not treated well. Majority of bimalleolar fractures with ankle subluxation are treated with open reduction and internal fixation. The purpose of this study is to evaluate the role and effectiveness of Trans-calcaneal wire as a provisional fixation tool during fixation of bimalleolar ankle fracture with ankle subluxation.
Material and Methods: 30 patients of bimalleolar ankle fracture with ankle subluxation were treated between June 2017 to June 2019 at Govt Medical College and Rajindra Hospital, Patiala. Patients having bimalleolar ankle fracture with ankle subluxation and skeletally mature patients willing to participate in the study were included. In all cases, ankle subluxation was first reduced by closed means and after checking the reduction in both orthogonal views under fluoroscopy, a trans- calcaneal K-wire was introduced through heel passing through calcaneum and talus and distal tibia. After reduction of ankle joint, fibula was fixed in all the cases with plating, followed by fixation of medial malleolus with 2 screws or 1 screw and 1 K-wire depending upon the size of fracture fragment. The trans -calcaneal Wire was removed in all the cases after fixation of both malleoli.
Results: Mean age of patients was 36.5 years. As per the Lauge- Hansen classification systems, 15 cases (50%), had Supination External Rotation type of injury, which was most common. Radiological union was seen at 15 ± 3.2 weeks in 19 cases (63.3%). 2 cases (6.7%) had superficial infection. There were no cases of non union or malunion in the study. As per the Baird Jackson scoring system, 16 (53.3%) cases had excellent results, 8 (26.7%) cases had good results, 4 (13.3%) cases had fair results and 2 (6.7%) cases had poor results.
Conclusion: Ankle reduction forms the mainstay in the treatment of bimalleolar fractures with ankle subluxation, as even a small displacement of the talus of even 1 mm can result in incongruency of the joint surfaces as to produce point loading of the articular cartilage sufficient to result in early degenerative arthritis. Trans-calcaneal K-wire has proved to be an effective tool for provisional reduction of ankle while fixing such fractures with good to excellent results in 80% of cases and does not cause any joint arthritis in long term.
