Abstract: Background and Objectives:
Ankle fractures represents 10% of all fractures making it a second most common fractures of lower limb after hip. Peak incidence of ankle fractures in younger men & older women have a bimodal distribution. Typically low energy injuries with majority occurring due to simple falls or Sports. Ankle joint is very congruous and any disturbance of the normal articular relationship may result in some progressive arthrosis of biomechanical dysfunction. Determining ankle stability for planning fracture management is very critical. Stable fractures can be managed conservatively but outcomes of unstable fractures are always better with surgical management. ORIF has shown clearly the superiority in literatures. Lateral malleoli without any deltoid ligament involvement can be treated conservatively with good results whereas lateral malleoli with deltoid ligament involvement leads to talar subluxation and arthritis hence needs to be fixed stably. The objectives is to study the functional outcomes and results of surgical management of malleolar fractures, and to know the complications of open reduction internal fixation of malleolar fractures.
30 patients with fresh malleolar fractures were taken into study. As soon as the patients were brought to emergency room a complete survey was done to rule out any significant injuries. Then radiographs were taken, both antero-posterior and lateral views of ankle joints. On admission history was elicited in relation to age, sex, occupation, address, mode of injury, past illnesses, associated medical aliments and was subjected to thorough clinical examination. Analgesics and below knee slabs were applied to alleviate the pain. Eventually fractures were classified according to Lauge Hansen’s classification system. Patients were operated as early as possible once they were fit for Surgery.
Results: Out of 30 patients treated 23(76.6%) had good to excellent results, 4(13.3%) had fair & 3(10.0%) had poor results, our study showed that mean age of presentation was 37.87 years with male preponderance & involvement of dominant limb(right side), most common mode of injury was road traffic accident, analysis according to lauge Hansen classification were found to have supination external rotation injury in common, there were no intraoperative complications, But had poor outcomes due to the superficial skin infection which was treated appropriately.
Interpretation and Conclusion: Mechanism of injury is necessary for accurate reduction & further management. Fibular length has to be maintained, Anatomical reduction is essential in all intra articular fractures like ankle joint, were weight bearing is essential.
Open reduction and internal fixation Guarantees high standard of reduction besides eliminating the chances of loss of reduction. Chances of non- union of medial malleolus was reduced by preventing interposition of periosteum or any other soft tissue. Even after cast immobilization for 3-4 weeks the results are satisfactory due to the vigorous physiotherapy which was followed immediately after cast removal. Tension band principles was followed for osteoporotic & small fragment fractures.