Operative treatment of bimalleolar fractures

Objective Anatomical restoration of the function and anatomy of the talocrural joint, anatomical reduction of fractures of the lateral and medial malleoli and to address ligamentous instability when achieving exercise stability. Indications Dislocated and intra-articular fractures of the lateral and medial malleoli. Contraindications Infections, peripheral arterial occlusive disease, critical soft tissue conditions. Surgical technique Placement in a supine position, lateral and medial access, reduction of the fractures by manipulation of the fragments with Kirschner wires or use of reduction clamps, control of the joint reduction, definitive fixation with traction screws and plate osteosynthesis of the distal fibula, screw, tension-band or plate osteosynthesis of the medial malleolus, in cases of syndesmosis instability exact restoration of the talocrural joint by implantation of adjusting screws, alternatively dynamic fixation with a suture-button system. Postoperative management Movement exercises of the talocrural joint after postoperative day 1, mobilization with partial weight-bearing of the affected leg with 20kg postoperatively for 6-8 weeks, with implantation of adjusting screws removal after 8 weeks and staged increase of weight-bearing, if necessary postoperative insertion of an orthesis. Results The anatomical reconstruction is decisive. Surgically treated bimalleolar fractures show good to excellent long-term results, the increasing number of affected malleoli correlates with a poorer outcome.