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Management of Isolated Lateral Malleolus Fractures

Aiyer, Amiethab A., MD; Zachwieja, Erik C., MD; Lawrie, Charles M., MD; Kaplan, Jonathan R. M., MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: January 15, 2019 - Volume 27 - Issue 2 - p 50–59
doi: 10.5435/JAAOS-D-17-00417
Review Article

Isolated lateral malleolus fractures represent one of the most common injuries encountered by orthopaedic surgeons. Nevertheless, appropriate diagnosis and management of these injuries are not clearly understood. Ankle stability is maintained by ligamentous and bony anatomy. The deep deltoid ligament is considered the primary stabilizer of the ankle. In the setting of an isolated lateral malleolus fracture, identifying injury to this ligament and associated ankle instability influences management. The most effective methods for assessing tibiotalar instability include stress and weight-bearing radiographs. Clinical examination findings are important but less reliable. Advanced imaging may not be accurate for guiding management. If the ankle is stable, nonsurgical management produces excellent outcomes. In the case that clinical/radiographic findings are indicative of ankle instability, surgical fixation options include lateral or posterolateral plating or intramedullary fixation. Locking plates and small or minifragment fixation are important adjuncts for the surgeon to consider based on individual patient needs.

From the Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL (Dr. Aiyer and Dr. Zachwieja), the Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO (Dr. Lawrie), and the Orthopaedic Specialty Institute, Orange, CA (Dr. Kaplan).

Dr. Aiyer or an immediate family member serves as a paid consultant to Medline and Paragon 28 and serves as a board member, owner, officer, or committee member of the American Orthopaedic Foot and Ankle Society. Dr. Lawrie or an immediate family member serves as a paid consultant to Medtronic. Dr. Kaplan or an immediate family member serves as a paid consultant to Medline and Paragon 28. Neither Dr. Zachwieja nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article.

© 2019 by American Academy of Orthopaedic Surgeons
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