Study on functional outcome of bimalleolar ankle fractures treated by open reduction and internal fixation

Nithin Gangadhran, Manju G. Pillai


Background: Ankle injury is the most common weight bearing orthopaedic musculoskeletal trauma encountered in emergency medicine and practice. Ankle joint is highly congruous and any disturbance of normal articular relationship may result in some progressive arthrosis of biomechanical dysfunction. As with all intra-articular fractures it necessitates accurate reduction and stable internal fixation. The objectives were to study the functional outcome of surgical treatment of bimalleolar ankle fractures and to know the complications of open reduction internal fixation of bimalleolar fractures.

Methods: 45 patients with malleolar fractures were included in this prospective longitudinal interventional study. Patients who underwent operative treatment were followed up regularly for 6 months with OPD visits and X-ray imaging at each stage. Patient parameters were recorded at immediate post op period, 6 weeks, 12 weeks and 24 weeks. Baird and Jackson scoring system for ankle were used for the functional outcome measurement.

Results: Most common type of injury pattern was supination-external rotation with 21 cases (47% of cases). The results are excellent to good in 65% of patients, 27% of patients had fair and 8% had poor result. Syndesmotic screw fixation was done with 4.5 mm cortical screw in 7 cases. Most common complication was surgical site infection in 3 cases (6.67%). 2 patients underwent implant removal due to unresolved infection at 3 months.

Conclusions: The results of operative fixation were satisfactory in 90% of patients. Most of the complications were minor and resolved within three weeks.



Bimalleolar fracture, Baird and Jackson scoring, Functional outcome of ankle fracture, Operative management

Full Text:



Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37(8):691-7.

Weert EMVSD, Lieshout EMMV, Vries MRD, Elst MVD, Schepers T. Determinants of outcome in operatively and non-operatively treated Weber-B ankle fractures. Arch Orthop Trauma Surg. 2012;132(2):257-63.

Michelson JD. Fractures about the ankle. J Bone Joint Surg Am. 1995;77(1):142-52.

Pott P. Some Few general remarks on fractures and dislocations. New Antiquarian. 1768;8(4):126.

Dupuytren G. Fractures of the lower extremity of the fibula, and subluxations of the foot. Med Classic. 1939;4:151-72.

Earl H. Simple succeeded by compound dislocation of the inferior extremity of the tibia with fracture of its posterior edge comminuted fracture of the fibula. Lancet. 2:346-8

Maisonneuve MGT. Resurchessur la fracture du perone. Arch Gen Med. 1940;7:165-87.

Tillaux D. Recherches clinique setexperimentalessur les fractures malleolaires. Bull Acad Med. 1872;1:817.

Michelson J, Moskovitz P, Labropoulos P. The nomenclature for intra-articular vertical impact fractures of the tibial plafond: pilon versus pylon. Foot Ankle Int. 2004;25(3):149-50.

Ashurst APC, Bromer RS. Classification and mechanism of fractures of the legbones involving the ankle: based on a study of three hundred cases from the episcopal hospital. Arch Surg. 1922;4:51-129.

Nelaton A. Elements of pathologic chirorgicale. 2nd ed. Paris: Germer-Baillaine; 1874: 296.

Bosworth DM. Fracture-dislocation of the ankle with fixed displacement of the fibula behind the tibia. J Bone Joint Surg Am. 1947;29:130-5.

Lauge-Hansen N. Fractures of the ankle. III: genetic roentgenologic diagnosis of fractures of the ankle. Am J Roentgenol Radium Ther Nucl Med. 1954;71(3):456-71.

Hahn DM, Colton CL. Malleolar fractures. AO Principles of fracture management. New York: Thieme; 2001: 583-4.

Wilson FC, Phillips HO Gilbert JA. Plantar flexion injuries of the ankle. An experimental study. Clin Orthop Relat Res. 1994;306:97-102.

Gougoulias N, Khanna A, Sakellariou A, Maffulli N, et al. Supination-external rotation ankle fractures: stability a key issue. Clin Orthop Relat Res. 2010;468(1):243-51.

Tejwani NC, McLaurin TM, Walsh M, Bhadsavle S, Koval KJ, Egolet KA. Are outcomes of bimalleolar fractures poorer than those of lateral malleolar fractures with medial ligamentous injury. J Bone Joint Surg. 2007;89(7):1438-41.