Ankle stability without the lateral malleolus—a report of 2 cases

Abstract

A 30-year-old man fell out of his motorboat and the screw of his outboard engine hit his left ankle, resulting in a 10 x 20 cm open wound, with large skinflap on the lateral side of the ankle. The lateral malleolus had disappeared (Figure 1). The talus was uncovered but the peroneal tendons were intact. In spite of the pain, the plantar and dorsal flexions were normal and stability was remarkably good.After debridement, the wound was closed. The ankle was immobilized in a below-knee leg cast. For 5 days i.v. antibiotics were given.After 1 week, partial weight bearing was started, with a below-knee walking cast. The skinflap became necrotic and complete secondary healing of the wound took several months. After 2 years, the patient had problems only with sport activities. The lateral stability was comparable to that on the other side. Plantar flexion of the right ankle was 25" and 20" on the left. The dorsal flexion was 5" on both sides. Case 2 (Bongers 1995)A 14-year-old male cyclist, hit by a truck, sustained a large soft tissue and bone defect on the lateral side of the left ankle. At surgery, 8 cm of the distal fibula was missing. On the anterior side, however, part of the periost remained, to which the remaining parts of the lateral ligaments were sutured. There was little instability on the lateral side as compared to the right ankle. The ankle was immobilized with an external fixator from tibia to calcaneus.The fixator was removed after 8 weeks and the ankle was further treated by means of a custom-made brace. Figure 1. Case 1. AP view of the left ankle at the time of presentation.Figure 2. Case 2. AP and lateral views of the left ankle after treatment for 1 year. Acta Orthop Downloaded from informahealthcare.com by 137.152.100.226 on 11/03/14 For personal use only.

Defect Fracture of the Distal Fibula with Soft Tissue Damage (Gustilo IIIB) in an Adolescent

“…After resection of a fibular segment leaving a caudal segment < 8 cm, six patients suffered an instability; in three, this was associated with cranial migration of the lateral malleolus as well. In contrast, several authors [18][19][20] reported that even years after resection of the distal fibula due to tumor, the tibiota- lar joint showed a normal configuration and no instability.…”