Trimalleolar fracture explained
See also: Bimalleolar fracture.
A trimalleolar fracture is a fracture of the ankle that involves the lateral malleolus, the medial malleolus, and the distal posterior aspect of the tibia, which can be termed the posterior malleolus. The trauma is sometimes accompanied by ligament damage and dislocation.[1]
The three aforementioned parts of bone articulate with the talus bone of the foot. Strictly speaking, there are only two malleoli (medial and lateral), but the term trimalleolar is used nevertheless and as such is a misnomer. The trimalleolar fracture is also known as cotton fracture.
Treatment
Surgical repair using open reduction and internal fixation is generally required, and because there is no lateral restraint of the foot, the ankle cannot bear any weight while the bone knits. This typically takes six weeks in an otherwise healthy person, but can take as much as twelve weeks. Non-surgical treatment may sometimes be considered in cases where the patient has significant health problems or where the risk of surgery may be too great.[1]
Further reading
- 15566703 . 2004 . Weber . Martin . Trimalleolar Fractures with Impaction of the Posteromedial Tibial Plafond: Implications for Talar Stability . Foot & Ankle International . 25 . 10 . 716–27 . 10.1177/107110070402501005 . 43182738 .
- 12735377 . 2003 . Weber . Martin . Malunion following Trimalleolar Fracture with Posterolateral Subluxation of the Talus — Reconstruction Including the Posterior Malleolus . Foot & Ankle International . 24 . 4 . 338–44 . Ganz . Reinhold . 10.1177/107110070302400406 . 20888046 .
- 8126036 . 1994 . Bucholz . R. W. . Fixation with bioabsorbable screws for the treatment of fractures of the ankle . The Journal of Bone and Joint Surgery . 76 . 3 . 319–24 . Henry . S . Henley . M. B. . 10.2106/00004623-199403000-00001 .
- 10.2106/JBJS.E.00856 . 16651584 . Pathoanatomy of Posterior Malleolar Fractures of the Ankle . The Journal of Bone and Joint Surgery . 88 . 5 . 1085–92 . 2006 . Haraguchi . Naoki . Haruyama . H . Toga . H . Kato . F .
- 12131390 . 2002 . Langenhuijsen . Johan F. . Results of Ankle Fractures with Involvement of the Posterior Tibial Margin . The Journal of Trauma: Injury, Infection, and Critical Care . 53 . 1 . 55–60 . Heetveld . Martin J. . Ultee . Jan M. . Steller . E. Philip . Butzelaar . Rudi M. J. M. . 10.1097/00005373-200207000-00012.
- 10.1097/TA.0b013e318187eb16 . 19131839 . Biomechanical and Clinical Evaluation of Posterior Malleolar Fractures. A Systematic Review of the Literature . The Journal of Trauma: Injury, Infection, and Critical Care . 66 . 1 . 279–84 . 2009 . Van Den Bekerom . Michel P. J. . Haverkamp . Daniel . Kloen . Peter .
- 10.1097/BTF.0b013e3182743f11 . The Posterolateral Approach for the Treatment of Trimalleolar Fractures . Techniques in Foot & Ankle Surgery . 11 . 4 . 189–93 . 2012 . Helmy . Naeder . Meyer . Dominik C. . Vienne . Patrick . Espinosa . Norman .
- 10.3113/FAI.2009.0309 . 19356354 . Posterolateral Approach to the Displaced Posterior Malleolus: Functional Outcome and Local Morbidity . Foot & Ankle International . 30 . 4 . 309–14 . 2009 . Forberger . Jens . Sabandal . Philipp V. . Dietrich . Michael . Gralla . Jan . Lattmann . Thomas . Platz . Andreas . 34963028 .
Notes and References
- News: Ankle Fractures. Orthopaedic Trauma Association. September 2007. AAOS.
