Case Study: Displaced Lateral Malleolus Fracture
of the right ankle because of fall injury

When your ankle is forced out of its natural position, it can strain, partially tear, or totally tear one or more of the ligaments in your ankle, resulting in a sprain. A tumble that twists your ankle is one potential cause of a sprained ankle. leaping or turning and stumbling on your foot.

The patient is an 82 year-old female, in our office today with complaints of right ankle pain over a week. The patient remembers his injury in a fall. The pain is mild in intensity. The patient describes the pain as dull. The pain is intermittent and does not disturb sleep.

The pain is not associated with swelling, bruising, numbness, tingling, radiating pain, weakness, bowel or bladder abnormality, gait problem, or limping, giving way, hand function difficulty.

The problem has been getting better since it started. Walking, standing, lifting, exercise, twisting, lying in bed, bending, squatting, kneeling, stairs, sitting make the symptoms worse. Rest, heat, ice, lying down, bending forwards makes the symptoms better.

She has her X-ray with her, we reviewed and discussed. We discussed chronic ankle pain and instability. We go over the surgical and non-surgical procedure and the patient will think about the surgery.

For now, she will continue the RICE procedure (Rest, Ice, Compression, Elevation) and will continue the splint. After some time, I received a call from a patient. The patient and her family opted for surgical management.

We discussed risks, benefits, and complications Including Infection, bleeding, nonunion, failure of fracture, failure of implant, need for repeat surgery, injury to adjacent nerves and vessels, blood clots, neurological, cardiac, pulmonary complications including death. The patient understood and signed the informed consent.

The patient was taken to the operating room where she was placed on a well-padded operating room table. General anesthesia was induced. The right lower extremity was prepped and draped aseptically in the usual fashion after application of tourniquet.

A time-out was called. Preoperative antibiotic was already given. A lateral incision was given over the lateral malleolus. With sharp dissection, the bone was reached. Fracture was impacted. The fracture was thoroughly washed. The fracture was reduced and held up with clamps.

A 4-hole distal fibular plate was opted held with olive K-wires. Finding an acceptable position in AP and lateral view, fixation of the plate was done to the fibula using four cortical nonlocking proximal screws and four locking distal screws

The wound was thoroughly washed and closed in layers using #0 Vicryl, #2-0 Vicryl, and # 3-0 Monocryl. Dressing was done using Xeroform, 4 x 4, Webril, and AO type posterior splint. The tourniquet was released. The patient was moved to Recovery in a stable condition.

After a week, suture removed and split were reapplied. Patient wearing walker boot to ambulate on her 4 weeks post-operative checkup and weight-bearing of 50%.

After a month, suggested to the patient to take X-ray to see the condition of the operated ankle. Result showed old surgically treated healed distal fibular fracture. Patient not undergone Physical Therapy. With the consistent follow up checkup and RICE procedure, patients get well.

Disclaimer – Patient’s name, age, sex, dates, events have been changed or modified to protect patient privacy.