A.O. classification takes into consideration the level of fracture of fibula. Higher the fracture of fibula from the tip of the lateral malleolus, more severe the injury.

Special X-ray

Mortice view of ankle joint is taken with foot 20 degrees internally rotated. This gives an excellent view of peritalar joint space. It is essential to restore equal joint space all around the talus to get good result.

Management of Malleolar Fractures

Management of fibular fracture is the key to success. Restoration of length, curvature, rotation of fibula and its relation in the tibio fibular syndesmosis is very important. This is best done by open reduction and internal fixation. Majority of fractures of fibula are spiral or long oblique requiring inter fragmentary screw fixation. followed by 1/3 tubular plate which is used in neutralisation or buttress mode for further stabilisation. The plate is best fitted on the postero lateral surface of the fibula after proper contouring to maintain the normal fibular anatomy.

Medial malleolus need fixation with either compression technique using two K wires and a figure of 8 wire loop or a K wire and a 4 mm distally threaded lag screw on a washer. Only in adduction type of injuries the medial malleolus may need a buttress plate fixation. The posterior malleolus needs to be treated on its own merit. Usually it can be fixed using a lag screw from anterior to posterior with x-ray or image intensifier control.

Complications

If surgery is delayed more than 24 hours after the injury, Oedema and fracture blisters may cause problem of wound closure, leading to exposed implants and infection.