These injuries are due either to high velocity accidents or fall from a height. Rarely, in old patients with osteoporotic bones, it may occur due to trivial trauma.

Due to severity of injury, the ankle gets swollen in no time and hence by the time the patient reaches the hospital, the oedema has already set in making it difficult to operate immediately.

The initial treatment would then consists of application of plaster slab and elevation of the limb, followed by delayed internal fixation.

Some times gross comminution and osteoporosis precludes internal fixation , in such an event, stabilisation of fibula is done to maintain length and an external fixation of tibia is done in distraction mode. This achieves fracture reduction by ligamentotaxis. Two to three weeks later bone grafting is performed in the subchondral area to fill up the defect. This approach may restore the anatomy reasonably well.

Complications

Fracture blisters, Oedema of the leg and foot, difficulty in wound closure after open reduction and internal fixation, skin necrosis and exposed implants are immediate complications.

While delayed or non union due to gross comminution and poor blood supply of the fragments, infection and osteomyelitis may occur as late complications.