Review Question - QID 884

A supination-adduction type injury consists of a vertical displaced medial malleolus fracture with marginal impaction of the tibial plafond and a low transverse fibula fracture. This type of injury is also associated with hyperdorsiflexion. The mechanism of a supination–adduction injury to the ankle results in a low transverse lateral malleolus avulsion and a vertical fracture of the medial malleolus secondary to inversion of the talus in the ankle mortise. The initial injury is a rupture of the lateral ankle ligaments or avulsion of the lateral malleolus. As the talus continues to invert, the medial malleolus is pushed to failure and fractures in a vertical fashion. The correct treatment for this type of injury is open reduction and internal fixation (ORIF) with correction of the impacted articular component. Screws alone or a tension band would not provide a vertically stable construct.

In the referenced article by McConnell et al, 8 ankle fractures of this variety were all treated with open reduction and internal fixation, two with medial screws perpendicular to the fracture and the other 6 with medial screws and a one third tubular antiglide plate. 6 of the patients treated in the study had excellent results after 2.5 years of follow up, the other 2 had good results after 2.5 years.

Example of a representative fixation construct of the injury is shown in Illustration A.