Date: Tue, 6 Mar 2001 12:56:35 +0500

Subject: Lateral Malleolar Fx

From: Alexander Chelnokov

Hello All

A worker, the injury was two months ago. Recent x-rays are attached - the first is AP and lat view, the second - AP view in standing.

A question is should the patient be operated now? Is restoring of exact shape of the distal fibula to be crucial for further life of the person? Is degenerative arthritis inevitable in the case if the fibula is left untouched?

THX in advance.

Best regards,

Alexander N. Chelnokov,
Ural Scientific Institute of Traumatology and Orthopaedics
Ekaterinburg 620014 Russia

Date: Tue, 6 Mar 2001 05:02:32 -0800

From: bruce meinhard

I would like to know if he has pain, and if a stress view showed motion at the fracture site under anesthesia. There seems to be a bit of callus on the proximal aspect of the fracture site on the lateral view. There is minimal shortening which could be accepted by many, but I would like to have an anatomic restoration. The morbidity here with plate and screws is small, and if the fracture is painful or not united and short, this would lead me to strongly consisder intervention.

BPM

Date: Tue, 06 Mar 2001 15:54:20 -0500

From: Michael S. Sirkin, M.D.

Is the patient symptomatic. Given these views the mortise is not displaced. The talus is in the proper place with regards to the tibia. There is no medial clear space widening, the overlap of the tibia and fibula are correct with no widening. I do not think there is any indication go ahead and fix this if except possibly a painful nonunion.

Date: Tue, 06 Mar 2001 20:34:41 -0600

From: Steven Rabin

unless there is pain or instability, i would also leave it alone.