Date: Date: Tue, 10 Jul 2007 16:47:36 -0400

From: Shital Parikh

Subject: Medial Malleolus Fx - Comminuted

16 year old male patient with a closed, communited fracture of the medial malleolus.

Click images to zoom in.

If i cant fix the fragments with K-wire, can i excise them and repair the deltoid...can someone give an opinion...

thanks
shital parikh, MD

Date: Wed, 11 Jul 2007 06:24:12 -0400 (EDT)

From: Michael A. Stracher, MD

For very small medial malleolar fragments, you might consider using a radial pin plate (from Trimed). I have used this in the past for very small comminuted medial malleoli with good results. See attached image.

Click image to zoom in.

Date: Wed, 11 Jul 2007 06:30:28 -0700

From: Nikolaj Wolfson

Dear Dr.Parikh:

It is obviously more than just medial malleolus fracture. The posterior one is also fractured and I am concerned about the integrity of the syndesmosis. You can examine it. I also would like to see full lower leg (Tibia/fibula) x ray.

Yes, Trimed radial pin plate, as demonstrated by Dr. Stracher, is an option. I have no experience with this hardware.

This might be one of the cases where no surgery is the best treatment modality. Just cast this patient, follow with weekly x rays and take it from there. If there is a displacement or painful non union in a future, you can address it at the later stage.

Good luck,

Nikolaj Wolfson, MD, FRCSC
Assistant Professor of Orthopaedic Surgery
Department of Orthopaedic Surgery
Keck School of Medicine
University of Southern California