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