From the Research
Surgical intervention through open reduction and internal fixation (ORIF) is the preferred treatment for bimalleolar fractures, as it allows for proper anatomical alignment of the ankle joint and prevents post-traumatic arthritis, chronic pain, and functional limitations. The goal of treatment is to restore the anatomy and function of the talocrural joint, and ORIF has been shown to produce good to excellent long-term results 1.
Indications for Surgery
Surgery is typically indicated for dislocated and intra-articular fractures of the lateral and medial malleoli, as well as for cases with ligamentous instability 1. The procedure involves anatomical reduction of the fracture fragments and fixation using plates, screws, or tension band wiring.
Surgical Technique
The surgical technique typically involves placement in a supine position, lateral and medial access, reduction of the fractures by manipulation of the fragments with Kirschner wires or use of reduction clamps, control of the joint reduction, definitive fixation with traction screws and plate osteosynthesis of the distal fibula, screw, tension-band or plate osteosynthesis of the medial malleolus, and in cases of syndesmosis instability, exact restoration of the talocrural joint by implantation of adjusting screws or dynamic fixation with a suture-button system 1.
Postoperative Care
Postoperative care typically involves movement exercises of the talocrural joint after postoperative day 1, mobilization with partial weight-bearing of the affected leg with 20kg postoperatively for 6-8 weeks, and staged increase of weight-bearing if necessary 1.
Outcomes
Studies have shown that surgically treated bimalleolar fractures have good to excellent long-term results, although the increasing number of affected malleoli correlates with a poorer outcome 1. A recent study found that functional outcomes following surgical treatment of bimalleolar ankle fractures are mostly excellent to good, with few complications 2. Another study found that patients with bimalleolar fractures had significantly worse function and a higher overall complication rate compared to those with lateral malleolar fractures and disruption of the deltoid ligament 3.
Recent Evidence
A 2022 study found that early surgical intervention, preferably within 8 hours of the injury, is recommended for bimalleolar ankle fractures in elderly patients, with careful evaluation of the local conditions and consideration of the patient's comorbidities 4. A 2021 study found that anatomical reconstruction is decisive in achieving good to excellent long-term results in surgically treated bimalleolar fractures 1.
Conclusion Not Applicable, Direct Answer Only
The recommended treatment for bimalleolar fractures is surgical intervention through ORIF, as it allows for proper anatomical alignment of the ankle joint and prevents post-traumatic arthritis, chronic pain, and functional limitations.