From the Research
Management of a lateral malleolus fracture with open reduction internal fixation (ORIF) with plating involves several key steps, with the most recent and highest quality study 1 suggesting that the choice between locking and nonlocking plates does not significantly impact functional outcomes. The procedure typically begins with preoperative assessment, including radiographic imaging to determine the fracture pattern and guide surgical planning. After administering appropriate anesthesia, the surgeon makes an incision over the lateral ankle, typically 10-12 cm in length, curving slightly posteriorly to the fibula. Careful dissection is performed to expose the fracture site while protecting the superficial peroneal nerve and peroneal tendons. The fracture is then reduced to restore proper anatomical alignment, with temporary fixation using K-wires or reduction clamps. A contoured plate (typically one-third tubular, neutralization, or anti-glide plate depending on fracture pattern) is positioned along the lateral fibula. Multiple screws are placed above and below the fracture line to secure the plate, with typical constructs using 3-4 screws on each side of the fracture. The surgeon confirms proper reduction and hardware placement with intraoperative fluoroscopy. The wound is irrigated and closed in layers, followed by application of a sterile dressing and splint. Postoperatively, patients typically remain non-weight bearing for 6 weeks, with early range of motion exercises beginning around 2 weeks. Physical therapy is initiated to restore strength and function, with full weight-bearing usually permitted between 6-12 weeks based on radiographic healing and clinical assessment, as supported by studies such as 2 and 3. Key considerations include:
- Preoperative planning and radiographic assessment
- Careful surgical technique to protect surrounding nerves and tendons
- Selection of appropriate plate and screw fixation based on fracture pattern
- Postoperative rehabilitation protocol to optimize functional recovery
- Recent studies, such as 1, indicate that the choice between locking and nonlocking plates may not significantly impact outcomes, but other factors like patient age and fracture complexity may influence the decision. Overall, the goal of ORIF with plating for lateral malleolus fractures is to achieve stable fixation, promote healing, and restore function to the ankle joint, with the most recent evidence guiding the choice of surgical technique and postoperative management.