Postoperative Complications Following Trimalleolar Fracture Surgery

Case Overview

This case study involves an adult patient who experienced a displaced trimalleolar fracture. The initial surgical intervention involved passing syndesmosis screws and reducing the tibia, but did not include plating the distal fibula.

However, within a month following this surgery, the patient exhibited joint instability necessitating revision surgery where a fibular plate was placed. Two months post-revision surgery, the patient required Tibialis Anterior (TA) lengthening. This case seeks expert insights from a specialist in foot and ankle orthopedics to review the medical records and opine on the standard of care provided.

Questions to the Orthopedic Surgery expert and their responses

How frequently do you perform surgery for trimalleolar fractures and manage postoperative care?

As a professor and vice chair of orthopedic surgery at a leading academic medical center with 15 years of experience in orthopedic trauma surgery at our Level I trauma center, I have treated thousands of patients with fractures and injuries to the musculoskeletal system, particularly ankle fractures. I encounter similar presentations at least once weekly in my practice.

What are the most pertinent measures that surgeons can implement to minimize the incidence of joint instability after trimalleolar fracture surgery?

Appropriate reduction and stable fixation of all malleolar fracture fragments are crucial steps in preventing complications such as joint instability after trimalleolar fracture surgery.

Have you reviewed a case similar to the one described above? If so, please briefly describe.

Yes, I have reviewed numerous cases similar to this one given my extensive experience in treating ankle fractures. In my practice, it is common to see patients presenting with trimalleolar fractures requiring surgical intervention.

About the expert

This expert has an extensive 15-year background in orthopedic surgery, with specialized training in biomechanical research and orthopedic trauma surgery. They are board-certified in orthopedic surgery and hold memberships in several professional organizations, including the Orthopedic Trauma Association and the American Academy of Orthopedic Surgeons. Currently serving as a professor of orthopedic surgery, the director of an orthopedic trauma fellowship and research program, and the vice-chairman of orthopedic surgery at a prestigious medical school, this expert has contributed significantly to their field through over 175 peer-reviewed articles, 35 book chapters, and several edited textbooks.