Surgical management of unstable ankle fracture (Weber type C, syndesmotic disruption, bi-/tri-malleolar) in a patient fit for surgery
Clinical scenario
This protocol applies to closed, unstable ankle fractures in patients who are fit for surgery. Unstable patterns that meet surgical criteria include:
- Weber type C fractures and Weber type B fractures with syndesmotic disruption
- Displaced fractures
- Unstable bi-malleolar and tri-malleolar fractures
- Fractures with joint incongruity or talar subluxation
Treatment approach (partial overview)
The primary intervention involves surgical open reduction and internal fixation. Intraoperative assessment of the syndesmosis is a key component of the procedure, with stabilisation performed when instability is found. The full protocol — including the complete surgical steps, timing guidance, and post-operative pathway — is available via the link below.
Goal: Stable ankle alignment and adequate fracture reduction at 6 weeks post-surgery
References
DOI: 10.1177/1750458920988162
- Unstable fractures are treated surgically in patients deemed fit enough to undergo surgery.
- These generally include: fractures with syndesmotic disruption (Weber type C and some type B fractures); displaced fractures; unstable bi-/tri-malleolar fractures and fractures with joint incongruity or talar subluxation.
- Surgical treatment mostly takes the form of ORIF using plates and screws to reduce and stabilise the mortise.
- Intraoperative fluoroscopy is used to monitor reduction and fixation.
- After the ankle mortise is fixed, the syndesmosis must be assessed intraoperatively using a stress test such as the Hook test.
- If instability is identified, syndesmotic stabilisation is required.
- NICE emphasises the importance of early fixation by advising surgery on the day of injury or the day after in patients under 60 years of age.
- After surgery, patients are followed up within six weeks to assess the stability and alignment of the ankle and to monitor for any surgical complications.
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