Arthroscopic ankle fusion to manage sequel of loss of lateral malleoli in compound crushed ankle injury

Abstract

Defect in the lateral malleolus along with lateral ligamentous injury of ankle is rare. It occurs mainly due to resection of distal fibula tumors and severe trauma leading to loss of lateral malleolus. Lateral malleoli has the major contribution in weight transmission to foot and ankle stability. To avoid persistent pain and gait abnormality due to ankle instability, reconstruction of bony defect is inevitable. Methods to address these defects are iliac crest bone grafting, vascular and nonvascular proximal fibula transfer, patella tendon bone graft and allograft. Donor site morbidity, allograft related problems are not rare. Arthrodesis of ankle gives painless stable joint. Arthrodesis can be performed by open and arthroscopic methods. Open method has more soft tissue dissection and too difficult in scenario with previous skin grafting with adherent skin to bone. We managed a case of compound ankle injury with loss of lateral malleolus with loss of lateral ligament in stages, first management of compound crushed ankle followed by arthroscopic ankle arthrodesis. Even after 6 year of follow patient has stable pain less ankle with satisfactory gait.

Fig. 1

(a,b-radiograph AP and lateral view of Right ankle following trauma), (c,d-radiograph after debridement and external fixtaion).

Fig. 2

(a,b-radiograph after removal of fixator,c-portal marking intraopaeratively for ankle arthroscopy).

Fig. 3

(a,b-radiograph showing complete fusion,c-clinical photograph after 18 months follow up).