In patients with particularly high-energy injuries causing open ankle fractures, the medial malleolus can be extruded from the ankle and either lost at the scene of the injury or unable to be fixed at the time of operative intervention. Minimal reporting of this devastating injury exists in the literature. Our study aims to report the outcomes in patients with open ankle fractures and loss of the medial malleolus. We retrospectively reviewed eight patients with this injury pattern over a 14-year span (2000–2014). Two of these patients were treated with below-knee amputation for a mangled extremity. Five of the patients were treated with tibiotalocalcaneal (TTC) arthrodesis. Of the five patients treated with ankle and subtalar arthrodesis, two were treated with open reduction and internal fixation (ORIF) prior to their arthrodesis. The remaining three patients were treated with arthrodesis after their initial surgical treatment with irrigation and debridement (I&D) and external fixation. Four of the six patients required soft tissue coverage with a rotational or free flap. All patients undergoing TTC arthrodesis went on to fusion; at final followup (average 2.7 years; 1.1–8.2 years), they reported minimal pain in the operative extremity and were able to ambulate. We found TTC arthrodesis to be a viable option for patients with this devastating injury. These findings could aid orthopedic surgeons not only in preoperative patient education and prognosis but also in operative planning in patients with this rare injury.

Keywords:Bone loss, Medial malleolus, Open ankle fracture, Outcomes.

How to cite this article:Lampley A, Dekker T, Catanzano A, Adams SB Jr. Open Ankle Fractures with Loss of the Medial Malleolus: A Case Series on a Rare Injury. The Duke Orthop J 2018;8(1):28-32.

Source of support: Nil

Conflict of interest: None