Laterally comminuted fracture-dislocations of the ankle are highly
unstable injuries in which anatomical reduction of the talus and
restoration of fibular length and rotation are difficult. To our knowledge,
no descriptions of the fracture pattern of these injuries and the surgical
technique for treating them are available, and surgical results with this
fracture have been disappointing. Discontinuity of the fibula as a result
of comminution makes accurate assessment of fibular length and rotation
impossible if the fibula is reduced first. Anatomical stabilization of the
talus beneath the tibia is achieved by reduction and fixation of the medial
malleolus. The fibular malleolus is then anatomically positioned in the
lateral articular facet of the talus and fixed in this position. The
osseous discontinuity of the fibula is grafted with bone. Clinical and
radiographic results of the technique were highly satisfactory after a mean
length of follow-up of thirty-four months.