Case for small group discussion Ankle fracture Case for small group discussion Ankle fracture in a pregnant woman AOTrauma—Foot & Ankle Module 1a: Ankle trauma—ankle fractures Stefan Rammelt, DE

Case description 21-year-old woman 8 weeks after malleolar fracture treated nonoperatively Week 12 of gestation Pain in left foot, increasing after weight bearing This is the fourth x-ray showing same displacement as the first one

Case description Full weight bearing Mild pain Treatment options? Timing?

Correction at 10 weeks postinjury Avulsion of anterior syndesmosis noted and fixed with screw

9-month follow-up Healthy baby No follow-up x-rays

1-year follow-up Patient satisfied Sends follow-up x-ray Plans plate removal

3-year follow-up Patient satisfied New baby on the way No follow-up x-rays

5-year follow-up Patient satisfied No restriction Occasional pain during sports Stable ankle No deformity 2 healthy babies

5-year follow-up

5-year follow-up

Take-home messages Early correction of malleolar malunions or malreductions to prevent posttraumatic arthritis Respect the radiographic landmarks for reduction and correction Exact reduction of syndesmotic avulsions is essential for correction Biomechanical and clinical studies indicate correction of displacement ≥2mm is necessary References: Rammelt S, Marti RK, Zwipp H. [Joint-preserving osteotomy of malunited ankle and pilon fractures]. Unfallchirurg. 2013 Sep;116(9):789–796. German. Rammelt S, Obruba P. An update on the evaluation and treatment of syndesmotic injuries. Eur J Trauma Emerg Surg. 2015 Dec;41(6):601–614. Rammelt et al. Unfallchirurg. 2013;116:789–796. Thordarson DB, Motamed S, Hedman T, et al. The effect of fibular malreduction on contact pressures in an ankle fracture malunion model. J Bone Joint Surg Am. 1997;79:1809–1815.