Насколько опасны переломы медиальной и латеральной лодыжек и как их лечить

Fractures involving both the medial and lateral malleoli—commonly referred to as bimalleolar ankle fractures—are considered serious orthopedic injuries. These fractures affect the distal ends of the tibia (medial malleolus) and fibula (lateral malleolus), compromising the structural integrity and stability of the ankle joint. Because the malleoli serve as critical attachment points for ligaments that maintain joint alignment and resist rotational forces, disruption of both structures significantly increases the risk of joint instability, malunion, post-traumatic arthritis, and long-term functional impairment.

Treatment is determined by fracture pattern, displacement, joint congruity, and patient-specific factors such as age, activity level, and comorbidities. Nonoperative management—typically involving immobilization in a cast or boot—is reserved only for nondisplaced, stable fractures confirmed by weight-bearing radiographs and clinical assessment. However, the majority of bimalleolar fractures are unstable and require surgical intervention.

Open reduction and internal fixation (ORIF) is the standard of care. This procedure involves precise anatomical realignment of the fractured bone fragments followed by stabilization using metallic hardware—most commonly lag screws and locking plates. The goal is restoration of joint surface congruity, proper fibular length, and tibiofibular syndesmotic alignment. In some cases—particularly when the posterior malleolus is involved (trimalleolar pattern)—additional fixation may be necessary to ensure rotational stability.

Postoperatively, patients undergo a structured rehabilitation protocol: initial non–weight-bearing status for 4–6 weeks, progressive weight-bearing as healing permits, and physical therapy focused on restoring range of motion, strength, proprioception, and gait mechanics. Full recovery typically takes 3–6 months, though return to high-impact activities may require up to 9–12 months. Close radiographic follow-up is essential to monitor bone union and detect early complications such as hardware failure, infection, or delayed union.