Modern Operative Treatment of Malleolar Fractures and Associated Consequences (Review)

The review covers the current state of the problem of operative treatment of malleolar fractures and the associated consequences. Various methods used in osteosynthesis of the malleolus were analyzed. The main criteria of the favorable arrangement of the fractured bone fragments for malleolus reposition are identified. Methods for recovery of the ligamentous apparatus of the ankle joint are described, that have been neglected by many surgeons, though in 50% of cases it causes development of chronic instability with further osteoarthrosis. The reason for large number of poor outcomes of malleolar fracture treatment is defined, which occur despite the anatomically precise reposition, recovery of the ligamentous apparatus and good postoperative care of patients. All this is mainly due to presence of post-traumatic articular cartilage defects that further induce development of osteoarthrosis. The main techniques used for arthroscopic treatment of this pathology are described, including that with the autologous chondrocyte implantation. Attention is given to the subject of primary and revision replacement of the ankle joint, the long term results in comparison with replacement of knee and hip joints are shown. The modern and most efficient techniques of the ankle joint arthrodesis are presented, including arthrodesis with a retrograde intramedullary rod and arthroscopic arthrodesis. The main techniques used for treatment of the post-traumatic ankle joint arthrosis are identified depending on its stage.