Comparison Between Fibula Plating Versus Intramedullary K-Wire With Medial Malleolar Screw for the Fixation of Bimalleolar Fracture of Ankle

This study was conducted to evaluate and compare the functional outcomes of two commonly employed surgical techniques for the management of bimalleolar ankle fractures: fibula plating and intramedullary K-wire fixation combined with medial malleolar screw fixation. Bimalleolar fractures of the ankle represent a significant portion of ankle injuries and are typically the result of rotational forces acting on the ankle joint. While low-energy mechanisms such as simple falls are common causes, there has been an increasing trend in high-energy trauma, particularly road traffic accidents, which has led to more complex fracture patterns with associated soft tissue injury.

The ankle joint is a highly complex structure composed of osseous and ligamentous components that function together to maintain stability and enable movement. Stability of the ankle depends not only on the integrity of the tibia, fibula, and talus but also on the surrounding ligamentous structures, particularly the deltoid ligament medially and the lateral ligament complex. Any disruption to this osteoligamentous unit can result in joint instability, altered biomechanics, and long-term functional impairment if not managed appropriately.

The deltoid ligament, in particular, plays a critical role in maintaining medial stability of the ankle joint. Injury to this ligament, whether partial or complete, can lead to significant instability, widening of the medial clear space, and potential long-term complications such as chronic pain, deformity, and post-traumatic arthritis. Therefore, a thorough clinical and radiological evaluation is essential in all cases of ankle fractures. Initial assessment should include neurovascular examination to rule out any compromise in circulation, as well as careful evaluation of soft tissue condition, as open fractures or severe soft tissue injury may significantly influence treatment options and prognosis.

Management of bimalleolar ankle fractures is generally surgical, as these injuries are considered unstable. Open reduction and internal fixation (ORIF) has long been considered the gold standard for treatment, particularly for achieving anatomical alignment, restoring joint congruity, and allowing early mobilization. Traditional fibular plating techniques provide rigid fixation and excellent stability; however, they require extensive soft tissue dissection, which may increase the risk of complications such as wound infection, skin necrosis, and delayed healing. These concerns have led to the exploration of less invasive fixation methods.

Intramedullary K-wire fixation represents a minimally invasive alternative that aims to reduce soft tissue disruption while still providing adequate stabilization of the fibula. This technique may be associated with reduced operative time, smaller incisions, and potentially fewer wound-related complications. However, concerns remain regarding the adequacy of fixation strength, maintenance of reduction, and overall functional outcomes when compared to traditional plating methods. Despite increasing use of this technique, there is limited high-quality comparative data evaluating its effectiveness, particularly in relation to early functional recovery.