Malleolar Fractures in Adults: Therapeutic and Evolutionary Aspects at the Dalal Jamm National Hospital in Guédiawaye

Daffé M^1*, Dembélé B¹, Diop M¹, Sow M¹, Tazit H¹, Diouf AB², Sané AD¹

¹Centre Hopitalier National Dalal Jamm, Guédiawaye, Dakar, Sénégal
²Hôpital de la Paix, Ziguinchor, Sénégal

*Correspondence author: Daffe Mohamed, Orthopaedic and Trauma Unit, Centre Hospitalier National Dalal Jamm Ancien parcours du golf, Guédiawaye, Dakar, Sénégal; Email: [email protected]

Citation: Daffé M, et al. Malleolar Fractures in Adults: Therapeutic and Evolutionary Aspects at the Dalal Jamm National Hospital in Guédiawaye. J Ortho Sci Res. 2025;6(2):1-6.

Copyright^© 2025 by Daffé M, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Table 1: Functional assessment by type of treatment.

Figure 1: Osteosynthesis of a bimalleolar fracture using an external screw plate and internal bracing with screw fixation of the syndesmosis.

Figure 2: Bimalleolar malunion secondary to orthopedic treatment.

Discussion

Our study encountered a number of difficulties:

• The non-use of some files due to poor archiving
• Non-cooperation of some patients in data collection and evaluation due to their unavailability

In our study, 88% of cases were admitted within 24 hours, 10% between 48 hours and 8 days and only 2% after 8 days. These results are comparable with those of Khortame, who reported that 82% of patients received a reduction within 24 hours of the accident and those of Batchom, who observed that 68.9% of patients consulted a doctor within the first 24 hours [4,5]. This trend is explained by the need for urgent management of malleolar fractures, in order to reduce complications and improve functional prognosis.

Although surgical treatment is the treatment of choice for malleolar fractures, orthopedic treatment is still indicated in the management of these injuries. In our study, malleolar fractures were treated surgically in 21 cases and orthopedically in 29 cases.

In our series, 29 cases (58%) underwent orthopedic treatment. This type of treatment is used for stable, non-displaced closed fractures. Lack of financial resources, apprehension about surgery and the clinical condition of some patients motivated orthopedic treatment of malleolar fractures. Our results are similar to those of Fadjoukou with (80.77%) in favor of the cruropedic cast [6].

In our series, the majority of patients received orthopedic treatment. As far as surgical treatment was concerned, the screw plate was the most commonly used material for the lateral malleolus, with 14 cases (66.6%) and bracing for the medial malleolus, with 9 cases (42.85%). Our results are compatible with those of Khortame, who found that 87% of patients benefited from a screw-retained plate at the level of the lateral malleolus and osteosynthesis of the medial malleolus was mainly performed with a screw-retained plate (87%) [4]. In the literature, the lateral malleolus is important for the stability of the mortise; its open osteosynthesis with a screw plate remains the reference treatment. Most medial malleolus fractures require screw fixation. In our series, the reason for bracing was that the fracture line was usually transverse and the equipment needed for closed screw fixation (image intensifier) was temporarily unavailable.

In our series, rehabilitation was carried out in 90% of cases after treatment, including 58% by a physiotherapist and 32% by the patient himself. This result is better than that of Ngo Yamben Ma, et al., in 2016 in Cameroon, who reported a rate of 65% in their study [7]. Rehabilitation is one of the pillars of treatment and guarantees the best results after optimal surgical treatment. Early initiation of rehabilitation helps to limit the sequelae of joint immobilization.

According to the KITAOKA score, the results were satisfactory overall, with 84% good results. This rate is comparable to that reported by Karouane (80%), Berhil (77.3%) and Fadjoukou (73.5%) [6,8]. Batchom, et al., obtained similar results, with a success rate of 74.2% [5,9]. These data confirm that our results are in line with previous studies, demonstrating the effectiveness of our treatment.

The functional results of orthopedic treatment were satisfactory overall, with 79.31% good results. The results found by Karouane (66.66%) and Berhil (76.4%) are almost similar to ours due to the quality of the initial reduction, which was generally satisfactory [8,9].

The functional results of surgical treatment were satisfactory overall, with 90.47% good results and better than those of Alji and Karouane with 83.9% and 83.33% [8,10]. These results can be explained by the fact that we have a short average follow-up with a small series, but also a great deal of experience with orthopedic treatment, given the problem of resources that many patients present. The overall mean time to consolidation was 87 days +/- 10.96 days, which corresponds to the time to consolidation reported in most studies [2,11].

Two patients (4%) treated orthopedically had secondary displacements detected by follow-up radiographs. Berhil found a percentage of 0.8% [9]. These secondary displacements were diagnosed late in 2 patients. This delay in diagnosis can be explained by the fact that more than half of the patients in plaster (78.70%) were seen in consultation after D21 and were not seen again at D3 for a repeat cast after the oedema had subsided.

One patient (2%) had an infection on osteosynthesis equipment. Targeted antibiotic therapy was prescribed after swabbing, in conjunction with antibiotic susceptibility testing. Our infection rate was lower than those of Fadjoukou and Berthé M, with 14.12% and 11.8% of cases respectively [6,12]. Krissian reports that infection varies from 1 to 48% depending on the study and has a poor prognosis after surgical treatment [13]. This requires rigorous prevention.

We had pseudarthrosis in two patients (4%). Some authors have found only a few cases of pseudarthrosis in their series [2,8]. These pseudarthroses can be explained by a reduction defect (joint congruence) and by secondary displacement in plaster. We obtained a vicious callus in 2 patients (4%) as often reported in several series [12,13]. Sane, et al., did not find any vicious callus in their study [14]. This is a rare complication, caused in our study by secondary displacement under plaster and by a reduction defect.

Conclusion

Malleolar fractures are common fractures that affect the anatomy of the ankle, with repercussions on its function. Management is based on orthopedic or surgical treatment, with the aim of reconstructing the anatomy of the ankle and avoiding complications.

Conflict of Interests

The authors declare no conflict of interest.

Funding/Sponsorship

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

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