Publication:

Outcomes of antiglide plate fixation for vertical medial malleolar fractures in supination-adduction ankle injuries: a prospective observational study

Background Vertical fractures of the medial malleolus associated with supination-adduction ankle injuries represent an uncommon but inherently unstable fracture pattern because of the predominance of vertical shear forces across the fracture site. Conventional fixation techniques may fail to provide sufficient resistance to these forces, increasing the risk of displacement, delayed union and unsatisfactory functional recovery. Antiglide plate fixation has been proposed as a biomechanically advantageous method that enhances fracture stability by counteracting shear stresses.

Methods A prospective observational study was conducted in the Department of Orthopaedics at a tertiary care teaching hospital. Twenty adult patients with vertical medial malleolar fractures resulting from supination-adduction ankle injuries were enrolled. All patients underwent open reduction and internal fixation using an antiglide plate. Clinical evaluation, radiographic assessment and functional outcome measurements were performed at 3 weeks, 6 weeks and 6 months following surgery. Functional recovery was assessed using the Olerud-Molander Ankle Score (OMAS).

Results The study included patients with a mean age of 38.1±8.87 years, of whom 70% were men. Road traffic accidents accounted for the largest proportion of injuries (45%). Radiological union was achieved within 10–12 weeks in more than half of the patients (55%). At the final follow-up, 70% regained full ankle range of motion. The mean OMAS improved progressively from 34.05±5.93 at 3 weeks to 83.00±17.99 at 6 months. Functional outcomes were excellent in 50% of patients and good in 35%, while postoperative complications were uncommon, with 80% of patients experiencing an uncomplicated recovery.

Conclusions Antiglide plate fixation offers reliable stabilization for vertical medial malleolar fractures associated with supination-adduction ankle injuries. The technique promotes satisfactory fracture healing, facilitates early rehabilitation and results in favorable functional outcomes with a low incidence of postoperative complications. These findings support its use as an effective surgical option for this challenging fracture pattern.