Cerclage of the lateral malleolus in displaced fractures of the ankle.
When open reduction is indicated the lateral malleolus fracture should be reduced as accurately as the medial or posterior malleolar fragments. The cerclage for displaced oblique or spiral fractures of the lateral malleolus is a simple, effective way of internal fixation with a minimal amount of metal implanted. Under direct vision an anatomical reduction is achieved and maintained. The proper use of a 20- or 18 -gauge wire with a mechanical wire tightner-twister is mandatory. A below-the-knee plaster cast is necessary for support for an average of eight weeks. In this series, with correct technique, no wires have loosened or broken. There has been no resorption of bone or refracture at the wire-loop site. No second surgery has been needed for removal of wires. The case material included 50 cases of ankle fractures from 1964 through 1976. In a displaced bimalleolar or trimalleolar fracture, the cerclage can be used in conjunction with various other internal fixation screws or nails applied to the medial and/or posterior malleolar fragment. The exact method varies depending on the type of fracture present. With increasing recognition of the importance of anatomic reduction of the lateral malleolus in the ankle fracture management, cerclage technique will contribute further toward the restoration of the normal ankle joint mechanics.
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