Tibial avascular necrosis in a trimalleolar ankle fracture

Abstract

Fractures involving the distal tibia and fibula are challenging to treat, and can have debilitating sequelae. While many fractures can be treated conservatively, open reduction with internal fixation for displaced or unstable variants is the standard of care. Complications in treatment of these complex fractures are relatively common and often unavoidable. The authors present the case study of a 49 year-old female who underwent open reduction with internal fixation of a closed  Danis Weber type-B trimalleolar ankle fracture and suffered avascular necrosis of the anterior lateral tibial plafond. This patient underwent successful trimalleolar ankle fracture fixation surgery, and subsequently suffered collapse of the anterior lateral aspect of the tibia 14 weeks following her index procedure. This case study lends an example of avascular necrosis causing devastating osseous collapse despite timely and robust fracture fixation.