NONUNION OF ANKLE FRACTURE

Nonunion of the ankle malleoli is extremely rare these days. This is p robably due to the fact that primary osteosynthesis is performed in an kle fractures instead of the conservative treatment given up to 20 yea rs ago. Today nonunions of the malleoli are seen, if at all, is infect ed cases after surgical procedures. Noninfected, stable and painless n onunions usually do not need any surgical correction. In painful cases , small fragments, especially of the medial malleolus, should be resec ted; larger fragments should be stabilized with two 3.5-mm cancellous screws. Alternatively, the tension banding technique, especially after Weber A fracture, produces high compression in the area of nonunion. In cases of additional a local upside cortical-cancellous bone graft s hould be performed in addition. In summary, the therapeutic approach r equires exact remodeling, bone-grafting and stabilization. Infected no nunions with loss of bone mass should be treated according to the guid elines for osteitis therapy.