Salvage of Failed Neuropathic Ankle Fractures: Use of Large-Fragment Fibular Plating and Multiple Syndesmotic Screws

The purpose of this study was to develop a salvage procedure for failed fixation of ankle fractures that
occurs in patients with sensory neuropathy. Six patients, with insensitivity to a 5.07 monofilament on
the plantar surface of their foot (five with diabetes mellitus, one with alcoholic peripheral neuropathy)
presented to a foot and ankle referral center with failed traditional fixation of their Weber B and C
ankle fractures. Five fractures were the result of trauma. One fracture occurred without a discernable
traumatic event. A laterally placed 4.5 DCP plate on the fibula with multiple 4.5-mm syndesmotic screws
engaging both cortices of the tibia was used as fixation. All patients postoperatively were immobilized
in a nonweightbearing below-knee cast for a minimum of 3 months after surgery. At follow-up, all six
patients were satisfied with their results as determined by aligned, functional, and asymptomatic limbs.
The patients were especially pleased that after multiple attempts to provide stability to their fractured
neuropathic ankles, they had retained their own legs and did not need an amputation. Fibular plate
fixation using multiple large-fragment syndesmotic screws provides a reasonable salvage alternative for
neuropathic patients with ankle fractures that failed using traditional hardware techniques. (Journal of
Surgical Orthopaedic Advances 14(2):85–91, 2005)
Key words: ankle fracture, diabetes, neuropathic, revision, syndesmosis