Medial brostrom repair to resolve anterior medial rotary laxity in Weber B ankle fracture: A case report

The ankle is one of the most commonly injured joints in the lower extremity. In the United States, there are over 2 million ankle injuries annually (1). Historically, the treatment of bimalleolar equivalent fractures includes the fibular fracture, and use of a syndesmotic fixation if syndesmotic laxity and medial widening are observed. This article argues that deltoid ligament repair should be done concomitantly with anterior medial capsule repair in order to fully address rotary laxity. The centerpiece of deltoid injury with capsule injury diagnosis is the widening of the medial clear space >4 mm and/or >1 mm difference than the contralateral limb on AP radiographs (1–7). We suggest that anterior medial capsule repair must be done with the deltoid ligament repair. We present a case of a Weber B fracture with uncertain deltoid involvement on pre-operative radiographs, for which a deltoid rupture with capsule involvement was determined intraoperatively with appropriate stress radiographs taken under general anesthesia. Repair of the deltoid using a low cost, non-intraarticular implant with concomitant repair of the anterior-medial capsule of the ankle joint was utilized. This medial ankle repair, in addition to ORIF of the fibula resulted in a satisfactory clinical and radiographic outcome.