Treatment of a pregnant patient with bilateral traumatic bimalleolar ankle fracture: a case report

Abstract

Ayak bileği kırıkları, iskelet travmaları sonrası oluşan tüm kırıklar içerisinde giderek artan sıklıkta görülmektedir. Tüm ayak bileği kırıklarının yaklaşık %25'ini bimalleoler kırıklar oluşturmaktadır. İki taraflı travmatik bimalleoller ayak bileği kırığı ise çok nadir görülen bir durumdur. Bu tablo içerisinde aynı zamanda sezaryen doğum ile müdahale edilmiş gebelik durumunun olması, olguyu özellikle venöz tromboembolizm ve ölümcül pulmoner emboli yönünden daha da komplike hale getirmektedir. Bu yazıda, sekiz aylık gebelik öyküsü bulunan ve araç içi trafik kazası sonucu iki taraflı bimalleoler ayak bileği kırığı olan 25 yaşındaki kadın olgu sunuldu ve uygulanan cerrahi tedavi sonrası elde edilen klinik ve radyolojik sonuçlar literatür ışığında tartışıldı.Anahtar sözcükler: Ayak bileği; iki taraflı; bimalleoler kırık; gebelik.The incidence of ankle fractures has been increasing among all fractures due to skeletal traumas. Bimalleolar fractures account for 25% of all ankle fractures. Bilateral traumatic bimalleolar ankle fracture is a very rare condition. In such a clinical presentation, pregnancy managed with cesarean procedure complicates the situation due to increased risk of venous thromboembolism and fatal pulmonary embolism. In this article, we report a 25-year-old female case within an eight-month pregnancy period who had bilateral bimalleolar ankle fracture due to an accident in a motor-vehicle and the clinical and radiological results of surgical treatment were discussed in the light of current literature data.

Bilateral simultaneous rotational ankle fractures: case series and literature review

“…16 There were only 6 separate cases reported in literature that are similar to our cases in being bilateral rotational type ankle injuries with some of them being identical. [10][11][12][13][14][15] Majority of the cases along with ours, were in fact as result of relatively high mechanism trauma and were associated with rotational injury patterns. This is unexpected especially when the energy absorbed caused symmetrical rotational injuries in contrast to axial type ankle fractures that commonly present as a result of high mechanism trauma.…”

“…4,17 There were only 2 cases reported in literature that were associated with bilateral adduction or abduction moment. 10,15 Sultan et al reported a uniquely presented bilateral symmetrical supination adduction fracture dislocation as a result of a tree log falling over the patients legs while working. 15 They highlighted an important aspect in this case that is feet position at time of injury being an important aspect leading to this presentation.…”

“…23 Another case reported by Atıcı et al of a pregnant lady who sustained what it seems a bilateral pronation abduction ankle fracture dislocation. 10 From the abstract, it is stated that she sustained a motor vehicle accident and the given Images on the full text, it fits LH PA II injury since she had comminuted fibular fractures and transverse medial malleolar fractures with an abducted talus.…”

“…8,9 Twisting mechanism can lead to multiple variety of injuries such as; Maisonneuve fracture, Tillaux fracture, or Lauge-Hansen classified ankle fractures, of which have been separately reported in literature to present bilaterally. [10][11][12][13][14][15] In this study, we present rare cases of simultaneous bilateral rotational fractures and reviewed similar cases presented in literature and discused the etiological mechanism of the injuries sustained and their presentation.…”