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 non-weight-bearing 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.