Postoperative Complications Following Trimalleolar Fracture Surgery

This case study examines a situation involving an adult who underwent surgery for a displaced trimalleolar fracture, but faced complications leading to additional surgeries.

ByWendy Ketner, M.D.


Published on February 14, 2024

Surgeons operating

Case Overview

This case study involves an adult patient who experienced a displaced trimalleolar fracture. The initial surgical intervention involved passing syndesmosis screws and reducing the tibia, but did not include plating the distal fibula.

However, within a month following this surgery, the patient exhibited joint instability necessitating revision surgery where a fibular plate was placed. Two months post-revision surgery, the patient required Tibialis Anterior (TA) lengthening. This case seeks expert insights from a specialist in foot and ankle orthopedics to review the medical records and opine on the standard of care provided.

Questions to the Orthopedic Surgery expert and their responses


How frequently do you perform surgery for trimalleolar fractures and manage postoperative care?

As a professor and vice chair of orthopedic surgery at a leading academic medical center with 15 years of experience in orthopedic trauma surgery at our Level I trauma center, I have treated thousands of patients with fractures and injuries to the musculoskeletal system, particularly ankle fractures. I encounter similar presentations at least once weekly in my practice.


What are the most pertinent measures that surgeons can implement to minimize the incidence of joint instability after trimalleolar fracture surgery?

Appropriate reduction and stable fixation of all malleolar fracture fragments are crucial steps in preventing complications such as joint instability after trimalleolar fracture surgery.


Have you reviewed a case similar to the one described above? If so, please briefly describe.

Yes, I have reviewed numerous cases similar to this one given my extensive experience in treating ankle fractures. In my practice, it is common to see patients presenting with trimalleolar fractures requiring surgical intervention.

About the expert

This expert has an extensive 15-year background in orthopedic surgery, with specialized training in biomechanical research and orthopedic trauma surgery. They are board-certified in orthopedic surgery and hold memberships in several professional organizations, including the Orthopedic Trauma Association and the American Academy of Orthopedic Surgeons. Currently serving as a professor of orthopedic surgery, the director of an orthopedic trauma fellowship and research program, and the vice-chairman of orthopedic surgery at a prestigious medical school, this expert has contributed significantly to their field through over 175 peer-reviewed articles, 35 book chapters, and several edited textbooks.

Expert headshot



About the author

Wendy Ketner, M.D.

Wendy Ketner, M.D.

Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.

Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.

Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.

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