Preventing Medial Tibial Stress Fractures After TAR: New Insights

Gregory Lundeen was the foot and ankle surgeon who first described medial malleolar fractures (MMF) in the context of total ankle replacement. Following his findings, it became standard practice to consider patients at risk for fractures if the width of the medial malleolar was less than 11 mm after bone cuts.

Prophylactic fixation of tibia

The most practical application has been using Patient Specific Instrumentation like Prophecy, which reports the medial malleolar width as part of the preoperative planning tool. If the medial malleolus is narrow (<11 mm), prophylactic fixation of the tibia is planned as part of the procedure and mitigate the risk of MMF. 

What’s new?

In their study published just this week, Palma et al. identified 20 patients who experienced MMFs more than four weeks postoperatively. Using a control group, they performed logistic regression to investigate the association between MMF and factors such as postoperative coronal alignment, medial malleolar width, and prophylactic fixation of the medial malleolus. The authors concluded that surgeons should consider prophylactic screw fixation in patients with a medial malleolar width of less than 10.3 mm or those at risk of postoperative varus deformity.