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June 14, 1958


Author Affiliations

U. S. Army

From the Orthopaedic Service, 98th General Hospital, APO 34, New York.

JAMA. 1958;167(7):828-831. doi:10.1001/jama.1958.02990240028005

Nonunion of the medial tibial malleolus is one of a group of fractures for which there is no satisfactory method of internal fixation. Most of the difficulties can be overcome by the use of the hookplate here described. Made of malleable stainless steel in several sizes, it can be adapted closely to the contours of the bone structure. The hookplate fixation has been successfully used in over 350 cases representing fractures of the media/ or lateral malleolus, comminuted or malunited malleolar fractures, olecranon fractures, especially if they were comminuted, and fractures in several other locations in the body. Usually these fractures represent a part of a joint, which is of great importance for structural stability and/or attachments of ligaments and tendons. In applying it, care is taken to preserve the articular surface of the bone and to achieve, if possible, a stable hairline reduction of the malleolar fragment so as to restore the normal ankle mortise. Also, the hookplate fixation allows a type of bone grafting procedure described and illustrated in this paper, which is technically not difficult. Ten fractures, one of which is described in some detail, have been treated with excellent anatomic and functional results.