LONG-TERM COURSE IN 119 CASES OF PSEUDARTHROSIS OF THE MEDIAL MALLEOLUS

In 1890 Bahr described pseudarthrosis of the medial malleolus, and in a subsequent paper (1912) he concluded that pseudarthrosis in this site was a fairly common complication to ankle fracture and that it caused serious symptoms. Schmidt (1929) and Felzenreich (1937) claimed that they could make a distinction between mobile and immobile pseudarthroses, only the former giving rise to symptoms, the latter being of no prognostic significance worth mentioning. In accordance with this finding, Bistrom (1952) and later Klossner (1962) found that the width of the pseudarthrosis played a prognostic role, a wide pseudarthrosis producing fairly pronounced complaints. These two authors felt, however, that the ptognosis also depended upon the site affected in the malleolus, a proximal localization giving rise to relatively severe complaints. In contradistinction, Hendelberg ( 1943) , Storen ( 1964), and Solonen (1965) found no evidence that pseudarthrosis of the medial malleolus caused any major complaints. This disagreement concerning the prognostic role of pseudarthrosis in the medial malleolus may be due inter ah to the lack of any symptom pathognomonic of this pseudarthrosis. After a complicated fracture of the ankle, therefore, there will always be considerable uncertainty as to whether possible symptoms are due to the malleolar pseudarthrosis or to other sequelae. To overcome this difficulty as far as possible, the assessment must be based upon materials in which the malleolar pseudarthrosis is the only radiological sequel to the fracture. However, none of the above-mentioned materials had been large enough for such a selective evaluation of the cases of pure pscudarthrosis.