A rare case of bilateral closed Supratubercular bimalleolar ankle fractures in an adult: a surgical case report

Introduction: Bilateral ankle fractures are rare injuries, particularly as closed supratubercular bimalleolar fractures. These unstable patterns involve a fibular fracture above the syndesmosis with medial malleolar injury and require precise anatomical reduction to restore ankle stability. Bilateral symmetrical involvement is exceptionally uncommon and may result from synchronized rotational forces applied to both ankles.

Case Presentation: A 35-year-old male with no prior medical history sustained bilateral ankle trauma after a low-energy fall. Examination showed bilateral swelling, deformity, and inability to bear weight, with intact skin and preserved distal neurovascular status. Radiographs revealed bilateral supratubercular lateral malleolar fractures associated with oblique medial malleolar fractures, confirming bilateral closed bimalleolar ankle fractures. The patient underwent single-stage bilateral open reduction and internal fixation using plate-and-screw constructs for the fibulae and cancellous screws for the medial malleoli, along with bilateral transsyndesmotic fixation. Postoperatively, immobilization was followed by progressive rehabilitation. Radiographic union was achieved at six weeks, and full, pain-free functional recovery was observed at three months.

Discussion: Bilateral ankle fractures are exceptional and may occur when similar rotational forces act simultaneously on both ankles. Supratubercular fibular fractures are often associated with syndesmotic disruption, making stabilization essential to restore ankle congruence and prevent long-term complications. Rigid internal fixation combined with syndesmotic stabilization allows early rehabilitation and favorable outcomes.

Conclusion: Bilateral closed supratubercular bimalleolar ankle fractures are an extremely rare injury pattern that can result from simultaneous rotational forces. Early diagnosis, anatomical reduction, stable fixation, and structured rehabilitation are key to achieving excellent functional outcomes.