Transcript Ankle Fractures: syndesmosis - Orthopedic Surgery | Tustin

Arash Aminian MD
June 7, 2013
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I have no conflicts of interest
20% of all ankle sprains
10% of all ankle fractures
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A deltoid tear can be seen with medial
malleolar fracture? T
Medial tenderness is predictive of deep
deltoid tear? F
Intra-operative post reduction stress
views should be performed after lateral
malleolus fixation? T
Bone quality
Pre-reduction films: energy of injury
Patient factors: BMI
Commonly mal-reduced: IR or anterior translation
Not every fracture is the same
Don’t be in a hurry
AITF
PITF
Transverse TF
IOS
Deltoid Ligament:
Superficial
Deep: prevents lateral shift and resists ER
Contribution from
peroneal/AT
Peroneal artery
perforates IO
membrane 3 cm
proximal to ankle
JBJS 2012
Fibula migrates 2.4 mm and ER with DF
Deltoid cut 2 mm shift/15 degrees valgus –
Harper 1987
• Can have a high fibula fx without
complete rupture of the IO, deep
deltoid
• 39% Weber B – Tornetta JOT 2007
Boden JBJS 1989
Maintain talus in mortise
1 mm shift-42% loss of contact surface RH
1976, 40% Lloyd FAI 2006
2 mm – 49% pressure Zindrick 1985
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Medial Tenderness
Anterior tenderness – nonspecific
ER test
Squeeze test
Check proximal fibula tenderness
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AP WB x-rays
Mortise: Medial clear space
“Shenton’s line”
Talocural angle 83 +/- 4 degrees on
mortise
Tib fib overlap/clear space
Stable vs Unstable
Acute vs Chronic
Latent vs Frank
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Hook test sensitivity/specificity 0.25/0.98
ER test sensitivity/specificity 0.58/0.96
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3 vs 4 cortices?
3.5 vs 4.5 mm? Biomechanically similar (FAI
2000)
Location of the screw?
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Postero-lateral to anteromedial
TSS fixation level above
plafond? 2-5 cm
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Use a clamp? Prevents motion, shifting of the drill
hole
Position of the ankle? DF (JBJS 2001)
HWR?
Fix a high fibula fracture vs only screws?
Fixing the posterior malleolus?
Displacement/stability
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2 wks in splint, then CAM
NWB 6 wks
WBAT with boot for 6 wks
Counsel about hardware breakage
Thank you