Ankle Fx and Syndesmosis Cases William Obremskey MD MPH MMHC - - PowerPoint PPT Presentation

Ankle Fx and Syndesmosis Cases

William Obremskey MD MPH MMHC Vanderbilt Orthopedic Trauma

22yo WF twisted R ankle

Lauge-Hansen: SER-4 Weber B

Classification?

Operative Planning

• Surgery?
• What to fix?
• Technique?

– Surgical approach – Reduction

• Implants?

Postoperative Xrays

• Postoperative management?

Syndesmosis Injury

19yo male football player

• Classification?

– PER (pronation external rotation)

• Surgical treatment?

Postop

• Intraop

– Combination

• f fixation
• 3mts

– Screw fatigue – No failure of reduction

25yo F twisted R ankle & felt a pop

• Anterior colliculus (of med malleolus) fx
• Syndesmosis widening

25yo F twisted R ankle & felt a pop

• PE: Always note

areas of tenderness, ecchymosis or swelling

• Palpate to the knee
• Syndesmosis

Squeeze test

• Xray the entire bone

if indicated

Maissoneuve Injury (prox fibula fx with syndesmosis and deep deltoid ligament disruption

6 week f/u

56yo F tripped in her yard

• Classification?

– Pronation-Abduction vs. fracture/dislocation?

56yo F

• Initial Management
• Closed Reduction- methods
• Acceptable?
• Next Move?

5 days later…

• CT scan can be very helpful

in understanding posterior malleolar fxs and with surgical planning

• Pronation-abduction
• Posterolateral approach to posterior malleolus and fibula
• Open reduction of posterior malleolus, remove interposed fragment (1st)
• Bridge plating
• Syndesmosis fixation

28yo F with twisting injury in rollerderby match

• Classification?...Surgical considerations?

– Pronation-Abduction – Syndesmosis injury likely – Small posterior malleolar fracture

• Bridge plating (extraperiosteal)
• Syndesmosis fixation (flexible)
• Posterior malleolus fixation not necessary