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 Classification? Weber B

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 of 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 (1 st ) • 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