S Scope Every Ankle Fracture: You Will Be Surprised With What You - PowerPoint PPT Presentation

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Scope Every Ankle Fracture: You Will Be Surprised With What You Find! The following relations exists Royalties and stock options – Smith and Nephew, Wolters Kluwer Consulting income – Smith and Nephew, Geistlich, Ossur, Cannuflow Research and educational support – Mitek, Smith & Nephew & Arthrex

QUESTION – Case 1 How Many People Would Arthroscope This Baseball Player’s Ankle Prior To ORIF ?

Question – Case 1 Arthroscopic Findings Torn Deltoid & Syndes. Lig Unstable Lateral OLT Loose Bodies

Role of Arthroscopy in Acute Fxs Assists in Reduction and Internal Fixation Permits Evaluation and Treatment of Intraarticular Pathology Prior to ORIF

Role of Arthroscopy in Acute Fxs Allows the Assessment of the Articular Surfaces After Reduction and Internal Fixation

Indications – Acute Fxs Minimal to Mild Displacement Easily Reducible by Manipulation Minimal to Mild Ankle Swelling No N-V Injury

Indications – Acute Fxs CONTROVERSIAL Arthroscope All Intra-and Extra Articular Fxs to Look for L.B., Osteochondral Lesion and Ligament Injury

Technique – Acute Fxs Patient is Paralyzed Gentle Distraction Establish AM, AL & PL Portals Wash Out Entire Joint and Remove All Clots Evaluate Fx Carefully

Technique – Acute Fxs Use AM, AL,PL Portals Remove Clot and Debris Exam Entire Joint Reduce Fx Under Fluoroscope Fix with Cannulated Screws

Tillaux Fracture-Definition Fracture of the Anterior Tibial Epiphysis Mechanism Avulsion of Epiphyseal Fragment Due to The Strong Anterior Tibiofibular Ligament External Rotational Force Across the Ankle Commonly Seen in Adolescents Treatment: ORIF

Syndesmosis Injury Carefully Evaluate the Entire Joint Determine if a Complete Tear Exists Assess Stability with Fluro and Arthroscope Look for Intraarticular Injury Insert Syndesmosis Screw and Reassess Stability

Syndesmosis Injury 31 Y/O Male Who Injured Rt. Ankle Sliding into 2 nd Base

Stress X-ray vs. Scope Dx of Syndemosis Injury Lui et al (2005) Treated 53 Weber B or C Fxs Intraop, 30% had Positive Stress X-rays; 66% had Positive Arthroscopic Findings Arthroscopy Aids in Analysis of Different Patterns of Syndesmosis Diastasis Arthroscopy Guides Reduction

Arthroscopic Findings of Ankle FXs 48 Patients (Loren & Ferkel) Mean Age 36 19 Female; 29 Male Variable Injury Mechanisms Average = 7 Days Interval to Surgery Arthroscopy 18:2002

Traumatic Articular Surface Lesions TASLs Full Thickness Chondral or Osteochondral Defects > 5 mm Diameter 30 ANKLES (61%)

TASLs Of The Talus 19 Lesions Medial Dome – 15 Lateral Dome – 4 Uniformly Displaced and Devoid of Subchondral Bone

“Lift Lesion” Lateral Inverted Osteochondral Fracture of the Talus 10 Pts with Acute Injury All Lesions Involved Lateral Talus with Lateral Ligament Injury 8 Lesions Were Reattached and Two Were Excised Results = 6 Good, 3 Fair, 1 Poor Arthroscopy 29:1826, 2013

Results Hintermann 2000 288 Acute Ankle Fractures Cartilage Lesions 79% Talus – 69% Distal Tibia – 46% Fibula – 45% Medial Mali. – 41%

Results Hintermann 2000 Frequency and Severity of Cartilage Lesions Increased From Weber B to Weber C Fractures

Summary – Scope Ankle Fx Treatment Arthroscopy Helpful in Dx and Rx of Acute Ankle Fxs & Detecting Associated Intra-articular Injuries Debridement Helps Pain, Swelling, Catching in Chronic Patients DF Harder to Regain Than PF Post-Fx

Pearls – Scope Ankle Fx Treatment Use Soft Tissue Distraction Gently & Exam Entire Joint Establish a Separate Inflow Cannula & Washout Joint Completely Use Fluoroscopy To Verify Hardware Position & Fx Reduction Get Out of The Dark Ages With New Techniques