Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with a bump under the ipsilateral hip to facilitate external rotation of the leg.

Anatomical surgical approach:  For the lateral malleolus, a lateral approach was utilized, beginning just distal to the tip of the lateral malleolus and extending proximally along the fibula. For deltoid ligament repair, a medial approach was made, starting just anterior to the medial malleolus and extending distally towards the navicular tuberosity. The syndesmotic injury was addressed through the lateral incision.

Intraoperatively, after anatomical reduction of the fibula, the FibuLock fibular nail was inserted following manufacturer's guidelines. Syndesmotic fixation was achieved using TightRope XP suture buttons, ensuring proper tension to restore the distal tibiofibular relationship. The torn deltoid ligament was meticulously repaired using FiberTak suture anchors, ensuring anatomical approximation of the ligament ends.

Postoperative protocol:   Postoperative rehabilitation protocol included non-weight bearing for the first 6 weeks followed by gradual progression to full weight bearing as tolerated over the next 4 weeks. Range of motion exercises were initiated early in the postoperative period under physiotherapist guidance.

Follow up:   Not specified

Orthopaedic implants used:   Arthrex FibuLock fibular nail, TightRope XP suture buttons, FiberTak suture anchors. Case originally posted on linkedIn by