Surgical Discussion

Patient was positioned supine on a radio translucent table. Initial surgical approach was lateral - there was no indication of static motise shift blocking fibular reduction so we could proceed with primary lateral reduction and fixation. The fibula was relatively simple to reduce and was fixed with a 3.5 mm locking plate. Anterior preparation to the Chaput tubercle and anterolateral tibotalar joint allowed direct reduction of the fibula into the syndesmosis under direct vision. This was temporarily fixed using k-wires, the syndesmosis fibres were avulsed completely from the tibial side and following whip stitch arming of the ligament it was secured back to bone using a suture anchor. To support the reduction a tricortical the screw was introduced. The posterior injury was therefore not addressed directly. Moving to the medial side the Herscovici B fracture was reduced, and due to is relatively small size it was fixed with a 4.0 mm cannulated screw and simple k-wire anti rotation screw.

Orthopaedic implants used:   Stryker 3.5mm Ankle System. Arthrex Fasttak Suture Anker.