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 hip and access to the lateral aspect of the ankle.

Anatomical surgical approach:  A lateral approach to the fibula was utilized, beginning just distal to the tip of the lateral malleolus and extending proximally along the shaft of the fibula. Subperiosteal dissection exposed the site of malunion. For deltoid ligament repair, a medial incision was made over the medial malleolus, and careful dissection was performed to expose the deltoid ligament without disturbing the overlying tibialis posterior tendon.

Intraoperatively, extensive grade 3 chondromalacia was noted laterally, necessitating thorough debridement. The fibula malunion required osteotomy, realignment, and fixation with an Apollo locking fibula plate. The deltoid ligament was repaired using JuggerKnot all-suture anchors, ensuring restoration of medial stability. The Syndesmotic Ladder technique was employed to address syndesmotic instability, reflecting the complexity of managing chronic ankle injuries in patients with metabolic disorders such as prediabetes.

Postoperative protocol:   Postoperative rehabilitation protocol included non-weight bearing (NWB) for 6 weeks followed by progressive weight bearing as tolerated. Range of motion exercises were initiated early, with close monitoring of glycemic control.

Follow up:   Not specified

Orthopaedic implants used:   GLW Medical Innovation Apollo locking fibula plate, Zimmer Biomet JuggerKnot all-suture anchors. Oiginally posted on LinkedIn by William Crawford, MD FAAOS