Surgical Discussion

Following initia debridement, VAC cover and Ex-Fix stabilisation, definitive nail osteosynthesis with supplementary monocortical provisional plating was done on day 7 with secondary wound closure of relative good soft tissue envelope. The monocortical locking plate was used to achieve and stabilise provisional reduction and fixation allowing accurate nail insertion and fixation. The plate was left in to support reduction of intermediate fragments although its biomenchanic stability isnt significant. Interestingly, by week 8 the entire construct has collapsed axially (telescoped) under full weight bearing. Alignment of the primary fracture is retained with perforation of the nail and distal interlock through the plafond and into the talus.