Surgical Discussion

The operation was done supine on a radio translucent operating table. A limited longitudinal lateral incision provided direct access to the fracture site. Reduction and temporary fixation using blunt bone reduction forceps allowed anatomical reduction of the fracture and fluoroscopic demonstration of the joint mortise which was anatomically restored. Direct visualisation of the anterior syndesmosis fibres demonstrated no rupture and dynamic testing demonstrated no instability. Definitive fixation was done with classical lag screw fracture compression with a secondary neutralisation plate. There was no indication of medial laxity intraoperatively. We did not surgically address the medial side. This patient will be managed full weight bearing in an ankle orthosis for 6 weeks.