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30 Mar 2023
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SER ankle injury with occult PITFL + deltoid instability

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Clinical Details

Clinical and radiological findings:  Referred as a simple Weber B from ER with insufficient plain film imaging. Passed through to a registrars list without further examination. no further imaging performed

Preoperative Plan

Planning remarks:  Planned as a Weber B fibula plate, but preop examination of the available plain films demonstrates deltoid and possible plafond injury

Surgical Discussion

Operative remarks: 

Following fixation of the fibula, AITFL is demonstrated macroscopically intact. Non stressed views look good with nice medial reduction, however dynamic stability testing demonstrates gross syndesmotic instability. Intraop 3D imaging (a luxury) demonstrates a PITFL avulsion, which together with the deltoid injury results in gross mortise instability. Reduction and fixation of the fibula in teh inscisura resulted in congruent stable reduction. repair of the deltoid was not deemed necessary based on dynamic stability.

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Dr Ed Oates
  • Germany , Schleswig Holstein
  • Area of Specialty - General Trauma
  • Position - Specialist Consultant
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