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Another Screwed Up Ankle refers to cases that I have collected
over the years. Some mine and the majority of them I inherited and had to re-do. It is a lot easier to re-do a fracture
then to re-do a malunion or nonunion later.
The common thread amongst all of these cases involved inexperienced surgeons.
Of all the fracture types, syndesmosis cases were the overwhelming majority of cases. Failing to pull the fibula to length
is a common pitfall.
Why must we repair these fractures anatomically - simply because the ankle joint will not tolerate
minor changes. Post-traumatic arthritis will eventually occur.
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How do you know that something is wrong? Look for
clues that the ankle is not reduced.
- Short fibula
- Fibular fracture is not anatomic
- Medial malleolous may be
stepped off
- Posterior malleolous is not reduced
- Maisonneuve fracture is not reduced
- Multiple syndesmotic drill
holes
- Deltoid repairs
- Worst clue, attempts to open a Maisonneuve fracture
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Talofibular notch doesn't line up
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Note the fibula is shortened and laterally displaced - not a lot but enough to cause the mortise
to widen soon after removing the syndesmotic screw
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This case has so many problems
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Medial malleolous is not even reduced, so everything is off
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Fibula is not anatomic likely comminuted, so determining length is very difficult especially with
a malreduced medial malleolous. This type of fracture should never have needed syndesmosis screws.
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Staples for a fibular fx?
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I wonder why this ankle will not move?
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Despite what Tornetta has published, with over 500 syndesmosis injuries, this case is proof that
we can over-reduce a syndesmosis. You can't get the fibula any closer then this. Note the fibula is perfectly positioned.
Within the syndesmosis section, show examples of malreduced fibulas.
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