Evaluation and Surgical Management of the Ankle by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783031335372
Publisher: Springer International Publishing

4.4 Fibular Reduction and Fixation

4.4.1 Spiral Pattern

These simple fracture patterns are the most common. The fracture hematoma is debrided, and the periosteum adjacent to the fracture is elevated to clearly define the fracture edges. The axilla of the fracture is most commonly posterolateral and should be clearly visualized. A small-pointed reduction clamp is applied transversely to the fracture and the posterior tine is rotated distally to restore length. Once reduction is obtained, it can be maintained with either lag-screw and laterally based neutralization plating or with posterolateral anti-glide plating. Although a 3.5 mm lag screw is commonly employed, we find a 2.0 mm or 2.4 mm screw to be more optimally sized for this application. A 1/3rd tubular plate or precountoured fibular plate may be placed in neutralization mode. Posterolateral antiglide plating may be less familiar but avoids subcutaneous implant placement, is biomechanically optimal, and allows the surgeon to use the plate to assist with the fracture reduction. An undercontoured 1/3rd tubular plate is applied to the posterolateral fibula with a screw placed in the axilla of the fracture so that plate functions in antiglide mode. Keeping the plate 1 cm from the tip of the fibula avoids peroneal irritation. An additional screw is placed into the proximal segment to control plate rotation. This provides sufficient fixation although a supplemental lag screw or screws into the distal segment can be placed at the surgeon’s discretion.

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