Sunday, July 8, 2012

Complex Ankle Fracture Dislocation

The Case of the Month for July 2012 is of a 60 year old healthy woman who fell down some stairs and suffered a Complex Ankle Fracture Dislocation

 The Patient was splinted, but not reduced at an outside facility and then transferred to HMC

Plain films confirmed the trimalleolar ankle fracture-dislocation and a CT scan revealed a rather large posterior malleolus fracture, which some might categorize as a posterior pilon fracture

We chose a posterolateral incision to address  the posterior malleolus and fibular components of the injury

We worked on both sides of the peroneal tendons

first posteriorly to address the posterior malleolus

Here we are with the posterior malleolus fracture exposed

We then reduce (put the fragment back into its anatomic position after cleaning it of clot and other debris) and then place small Kirschner wires to hold it provisionally until more definitive fixation is applied

We then place a buttress plate and screws to fix the posterior malleolus of the tibia. Even this provided significant stability

We then worked anteriorly to the peroneals to access access and treat the fibular fracture

Once we fixed the fibula, we turned our attention to the medial or inside part of the ankle to address the medial malleolar fracture

Below are the final radiographs taken in the operative suite at the time of surgery

Author by Robert P. Dunbar, Jr,, M.D.