SURGEON:***

ASSISTANT:
PREOPERATIVE DIAGNOSIS:Closed bimalleolar ***ankle frac!re"
POSTOPERATIVE DIAGNOSIS:Closed bimalleolar ***ankle frac!re #i$*** s%ndesmoic
disr!&ion"
OPERATION PER'OR(ED:O&en red!cion and inernal fi)aion of bimalleolar ankle frac!re
#i$*** s%ndesmoic scre# &lacemen* ***foo"
ANEST+ESIA:General #i$ ***&o&lieal block"
+E(OSTASIS:Pne!maic $i,$ o!rni-!e a .// mm+, and 0o1ie"
ESTI(ATED 02OOD 2OSS:(inimal"
(ATERIA2S:***."3 corical scre# imes 3"4"/ cancello!s scre# ime ."/"56 78#ire ) 6* 96
'iber#ireOne8$ird !b!lar &lae* : $oles* imes one"
IN;ECTA02ES:***6/ ml of /"63< (arcaine #i$ e&ine&$rine in=eced ino $es!r,ical sie
&oso&erai1el%"
DRESSINGS:.8#a% s&lin"
CO(P2ICATIONS:None"
PROCEDURE IN DETAI2:T$e &aien recei1ed ***,m of Ancef &reo&erai1el% and !nder mild
sedaion #as bro!,$ ino $e o&erain, room and &laced s!&ine on$e able" A s!r,ical ime o!
#as $en aken in #$ic$ $e&aien* $e s!r,ical sie* and $e &roced!re #ere 1erified"Afer
,eneral anes$esia #as obained* a &ne!maic $i,$o!rni-!e #as &laced o1er a &added >ebril
aro!nd $e ***$i,$" T$e ***foo and ankle #ere scr!bbed* &re&&ed anddra&ed in $e !s!al
ase&ic manner" An Esmarc$ banda,e #as!ili?ed o e)san,!inae $e e)remi%* and $e
o!rni-!e #as$en inflaed"
Aenion #as direced o $e ***laeral ankle #$ere alon,i!dinal skin incision #as made o1er
$e fib!la" T$eincision #as $en carried do#n o $e bone in la%er b% la%erfas$ion* a1oidin, an%
ne!ro1asc!lar sr!c!res !nil $e frac!resie #as e)&osed" Once $e frac!re sie #as noed* i
#as noed o be a s&iral obli-!e frac!re #i$ a &oserior s&ike"Ne)* $e &eriose!m #as incised
and refleced aro!nd $efrac!re sie" T$e frac!re sie #as $en disraced and $e$emaoma #as
remo1ed !sin, a bone c!rre" Afer fl!s$in, $e area#i$ normal saline* $e frac!re #as red!ced
and clam&ed inanaomical &osiion" An inerfra,menar% scre# #as $en &laced inanerior
&ro)imal o &oserior disal orienaion and #as fo!ndo &ro1ide ,ood com&ression across $e
frac!re sie" T$ered!cion clam&s #ere $en remo1ed* and a ***8$ole one8$ird!b!lar &lae #as
&laced o1er $e frac!re sie"O!r aenion #as direced o $e medial as&ec of $e ***ankle
#$ere a c!r1ilinear skin incision #as made o1er $e medial malleol!s" T$e incision #as $en
carried do#n o $e le1el ofbone* e)&osin, $e rans1erse medial malleol!s frac!re" T$e
&eriose!m #as incised and refleced aro!nd $e frac!re sie" T$e &oserior ibial endon #as
e)amined and #as fo!nd o be inac" Usin, red!cion clam&s* $e medial malleol!s fra,men #as
clam&edino is a&&ro&riae &osiion" Ne)* #e &lace #oT#o *** 78#ires across $e frac!re sie*
#$ic$ #ere incor&oraed ino a ension band #ire alon, #i$ a 4"/ cancello!s scre# alon, #i$ a
96 'iber#ire" T$e ension band #irin, #as fo!nd o &ro1ide ,ood com&ression across $e frac!re
sie"Ne)* #e obained fl!orosco&% ima,es* confirmin, ,ood len,$ and&osiion of bo$ $e
cann!laed scre#s as #ell as $e fib!lar &lae"
Ne)* !sin, $e e)ernal roaion and bone $ook es* #ec$ecked $e ine,ri% of $e s%ndesmosis
and fo!nd i o be ***sable" A $is&oin #e &laced a 4"3 f!ll% $readed corical scre# $ro!,$
$efib!lar &lae and ino $e ibia #$ile $oldin, $e s%ndesmosisred!ced #i$ a &el1ic red!cion
clam&" A $is &oin ne#fl!orosco&% ima,es #ere obained* confirmin, ,ood o1erall&osiion of
all $e $ard#are and ,ood red!cion of $e ankle #i$,ood ankle morise ali,nmen"
0o$ incisions #ere irri,aed #i$ co&io!s amo!ns of normalsaline and closed in la%er b% la%er
fas$ion !sin, skin sa&lesfor skin clos!re"T$e incisions #ere dressed #i$ Ada&ic co1ered#i$
,a!?e* fl!ffs* 7lin,* and >ebril follo#ed b% a .8#a% s&lin"T$e $i,$ o!rni-!e #as $en
deflaed* and &rom& $%&eremiares&onse #as noed o all di,is of $e ***foo"
T$e &aienoleraed $e &roced!re and anes$esia #ell" +e #as ransferredo $e reco1er% room
#i$ 1ial si,ns sable and 1asc!lar sa!sinac o $e ***foo"'ollo#in, $e &eriod of
&oso&erai1e moniorin,* $e #ill bedisc$ar,ed #i$ insr!cions o remain non#ei,$bearin, on
$e***foo and o ele1ae and ice $e foo as m!c$ as &ossible"7ee& $e s&lin clean* dr% and
inac !nil $e follo#8!&1isi"
Call $e clinic of an% &roblems arise" Re!rn o $e clinic for &oso&erai1e follo#8!&"