Professional Documents
Culture Documents
Classifications
1. Lauge-Hansen
Type Pathology
Maissoneuve’s fracture
Bosworth Fracture
Tibiotalar congruency
Surgical technique
Standard AO fixation
Interfragmentary screw and 1/3 tubular neutralisation plate for fibula
and lag screw fixation for medial malleolus
Syndesmosis screw is required if fibula is unstable at end of fixation
(engage 3 cortices and ensure the ankle is at 90º when inserting screw,
and that the screw is not lagged) Screw needs to be removed before
weight bearing can be commenced
Alternative fixation for Type B fractures of the fibula is the anti-glide
plate which has been shown to be biomechanically superior to a
lateral plate
Posterior malleolus fractures need to be fixed if there is > 25% of the
articular surface involved. This is often underestimated on lateral
radiographs.
Post-operative management
Arthritis
Prognosis
Prospective trial shows higher total ankle scores in those that are operatively
treated- especially so in those pts more than 50 yrs old
Type Pathology
I Undisplaced
Initial treatment
Investigations
X-ray plus CT
Timing of surgery
Type II and III - goal is to keep talus centred under the tibia while soft
tissue heal over 7 to 21 days
Study by M.Sirkin et al 1999, a series of pilon fractures underwent
immediate external fixation and ORIF of the fibula, and formal ORIF
of the tibial articular surface was performed on a delayed basis (avg.
delay 12-13 days); - using this protocol, no patient that presented with
a closed injury developed a full thickness skin necrosis and none
required secondary soft tissue coverage
The historically high rate of infection and skin necrosis following
ORIF of these injuries is most related to operative timing - in the
study by MJ Patterson and JD Cole (JTO 1999), all patients
underwent a two staged technique for the treatment of complex pilon
fracture - initially all patients underwent immediate fibular fixation
and placement of a medial fixator
Surgical options
1. ORIF
Will align the tibia but will not address the central depression of the
joint surface.
Useful as first part of 2 -stage procedure (to allow soft tissue
management & CT & planning)
Outcomes