ankle fractures: syndesmosis
DESCRIPTION
Ankle Fractures: syndesmosis. Arash Aminian MD June 7, 2013. DISCLOSURE. I have no conflicts of interest. Syndesmosis : Why?. 20% of all ankle sprains 10% of all ankle fractures. Questions: evidence vs eminence based. A deltoid tear can be seen with medial malleolar fracture? T - PowerPoint PPT PresentationTRANSCRIPT
Arash Aminian MD
June 7, 2013
20% of all ankle sprains
10% of all ankle fractures
•A deltoid tear can be seen with medial malleolar fracture? T•Medial tenderness is predictive of deep deltoid tear? F•Intra-operative post reduction stress views should be performed after lateral malleolus fixation? T
Bone qualityPre-reduction films: energy of injuryPatient factors: BMICommonly mal-reduced: IR or anterior translation
Not every fracture is the sameDon’t be in a hurry
AITF
PITF
Transverse TF
IOS
Contribution from peroneal/AT
Peroneal artery perforates IO membrane 3 cm proximal to ankle
JBJS 2012
• Can have a high fibula fx without complete rupture of the IO, deep deltoid
• 39% Weber B – Tornetta JOT 2007
Boden JBJS 1989
Maintain talus in mortise
1 mm shift-42% loss of contact surface RH 1976, 40% Lloyd FAI 2006
2 mm – 49% pressure Zindrick 1985
• Medial Tenderness• Anterior tenderness – nonspecific• ER test• Squeeze test• Check proximal fibula tenderness
• AP WB x-rays• Mortise: Medial clear space• “Shenton’s line”• Talocural angle 83 +/- 4 degrees on
mortise• Tib fib overlap/clear space
• 3 vs 4 cortices? • 3.5 vs 4.5 mm? Biomechanically similar (FAI
2000)• Location of the screw?
• Postero-lateral to anteromedial
• TSS fixation level above • plafond? 2-5 cm
• Use a clamp? Prevents motion, shifting of the drill hole
• Position of the ankle? DF (JBJS 2001) • HWR?• Fix a high fibula fracture vs only screws?• Fixing the posterior malleolus?
Displacement/stability