Frank Diastasis with Weber B or Weber C Fibula Fracture

Surgery of the ankle fracture is usually indicated in this case, and stability of the syndesmosis can be assessed intraoperatively. The cotton test involves a towel clip on the fixed fibula and application of a lateral pull on the fibula. The external rotation

Figure 68-8 Syndesmosis reduction and fixation.

stress test can also be performed with a mortise view of the ankle and external stress applied. Any diastasis at the syn-desmosis indicates instability and should be repaired with screws as described previously. The screws can go either through or around the plate so preoperative planning is a must to prepare for possible screw placement. In many bimalleolar ankle fractures, fixation of the medial malleolus restores the medial anatomy and ligamentous structure; thus, syndesmosis screws may not be required. Stress views can help determine whether they are needed (Fig. 68-8 and Table 68-1).

Results

Most follow-up studies of syndesmosis injuries have few patients. In Fritschy's report on 10 patients with syndesmotic injury, three were treated surgically and seven with walking casts. They all returned to World Cup skiing, with one having persistent pain.16 Edwards and DeLee reported on six cases of frank diastasis; four patients had good results and two patients

Table 68-1 Treatment of Ankle Fractures

Nonoperative

Operative

Weber A

Weber C

Mortise displaced <4mm

Mortise displaced >4mm

Contraindications to surgery

Bimalleolar fracture

Serious comorbidity

Displaced Weber B

Soft tissue related

with mild ankle pain and restriction in ankle motion had fair results.17 Syndesmosis injuries appear to add morbidity to ankle fractures and early diagnosis may lead to an improved result both clinically and emotionally because the expectations will be more appropriate.

Was this article helpful?

0 0
Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

Get My Free Ebook


Post a comment