Rockwood Adults CH64

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CHAPTER 64 • Ankle Fractures

OPERATIVE TREATMENT OF ANKLE FRACTURES Open Reduction and Plating The AO doctrine in the 1970s for early movement achieved by open reduction and rigid internal fixation led to rapid popularization of the use of a lag screw protected by a later- ally placed neutralization plate (Fig. 64-21A). 266 Early results achieved with this technique were good both clinically and radiographically 164,229 and it has remained the gold standard for 50 years. Since then fibular plating has diversified to include buttress, bridging, and compression techniques, with

specified, and the CT scans were taken two years after injury. Other authors have found no functional impairment with malreduced syndesmoses. 59,404 Malreduction is notoriously difficult to recognize intraoperatively, partly due to anatomical variation and partly due to the limitations of two-dimensional intraoperative fluoroscopy which has been shown to be unable to detect rotation of the distal fibula within the syndesmosis of up to 30 degrees. 236 Malreduction therefore often requires postoperative CT evaluation 123 to be recognized, although the criteria for a “normal”mortise, 264 let alone adequate reduction, 404 remain uncertain.

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D Figure 64-21.  A: A lateral malleolar facture treated with an interfragmentary screw and a one-third tubular neutralization plate. B: A dorsally placed one-third tubular plate. C: A one-third tubular plate applied using a bridging technique with minimal soft tissue stripping at the fracture site. D: Three interosseous screws used to reconstruct a long spiral fibular fracture in a younger patient with good bone.