This document discusses surgical techniques for fixing ankle fractures. It describes the anatomy of the ankle joint and surrounding ligaments. Common fracture patterns are described using the Weber classification system. Surgical approaches and fixation methods are outlined, including lateral plating, lag screws, and posterior plating. The principles of fixation aim for stability, articular congruity, and restoration of the fibula. Factors such as the position of the foot, deforming forces, and stability tests are important to consider when determining appropriate treatment.
8. Why do people get it wrong?
• Underestimation of the fracture
• Lack of understanding of ankle
fracture patterns
• Lack of understanding of the
basic principles of fracture
reduction & stabilisation
9. Surgical and functional anatomy of
the ankle joint
• Ankle joint = 3 bone articulation
between tibia, fibula and talus
• 80% load transmitted through
the tibial plafond of the talar
dome in single leg stance
• Talar dome is wider anteriorly
than posteriorly = section of a
cone, with apex medial, fully
congruous
10. Surgical and functional anatomy of
the ankle joint
• Strong ligaments support
the ankle Medially:
• superficial deltoid ligament
• deep deltoid ligament
• Deep deltoid acts as a
check-rein to abnormal
talar movement
• Draws in and stabilizes the
talus on axial loading
19. Weber classification
• Level of fibular fracture
relative to the syndesmosis
• A = below syndesmosis
• B = level of syndesmosis
• C = above level of
syndesmosis
21. Assessment of stability
• the difference between
SER II and SER IV (40-
75% ankle #s)
• because SER II injuries do
well whether treated
operatively or otherwise
• whereas most SER IV #s
do better with an ORIF
24. Principles of fixation
• Key goals are:
• stability
• articular congruity
• restoration of fibular length
and rotation
• Fix LM #
• interfragmentary lag screw +
neutralisation (1/3rd tubular)
plate
• bridging plate DCP/LCP
• Fix MM #
• 2x screws
• tension band wire
• Fix PM #
25. Diastasis screw - how
• Primary issues
• clamp reduction
• position 2-3cm above joint line
• position screw not compression
screw
• through plate if low enough
• Secondary issues
• 1 vs 2 screws
• 3.5mm vs 4.5mm screws
• 3 vs 4 cortices
• ankle position at time of
insertion
• post-op regimen
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31. In Summary
• Isolated Weber B LM #s, no talar shift, no medial
signs = (probably) Stable
• Isolated Weber B LM #s, no talar shift, +ve medial
signs = Assess for stability
• Bimalleolar #s = ORIF
• Isolated Weber B LM #s with talar shift = ORIF
• Weber C LM #s = ORIF
