The goal of ankle fracture management is to restore a stable and congruent joint. Operative management is recommended for most displaced fractures, fractures with dislocations, and open fractures.
This video article walks through the surgical management of a 23-year-old male who sustained a trimalleolar ankle fracture with concomitant dislocation and syndesmotic injury following a motor vehicle collision. Dr. Weaver discusses the surgical landmarks and approaches to the ankle, the methods of fixing the malleoli and the syndesmosis, and common concerns that arise during the surgical management of ankle fractures.
Chaim Miller Sidney Kimmel Medical College at Thomas Jefferson University
In this case, Dr. Asif Ilyas at the Rothman Institute presents a zone 2 flexor tendon repair with a 4-0 Ethibond suture with a modified Kessler stitch that resulted in an 8-core strand repair. The procedure was done under wide awake local anesthesia no tourniquet (WALANT) protocol, which among other strengths allows the surgeon to test the repair and set postrehabilitation expectations for the patient.
Michael J. Weaver, MD Associate Orthopaedic Surgeon, Brigham and Women’s Hospital Assistant Professor of Orthopedic Surgery, Harvard Medical School Brigham and Women’s Hospital
The patient in this case is an 81-year-old male with dementia who sustained an unwitnessed fall that resulted in a displaced intra-articular distal femur fracture. Here, Dr. Weaver at Brigham and Women’s Hospital repairs the fracture by performing an open reduction and internal fixation with a LISS plate. An anterolateral approach was used to visualize the joint surface and obtain an anatomic reduction of the articular surface, and a percutaneously-placed lateral lock plate was used to bridge the area of comminution while restoring length, alignment, and rotation to hopefully allow for biologic fixation that permits the bone to heal well.
Andrew Straszewski, MD Resident Physician Orthopaedics
Kenneth Wilson, MD, FACS Associate Professor of Surgery
In another trauma case with UChicago Medicine, Drs. Kent, Jeffries, Straszewski, and Wilson evaluate and treat a patient with a gunshot wound and femoral fracture. An ABI was obtained, CT angiography was evaluated, and proximal tibial traction was performed for pain management.
Dr. Weaver treats a periprosthetic femur fracture with the patient positioned supine on a fracture table using a cephalomedullary nail. The fracture table provides adequate traction to assist in reduction of the fracture.
JoMI’s surgical videos took a trip to Haiti. The Haitian Annual Assembly of Orthopaedic Trauma (HAAOT) is a three-day program held annually in Port-au-Prince and is the only organized orthopaedic continuing medical education course in the country.