Dance Around the Fibula with a Twisted Plate: A Technical Note

Area of Science:

• Orthopedic Surgery
• Traumatology
• Anatomy

Background:

• Posterior malleolar fragment (PMF) plays a crucial role in trimalleolar ankle fractures.
• Fragment morphology, not size, dictates PMF management.
• Intra-articular step-offs and incisura fibularis incongruency lead to osteoarthritis and poor outcomes.

Purpose of the Study:

• To describe a novel surgical technique for fixing unstable ankle fractures involving a combined PMF and high supra-syndesmotic fibular fracture.
• To address the limitations of traditional posterior approaches, such as ankle joint mobility restriction.

Main Methods:

• A surgical technique using two small windows and a twisted one-third tubular plate for fixation.
• Minimizing the posterolateral window size to reduce fibrous adhesions and flexor muscle shortening.

Main Results:

• The described technique allows for anatomical reduction and fixation of the PMF and fibular fracture.
• Reduced window size diminishes arthrofibrosis and flexor muscle shortening, preserving ankle joint mobility.

Conclusions:

• This technique offers an effective solution for complex ankle fractures, preserving ankle joint mobility.
• Focusing on fragment morphology and employing minimally invasive approaches is key for optimal patient outcomes.