[Arthroscopically assisted fracture treatment and open reduction of the posterior malleolus : New strategies for management of complex ankle fractures. Video article].

OBJECTIVE

Identification and treatment of intra-articular injuries, stabilization of the syndesmotic complex by open reduction and internal fixation (ORIF) of the posterior malleolus (PM).

INDICATIONS

Bimalleolar and trimalleolar fractures, patients with functional demands.

CONTRAINDICATIONS

Soft tissue injuries/infections in the area of the surgical approach, higher grade circulatory disorders, diabetes mellitus.

SURGICAL TECHNIQUE

The video exemplarily depicts the arthroscopically assisted treatment (AORIF) of a trimalleolar fracture and ORIF of the PM via the dorsolateral approach. Positioning in an unstable lateral position, arthroscopy via standard ventral portals in external rotation, resection of interposing capsular ligamentous structures, removal of loose bodies, diagnosis and treatment of cartilage lesions. Dorsolateral approach dorsal to the peroneal tendons and incision of the fascia of the lateral and deep lower leg compartments, retraction of the flexor hallucis longus muscle medially, visualization of the PM, reduction and fixation with an antiglide plate. Development of a full thickness flap above the superficial fascia to visualize the lateral malleolus, fixation according to AO principles. Repositioning to the supine position without changing the sterile covers, medial approach for fixation of the medial malleolus, stability testing of the distal tibiofibular joint, final arthroscopy, and wound closure.

FOLLOW-UP: Cooling and elevation, 6 weeks of partial weight-bearing (20 kg), early functional exercises, full weight-bearing after clinical radiological follow-up at 6 weeks postoperatively.

RESULTS

It is known that relevant chondral injuries frequently occur in complex ankle fractures and that ORIF of the PM leads to stabilization of the distal tibiofibular joint. So far only few clinical results have been published regarding AORIF and ORIF of the PM; however, the majority of the studies available found significantly better results for AORIF and ORIF of the posterior malleolus compared to conventional treatment.