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Syndesmosis cases should be the simplest and easiest cases
to do, but for some unknown reason they seem to be the cases that most frequently see screwed up.
Within the military
PER (pronation-external rotation) cases were 39% of our surgical cases. Far higher then what is seen in the civilian world.
Some studies are suggestive that PER injuries are less then 10% and Maisonneuve fractures are as high as 50%.
Following
these steps:
- Place the ankle in a mortise view
- Use a c-arm
- Reduce the fibula by joysticking the fibula too
length
- Dorsiflex the ankle maximally
- Reduce the syndesmosis with a large pelvic reduction forceps
- Drill parallel
to the joint
- Drill parallel to the bed
- Drill above the syndesmosis joint
- Utilize one or two 4.5mm cortical
screw(s)
- Use four cortices
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There is the assumption that the syndesmosis can not be over-reduced
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This ankle is so over-reduced the ankle can't even move
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Fibula is posteriorly displaced - prefer to plate fractures at this level
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Depuy pelvic reduction forceps in use
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It helps to reduce the syndesmosis - very wide
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Maisonneuve fracture is also displaced
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Patient could not dorsiflex his ankle.
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Malreduced
syndemsosis and percutaneous attempt at fixating the Chaput fracture.
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