Description of patient (type of occupation, indication of age, intensity of sport):
A 32 years old active female.
History and previous treatment:
Bimalleolar fracture 2 month back ( distal tibia open fracture, distal fibula closed fracture), treated with ORIF + Ex Fix , 4 weeks after initial surgery Ex fix removed and wound debridement.
Ankle pain and syndesmotic squizze test is painfull
deep ankle pain, ROM 20 plantar and 10 dorsal.
[Picture 1 - 3]
Early postop (orif + Ex Fix)
Additional investigation (CT/MRI):
3d CT scan : Tillaux fragnet fractured nonunited blocking groove for fibula
Old ( 10 week !) syndesmotic injury with painful ankle
Question(s) to this case:
Best operative treatment solution , any advantage from anterior ankle artroscopy?
Difficult case. There is shortening and malposition of the fibula. There is malpositioning of the medial malleolar fracture and there malposition and non-union of the tertius fragment and the Tillaux fragment. I see 3 options:
No 1: reconstruction of all components: Lengthening and derotation of the fibula. Reconstruction of the medial malleolar fracture in anatomic position and reconstruction of the tertius fragment and the Tillaux fragment.
No 2: Reconstruction of the medial malleolar fracture in anatomic position and reconstruction of the tertius fragment and the Tillaux fragment and Synostosis of the fibula.
No 3: Ankle Arthrodesis.
I would probably go for option 1 and if during the procedure anatomic reconstruction of the fibula is not possible the go to option no 2