Careful pre-operative planning


This 26-years old patient was treated for a distal tibia fracture on the left side. 4 years later she had a correction osteotomy because of an intra-articular step-off. On investigation there is recognizable tenderness on palpation to the anterolateral joint line and at the level of the protruding distal screw. The lateral X-ray suggests that the screw is placed through the plate. 

Picture 1: The AP X-ray confirms that the screw and K-wire are located near the anterior-inferior tibiofibular ligament (AITFL) insertion on the distal tibia.

Picture 2: Endoscopic removal of the screw and K-wire. On the right image you see the screw head and bent tip of the K-wire, which is lifted with an elevator, and on the right image you see the endoscopic view after removal. The plate was removed. The patients complaints dissolved.