A fibular notch approach for the treatment of ankle fractures involving the distal tibial plafond

Wenqing Qu,Tong Liu,Yiheng Cheng

doi:10.1186/s13018-021-02270-3

Abstract

BackgroundAlthough efficacy is related to many factors, the surgical approach is one of the most important intervention factors for complex ankle fractures. Ankle fractures involving the distal tibial plafond frequently present a surgical challenge in choosing which incisions will be best for surgical treatment. Here, we present an innovative fibular notch approach for the treatment of some specific ankle fractures and present a series of patients with either functional or radiographic outcomes.MethodsTwenty-two patients with distal tibial plafond fractures with concomitant fibular and distal tibiofibular syndesmosis injuries were treated through a fibular notch approach in this retrospective study. The details of the surgical technique were reviewed from the operative notes. Relevant data were reviewed from the medical records. The quality of fractures and syndesmosis reduction was examined using CT scans, and lateral stability of the ankle was assessed by physical examination and stress radiographs. The American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) score was implemented for clinical functional assessment.ResultsAll surgeries were successfully performed via the fibular notch approach as the primary approach with excellent intraoperative visualization. Postoperative radiography revealed satisfying restoration of all fractures and syndesmosis. All fractures healed with an average time of 17.3 ± 3.6 weeks. Mild posttraumatic osteoarthritis (PTOA) was present in 4 patients. The average AOFAS score was 88.8 at the last follow-up.ConclusionsThe fibular notch approach is a safe and reliable approach for the treatment of specific ankle fractures involving the distal tibial plafond. This approach provides excellent direct visualization of the fragments and articular surface without significantly increasing iatrogenic injuries. Satisfactory radiographic and clinical results were observed, and further clinical and anatomical studies are recommended to ascertain the feasibility of this approach in the treatment of complex distal tibial fractures.

Highlights

Efficacy is related to many factors, the surgical approach is one of the most important intervention factors for complex ankle fractures
Orthopedic surgeons have been striving for ideal results; posttraumatic osteoarthritis (PTOA) and soft tissue-related complications have been bothersome to patients and surgeons, especially when there are comminuted articular fragments [3, 4]
The inclusion criteria were as follows: comminuted distal tibial plafond fracture with concomitant fibula and distal tibiofibular syndesmosis injury, definitive open reduction internal fixation (ORIF) performed using a fibular notch approach as the primary approach, adult fracture, and a minimum of 12 months of followup

Summary

Introduction

Efficacy is related to many factors, the surgical approach is one of the most important intervention factors for complex ankle fractures. Efficacy is related to many factors, the surgical approach is one of the most important intervention factors for complex distal tibial fractures [2, 3, 5, 6]. Severe ankle fractures (AO/ OTA type 44) and distal tibial plafond fractures (AO/ OTA type 43) are caused by combined axial load and valgus or rotational force. Sometimes, they are characterized by concomitant fibular fracture and distal tibiofibular syndesmosis injury. A conventional single incision is usually insufficient for direct visualization of the articular fragments, especially the whole articular surface, while a more visible combined incision carries an increased risk of narrow skin bridge necrosis [5, 10]

Objectives

Methods

Results

Discussion

Conclusion