Ankle Dislocation Research Articles

Trimalleolar Fracture Associated with Subcutaneous Rupture of the Achilles Tendon and Traumatic Peroneal Dislocation: A Case Report and Review of the Literature.

We report the case of a 44-year-old man who sustained an Achilles tendon rupture with an associated trimalleolar fracture and traumatic peroneal dislocation of the left ankle after a snowboarding injury. These injuries have been surgically repaired; the patient has returned to all his activities 18 months after surgery. The possibility of such injuries occurring in combination should be considered. A thorough history, physical examination, and plain radiographs should be performed in higher energy trauma to the ankle. Additional diagnostic tests such as ultrasonography or magnetic resonance imaging may be used to supplement treatment. Level 5.

Superficial Peroneal Nerve Laceration and Repair in the Setting of a Bosworth Fracture: A Case Report

The superficial peroneal nerve (SPN) is at increased risk of injury in the setting of ankle fractures. We report a case of SPN laceration in the setting of a Bosworth fracture that likely occurred as the fibula became entrapped behind the tibia upon initial injury, pulling the SPN posterior and resulting in a traction tear. Radiographic evaluation performed when the patient presented to the emergency department demonstrated a Bosworth fracture, widening of the medial clear space, and posterior ankle dislocation. Closed reduction was attempted. Although the fibula remained entrapped behind the tibia, the talus was successfully reduced, and a short leg splint was applied. Fracture fixation and acute, direct repair of the nerve were completed during operative fixation 15 days from the initial injury, following the resolution of soft tissue swelling. The patient reported a complete return of sensation in SPN distribution 2 weeks postoperatively. Radiography showed an anatomically reduced ankle with hardware intact and in place. At 1-year follow-up, SPN sensation remained intact, radiography ultimately indicated a healed fracture site, and the patient reported that she was able to ambulate without pain. Our case provides support for acute, direct repair of SPN lacerations in concomitant Bosworth fractures. Level of Evidence: Level V, case report.

Incidence of post-traumatic osteoarthritis in 44B ankle fractures: Analysis of risk factors

ObjectiveThe purpose of this study was to analyse the clinical and radiographic data of a consecutive series of patients treated surgically for AO/OTA 44B ankle fracture at Ferrara University Hospital, Italy, with a view to identifying risk factors contributing to worse clinical and radiographic outcomes with a minium follow up of 6 years. Materials and methodsFor each patient the following data were recorded: gender, age, Body Mass Index (BMI), follow up (months), previous ankle sprains, type of work, Kellgren-Lawrence (K&L) score, AO/OTA classification for ankle fracture, Foot and Ankle Disability Index (FADI score), ankle dislocation, syndesmotic transfixation, quality of reduction. ResultsFADI score in patients with AO/OTA 44B1 fracture was 95.5±7.5, in 44B2 it was 90.0±8.4 and in 44B3 it was 84.0±13.0 (p25 it was 88.6±11.4 (p=0.047 95%I.C. 0.01-8.10). In case of fracture-dislocation there was a statistically significant difference in the FADI (94.4±6.0 vs 85.8±11.98)(P=0.002 95% I.C. 0.01-8.9). In the former group, there was a statistically significant difference in the ​the K&L (1.97±0.65 vs 2.63±0.85) (P=0.006 95% I.C 0.01-1.00).Finally, the quality of the reduction was a statistically significant parameter in both the FADI and K&L (P=0.012 95% I.C. 0.90-10.60 and P=0.012 95%I.C. 0.01-1.00 respectively). ConclusionThe most influential risk factors for worse outcome in AO/OTA 44B ankle fractures were found to be BMI, injury severity, fracture-dislocation and reduction quality.

EFFECT OF FIBULA SHORTENING ON MEDIAL CLEAR SPACE AND LATERAL TRANSLATION OF THE TALUS: AN ANATOMICAL CADAVERIC STUDY

IntroductionFibula shortening with an intact anterior tibiofibular ligament (ATFL) and medial ligament instability causes lateral translation of the talus. Our hypothesis was that the interaction of the AITFL tubercle of the fibular with the tibial incisura would propagate lateral translation due to the size differential.AimTo assess what degree of shortening of the fibular would cause the lateral translation of the talus.MethodologyTwelve cadaveric ankle specimens were dissected removing all soft tissue except for ligaments. They were fixed on a specially-designed platform within an augmented ankle cage allowing tibial fixation and free movement of the talus. The fibula was progressively shortened in 5mm increments until complete ankle dislocation. The medial clear space was measured with each increment of shortening.ResultsThe larger AITFL tubercle interaction with the smaller tibial incisura caused a significant increase in lateral translation of the talus. This occurred in most ankles between 5–10mm of fibular shortening. The medial clear space widened following 5mm of shortening in 5 specimens (mean=2.0725, SD=±2.5338). All 12 specimens experienced widening by 10mm fibula shortening (Mean=7.2133mm, SD=±2.2061). All specimens reached complete dislocation by 35mm fibula shortening. Results of ANOVA analysis found the data statistically significant (p<0.0001).ConclusionThis study shows that shortening of the fibula causes a significant lateral translation of the talus provided the ATFL remains intact. Furthermore, the interaction of the fibula notch with the ATFL tubercle of the tibia appears to cause a disproportionate widening of the medial clear space due to its differential in size. Knowledge of the extent of fibula shortening can guide further intervention when presented with a patient experiencing medial clear space widening following treatment of an ankle fracture.

Advancing treatment strategies for posterior malleolar malunion: The ankle dislocation method

BackgroundThis study aimed to assess the radiological and clinical outcomes of treatment using the ankle dislocation method for posterior malleolar malunion. MethodThirty-one patients with posterior malleolar malunion who underwent treatment using the ankle dislocation method from May 2015 to October 2021 were retrospectively analyzed. Key outcome measures were radiographic parameters (articular step-off, tibiofibular clear space, fibular length, tibial lateral surface angle, and ankle osteoarthritis), clinical scores (American Orthopaedic Foot and Ankle Society ankle-hindfoot scale and Visual Analogue Scale), and patient satisfaction rate. ResultPreoperative computed tomography revealed that Bartoní ček types 3 and 4 accounted for 64.5 % (n = 20) of total cases. Most posterior malleolar malunions were accompanied by depressed intercalary fragments (61.2 % [n = 19]). At the final follow-up, radiographic parameters and clinical scores showed significant improvements postoperatively (P < 0.05), with a high patient satisfaction rate of 77.4 %. Subgroup analysis revealed that the posterior malleolar fracture morphology significantly affected postoperative pain, particularly in more complex fractures (P < 0.001). ConclusionThe ankle dislocation method effectively exposes the distal tibial articular surface and facilitates the anatomical restoration of joint congruity under direct vision. This approach substantially improves the clinical and imaging outcomes in patients with complex posterior malleolar malunion. Levels of EvidenceLevel IV, retrospective case series.

Homeopathic Ankle Dislocation for Treatment of Unstable Trimalleolar Fractures Involving Posterior Die-Punch Fragment: A Retrospective Cohort Study.

Unstable trimalleolar fractures are relatively complex and more difficult to manage if die-punch fracture is present. We aimed to evaluate the curative effect of homeopathic ankle dislocation on the unstable trimalleolar fractures involving posterior die-punch fragments. A total of 124 patients diagnosed with unstable trimalleolar fractures combined with post-die punch fragment between June 2008 and June 2020 were retrospectively included. Patients who received homeopathic ankle dislocation were named as the experimental group, and patients who accepted conventional treatment were control group. The fracture healing time, wound healing, American Orthopedic Foot and Ankle Society ankle-hindfoot scale (AOFAS), visual analogue scale (VAS), the Kellgren-Lawrence arthritis grading scale (KLAGS) and short-form 36 score (SF-36) scores were collected. Student t-test was used for fracture healing time. Wound healing and SF-36 were compared using the Mann-Whitney test. Repeated measurement analysis of variance (ANOVA) was used for AOFAS and VAS. χ2-test was used for KLAGS. AOFAS showed statistically significant differences between the two groups (p = 0.001). In non-weight-bearing and weight-bearing conditions, VAS scores were significant different between the two groups, and there was an interaction between group and time point (p < 0.001). The experimental group was superior to the control group in terms of physical function (p = 0.022), role-physical (p = 0.018), general health (p = 0.001) and social function (p = 0.042).The operation time of experimental group was shorter than that of control group (p < 0.001). Homeopathic ankle dislocation is used for the unstable trimalleolar fractures involving posterior die-punch fragment, which can provide better functional outcomes while shortening the operation time and recovery period.

Luxação Fechada Pura do Tornozelo no Jiu-Jitsu

Ankle fractures-dislocations are very common and are often associated with injuries in sports context. Ankle dislocations without associated tibia or fibula fractures, are extremely rare due to the ligamentous and capsular resistance of this joint, which exceeds bone resistance. We present a clinical case of a pure closed dislocation of the ankle that occurred during the practice of Jiu-Jitsu. After closed reduction, the patient underwent immobilization of the limb, which was followed by physiotherapy, obtaining satisfactory results, and returning to sports without restrictions after 4.5 months. In this paper it is discussed this rare traumatic injury in terms of epidemiology, pathophysiology, diagnosis, and treatment

Level of Physical Activity among Working Females Wearing High Heels

Background: Previous studies have indicated that wearing high-heeled shoes (HHS) may be associated with foot and low back pain and could potentially affect the physical activity levels of women. The impact of HHS on musculoskeletal discomfort, fatigue, and biomechanical alterations has been substantiated, albeit with varying conclusions regarding their influence on physical activity and health. Objective: The objective of this study was to evaluate the level of physical activity among working females who regularly wear HHS and to determine any associations with musculoskeletal discomfort. Methods: A descriptive cross-sectional study was conducted with 125 participants recruited from various malls in Lahore using non-probability convenience sampling. The inclusion criteria encompassed adult females aged between 19 to 44 years, wearing heels of varying types and heights for a minimum of six hours per day. Exclusion criteria included a history of ankle dislocation, foot surgery, orthopedic or neurological anomalies, systemic illness affecting physical activity, or flat feet. Physical activity levels were assessed using the International Physical Activity Questionnaire short-form (IPAQ-sf), and data were analyzed using the Statistical Package for Social Sciences (SPSS) version 25. Results: The average age of participants was 25.14 years with a standard deviation of 4.509. The mean physical activity level was 1615.33 METs with a standard deviation of 1065.15. The majority of participants (54.4%) displayed a moderate level of physical activity, while 29.6% were categorized with low and 16% with high levels of physical activity. No significant correlation was found between heel height and physical activity levels or musculoskeletal discomfort. Conclusion: Working females wearing high heels predominantly exhibit moderate levels of physical activity. The lack of significant associations suggests that heel height does not directly correlate with reduced physical activity or increased musculoskeletal discomfort in this sample. These findings highlight the complexity of factors influencing physical activity and musculoskeletal health in the context of HHS use.

A rare case of early onset arthritis as a sequelae of fracture dislocation of ankle

A rare case of early onset arthritis as a sequelae of fracture dislocation of ankle

A Retrospective Comparison of Single Screw vs Dual Screw Fixation for Treatment of Medial Malleolus Fractures

Category: Trauma; Ankle Introduction/Purpose: Medial Malleolus Fractures (MMF) are frequently managed by orthopaedic surgeons and are one of the most treated fractures of the ankle. Many approaches to fixation are described in the literature. Currently, there is a lack of consensus on the number of screws used in fixation when attempting lag-screw fixation of MMF. Aim: To compare the outcomes of MMF with patients between fractures which have either undergone single-screw (SS) or dual-screw (DS) fixation. Methods: Patients who had undergone surgical fixation of their MMF were identified from 2012 to 2022, using electronic patient records. Analysis of their pre-operative, intra-operative and post-operative radiographs was performed to determine the initial type of injury and then surgical outcomes relating to non-union, malunion and whether revision surgery was required. Results: A total of 653 patients were identified across a 10-year period. There were 271 patients (41.50%) in the SS group and 382 patients in the DS group (58.50%). When comparing the outcomes of SS compared to DS, a non-union rate of 19.19% (52/271) was found in the SS group as compared to 18.85% (72/382) in the DS group. There was a malunion rate of 11.07% (30/271) in the SS group as compared to 3.93% (15/382) in the DS group, which was statistically significant (p &lt;.001). On multi regression analysis, the other factors which gained significance for development of non-union was non fixation of syndesmosis (p= .039), ankle dislocation on arrival (p &lt;.001) and non-restoration of fibular length (p &lt;.001). Conclusion: Use of a single screw rather than double screw showed a significant increase in non-anatomical reduction but did not increase non-union or reoperation rate. Syndesmosis fixation has clear impact on the stresses on the medial malleolus and should have a low index of suspicion of injury and fixation.

Effect of Fibula Shortening on Medial Clear Space and Lateral Translation of the Talus: An Anatomical Cadaveric Study

Category: Ankle; Trauma Introduction/Purpose: Fibular shortening with an medial and syndesmotic ligament instability causes lateral translation of the talus. We hypothesise that the interaction of the anterior inferior tibiofibular ligament (AITFL) tubercle of the fibular with the anterior tibial incisura would precipitate lateral translation due to the size differential. Methods: Twelve cadaveric ankle specimens were dissected, removing all soft tissue except for ligaments. They were fixed onto a bespoke jig allowing tibial fixation and free movement of the talus and fibula. The fibula was progressively shortened in 5mm increments until complete ankle dislocation, measuring the medial clear space with each increment. Results: The larger AITFL tubercle interaction with the smaller tibial incisura caused a significant increase in lateral translation of the talus. This occurred in most ankles between 5-10mm of fibular shortening. The medial clear space widened following 5mm of shortening in 5 specimens (mean: 2.07, s.d: 2.53). All 12 specimens experienced widening by 10mm fibular shortening (Mean: 7.21mm, s.d: 2.21) and reached complete dislocation by 35mm fibular shortening. Conclusion: This study shows, that with fibular shortening, the interaction between the distal fibular AITFL tubercle and the anterior tibial incisura precipitates a lateral translation of the talus in an ankle fracture model where the medial and syndesmotic ligaments have been transected and the lateral ligaments remain intact. The interaction occurred between 5 and 10mm of fibular shortening. Beyond this point there was a near linear correlation between fibular shortening and medial clear space widening

Treatment of Intra-Articular Lesions After Posterior Inferior Tibiofibular Ligament Injury: A Case Series of Elite Rugby Players.

Surgical intervention is not typically used to treat symptoms after mild tibiofibular ligament injuries without ankle dislocation or subluxation. To describe outcomes in patients arthroscopically treated for unique intra-articular lesions after sustaining syndesmosis injury of the ankle. Case series; Level of evidence, 4. A total of 11 elite male rugby players with a mean age of 21.0 years (range, 17-28 years) were referred to our hospital for prolonged posterior ankle pain after a high ankle sprain during rugby football. The patients were examined using standing view radiography, computed tomography (CT) and magnetic resonance imaging (MRI) to determine the extent of ligament damage. Posterior ankle arthroscopy was performed to examine intra-articular lesions. The patients were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle/hindfoot rating scale and sports activity score of the Self-Administered Foot Evaluation Questionnaire (SAFE-Q). The average reduced tibiofibular overlap on the standing mortise view was 1.2 mm (range, 0.5-2.0 mm) compared with the opposite ankles. Mason type 1 fracture was detected on CT in 6 patients, and ossification of the interosseous membrane was detected in 2 patients. A bone bruise in the posterior malleolus was observed on MRI in all but 1 patient. Intra-articular fragments located in the posterior ankle were observed and removed arthroscopically. Symptoms improved rapidly after arthroscopic treatment in all patients. All patients returned to rugby games at a median of 11 weeks postoperatively. The median AOFAS scores improved from 77 preoperatively to 100 postoperatively (P < .01), and the median SAFE-Q sports activity subscale score improved from 49.4 to 100 (P < .01). All unique intra-articular lesions that developed in rugby football players after syndesmosis injury were able to be treated arthroscopically. Patients returned to playing rugby football without syndesmosis reduction. Posterior ankle arthroscopy was effective in patients with residual symptoms after syndesmosis injury.

A novel smoothed (SMO) point mutation in congenital tibial hemimelia: a case report

BackgroundCongenital tibial hemimelia (CTH [MIM: 275220]) is a rare congenital limb deficiency that manifests as a shortened, curved, dysplastic or absent tibia with polydactyly. In previous studies, mutations of a distant sonic hedgehog (SHH) cis-regulator (ZRS) and a Shh repressor (GLI3) were identified.Case presentationHere, we admitted a 20-month-old boy who manifested with right tibial deformity, varus foot, ankle dislocation, and ipsilateral preaxial polydactyly. After genetic sequencing and data analysis, the results revealed a 443 A > G mutation in the father and a 536 C > T mutation in the mother in exon 2 of the Smoothed (SMO) gene at 7q32.1, with the coexistence of both mutant alleles in the proband/patient.ConclusionsOur report suggests that even though not previously reported, SMO mutations may be associated with limb anomalies such as tibial hemimelia via Hh signaling in humans and has implications for genetic counseling.

Coronal Shearing Fracture of the Talar Body with Talar Head Dislocation Related to a Navicular Compression Fracture: A Rare Case Report.

A talar body fracture is typically associated with talar body dislocation, resulting in ankle and subtalar joint subluxation and/or dislocation. A talar body fracture with talar head dislocation is a very rare injury. In this report, we describe the case of a 23-year-old man who suffered a coronal shearing fracture of the talar body with talar head dislocation related to a navicular compression fracture. The patient sought orthopedic consultation 6 weeks after injury. The injury was managed with open reduction, talar head relocation, internal fixation of the talar body fracture with Kirschner wires and cancellous screws and talonavicular fusion with an iliac bone autograft. Follow-up 4 years after operative treatment showed that the patient had satisfactory treatment results, including good bone healing with minimal changes in the anterior talotibial compartment and excellent function of the hindfoot and ankle.

Short‐Term Outcomes of Enhanced Recovery after Surgery (ERAS) for Ankle Fracture Patients: A Single‐Center Retrospective Cohort Study

Enhanced recovery after surgery (ERAS) has been successfully adopted for the improvement of medical quality and efficacy in many diseases, but the effect thereof for ankle fracture patients can vary. The aim of the present study was to explore the short-term postoperative outcomes of ERAS among ankle fracture patients. The present study was a retrospective cohort study conducted between January 2019 and May 2019. One hundred and sixty ankle fracture participations (58 males and 102 females, aged 41.71 ± 14.51 years) were included. The participants treated with open reduction and internal fixation were divided into two groups (non-ERAS vs. ERAS) depending on whether ERAS was applied. Postoperative outcomes included American Orthopedic Foot and Ankle Society (AOFAS) score, length of stay (LOS), hospital cost, complications, and consumption of opioids. To assess the association between the groups and outcomes, generalized estimating equation (GEE) modeling and multivariable linear regression analysis were performed. The average follow-up periods of the participations were 24months postoperatively. No significant differences were detected between the non-ERAS group and ERAS group with respect to the demographic of patients in terms of gender, age, Danis-Weber classification of fracture, dislocation of ankle joint, and comorbidity (P >0.05). Significant differences in terms of a higher AOFAS score were found in the ERAS group compared with the non-ERAS group (6.73, 95% CI, 5.10-8.37, p < 0.001) at 3 months postoperatively (PO3M) and (4.73, 95% CI, 3.02-6.45, p < 0.001) at 6 months postoperatively (PO6M). However, similar AOFAS scores were found at 12months postoperatively (PO12M) (0.28, 95% CI, -0.32 to 0.89, P >0.05) and at 24months postoperatively (PO24M) (0.56, 95% CI, -0.07 to 1.19, P >0.05). Additionally, the GEE analysis and group-by-time interaction of AOFAS score revealed that the ERAS protocol could facilitate faster recovery for ankle fracture patients, with higher PO3M and PO6M (both P < 0.05). At the same time, significant differences in terms of a shorter length of stay (-3.19, 95% CI, -4.33 to -2.04, P < 0.01) and less hospital cost (-6501.81, 95% CI, -10955.21 to -2048.42, P < 0.01) were found in the ERAS group compared with the non-ERAS group. By reducing LOS and hospital cost, the ERAS protocol might improve the medical quality and efficacy. The present study can provide a realistic evaluation and comparison of the ERAS protocol among ankle fracture patients, and ultimately guide clinical decision making.

Research progress in finite element analysis of ankle sprains

Ankle dislocation is the most common sports injury and is often associated with sports injuries. Among them, the tendon ligament causes damage to the posterior ankle ligament and the posterior ankle ligament. Important stabilizing structures, especially the anterior fibula ligament and the heelofibular ligament, play an important role in maintaining balance, and their injuries can lead to instability on the lateral side of the ankle. This seriously affects the function of the ankle. At the same time, it has a stabilizing effect on the lower joint, and its damage will also affect the function of the lower joint. [1-2] Foreign scientists have collected cases of acute fractures of the ankle joint, but only the central ligament rupture. Almost all injuries to the central tendon can cause a partial tear of the ligament. However, severe hallux valgus abuse can still lead to isolated damage to the triangular ligament. [3-4] Study surface emography and other techniques for basic ankle fracture studies to address the biomechanical and kinematic problems of ankle sprains. The biomechanics of ankle injuries will now be discussed in conjunction with the mechanisms of ankle injuries. To discuss the biomechanics and kinematics of ankle sprains.

Early total care for open lateral ankle dislocation without tearing of tibiofibular sindesmosis: case report

Early total care for open lateral ankle dislocation without tearing of tibiofibular sindesmosis: case report

Epidemiology of Isolated Ankle Dislocations in the United States

Category: Trauma; Ankle Introduction/Purpose: Isolated ankle dislocations (IADs) are rare type of dislocation associated with significant morbidity. Prompt reduction is indicated to prevent negative sequelae. Considering the potential negative outcomes associated with this injury, we sought to identify populations at increased risk. Methods: The National Electronic Injury Surveillance System (NEISS) database was queried to identify patients who presented to Emergency Departments (EDs) in the U.S. for IADs between 2001-2019. NEISS codes indicating ankle dislocation as the primary diagnosis were utilized. Population estimates were derived from the U.S. Census Bureau for calculation of incidence in person- years. Chi-square analysis and Wald chi-square tests were performed to assess differences between subgroups. Results: An estimated 52,520 IADs (2,862 per year) were identified among a population at risk of 5,853,993,882 person-years. The estimated incidence of IADs in the general population presenting to EDs was 0.90 per 100,000 person-years. Patients with IADs were most commonly male (61.6%), white (71.9%), and between 15-35 years old (60.1%). Patients aged 15-20 years comprised the highest proportion of IADs (19.6%). Surprisingly, sport-related activities accounted for a minority of injuries (38.2%), with most of these occurring during basketball (47.8%), football (12.9%), and soccer (9.8%). Most IADs were due to non- athletic activity, with falls from stairs (30.8%) and ladders (13.4%), and skateboarding (5.0%) being the most common mechanisms. When comparing injured male and female patients, female patients were older (45.2 vs 32.0 years; P&lt;0.001), more likely to be injured during non-athletic activities (83.9% vs 48.1%; P&lt;0.001), and more likely to be hospitalized after ED visit (27.3% vs 17.6%; P&lt;0.001). Conclusion: IADs are extremely rare. They occur most frequently during non-athletic activities in young-to-middle-aged Caucasian men. Although more common in males, females with IADs tend to be older, more likely to be injured during non- athletic activities compared to sports, and more likely to be hospitalized. This suggests that, when IADs do occur in women, they may be at higher risk for negative outcomes.

A systematic review of ankle fracture-dislocations: Recent update and future prospects.

BackgroundAnkle fracture-dislocations are one of the most severe types of ankle injuries. Compared to the simple ankle fractures, ankle fracture-dislocations are usually more severely traumatized and can cause worse functional outcomes. The purpose of this study was to review the previous literatures to understand the anatomy, mechanisms, treatment, and functional outcomes associated with ankle fracture-dislocations.MethodsThe available literatures from January 1985 to December 2021 in three main medical databases were searched and analyzed. The detailed information was extracted for each article, such as researchers, age, gender, groups, type of study, type of center research, level of evidence, significant findings, study aim, cause of injury, time from injury to surgery, type of fracture, direction of dislocation, follow-up, postoperative complications and functional evaluation scores.ResultsA total of 15 studies (1,089 patients) met the inclusion criteria. Only one study was a prospective randomized trial. The top-ranked cause of injury was high-energy injury (21.3%). Moreover, the most frequent type of fracture in ankle dislocations was supination-external rotation (SER) ankle fracture (43.8%), while the most common directions of dislocation were lateral (50%) and posterior (38.9%).ConclusionsCollectively, most ankle fracture-dislocations are caused by high-energy injuries and usually have poor functional outcomes. The mechanism of injury can be dissected by the ankle anatomy and Lauge-Hansen's classification. The treatment of ankle fracture-dislocations still requires more detailed and rational solutions due to the urgency of occurrence, the severity of injury, and the postoperative complications.

Laterally Based External Fixation for Pott's Fractures.

In this article, we describe the construction and appropriate use of a lateral-based fixator for ankle fractures. This lateral-based frame is useful for treating Pott's fractures. With lateral ankle dislocations, the lateral frame places the hindfoot in alignment with the leg. Soft tissue trauma has been recognized as an early limiting factor in patients with ankle fractures, in addition to the need for obtaining and maintaining anatomic position. A kickstand is added for heel and medial soft tissue offloading. The lateral frame is a quick and reproducible technique with satisfactory results.Level of Evidence: Level V: Surgical Technique.