Synthes
Basic principles
– Many of these fractures are due to high energy injuries and
may require provisional stabilization by reduction and fixation
of an associated fibula fracture and use of a large external
fixator across the ankle joint. When the soft tissues are stable,
definitive fixation with a hybrid fixator will follow.
– Apply distraction, if required. The Large Distractor (394.35)
may be placed across the ankle joint to provide ligamento-
taxis and to aid in fracture reduction.
– Restore the articular surface. Screw fixation must be used
to provide interfragmentary compression after anatomic
reduction of the articular surface. Bone graft may be
necessary for any metaphyseal defect.
2
– Opposing spade-point reduction wires may be used.
3,4
They prevent frame movement and are helpful in the
reduction of small fragments. When using spade-point
reduction wires, insert the wire until the “olive” contacts
the bone surface. Washers can be used in osteopenic
bone (see Figure 3).
– To increase frame stability, the distal pin on the anterior
rod should be 2 cm proximal to the fracture, and the
second pin should be as far proximal as possible. To
accommodate pins placed in differing planes, modular
frame technique, using more than one carbon fiber rod,
can be used in place of the anterior frame. (See the
Basic
Modular Frame Technique Guide.
)
– A second carbon fiber rod must be placed either laterally
or medially for optimal stability. When ORIF is performed
on the fibula, the rod must be placed medially in order to
prevent varus deformity. A third rod can be added on the
opposite side.
– Preoperative planning of clamp and ring placement should
take future x-ray visibility of both the joint line and the
fracture site into consideration.
– To achieve fine distraction, Open Compressors (393.76)
can be used (Figure 4). For more information, consult the
Open Compressor Technique Guide
.
Figure 4
Figure 3
2. R. Barbieri, R. Schenk, K. Koval, K. Aurori, and B. Aurori. “Hybrid External
Fixation in the treatment of tibial plafond fractures.”
Clinical Orthopaedics and
Related Research
. 1996;332. 16–22.
3. G.L. Orbay, V.H. Frankel and F.J. Kummer. “The Effect of Wire Configuration
in the Stability of the Ilizarov External Fixator.”
Clinical Orthopaedics and Related
Research.
1992;279. 299–302.
4. Kummer. op cit..
