Arthrex tightrope for acute syndesmotic injury and Stryker Variax plate for fibula fracture
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Learn the Arthrex tightrope for acute syndesmotic injury and Stryker Variax plate for fibula fracture surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Arthrex tightrope for acute syndesmotic injury and Stryker Variax plate for fibula fracture surgical procedure.
The distal tibiofibular syndesmosis is a unique syndesmotic joint, powerfully bound by a variety of ligaments to maintain the integrity of the ankle mortise. The distal anatomy of the two bones are created in such a way that the medial surface of the distal fibula fits into a groove on the lateral surface of the distal tibia called the incisura fibularis which offers the bony stability to this joint. The anterior part of this joint is stabilised by the Anterior Inferior Distal Tibio-Fibular ligament (AITFL), the posterior aspect by the Posterior Inferior Distal Tibio-Fibular ligament (PITFL) and the transverse Tibio-Fibular ligament. Directly between the contiguous surfaces of the tibia and fibula is the interosseous ligament which extends throughout the length of the fibula.
The PITFL is by far the strongest ligament in this complex and is the least likely to be ruptured. Once ruptured however it is most likely to be associated with severe rotational or dislocating injuries of the ankle and associated ankle instability.
The syndesmotic ligaments stabilise the fibula with respect to both talus and tibia, whilst allowing a degree of rotation of the fibula, required in particular during full ankle dorsiflexion when the widest portion of the talus comes into the mortise. As with any ligament injury the key point is not solely whether these ligaments have been injured, but rather their stability in determining the need for treatment. If instability is not addressed, high contact pressures at the joints surface ensue and early degenerative change occurs in most patients.
Traditional fixation of unstable syndesmotic injuries has been with two parallel, non-compressive, small fragment screws placed across the ankle at the level of the tibial incisura. Such fixation also requires a decision as to whether the screws need to be removed and furthermore, the optimal timing for such removal.
The use of a Arthrex tightrope implant, is far more physiological in terms of the way the syndesmosis is held, allowing more normal movement at the ankle mortise. It is a simple and ingenious implant that has proved its worth not only in syndesmotic ankle reconstruction but also in the shoulder and forefoot. It consists of two metal buttons that rest on the respective bony surfaces to be approximated, and a robust four stranded Fibrewire suture construct which links these buttons. The design allows easy apposition of the buttons towards each other by the effective “slip-knot” set up of the suture strands.
Readers will also find of use the following OrthOracle techniques:
Author:Mark Herron FRCS
Institution: The Wellington Hospital, London, UK.
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
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- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
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The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
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