Internal fixation of ankle fracture : Fibula pro-tibia fixation technique with Stryker Variax plate
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The management of unstable ankle fractures in the elderly is both controversial and evolving. The importance of early ambulation in this patient group, for the same reasons as in a hip fracture patient, is being increasingly recognised.
Fracture-dislocations in osteoporotic bone are increasingly common with an ageing population and in order to allow early ambulation fixation techniques need to be employed which provide a higher degree of stability than is required in a younger patient cohort.
With a fibula fracture the traditional technique of fixation with a 1/3 tubular plate may not allow an adequate hold on soft bone, in particular if early mobilisation is going to be aimed for. The tibia however provides an excellent “internal strut” to bolster the fibulas’ stability and the use of screws which pass from the fibula and into the tibia has been termed “fibula pro-tibia fixation”. It was originally described for fixation in the context of tibial non-unions by DeOrio and Ware (Foot Ankle Int: March 24(3) 2003. Salvage technique for treatment of peri-plafond tibial fractures: the modified fibula-pro-tibia procedure). Its use in management of the acute ankle fracture has yet to be formally published in the Orthopaedic literature, though is a technique that we have found of significant merit at the Northern General Hospital in Sheffield.
Author: Chris Blundell MD, FRCS (Tr & Orth).
Institution: The Northern General hospital, Sheffield, UK.
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Question 1 of 15
In the elderly patient with an osteoporotic ankle fracture which one of the following takes priority for management ?CorrectIncorrect
Question 2 of 15
Regarding the Fibula Pro-tibia technique which one of the following is true?CorrectIncorrect
Question 3 of 15
Using the tibia to augment the stability results in which one of the following?CorrectIncorrect
Question 4 of 15
Which one of the following would NOT be an alternative to this technique in this patient population?CorrectIncorrect
Question 5 of 15
Comparing the Pro-tibia technique to hindfoot nailing which one of these statements is correct?CorrectIncorrect
Question 6 of 15
Which one of the following statements is true of an ankle dislocation with a posterior malleolus fracture?CorrectIncorrect
Question 7 of 15
Once the incision has been made in the skin which one of the following statements is true?CorrectIncorrect
Question 8 of 15
Regarding the use of self retaining retractors which one statement is FALSE?CorrectIncorrect
Question 9 of 15
The fracture is reduced and held, but which technique is not employed?CorrectIncorrect
Question 10 of 15
There are many ideal characteristics for a plate for fixation, but which one statement is incorrect?CorrectIncorrect
Question 11 of 15
Once the plate has been applied to the bone, fixation is made proximally and distally first. Which one of these statement reflects the rationale?CorrectIncorrect
Question 12 of 15
For the long fibula pro-tibia screws according to the author which one of the following is false?CorrectIncorrect
Question 13 of 15
For the medial malleolus fracture select the one false statementCorrectIncorrect
Question 14 of 15
Regarding the final outcomes which one of these is true?CorrectIncorrect
Question 15 of 15
Regarding the literature around this subject which one statement is correct?CorrectIncorrect