Ortho Solutions Group - U.S. reposted this
Fellowship-Trained Podiatric Surgeon | Trauma, Orthopedics, Bunions, Minimally Invasive Surgery, Limb Preservation
Here is a mason and malloy type 3 fracture. Sequence of events: 1.) posterior medial approach with direct buttress plating. 2.) transitioned to supine and addressed fibula with clamp in “mini-open” approach. Trick is to always keep clamp on while drilling for nail. It ensures no shortening. I also keep a wire through jig proximal to ensure this in quadracortical fashion. Place nail. I choose this nail as it adheres to patient anatomy- just look at the bend and does not create malreduction of distal fibular fragment. In this case, the posterior spike was stubborn and translated laterally a bit after removal of clamp, but decided to leave it be as length and rotation were restored. 3. Address medial malleolus with washer. Very soft bone medially. 4. Stress syndesmosis which was quite stable with re-establishing tether of PITFL, but this is not always the case. I stress every case. Here is my take on fibular nails. For me, it is not industry or profit driven, but rather data driven. There is enough prospective randomized clinical trials, meta-analyses, biomechanical studies, and cost effective analyses to suggest nailing is not inferior. In my hands, I will use load sharing device when I can due to its biomechanical superiority plus with its added benefit of allowing me to perform mini open surgery with no prominent lateral plate.
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