Treatment bimalleolar fracture with internal fixation
PREOPERATIVE DIAGNOSIS: Right ankle trimalleolar fracture.
POSTOPERATIVE DIAGNOSIS: Right ankle trimalleolar fracture.
OPERATIVE PROCEDURE: Open reduction, internal fixation of right ankle medial and lateral malleolar fractures.
INDICATIONS: This 21-year-old lady sustained the above fracture about 4 days ago. Her x rays showed translation of the mortise laterally. She was PARd, referenced her options and accepted the above procedure.
DESCRIPTION OF PROCEDURE: Under general anesthesia and tourniquet control, the right ankle was prepped and draped using normal sterile technique. The standard longitudinal approach to the medial malleolus was mad through the skin and subcutaneous tissues over the shoulder of the medial malleolus. The fracture was identified and cleaned of clot and miscellaneous debris.
Next, a standard longitudinal approach to the lateral malleolus was made through the skin and subcutaneous tissues. The soft tissues were elevated off the fracture, and it was possible to reduce this fracture anatomically. While the fracture was held reduced anatomically a 6-hole one-third tubular plate was placed across the fracture. The distal 2 screw holes were filled with fully-threaded cancellous screws, and the proximal 3 screw holes were filled with fully-threaded cortical screws. The fracture was stable following placement of this plate and screws.
The medial malleolus was then reduced anatomically and held while a screw hole was placed at the styloid of the medial malleolus. The dissection was tedious based on the size of the fracture. A partially threaded small fragment cancellous screw and washer were applied through the screw hole into the distal tibia.
Intraoperative x-rays at this point revealed that the patients lateral malleolus was anatomic and that all screws were extraarticular. In addition, the medial mortise was anatomic. There was less than 1 mm gap of the medial malleolus at the exterior surface. This was accepted. The wounds were irrigated and closed with absorbable sutures and staples. A light dressing and sugar tong splint were applied.
TOURNIQUET TIME: 60 minutes.
BLOOD LOSS: Minimal.
PLAN: The patient was given a prescription for 20 Percocet and 20 Vistaril 50-mg tablets to be taken postoperatively for pain control. She will return to see me in the office in a week for dressing removal. At that point we should get an x-ray of her right ankle, 3 views, out of her splint and then most likely place her in a fracture walker.