Case Study with reference to unique and inventive surgery carried out by Zulfikar Ali, Kurt Haendlmayer
Trans osseous approaches has been described in literature for debridement and microfracture of osteochondral injuries and lesions. Such an approach and technique for fracture fixation has not been described.
A 69 yr old type 2 diabetic, active gentleman sustained an injury to his right ankle when he fell through the roof of his garage while working in his loft. He fell through a height of nearly 8 feet sustaining a closed, neuro vascularly intact complete articular (43C) distal tibial and displaced, comminuted lateral talar dome fracture.
Traditionally the lateral talus is approached through a fibular osteotomy. In this case, we reduced the talar dome through the anterior approach of the distal tibia which was required to address the plafond fracture. Once the desired anatomical reduction was achieved through this approach the talus was fixed the through a hole drilled though the fibula rather than a fibular osteotomy. The fixation was achieved with a 2mm cannulated screw. The guide wire for the screw was carefully placed through a 3.5 mm drill hole in the fibula, the direction of the drill hole was in line with the direction of the screw which was perpendicular to the fracture line to achieve optimal reduction and compression.
By using such a technique we were able to avoid the added co morbidity of a fibular osteotomy and its subsequent fixation.
Our radiological and clinical results have been satisfactory as evidenced by subsequent radiological images and the scoring of the patient on self assessment questionnaires with SF-36 and FAOS (Foot and Ankle Outcome Score)
This technique of fixation is reliable and is worth considering if the fracture configuration allows it and one is able to achieve optimal reduction. The advantage of avoiding the co morbidity of an added fibular osteotomy and its fixation is significant.