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21 Apr 2023
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Geriatric 'Snowboarder' fracture - Lateral talar process + fibula fracture


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Clinical Details

Clinical and radiological findings:  A unique injury of a dorsiflexed 'brake foot' injury sustained by an 85yo F in a motor vehicle accident. Whilst the classical 'snowboarder' fracture is seen in the dorsiflexed foot under high axial load and external rotation, a similar load constellation may be experienced by a dorsiflexed foot on a brake pedal under heavy breaking prior to frontal collision where a peak axial impulse force occurs.

Preoperative Plan

Planning remarks:  Initial consideration was given to simple cannulated screw fixation, however given the osteoporotic nature of the bone and the low pull-out strength of individual screws , this was considered insufficient. Instead we chose to anchor the LTP with a small 2.0mm locking plate, utilising divergent locked screws in the plate to prevent failure of fixation and loss of reduction under load.

Surgical Discussion

Patient positioning:  Supine

Anatomical surgical approach:  Single curved incision over the distal fibula curving anteriorly over the LTP and extending distally in line with the 4th MT Ray

Operative remarks: 

coming

Postoperative protocol:   NWB/TWB 8W in an ankle Orthosis. ROM exercise out of the Orthosis allowed

Orthopaedic implants used:   Stryker 2.0mm Minifragment plate (Talus) Synthes 3.5/2.7mm LCP distal locking fibula plate

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Dr Ed Oates

  • Germany , Schleswig Holstein
  • Area of Specialty - General Trauma
  • Position - Specialist Consultant
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