Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with the affected limb elevated and supported to allow optimal access to the lateral and medial aspects of the ankle.

Anatomical surgical approach:  A mini anterolateral approach was utilized, involving an incision over the anterolateral aspect of the ankle joint. Dissection proceeded through the subcutaneous tissue to expose the Chaput fragment and syndesmosis. Careful debridement was performed to remove the incarcerated osteochondral fragment from the incisura.

The surgeon emphasized the importance of obtaining a CT scan for this fracture pattern to identify subtle findings that influence surgical planning. The presence of a Chaput fragment provided a bony equivalent for accurate syndesmotic reduction. Thorough debridement was essential to remove impediments to reduction, such as the osteochondral fragment. Stacked 1/3 tubular plates were preferred for fibular stabilization due to their stiffness and low profile.

Postoperative protocol:   Postoperatively, the patient was placed in a splint with non-weight bearing status for 6 weeks. Progressive weight bearing was initiated thereafter, with physical therapy focusing on range of motion and strengthening exercises.

Follow up:   Not specified.

Orthopaedic implants used:   Stacked 1/3 tubular plates, 3.0mm screws for medial malleolus fixation.