Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with the injured leg draped freely to allow manipulation and access to both the ankle and proximal fibula.

Anatomical surgical approach:  A longitudinal incision was made over the lateral aspect of the ankle to expose the distal fibula and syndesmosis. Subperiosteal dissection was performed to access the fibula and syndesmotic region. An open reduction was achieved by direct visualization of the tibial, fibular, and talar cartilage confluence. A separate incision was made proximally to address the fibular fracture.

The surgeon emphasized the importance of achieving an anatomical reduction of the syndesmosis, using a thumb reduction technique rather than clamping to minimize malreduction risk. The fibula was fixed first to ensure proper length and rotation, followed by syndesmotic stabilization with two quad cortical screws. Intraoperative imaging, including fluoroscopy and O-arm, confirmed satisfactory reduction and fixation.

Postoperative protocol:   The postoperative rehabilitation protocol included 10 weeks of non-weight bearing, with initiation of ankle and subtalar joint motion exercises at 2 weeks post-surgery. The decision to retain or remove the screws was based on patient preference regarding discomfort.

Follow up:   Not specified.

Orthopaedic implants used:   Quad cortical screws for syndesmotic stabilization.