Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with a bump under the ipsilateral hip to facilitate access to the medial aspect of the ankle.

Anatomical surgical approach:  A direct medial approach was utilized, involving an incision over the medial malleolus. Careful dissection was performed to expose the fracture site, allowing for direct visualization and reduction of the malleolar fragment. The syndesmosis was addressed through a separate lateral incision

Intraoperative findings confirmed a rotational and lengthening malreduction of the medial malleolus, which had resulted in anterior displacement of the talus. The deltoid ligament's tension was corrected by achieving an anatomical reduction of the medial malleolus, thereby realigning the talus and fibula within the syndesmosis. The surgeon emphasized the importance of obtaining true lateral imaging intraoperatively to confirm proper reduction.

Postoperative protocol:   Postoperative rehabilitation included immobilization in a short leg cast for 4 weeks, followed by progressive weight-bearing as tolerated. Physical therapy was initiated at 6 weeks postoperatively to restore range of motion and strength.

Follow up:   Not specified.

Orthopaedic implants used:   Medial malleolar screws, syndesmotic fixation screws.