- Discussion:
- comminuted frx of fibula tend to result from high energy injures resulting from
direct lateral trauma or vertical loading;
- assoicatted injuries include:
- impaction frx of lateral tibial plafond;
- metaphysis of tibia (
Pilon frx);
-
medial malleolus;
- w/ these frx it is important to have x-ray of opposite &, uninjured
ankles as a template.
- comminution makes it difficult to judge rotation and length;
- associatted medial malleolar frxs, should be stabilized first to guide
reduction of the fibula;
- w/ minmal comminution, consider
Lag Screw fixation;
- w/ significant comminution, consider indirect reduction techniques & then
spanned w/ plate using screw fixation proximal and distal to frx site;
- Reduction:
- provisional K wire is placed from fibula into talus or into tibia;
- a plate is contoured to span the area of comminution;
-
plate along posterior surface of fibula allows thicker, stronger plate to be
used w/ less risk to the overlying soft tissues;
- Indirect Reduction:
- used for type C fibular frx w/ comminution;
- contour plate and attached plate distally & controlled proximally w/ clamp;
- bone spreader is levers against a more proximal, temporary screw;
- this will push distal fragment into a reduced position & restore fibular length;
- comminuted fragments are teased into place;
- plate is then attached proximally;
