Reduction of SER / Weber B Frx

- Radiographs:
     - rarely long posterior spike of distal fragment is comminuted;

- Fracture Characteristics:
     - w/ supination external rotation frx, spiral oblique frx usually begins in almost transverse plane distally on anterior surface of the fibula at or just above level of plafond;
     - it spirals externally, w/ frx exiting proximally on its posterior surface;
           - hence, look for posterior spike;
     - malleolar fragment carries the lateral attachment of ATLF
           - this structure can often be a guide to reduction;

- Technique:
     - fracture is distracted with longitudinal distraction and inversion of the foot opening the fracture site.
     - fracture hematoma is curetted free from the bone ends.
     - #15 blade was used to remove periosteum from edges of fracture site.
     - reduction is obtained showing anatomic interdigitation of fracture fragments;
     - reduce & internally fix lateral malleolus or fibular frx before fixing medial malleolus component;
     - expose fracture & anterior surface of fibula proximal to it, explore joint, using an intra-articular angled retractor anteriorly;
     - distal fibula is grasped with pointed reduction forceps & teased into position;
            - simultaneous control of proximal fibular fragment w/ bone aids reduction;
            - small, pointed or lobster claw reduction forceps is used to oppose frx as proximal and distal pieces are realigned;
            - a useful technique to hold the reduction, involves insertion of one or two K wires across the frx site;
                    - following this, reduction clamps can be applied to facilitate insertion of a lag screw;
                    - K wires will have to be removed prior to lag screw insertion;
     - unless extensively comminuted, posterior spike can guide restoration of length and rotational alignment;
            - it may  be repositioned first, & held in place while reduction is completed;
     - once reduction is achieved, no talar tilt should remain;
     - fixation of fibular in shortened or rotated position will often cause rapid dissolution of the ankle joint;
            - usual reason for persistent valgus talar tilt is comminuted fibular fracture in which proper length has not be restored

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, November 26, 2012 3:32 pm