ankle trauma - apma.org trauma national 2018.pdf · ankle trauma utilization of ex fix and proper...

Ankle Trauma Utilization of Ex Fix and Proper Plating

Techniques

Dr. Javan S. Bass, FACFAS

Metro Foot & Ankle Centers, PC

Georgia Podiatric Association Board of Directors

No Disclosures

Why Bother?

Plate Ratio and Screw Density

Plate ratio is ratio

btw plate length and

fracture length

-(2/3:1) - complex frx’s

-(8/10-1) - simple frx’s

Increase working length

Decrease screw load

Gautier et al, Injury, Int J. Care Injured 2003

Plate Ratio and Screw Density

Screw density refers to

number of screws

occupying holes within

the plate

- 0.5 when possible

Decreased screw density

allows for decreased bending

moments

Gautier et al, Injury, Int J. Care Injured 2003

Increased Bending Moments

Pilon

Fall from a height

MVA

High Energy Sports

Injury (shaft)

- soft tissue damage

closed vs open

4 Classic Principles

Plate the fibula to length

Articular Reconstruction

Bone grafting of metaphyseal defects

Medial buttress of the tibia

Ruedi et al, Clin Orthop Relat Research 1979

Principles

Proper diagnosis

Initial Management

Definitive ORIF

CT scan

Tornetta et al

Clin Orthop Relat Research 1996

-22 patients, surgical

course altered for 64%

Proper Diagnosis

X-ray vs CT

Initial Management (Ex-Fix)

Patterson and Cole

-1st described 2 stage

-Definitive treatment in 10-14 days

Sirkin et al

-Popularised protocol

(open vs closed)

Ex-Fix “Delta vs A frames”

Fibula plating

2 Plate Fixation


Penny et al, Injury 2016

-High energy Pilon

-3 primary fragments

-8 of 10 plates failed

Recommend 2 plate fixation

Medial Buttress

Shaft Injuries

Thank You

Metro Foot and Ankle Centers, P.C

Metrofootanklepc.com

[email protected]

[email protected]

I.G. @drjavansbass

770-484-9599

ankle trauma - apma.org trauma national 2018.pdf · ankle trauma utilization of ex fix and proper...

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