RRA - Surgical Principles

Question 1

During surgery, fixation of the fibular fracture is usually the:

Answer 1

First step in the ORIF of a pilon fracture.

EXPLANATION: “In previous studies, most authors agree that the distal fibula plays the key role in the stability of the ankles because 1 mm lateral displacement of the talus decreases the tibiotalar contact surface by 42%. As we know, ankle instability increases the risk of tibiotalar arthrosis. . .We concluded that rigid fixation of the fractured fibula in the pilon fracture provided strong ankle stability and should decrease the ankle arthrosis.”.

Question 2

Ideal positioning for ankle fusion

Answer 2

• Sagittal plane- 90 degrees
• Transverse plane- ~10 degrees externally rotated
• Frontal Plane- slightly valgus and lateral to mid-diaphysial line by 5-10mm in isolated ankle fusions but with TC fusions the calcaneal bisection should be parallel and overlap the mid-diaphyseal line of the tibia