Philosophy of Malleolar Fractures

AO North AmericaPodiatric Advanced Course

Orlando, FL

Shannon M. Rush, DPM, FACFAS

Department Of Orthopedics and Podiatric SurgeryPalo Alto Medical Foundation -Camino DivisionMountain View, CA

AO Philosophy

Atraumatic technique Biologic dissection

Anatomic reduction Articular vs extra-articular

Stable internal fixation Early joint motion and WB

Early functional rehabilitation Dependant on first three goals

Philosophy of Malleolar Fractures

Relevant preoperative factors

Patient’s age & health status

Co-morbidities (DM, PVD, BMI)

Associated injuries• Mobility

Has the patient ambulated on the ankle?• Compliance and stability

Philosophy of Malleolar Fractures

Relevant surgical issues Fracture pattern Soft tissue injury Imaging

• Stress views– Syndesmosis

Surgical planning• Incision approach

Fixation• Fracture mechanics

Ankle Biomechanics Subtalar Joint

Torque converter Influences talar rotation

Trochlear surface of talus Frustrum

Rotational/translational forces Fracture patterns

• Shear, compression, avulsion

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