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
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30