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Re: Несостятельность фиксации
Alexander Chelnokov 05 Август 2003, 15:30
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It doesn't look like the fibula needs re-fixation. So maybe try ligamentotaxis by external fixator and then the diastasis screws through empty holes of the tibial plate?
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Re: Несостятельность фиксации
Отправитель: Marco Berlusconi 09 Август 2003, 22:07
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I think that you can obtain very little result with ligamentotaxis so,in my opinion, you have 2 options:
1. new ORIF with these steps: A) longer fibular plate (6 or 7 holes without the interfragmentary screw. B) with a severe look at the skin condition, rebuild the distal tibia with open reduction using the lateral edge as a parameter of the reduction. A Weber clamp should maintain the reduction of the epiphysis and a 6.5 all threaded cancellous screw shoul substitute the weber clamp. Now you can add either a new AO LCP pilon plate with combined 3.5 and 4.5 holes or a 3.5 T-LCP - 5 holes plate for the lateral column and a contoured 4.5 LCP plate - 8 holes for the medial column C) return to the fibular side and
put, trough the lateral plate, one single 4.5 cortical screw in order to stabilize the sindesmosis (even if, really, the Chaput tubercle should be kept in place by your lateral column plate).
2. You can think that this will be a lost ankle and so you can do an ankle fusion.
Let me know your decision
Best regards
Marco Berlusconi
Trauma unit
Istituto Ortopedico Galeazzi Milan Italy
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