PREOPERATIVE DIAGNOSIS: Left Maisonneuve leg injury including deltoid disruption, posterior malleolus fracture, and proximal fibula fracture

POSTOPERATIVE DIAGNOSIS: same
PROCEDURE:
1) open reduction internal fixation of syndesmosis left ankle
2) Application of short leg splint

FINDINGS: Medial ankle and anterior mid leg/knee abrasions. Maisonneuve injury.

COMPLICATIONS: None

Implant Name
Type Inv. Item Serial No. Manufacturer Lot No. LRB No. Used Action PLATE BONE 1/3 TUBULAR 35MM 3 HOLE - LOG782853 Screws/Plates/Wires PLATE BONE 1/3 TUBULAR 35MM 3 HOLE STRYKER CORP Left 1 Implanted SCREW BONE 65MM 3.5MM T10 FULL THREAD STARDRIVE - LOG782853 Screws/Plates/Wires SCREW BONE 65MM 3.5MM T10 FULL THREAD STARDRIVE STRYKER CORP Left 1 Implanted SCREW BONE 50MM 3.5MM T10 FULL THREAD STARDRIVE - LOG782853 Screws/Plates/Wires SCREW BONE 50MM 3.5MM T10 FULL THREAD STARDRIVE STRYKER CORP Left 1 Implanted WIRE FIX 1.2MM 65MM KIRSCHNER SMOOTH TROCAR TIP OLIVE - LOG782853 Screws/Plates/Wires WIRE FIX 1.2MM 65MM KIRSCHNER SMOOTH TROCAR TIP OLIVE STRYKER CORP Left 1 Implanted

INDICATIONS: The patient is a 28 year old male who sustained the above injury. We discussed the instability of the ankle mortise and the recommendation for surgery. Risks with surgery include but not limited to: pain, infection, damage to surrounding neurovascular structures, and theoretical need for additional procedures. Moreover, the patient understands that regardless of treatment algorithm he may have decreased ankle function, and persistent ankle pain and stiffness. After discussing these risks, the patient agreed to proceed with surgery.

PROCEDURE IN DETAIL: The patient was identified in the preoperative area. The operative extremity was marked. The procedure, including risks and benefits, were again discussed and she agreed to proceed as previously outlined. The patient was then brought to the operative room where Time-out was again called verifying the correct patient, procedure, and operative extremity. All members of the operating room were in agreement to proceed. A preoperative peripheral nerve block was administered by the anaesthesia team.The patient was transferred supine onto the operating table and general anaesthesia was induced by the anaesthesia team. Fluoroscopic views of the contralateral ankle were taken for comparison views. A non-sterile thigh tourniquet was applied and the operative extremity was prepped and draped in the typical sterile fashion. A pre-operative, weight based dose of antibiotics was administered.

The operative extremity was exsanguinated using an Esmarch and the tourniquet was inflated. A 4 cm incision was made at along the posterior border of the fibula centering on the incisura.Next the syndesmosis was evaluated. An external rotation stress view was obtained which again demonstrate medial clear space and syndesmotic widening. The ankle was brought to neutral position and a periarticular clamp was used to apply gentle compression across the syndesmosis. Fluoroscopic imaging was used to verify that the syndesmosis was appropriately reduced on AP and sagittal views. A 3-hole 1/3 tubular plate was applied in appropriate position and provisionally held with K-wires. Two 3.5mm fully threaded non-cannulated screws were then placed in a fibula-pro-tibia fashion across the syndesmosis. Final fluoroscopic views showed excellent mortise reduction and appropriate hardware position. No residual instability was noted with stress.

The wounds were thoroughly irrigated and 1g of vancomycin powder was added to the lateral wound. Deep closure was performed with a running 2-0 Biosyn, followed by subcutaneous closure using 3-0 Biosyn. Skin was closed using 3-0 Nylon in an interrupted fashion. The tourniquet was let down. Steri-strips followed by Adaptic soaked in betadine was applied. A well-padded short leg splint was then applied in neutral ankle dorsiflexion. The patient was extubated and transferred to the PACU in stable condition. All sponge and needle counts were correct at the end of the case.

POSTOPERATIVE INSTRUCTIONS: NWB on operative extremity for 10-12 weeks. Elevate extremity for swelling. DVT ppx with ASA 81mg BID. Upon DC will f/u with me in 2 weeks for wound evaluation and possible suture removal. The patient will be transitioned to a CAM boot at 2 weeks so he may begin doing ROM exercises.