Distal Tibial/Medial Malleolus Fracture


41 yo male fell from tree stand. It’s 🦌 hunting season in Indiana!
8-10ft fall. Axial force. Resulted in comminuted distal tib/medial mall fracture. Sustentaculum frx, and non displaced (not pictured navicular fracture).

-ER told him he had 1 fracture

-Referring Orthopod told him he had 2 fractures….

-Plot twist, I told him by end of surgery he had 3 foot/ankle fractures, and 1 hand fracture.

-Used 2.7mm scope to clean out joint, inspect for loose bodies, and OCD’s.

-We did debride the joint for 30 minutes prior to ORIF.

-Pearl is to set pump pressure to 20 so excessive ingress doesn’t cause extravasation of tissues.

-Small chondral fissure/damage found (pictured), and plenty of debris to remove.

-Hand fracture was sustained day prior due to fall from knee scooter. He will be referred to my partner for that. He was placed in Spica splint for that.

-In hindsight hook plate wasn’t really necessary. Tamping the tines in further was going to malreduce frx due to it being an impaction frx. We used Hintermann to walk the fracture distal some. We collected some delt and periosteum in tines and left it be. Fracture reduced well, and medial gutter was clean. Hopefully scope assist will allow for less stiffness and better ROM….

Your results will vary.