u/BCCS

See previous post for injury films. Lots of good discussion in the last post, a few people said rings and I'd love to hear some more rationale for that approach. This patient had a healthy soft tissue envelope and didn't blister so I was comfortable putting incisions around the ankle.

Started prone after ex fix removal, posterolateral and medial approaches. Did the fibula first, that brought down the volkmann fragment. Next posterolateral and medial buttress plates with short unicortical screws up top to avoid the nail path. Closed up and flipped supine.

Suprapatellar approach for the nail, perc clamps for the reduction. This was a small tibia, an 8mm nail was getting hung up on the unicortical screws so a blocking drill bit was placed to kick the nail anterior. I had to play with the rotation of the nail distally to get a good shot for 2 interlocks.

Post op plan to start ROM at 2 weeks and partial WB at 6 weeks.

What would you have done differently? Let's hear some thoughts!

Here's a good ankle/tibia I had on call recently. I think there's a lot to discuss and multiple ways to attack it. I'll show what I did tomorrow, for now let's hear your thoughts!

Patient is 30s, active and healthy. Twisting mechanism when the foot got stuck rock climbing. Closed NVI. Ankle reduced in ED but falls out again in the splint so taken same day for ex fix.

What's your plan for definitive fixation? Implants, positioning, approaches? Post op plan, time till allowing WB? Discuss!