踝关节手术入路.ppt

* Antiglide plating is appropriate for SE patterns of fractures of the lateral malleolus. This fracture pattern is spiral and runs from anterior inferior to posterior and superior. POSTEROLATERAL INCISION A posterolateral incision is chosen when performing antiglide plating. It is helpful to have a bolster on the affected side buttocks to internally rotate the leg, allowing for easier access to the posterior aspect of the lateral malleolus. The incision should be just posterior to the bony region of the fibula, as seen here. PERONEALS FIBULA An incision is made just anterior to the peroneal musculature and tendons, allowing for their posterior retraction. FRACTURE With posterior retraction of the peroneals, the fracture is readily evident. After cleaning of the fracture callus, a reduction is performed using the plate. The plate is pushed up subperiosteally proximally, allowing for one of the holes in the plate to be immediately superior to the fracture. A clamp is then placed from the anterior aspect of the intact fibula proximally over the plate and the plate is used as a reduction tool. Rotation of the plate in a more posterior or more anterior direction may be required in order to allow the plate to function in this capacity. It is crucial that a clamp placed at the level of the most distal screw in the proximal fragment obtains a reduction of the fracture. If this does not occur, this technique is not applicable for the fracture pattern. The clamp placed at the level of the hole just proximal to the fracture reduces the fracture. FRACTURE REDUCED WITH CLAMP *