Master Techniques in Orthopaedic Surgery: The Foot and Ankle

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43 Arthroscopic-Assisted Open Reduction and Internal Fixation Ankle

FIGURE 43.6 Arthroscopic evaluation of chondral fissuring.

FIGURE 43.7 Microfracture during arthroscopic assisted ankle fracture fixation.

arthroscopic measurement of medial clear space may be more accurate than fluoroscopic examina tion. 10 The syndesmosis may then be inspected, and subluxation of the fibula relative to the tibia can be assessed (Fig. 43.8). 11,12 The articular surface can be evaluated for further assessment of fracture displacement (Fig. 43.9). The arthroscopic instruments are then withdrawn, and exposure, reduction, and fixation of the fracture are undertaken as per surgeon preference (Figs. 43.10A through C, 43.11, and 43.12). Following fracture fixation, fluoroscopic stress views are taken to assess the stability of the syndes mosis (Fig. 43.13). This can then be correlated with repeat arthroscopic examination. If the tibio fibular clear space widens with stress testing, then further fixation of the syndesmosis is warranted. This can be performed with either tri- or quadricortical screws or with dynamic fixation using a suture-based construct. Following syndesmotic fixation, the ankle can be arthroscopically assessed to evaluate syndesmotic stability. Figure 43.14 demonstrates final radiographic imaging. Wounds are then closed as per surgeon preference, and the patient is placed in a well-padded splint. In unique cases involving the posterior malleolus, posterior arthroscopy can be utilized. In these situations, the patient is placed in a prone position with the feet off the edge of the bed. A thigh tourniquet is utilized. The standard anatomic landmarks including the medial/lateral malleolus, Achilles tendon, and sural nerve are marked and identified. Posteromedial and posterolateral portals

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FIGURE 43.8 Evaluation of syndesmosis during arthroscopic assisted fracture fixation.