Rockwood Adults CH64

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CHAPTER 64 • Ankle Fractures

A

B

C

D

Figure 64-20.  A: An anteroposterior radiograph showing a diastasis following a rotational injury. B: Intraoperative view of the incision over the syndesmosis. The periarticular clamp is applied to the medial and lateral malleoli through separate stab incisions. The heavy K-wire placed in the distal fragment is used as a joystick. C: Intraoperative view of the syndesmosis showing the diastasis. D: Intraoperative view of the syn- desmosis showed that it has been reduced and compressed. Note the congruent articular surfaces that come together to form three lines in a “Mercedes-Benz sign”. E: An intraoperative mortise view. A single 3.5-mm screw has been placed at the upper border of the syndesmosis. Note the “fibular nipple”: A radiographic extension of the articular surface of the fibula which runs confluently into the line of the tibial plafond, in a sim- ilar manner to the Shenton line at the hip.

E