1. Case for small group discussion
Ankle fracture
Case for small group discussion
AOTrauma—Foot & Ankle
Module 1a: Ankle trauma—ankle fractures
Stefan Rammelt, DE

2. Case description 45-year-old woman Slipped and fell Closed fracture
Minimal soft-tissue swelling
Type of fracture?
Reduction/ fixation?

3. Internal fixation Syndesmotic stability—Hook test (Heim)
Discuss: direction of pull on fibula to check for instability; both laterally and posterially.

4. Syndesmosis stabilization
Open reduction
Curved reduction clamp
Tibiofibular set screw (diastasis screw)

5. Take-home message
Not all Weber B type fractures have a stable syndesmosis — be suspicious!
Syndesmosis controversies:
Screw or other device?
Size and type of screw?
When to remove?
Three or four cortices?
To lag or not to lag?
How high above the syndesmosis?