PMC5902103_01
Preoperative lateral (a), AP (b), and mortise (c) radiographs showing tibiotalar dislocation and impingement of the fibula behind the tibia with no fractures.
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fig1
A 3-view X-ray of the ankle confirmed the dislocation of the fibula posterior to the tibia and posterior dislocation of the talus, while showing the stable intramedullary nail and distal screw with no apparent lucencies (Figure 1).
Intraoperative lateral radiograph showing placement of syndesmotic screws and the undamaged previously placed tibial nail.
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fig2
The fibula was then held in place with a Kirschner wire and fixed by placing two quadricortical screws through the tibia, using radiographic guidance to avoid the previously placed nail and remaining distal screw (Figure 2).
Postoperative lateral (a), AP (b), and mortise (c) radiographs showing 2 quadricortical screws stabilizing the syndesmosis with no evidence of hardware failure.
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fig3
At 3 months postoperatively, the fixation continued to remain stable (Figure 3).