PMC7685834_01
Initial radiographs demonstrating trimalleolar ankle fracture.
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Radiographs were taken which demonstrate an SER4 trimalleolar fracture (Figure 1) which was closed reduced and temporized in a bivalved short leg cast.
Progression toward chronic ankle deformity and malunion.
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Over the course of the next several months, the patient was noncompliant with weight-bearing precautions in her short leg cast and developed a valgus ankle malunion with severe syndesmotic widening and subluxation of the talus with medial skin tenting (Figure 2).
Partial correction of valgus deformity with plate-assisted talar reduction.
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TTC nail. The screws were intentionally placed posteriorly in the tibia to allow for nail passage (Figure 3).
Anatomy of the medial ankle.
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Due to the potential risk of damage to the medial plantar artery and nerve, as well as the tendons passing posteromedial to the medial malleolus, a superficial skin incision was made with blunt dissection down to the bone, and insertion of the trocar to protect these structures (Figure 4).
Technique for placement of calcaneal interlocking screw in the tibiotalocalcaneal nail.
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Figure 5, the midfoot osseous structures were drilled through, passing the drill bit out of the heel, then passing the screw from posterior to anterior as the drill bit was withdrawn. Final radiographs were taken (Figure 6), and the soft tissues were sutured together.
Final implant construct.
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Figure 5, the midfoot osseous structures were drilled through, passing the drill bit out of the heel, then passing the screw from posterior to anterior as the drill bit was withdrawn. Final radiographs were taken (Figure 6), and the soft tissues were sutured together.