Bimalleolar Ankle Fracture Open Reduction and Internal Fixation

1. Introduction

2. Surgical Approach

3. Tourniquet

4. Lateral Incision

5. Exposure with Care to Preserve Superficial Peroneal Nerve

6. Clearing Fracture Edges

7. Provisional Anatomic Reduction with Pointed Reduction forceps

8. Interfragmentary Screw

9. K-Wire to Prevent Rotation

10. Neutralization Plate Along the Lateral Fibula

1. Place Plate and Hold with K-Wires
2. One Bicortical Non-locking Screw Proximally and One Unicortical Locking Screw Distally
3. X-Rays
4. More Bicortical Non-locking Screws Proximally and Unicortical Locking Screws Distally
5. Remove K-Wires
6. X-Rays

11. Medial Incision

12. Exposure with Care to Preserve Saphenous Vein

13. Clearing Fracture Edges and Visualization of the Anteromedial Corner of the Tibiotalar Joint

14. Provisional Reduction with Two Guidewires

1. X-Rays

15. Two Partially-Threaded, Cannulated Screws

1. X-Rays

16. Final X-Rays

17. Cotton Test

18. Closure

19. Dressing and Short Leg Splint to Maintain Neutral Ankle

20. Post-op Remarks