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Christian Boldin, Wolfgang Grechenig, Johannes Mayr, Rudolf Szyszkowitz |
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Objective: Closed or open reduction and internal fixation
of Maisonneuve fracture with the goal to restore
form and function of ankle joint. Prevention of posttraumatic
osteoarthritis.
Indications: Proximal fibular fractures associated with
rupture of the distal tibiofibular syndesmosis, the interosseous
membrane, and the deltoid ligament; sometimes
associated with fracture of the medial malleolus
and the posterior rim of the tibia.
Contraindications: Poor skin and soft-tissue conditions.
Poor general health.
Surgical Technique: Open or closed reduction and
repositioning of lateral malleolus into fibular incisure
of the tibia. Internal fixation with one or two temporarily
inserted syndesmosis screws. Suture of syndesmosis.
Treatment of associated injuries.
Postoperative Management: Split below-knee cast.
After wound healing closed below-knee cast for 6 weeks
and walking with crutches and partial weight bearing.
Removal of syndesmosis screw(s) 6–8 weeks postoperatively.
Once ligamentous stability has been ascertained,
increasing mobilization and weight bearing.
Results: An exact diagnosis, meticulous reduction and internal
fixation as well as intensive postoperative physiotherapy
will guarantee a satisfactory functional result. |
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