Ankle Fractures: Fixing the Fracture With a Plate and a Suture Implant

Ankle Fractures: Fixing the Fracture With a Plate and a Suture Implant

This live surgical demonstration will show how a fracture to the small outside ankle bone, the fibula, is fixed using a metal plate and screws. Here we have a right ankle and can see the surgeon has made a larger open incision on the outside of the ankle bone. They will carefully dissect through the soft tissue to expose the bone and fracture location, to initially align the bone back to its normal position.

The surgeon may use a combination of tools. Here we see a reduction clamp being used to hold the bone in place. Once the bone is aligned, a hole is prepared and measured for a screw. This screw will sit across the fracture line with the goal of compressing the two pieces of bone together.

Next, the appropriate size metal plate is selected and placed over the fibula. To secure the plate to bone, screws are used in the appropriate holes in the plate. The surgeon will typically use a depth guide and measure the depth of bone from the plate to the opposite side to determine which screw size to use. The screw is to exit the bone slightly, but not go too far as to avoid impingement on other structures around the ankle.

Here, we see a depth guide that the surgeon can directly measure from while preparing the hole. Another type involves a probe that is hooked onto the other side of the drill hole after it is already prepared. The surgeon will continue to repeat these steps: drill, measure, and place screws.

Depending on the location and complexity of the fracture, a surgeon may not include screws into every screw hole on the plate, but there should be multiple screws placed both above and below the fracture line for good stability while the fracture heals.

To stabilize the joint between the fibula, the small outside bone, and the tibia, the larger shin bone, surgeons will place a suture construct through the plate and across the two bones. Small metal buttons hold the suture tight across the joint and allow for alignment of the joint as the fracture heals. In this video, we see that two of these constructs were used.

After surgery is complete, the soft tissue and skin will be closed, followed by placement of a splint to protect the ankle while it heals.