![]() The proximal pin should be placed in the anterior half of the tibia. Note: The course of the anterior compartment neurovascular bundle, and also the superficial peroneal nerve, should be considered during pin placement. The threaded rod of the distractor is placed posterolaterally, away from the incision. The distal pin, anterior to the axis of rotation of the talus, produces ankle joint distraction and plantarflexion, maximizing articular visualization. A second 4 mm Schanz pin is placed from lateral to medial into the tibial shaft, proximal to the intended plate. To apply the distractor laterally, a 4 mm Schanz pin is placed transversely from lateral to medial into the talar neck, through the surgical incision. A temporary joint bridging external fixator is typically replaced with a distractor during definitive articular surface reduction and fixation. Return of skin wrinkles is a good sign of soft-tissue recovery.Īpplication of a distractor intraoperatively greatly assists with articular visualization and alignment of several of the major articular fragments. Definitive open reconstruction after 5-21 days: It should be delayed until the soft tissues have recovered sufficiently to allow definitive reconstruction.External fixation pins should avoid the planned future surgical approaches including the neck of the talus. Joint bridging external fixation: It should be remote from the fracture.With complex fibular fractures, it may be better not to fix the fibula in the first stage. This assists with proper positioning of the posterolateral tibial articular fragment (from the attachment of the posterior tibiofibular ligaments) and, in turn, with reduction of the talus relative to the tibial shaft. Fibular reduction and stabilization: Accurate reduction and stabilization of the fibula re-establishes its proper length, alignment and rotation.It is generally advisable to proceed in two or more stages: (Tscherne classification, closed fracture grade 2 or 3)
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