Ankle fractures are frequent injuries. Depending on the number of ligament and bone structures involved, these fractures may be unstable, thus surgical treatment recommended. Although simple cases have an excellent prognosis, serious injuries, as the one presented in the left image, demand a thorough evaluation, as the usually present with occult cartilage, ligament or tendon injuries, which require further treatment.
Arthroscopy is a powerful ally in the acute treatm of these injuries, enabling the diagnosis of syndesmosis instability (image above) or articular cartilage lesion (contusion of articular cartilage in the image bellow), which allows the immediate treatment of injuries that would beundiagnosed otherwise.
In this case, the syndesmosis malreduction, togheter with the posterior position of the lateral maleollous , prevents that the larger anterior part of the talus may fit in the bimaleollar mortise, leading to a fixed equinus, as shown in the image bellow, under anesthesia.
It was necessary to perform a review surgery in order to correct the syndesmosis reduction, that enabled a normal gait with restoration of the ankle range of movement.
In diabetic patients, acute fractures may evolve to neuroarthropaty (Charcot foot), leading to big deformities and loss of fixation due to poor bone quality.
In this case an arthroscopic arthrodesis, assured a minimally agressive procedure, preserving the blood supply, which enabled a faster recovery.
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