Trauma 101- 6.0 Ankle Fractures

Question 1

How many x-rays to docs take to evaluate an ankle fracture? What are they?

Answer 1

3
Standard AP
Lateral
Mortise View (oblique)

Question 2

Treatment of ankle fractures includes both operative and non operative. What is the treatment for a displaced ankle fracture?

Answer 2

Internal fixation
Plates/Screws
Tension band wiring

Question 3

Name the four options for an ankle fracture on the lateral side?

Answer 3

screws only
lateral side plates (usually 7 hole plate, a lag screw)
posterolateral plating
posterior plating

Question 4

Name the options for an ankle fracture on the medial side?

Answer 4

Tension band wire- K wire & tension band
Screws only- two screws, typically cannulated screws run up through medial malleolus to compress
Plates/Screw Combination

Question 5

The last thing a surgeon will do is check to see if syndesmotic joint is disrupted. If it is disrupted, what will they do?

Answer 5

Fixate the syndesmotic joint. After they plate/screw on fib and/or tib, they do a hook test ie pull the fibula away from tibia & if any movement, they have to fix syndesmotic joint.

Question 6

Which fractures typically use a Posterior Antiglide Plate?

Answer 6

Weber B
The slide plate helps resist proximal migration and rotation of the distal fragment.
Advantage is distal screws can obtain better purchase since they engage into a thicker part of the distal tibia & it engages two cortises instead of one.

Question 7

What two things does the surgeon hope to achieve when trying to restore ankle joint anatomy?

Answer 7

Fibular Length

Syndesmotic Stability

Question 8

What would you bring to an ankle fracture?

Answer 8

1/3 tubular plate & Asnis III 4.0 screws (make sure it’s same metal)

Question 9

What is the difference between the SPS 4.0 small frag set & AxSos?

Answer 9

Instrumentation

AxSOS has locking capabilities

Question 10

What are indications for a Variax Fibula Plate?

Answer 10

Internal fixation of distal fibula
Weber A, B, C
Distal fibula unions and nonunions

Question 11

What is the thickness of the Variax Fibula Plate?

Answer 11

2mm in the shaft

1.3 in distal portion for lateral malleolus

Question 12

What are the characteristics of SmartLock Technology?

Answer 12

The plate is Ti Grade II (softer Titanium)
The screw is Ti Grade V (harder)
Poly axial locking capabilities (+/- 15 degrees) in any direction
When the screw is used, the thread underside of the head of screw reshapes or engages in the circular lip of the plate, which is that of softer titanium

Question 13

What screws does a Variax Fibular Plate use?

Answer 13

3.5 locking & 3.5 non-locking

Question 14

What is the plate range for a Variax Fibular Plate?

Answer 14

3-9 holes

Universal plate design

Question 15

What are indications for the T2 Ankle Arthrodesis nail?

Answer 15

Post traumatic & primary Arthrosis/Pseudarthrosis
Revision of failed ankle arthrodesis
failed total ankle replacement
RA w/severe deformity
neuroarthropathy

Question 16

What are the specs for a T2 Arthro Nail?

Answer 16

L&R nails
Lengths: 150, 200, 300 (the 150 & 200 are targeted in prox locking holes, the 300 are not)
Shaft diameter: 10, 11, 12 mm
Connection diam: 12 (bottom portion)
5 mm partially threaded and fully threaded
Compression cannulated screw
End caps (for nail extension or locks most distal screw to create fixed angle)

Question 17

On the T2 Arthro Nail, what kind of bend does it have?

Answer 17

5 degree lateral bend for better anatomical fit and calcaneal purchase

Question 18

How many bones are in the foot?

Answer 18

26 bones
tarsals (7)
metatarsals (5)
Phalanges (14)

Question 19

What are the screw options with Variax Foot System?

Answer 19

2. 7 locking
3. 7 non locking
4. 5 locking
5. 5 non locking

Question 20

What are the implant plate options in the AxSOS 4.0 small set?

Answer 20

3.0 locking 1/3 tubular plate- holes 2-12
4.0 locking recon plate- holes 2-12
SPS compression plate (waisted & standard)
SPS 1/3 tubular plate - holes 2-14

Question 21

What screws are avail in AxSOS 4.0?

Answer 21

4. 0 locking (14-95mm) self tapping
5. 5 cortical screws (14-95) self tapping
6. 0 fully threaded cancellous screw (14-95mm)
7. 0 partially threaded cancellous screw (14-100)

Question 22

True or False: The AxSOS screws are locking screws that thread the entire length of the screw to engage the plate, and should not be used on power. Self tap & use torque limiter.

Answer 22

TRUE

Question 23

How many trays are there with the AxSOS?

Answer 23

3:
AxSOS locking instruments
AxSOS small frag implants
AxSOS Screw Tray

Question 24

In the AxSOS instrument tray, what does it contain in the top/bottom trays?

Answer 24

AxSOS 3.0/4.0 locking instruments (top)

AxSOS 3.5/4.0 instruments (bottom)

Question 25

What color are the AxSOS 4.0 instruments?

Answer 25

Orange

Question 26

What are the contents of the AxSOS 4.0 instrument tray?

Answer 26

3.1 drill (for 4.0 locking screws)
4.0 tap
teardrop handle screwdriver (for T15 drive)
screw holding sleeve
drill guide
depth gauge
torque limiter
locking insert extractor

Question 27

What do we use the AxSOS 3.0 Instruments for?

Answer 27

locking 1/3 tubular plate (2-14 holes)

3.0 locking distal radius plate (in AxSOS extremity)

Question 28

What color is associated with the AxSOS 3.0 instruments?

Answer 28

White

Question 29

What are the contents of the AxSOS 3.0 instrument tray?

Answer 29

2.3 drill for 3.0 screws
3.0 tap
torque limiter screwdriver with a T8 drive
screw holding sleeve
drill guide
depth gauge

Question 30

In the bottom of the AxSOS instrument tray are the SPS (non locking) instruments. What do they include?

Answer 30

drill guides/screwdrivers
reduction clamps
bending irons
drills/taps in non locking
*if you work from left to right, you can remember
Left to right: 2.5 drill (gold) used for screws, 3.5 overdrill, 3.5/4.0 tap, screw capture sleeve, countersink, K wires 1.25, 1.6, 2.0, Hohmans ret, inst for 2,7 optional screws- 2.0 drill, 2.7 overdrill, 2,7 tap, extra red inst- bone hook

Question 31

What are the indications for the Anchorage Bone Plate system?

Answer 31

Stabilization of fresh fractures, revision procedures, joint fusion, and reconstruction of small bones of the hand, feet, wrist and ankles, fingers and toes.

Question 32

True or False: Both MTP plate and the Lapidus plate have L/R plates and locking and non-locking screws?

Answer 32

True

Question 33

What are the drill bit sizes for the Anchorage plates?

Answer 33

2. 0 drill for 3.0 screw

2. 5 drill for 3.5 screw

Question 34

What are indications of the Easy Clip?

Answer 34

Fixation of osteotomies, arthrodesis, and fractures of the foot, hand, wrist,

Question 35

What contraindications are there for the Easy Clip?

Answer 35

Ni allergy

Question 36

What sizes do we carry in the Micro Asnis screws?

Answer 36

2. 0 (blue)

3. 0 (purple)

Question 37

What are the core diameters of the Micro Asnis screws?

Answer 37

1. 5 in the 2.0 screw

2. 0 in the 3.0 screw

Question 38

What lengths do the Micro Asnis screws come in?

Answer 38

2. 0 screw lengths- 8-30mm, thread length range 4-14; addt’l 2.0 micro Asnis washer
3. 0 screw lengths- 8-40mm, thread length range 4-18mm; addt’l 3.0 Asnis Micro washer

Question 39

What are the Coughlin reamers primarily used to perform?

Answer 39

1st MPJ small joint fusions

Question 40

What are the indications for the Coughlin reamers?

Answer 40

Create paired convex and concave surfaces of the distal metatarsal head and proximal phalangeal joint; create a broad and consistent bone surface for optimal position of the toe