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Reduction of SER / Weber B Frx

- Radiographs:
     - rarely long posterior spike of distal fragment is comminuted;

- Fracture Characteristics:
     - w/ supination external rotation frx, spiral oblique frx usually begins in almost transverse plane distally on anterior surface of the fibula at or just above level of plafond;
     - it spirals externally, w/ frx exiting proximally on its posterior surface;
           - hence, look for posterior spike;
     - malleolar fragment carries the lateral attachment of ATLF
           - this structure can often be a guide to reduction;

- Technique:
     - fracture is distracted with longitudinal distraction and inversion of the foot opening the fracture site.
     - fracture hematoma is curetted free from the bone ends.
     - #15 blade was used to remove periosteum from edges of fracture site.
     - reduction is obtained showing anatomic interdigitation of fracture fragments;
     - reduce & internally fix lateral malleolus or fibular frx before fixing medial malleolus component;
     - expose fracture & anterior surface of fibula proximal to it, explore joint, using an intra-articular angled retractor anteriorly;
     - distal fibula is grasped with pointed reduction forceps & teased into position;
            - simultaneous control of proximal fibular fragment w/ bone aids reduction;
            - small, pointed or lobster claw reduction forceps is used to oppose frx as proximal and distal pieces are realigned;
            - a useful technique to hold the reduction, involves insertion of one or two K wires across the frx site;
                    - following this, reduction clamps can be applied to facilitate insertion of a lag screw;
                    - K wires will have to be removed prior to lag screw insertion;
     - unless extensively comminuted, posterior spike can guide restoration of length and rotational alignment;
            - it may  be repositioned first, & held in place while reduction is completed;
     - once reduction is achieved, no talar tilt should remain;
     - fixation of fibular in shortened or rotated position will often cause rapid dissolution of the ankle joint;
            - usual reason for persistent valgus talar tilt is comminuted fibular fracture in which proper length has not be restored

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