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This is Pre and Post op xrays of surgical correction of a syndesmotic rupture that failed the first time by a different physician due to screw break. On the Post operative films by our physicians, the space between the medial malleolus and talus is decreased and the joint is congruent and symmetrical. We bore a hole in the bone at the prior screw sites, added two syndesmotic screws that went across both bones for added stability as well as 2 Arthrex tightopes.
In the x-rays below there are fractures seen in the midtarsal bones that can occur with a high impact twisting injury where the foot is caught in something like the stirrup of a horse saddle or from direct high impact traums to the middle of the foot. The fractures can be seen from a view at the top of the foot (left) and side of the foot (right). This injury requires open reduction with internal fixation in order to re-align the fractured bones and prevent disability (Bottom left).
Below is case of a fracture of the ankle classified as PER IV injury meaning pronation with external rotation. The foot was in a pronated position planted and the force of the impact causing external rotation of the limp on that planted foot resutls in disruption of the deltoid ligament medially, tears of the anterior and posterior tibia-fibular ligaments, disruption of the tibia-fibula syndesmosis and ending with a high fibular fracture (both top images). This injury requires open reduction with internal fixation to reduced the fibular fracture with plate and screws and re-aproximation of the syndesmosis with a screw in order to re-align the ankle joint and allow the torn ligaments to heal appropriately (bottom left).
Below are image of pre and post - surgical repair of the an bimalleolar ankle fracture. This is case where the fracture on the fibula is at the level of the ankle joint and not above which has not disrupted the articular between the tibia and the fibula. This injury has cause a shift in the talus laterally within the joint mortise (left). Surgical correction does require open reduction with internal fixation with allows appropriate healing of the fractures and re-aligns the talus within the reduced ankle joint mortise (right).
The x-ray images below demonstrate another case of a bimalleolar ankle fracture in both and oblique view (left) and anterior - posterior view (right).
Below is the same patient seen above after surgical repair with open reduction and internal fixation with screws for the medial malleolar fracture and screws and plates for the lateral mallolar fracture. Note the even joint spacing across the ankle mortise after correction (left) that is not evenly spaced in the pre-surgical picture (above right).
Below is an flouroscopic image of a complete disruption of the anterior and posterior tibia-fibular ligaments as well as the syndesmosis. This creates a highy unstable and non-functional ankle.
There are different fixation techniques that can be used to repair this type of injury. Very strong, braided suture (ex. Arthrex, Inc.- Tightrope) is placed throught drill holes to secure the reduction (top left). One could also use a combination of the suture and a surgical screw (top right), or two surgical screws (bottom left) that traverse all four cortices of the bone to provide very strong reduction of the syndesmotic dysruption.
First Metatarsal Fracture
This is post-operative x-ray of a repair of a fracture of the long bone of foot connected to the great toe, There are three pins holding the fracture fragments in place, and once this heals the pins are removed.
This following x-ray is that of a fracture of an ankle of an adolescent with open growth plate of the long bone of the leg called the tibia. The fracture is in one of the bones that make up the ankle joint. The fracture is a result of injury to the ankle.
These are post-operative x-rays after repair of the fracture using screws that remain permanently in most cases but does not cross the growth plate to allow healing of the fracture without affecting the growth of the leg bone. Bone healing typically takes 6-8 weeks.
Lis Franc's Injury
This is an example of an injury to the arch of the foot involving the Lis Franc's ligament between the base of the 2nd metatarsal and the medial cuneiform bone. This is a very important stabilizing ligament of the foot (left). This injury is repaired surgically with screws, pins and occasionally surgical plates. This case was corrected with a combination of screw and pins (right).
This is an example of a triplane child fracture prior to surgical intervention
This is pre and post surgery picture of a Triplane fracture of the distal tibia
In the images below there is an example of a calcaneal fracture. Fractures of the calcaneus typically occur from fall from a height onto the heel. the talus which is the bone above the heel bone acts like a hammer on the calcaneus which is the anvil. The calcaneus is a very porous bone which upon impact tends to build intraosseus (inside bone) pressure then the walls of the bone especially the outside wall implodes and the end result is a comminuted fracture as seen in the x-ray (left image). It requires several screws throught a specialized fracture plate to fix the bone to allow it to heel properly (right image).
The following are pictures of a healed talar neck fracture status post ORIF. Due to the severity of the injury, the patient suffered subtalar arthritis and pain. The patient's heal also began to tilt in due to the injury. We performed a calcaneal osteotomy with subtalar fusion to correct the patient's foot.
These are pictures of a Pilon fracture that was performed by a different surgeon. The anterior tibial plate was placed too distal and invaded the patient's joint. These injuries often cause post-traumatic arthritis regardless of the fixation. The plate was removed and the patient had some relief. Approximately 1 year later, the patient underwent a successful arthroscopic fusion.
S/P Pilon with anterior plate too distal
After removal of the plate prior to arthroscopic fusion
After arthroscopic fusion
Preop before Percutaneous Screw Fixation (below)
These X-rays of the foot after surgical repair of the Jones Fracture which is important to stabilize this fracture not only for adequate healing but also because of soft tissue structures such as ligament and tendon that attach to the base of the the 5th metatarsal.
Pre and Post-op X-rays status post ORIF Lateral Malleolar Fracture (Below)
Pre and Postop Lis Franc Fracture
Pre and Postop Percutaneous fixation of Jones Fracture
Pre and Postop Xray of TIbial Stress Fracture
The following x-rays in sequence are that of a case of a navicular fracture which was repaired with open reduction and internal fixation with screws and surgical plate. The first two images are pre-operative images showing a fracture that is difficult to see. Given the clinical picture it is always a good idea to order advanced imaging to be sure of diagnosis. The last three images are post-surgical repair of the fracture.
Before and After X-rays of syndesmotic rupture with proximal fibular fracture. The first surgery is 2 syndesmotic screws. After 12 weeks, the proximal screw was removed and a tight rope was applied. The second screw was left in for increased stability
Lis Franc Fracture Before and after Surgery (Below)
Before and after metatarsal base fracture
Pre and Postop Lis Franc
Pre and Postop Calcaneal fracture (below)
Below are intraop pics of an open 1st metatarsal fracture after plate fixation
This is a picture before open reduction internal fixation (ORIF) of a displaced intra-articular calcaneal fracture.
These are pictures after plate and screw fixation of the above fracture. In these views, the joint surface has been reduced and then reestablished.
These are two pictures of an intra-articular calcaneal fracture with joint depression and displacement prior to repair.
The following two pictures are after repair and reestiablishment of the depressed joint back to normal alignment (ORIF calcaneal fracture).
Pre and Postop Calcaneal fracture
Series of Intraop Pics of an achilles rupture with part of posterior calcaneus still attached. This was a 17 year old competitive cheerleader who jumped and injured her heel.
The achilles torn off of the back of the calcaneus and a portion of the heel is still attached to the Achilles. The back of the heel bone is the rounded yellowish bone at the bottom of the incision site.
Nonabsorbable suture has been weaved through the Achilles to repair it back to the back of the calcaneus
A trough is made in the calcaneus due allow the tendon to have ingrowth at its reattachment site in the posterior heel.
The suture from the Achilles is placed through two small drill holes in the trough and out the bottom of the heel bone.
The Achilles is tensioned down into the trough and reattached to the calcaneus
Before and after Ex Fix
Intraop Pic of Lateral Malleolar Avulsion fracture before and after screw fixation.
Intraop pics of 5th metatarsal metaphyseal-diaphyseal stress fracture during repair. We clean out the nonunion fracture and then applied bone graft from the patient's heel into the void to stimulate healing. A screw is then placed across the fracture site.
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