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Ankle Trauma Utilization of Ex Fix and Proper Plating
Techniques
Dr. Javan S. Bass, FACFAS
Metro Foot & Ankle Centers, PC
Georgia Podiatric Association Board of Directors
Plate Ratio and Screw Density
Plate ratio is ratio
btw plate length and
fracture length
-(2/3:1) - complex frx’s
-(8/10-1) - simple frx’s
Increase working length
Decrease screw load
Gautier et al, Injury, Int J. Care Injured 2003
Plate Ratio and Screw Density
Screw density refers to
number of screws
occupying holes within
the plate
- 0.5 when possible
Decreased screw density
allows for decreased bending
moments
Gautier et al, Injury, Int J. Care Injured 2003
4 Classic Principles
Plate the fibula to length
Articular Reconstruction
Bone grafting of metaphyseal defects
Medial buttress of the tibia
Ruedi et al, Clin Orthop Relat Research 1979
CT scan
Tornetta et al
Clin Orthop Relat Research 1996
-22 patients, surgical
course altered for 64%
Initial Management (Ex-Fix)
Patterson and Cole
-1st described 2 stage
-Definitive treatment in 10-14 days
Sirkin et al
-Popularised protocol
(open vs closed)
4 Classic Principles
Plate the fibula to length
Articular Reconstruction
Bone grafting of metaphyseal defects
Medial buttress of the tibia
Ruedi et al, Clin Orthop Relat Research 1979
4 Classic Principles
Plate the fibula to length
Articular Reconstruction
Bone grafting of metaphyseal defects
Medial buttress of the tibia
Ruedi et al, Clin Orthop Relat Research 1979
Articular Reconstruction
Penny et al, Injury 2016
-High energy Pilon
-3 primary fragments
-8 of 10 plates failed
Recommend 2 plate fixation
4 Classic Principles
Plate the fibula to length
Articular Reconstruction
Bone grafting of metaphyseal defects
Medial buttress of the tibia
Ruedi et al, Clin Orthop Relat Research 1979
Thank You
Metro Foot and Ankle Centers, P.C
Metrofootanklepc.com
I.G. @drjavansbass
770-484-9599