2025 AOFAS Annual Meeting-Symposium 7A: Ankle Fractures Are Not Just Plates and Screws & Symposium 8A: Sports Shorts I: Tr

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Video Summary

The symposium on ankle fractures emphasized that fractures are more than just bone injuries—they involve critical ligamentous structures like the syndesmosis and deltoid ligaments, which heavily influence outcomes. Dr. John Backus highlighted the high rate of syndesmosis malreduction (up to 52%) and its link to post-traumatic arthritis. He advocated for direct visualization—via arthroscopy or contralateral imaging—to improve reduction quality, cautioning against over-compression from clamps. Repair techniques include screws or suture-button devices, with potential need for deltoid ligament repair to restore joint stability.<br /><br />Dr. Samuel Ford discussed complex ankle fractures in neuropathic or diabetic patients, advocating for personalized treatment. He presented the use of tibiotalocalcaneal (TTC) nails with minimally invasive joint preparation to achieve stable, plantigrade feet allowing early weight-bearing. He stressed weighing infection risk, patient comorbidities, and fracture patterns to choose between standard ORIF, fibular nails, or TTC nails, emphasizing individualized care.<br /><br />Dr. Lorena Pineda reviewed intramedullary fibular fixation as a minimally invasive alternative to plating, especially beneficial in elderly or comorbid patients. Biomechanical and clinical studies show comparable union rates and stability but fewer wound complications and faster recovery with nails.<br /><br />In treating instability, attendees emphasized the complexity of syndesmosis and deltoid ligament injuries and the importance of comprehensive clinical, imaging, and arthroscopic assessment. Arthroscopic Broström procedures and internal brace augmentation are effective for chronic lateral ankle instability. Subtalar joint instability, previously underappreciated, affects up to 20% with lateral instability, requiring careful diagnosis and repair.<br /><br />Consensus included caution in over-constraining joints, individualized rehab, prolonged bracing post-op (up to 6 months), and conservative surgical indications for osteotomies, reserved mostly for revision cases. Overall, multidisciplinary approaches combining precise diagnosis, personalized fixation techniques, and functional rehabilitation optimize outcomes in ankle fracture and instability management.

Keywords

ankle fractures

syndesmosis injury

deltoid ligament

syndesmosis malreduction

post-traumatic arthritis

arthroscopy

contralateral imaging

screw fixation

suture-button devices

deltoid ligament repair

tibiotalocalcaneal (TTC) nails

intramedullary fibular fixation

arthroscopic Broström procedure

internal brace augmentation

subtalar joint instability