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Ankle Fractures and Tendons

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Ankle fractures come in all shapes and sizes. Most are mild and can be managed with a walking-boot or a cast. Occasionally, they are more severe and can involve several parts of the ankle, such as the medial and lateral malleoli. Once two of the three main bony supports of the ankle are compromised, surgery is often required. Operating on the medial (or inside) malleolus is often completed percutaneously. Small incisions are beneficial due to less pain, swelling, bleeding and scarring. However, they can make it hard to identify other vital anatomic structures, in this case, the posterior tibial tendon. This patient had persistent pain and swelling about the inside part of the ankle many months after their fracture healed. Upon removal of implants, it is evident that the screw head was rubbing on the posterior tibial tendon, secured here with a red band. Luckily, removing the screw was sufficient to resolve their symptoms. However, it is a good point to remember that smaller incisions are not always better. It’s a little like driving with blinders on. Keeping a broad field of exposure allows the surgeon the best opportunity to fully evaluate the surrounding structures. So, sometimes a bigger incision is better.

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