Ankle Fractures: Fixing the Fracture With a Bone Nail and Screws

Ankle Fractures: Fixing the Fracture With a Bone Nail and Screws

When a patient suffers a broken ankle or fracture on the outside bone of their lower leg, called the fibula, there are a few options for the surgeon to stabilize and fix the broken bone. This cadaveric surgical demonstration will show a minimally invasive bone nail that is inserted into the bone to hold the fracture together while it heals.

For this procedure, the patient would be lying on their back, known as the supine position, on the operating table. Here, we can see the surgeon has marked out the skin with important landmarks that help them know where to make the small incision. Once the incision is made, a small pin or wire is placed from the bottom of the bone through the lower portion of the broken bone into the upper portion to hold the two pieces in place and ultimately help guide the nail that will be used.

X-rays are taken throughout surgery to verify that the wire is, in fact, in the center of the bone to help gain maximal control of the fracture and be sure the nail stays within the bone throughout the procedure. It is important to note that in this video, since it is a cadaveric demonstration, there is no fracture seen on the x-ray images in the upper right hand corner.

With the wire in place, a large reamer drill is used to open up the canal in the bottom portion of the bone for the nail. Once the larger hole is opened, a smaller reamer is used to make room in the canal further up the fibula. Now that the bone is prepared, we are ready to introduce the bone nail. The nail itself is inserted into the bone while attached to a drill guide. This guide will help place final screws to secure the nail in place after insertion into the bone canal.

Small wires are used along with x-ray images to be sure the guide aligns well with the holes in the nail, so as the surgeon drills for the final screws, there is no contact with the nail itself. A screwdriver is placed into the nail and then turned. This releases the small tabs or talons at the top-end of the nail. They flare out and into the surrounding bone to help secure the nail in place.

Drill sleeves and guides are then placed into the hole of the guide, and screws are placed into the bone and through the nail for final fixation into place. Finally, if there is an injury to what is known as the syndesmosis of the ankle, the joint connecting the tibia, the shinbone, and the fibula, the small outside ankle bone, there is a hole in the guide and nail to allow for the surgeon to place a suture construct. Small metal buttons hold the suture tight across the joint and allow for alignment of the joint as the fracture heals.