Syndesmosis disruption alone or accompanying an ankle fracture is a frequent injury addressed by the foot and ankle surgeon. Reduction and fixation are usually performed with the use of implants as a tight rope and/or screw(s). When treating complex articular injuries requiring multiple buttress plates, the ability to enhance fixation with syndesmotic implants can be difficult in the presence of other hardware. We propose a technique using an anterior cruciate ligament targeting drill guide to precisely place syndesmotic fixation across both plates to achieve the ideal construct for stability. In this case, we used flexible fixation for the syndesmosis.

Case:A 17-year-old adolescent boy complained of plantar pain at the first metatarsal 2 months after a catfish spine injury. Imaging was consistent with a retained foreign body, and surrounding osteolysis was concerning for osteomyelitis. He underwent surgical debridement and was found to have inflammation and necrosis, apparently caused by catfish spine venom.Conclusion:Although osteolytic lesions are commonly attributed to infection or tumor, in the situation of venomous injuries, osteolysis can be a sequela of the severe local inflammatory reaction due to the toxins. Debridement is vital to remove the offending agent and the local toxins from the venom.