Additional table for easier access to ankle fracture

Abstract

An interest in the fixation of posterior malleolus via the posterolateral approach has gained popularity recently. Most surgeons choose prone or lateral position during the surgery, and this study proposes an additional radiolucent table for easier access to the posterolateral anatomic structure of ankle joint, and compares it with traditional positioning. From September 2014 to September 2018, 21 patients with trimalleolar fractures and 28 patients with posterior malleolus and fibular fractures receiving open reduction and internal fixation (ORIF) using the posterolateral approach with the utilization of an additional radiolucent table were included in Additional Table group. Patients of matched sex, age, and injury type using the same surgical approach with the traditional positioning were selected from the hospital database and included in the Traditional group. Baseline information and clinical parameters were recorded. No significant differences existed concerning age, sex, or operative side between the 2 groups in patients with trimalleolar fractures. The time for positioning was significantly longer in the Traditional group (20.5 ± 6.45 minutes) than the Additional Table group (12 ± 3.5 minutes) ( P < .001). Besides, the operative time in the Traditional group (75.28 ± 5.45 minutes) was significantly longer than the Additional Table group (58 ± 5.95 minutes) ( P < .001). There was no case of nonunion and malunion in both groups. At 12-month follow-up, the American Orthopedic Foot and Ankle Society Scale (AOFAS) score showed no significant difference between the 2 groups ( P = .46). In patients with fibular fracture and posterior malleolus fracture, no significant differences existed concerning age, sex, operative side between the 2 groups. The time for positioning was significantly longer in the Traditional group (16.5 ± 3.45 minutes) than the Additional Table group (11 ± 3.5 minutes) ( P < .001). Besides, the operative time in the Traditional group (55.28 ± 8.45 minutes) was significantly longer than the Additional Table group (44 ± 7.95 minutes) ( P < .001). There was no case of nonunion and malunion in both groups. At the 12-month follow-up, the AOFAS score showed no significant difference between the 2 groups ( P = .26). The novel positioning with an additional table is an excellent choice for trimalleolar fracture, posterior malleolus fracture, with/without distal fibular fracture.

Positioning Pearls in Foot and Ankle Surgery: A Contemporary Review

“…Numerous modifications have been described in the literature pertaining to lateral positioning. 13,23,24 One such variation described by Lees et al has been coined the "Floppy Lateral Position." This was motivated by the challenges of capturing lateral fluoroscopic views with traditional lateral.…”

“…Also, the extra radiolucent table may be challenging to use in small operative theaters. 24 Lateral positioning confers increased risk compared to supine positioning despite its relative ease in setup. Inherently, body contact area is decreased, resulting in increased pressure at those points where the body contacts the OR table.…”

“…Numerous modifications have been described in the literature pertaining to lateral positioning. 13 , 23 , 24 One such variation described by Lees et al has been coined the “Floppy Lateral Position.” This was motivated by the challenges of capturing lateral fluoroscopic views with traditional lateral. 23 These authors describe a technique in which the leg can be rotated for anteroposterior and lateral views with minimal image intensifier movement and with dynamic access to all aspects of the foot and ankle.…”

“…Liu et al 24 describe a variation on the floppy lateral positioning utilizing an additional orthogonal radiolucent table adjacent to the operative extremity. These authors describe a technique in which a very large hip bump is placed under the operative hip and with knee flexion, the foot is placed onto the orthogonal table for posterolateral or lateral approaches to the ankle.…”