Please login to view this media
- Talk
- UK
Posterior Malleolar Fractures: Obligation, Opportunity or Tempation?
Description
In this presentation, Bob Handley discusses the complex topic of posterior malleolar fractures, particularly focusing on when surgical intervention is necessary. The presentation opens with an introduction to the controversial nature of posterior malleolar injuries and highlights the advancements in imaging, specifically the role of CT scans, which have revolutionized the understanding of ankle injuries. Handley presents a historical perspective on the evolution of orthopedic diagnostics, illustrating the shift in naming conventions of injuries from "dislocations and fractures" to "fractures and dislocations" following the advent of radiography.
Throughout the session, he explores two major articles that present opposing views on the necessity of fixing posterior malleolar fractures, sparking a discussion on the merits and consequences of surgical intervention. Handley emphasizes the importance of individualized patient assessment and advocates for a careful evaluation of the risks and benefits associated with surgery. This is illustrated through his personal clinical experiences, including a case study where a CT scan revealed critical information about a patient's fracture configuration that influenced the surgical approach.
He outlines specific scenarios in which surgical intervention is warranted, such as uncontrolled posterior instability and significant joint surface elevation, contrasting them with less clear-cut cases that may not require surgery. Handley also addresses the surgical complexity involved in fixing these fractures, particularly the potential complications stemming from extensive dissections during the procedure.
The talk concludes with recommendations for thoughtful engagement with imaging data and the reminder that identifying a posterior malleolar fracture does not automatically necessitate surgical intervention. Bob Handley urges the audience to adopt a balanced perspective toward treatment options, advocating for a nuanced understanding of the surgical fixation decision process. This presentation provides valuable insights into the guidelines for managing posterior malleolar fractures and encourages reflection on personal surgical practices.