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Orthopaedics
Foot and Ankle
Built from Orthopedic Trauma Essentials
What’s inside
7 sections · 154 slides
Overview
- The five injuries in this topic
- Themes that run through all five
- Bones of the foot from above
- A map of the foot and ankle
Ankle (malleolar) fractures
The deltoid ligament, the syndesmosis, looking inside the joint, and how soon to walk
- The deltoid ligament: what it does
- How often is the deltoid torn?
- The old answer: fix the fibula, leave the ligament
- Why that trial does not settle it
- The newer case for repairing it
- Complications when the deltoid was not repaired
- What the pooled comparative studies add
- Lateral malleolus plate with a medial suture anchor
- Deltoid repair: bottom line
- The syndesmosis: what it is
- The real problem is reduction, not metal
- Trouble with trans-syndesmotic screws
- Why suture buttons became popular
- Screw choices that turned out not to matter
- Screw choices that do seem to matter
- Suture button versus static screw
- Three ways to hold the syndesmosis
- Hybrid fixation
- Syndesmosis: bottom line
- An ankle fracture is not only broken bone
- The outcome puzzle
- Does looking inside help?
- What arthroscopy costs
- Arthroscopy: bottom line
- How soon should the ankle take weight?
- Walking early: the retrospective cohort
- What early weightbearing delivered
- Early motion is a separate question
- Rehabilitation: bottom line
Talus fractures
A bone with a fragile blood supply: timing, constructs and approach
- The talus and calcaneus in profile
- Why the talus is a special bone
- What still has to happen immediately
- The old assumption
- What newer series show
- What actually drives osteonecrosis
- Osteonecrosis is not automatically a disaster
- Timing: bottom line
- What fixation has to achieve
- Percutaneous screws: narrow indications
- Screw fixation of a talar neck fracture
- Screws alone: the trade-off
- Where screws go wrong
- Plates for comminuted fractures
- The medial talar body
- Plate and screw fixation of a talar fracture
- Construct: bottom line
- Choosing the approach
- Single versus dual approach
- >90%
- Reading those numbers
- Mapping the fracture before choosing the incision
- A minimally invasive alternative
- The peroneal tendons: an easy miss
- Approach: bottom line
Calcaneus fractures
Operate or not, which window, and what to do with the worst pattern
- The heel bone and what breaks
- Landmarks of the hindfoot on a side view
- What surgery is trying to restore
- When not to operate
- The Canadian randomised trial
- Why that trial travels badly
- The UK Heel Fracture Trial
- The fine print of that trial
- The same trial at five years
- The Cochrane review
- Operate or not: bottom line
- The approach problem
- Approaches from most to least invasive
- The extensile lateral approach
- The sinus tarsi approach
- Extensile lateral versus sinus tarsi
- Percutaneous and arthroscopically assisted fixation
- Approach: bottom line
- Sanders type IV: the worst pattern
- Three strategies for the worst pattern
- Fixation versus fusion at the first operation
- Sanders type IV: the trial numbers
- If fusion is needed later, does the first operation matter?
- Sanders type IV: bottom line
- Does the implant matter?
- What the bench testing showed
- Percutaneous screws in high-risk patients
- Is bone grafting worth it?
- Implants and graft: bottom line
Lisfranc injuries
Stable or not, fix or fuse, and the rise of flexible fixation
- What the Lisfranc joint is
- The midfoot joint line on an oblique view
- Why the debate exists
- The randomised trial in non-displaced injuries
- Prospective cohort of stable injuries
- Retrospective series of 55 patients
- The systematic review is less comfortable
- Non-displaced injuries: bottom line
- Displaced injuries: why fusion entered the argument
- The landmark randomised comparison
- The second randomised study
- Newer randomised evidence disagrees with itself
- A third option appears
- Fix or fuse: bottom line
- The problem with transarticular screws
- Bioabsorbable versus steel screws
- Fibre tape on the bench
- Flexible fixation in the clinic
- A second systematic review agrees
- Flexible fixation: bottom line
Fifth metatarsal fractures
Zones, the Jones fracture, athletes, and the dancer's fracture
- Why the exact spot matters
- The three classic zones
- How to read the zone summary
- Summary of fracture characteristics and treatment strategies by zone of proximal fifth metatarsal injury
- Is the three-zone system reliable?
- What the reliability study found
- A newer classification
- Building imaging into classification
- Classification: bottom line
- The Jones fracture
- The case for operating
- The case for waiting
- Jones fracture: bottom line
- Athletes are a different problem
- 98.4%
- What that meta-analysis showed
- 99.0%
- Intramedullary screw in a proximal fifth metatarsal fracture
- Do biologics help?
- Why biologics are not routine
- Revision is where biologics earn their place
- Screws are not trouble-free
- Locking plates as an alternative
- Plate and screws on a proximal fifth metatarsal fracture
- Athletes: bottom line
- The dancer's fracture
- Treating a dancer's fracture
- The dancer's fracture in athletes
- Dancer's fracture: bottom line
Pulling it together
What to carry away, and where the evidence is still thin
- Four threads across all five injuries
- Quick revision: the ankle
- Quick revision: talus and calcaneus
- Quick revision: Lisfranc and fifth metatarsal
- Where the evidence is still thin
- References
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- Orthopedic Trauma Essentials 2026