Arthrex Ankle Fracture System with Troy Watson, MD
Q. What type of fracture pattern/injury did your patient have?
A. My patient highlighted this month is a Welterweight UFC fighter who sustained a severe fracture while competing in the octagon. He sustained a closed high ankle fracture with a syndesmosis rupture. He was taken to the operating room for urgent open reduction and internal fixation. At the onset, it was our goal to get him back into the ring as quickly as possible and return him to his pre-injury level of competition.
Q. Considering you were treating a high-impact athlete, what type of implant were you looking for and why did you choose Arthrex?
A. We were looking to provide stable internal fixation. We used the Arthrex one-third tublar plate and the TightRope device to stabilize the syndesmosis.
Q. Was there anything unexpected during the case and did you have the implant and instrument selection you needed?
A. I felt it was imperative to have multiple implant options during the case, should there be anything unexpected and that is exactly why I chose the Arthrex system. The set includes basic plates like one-third tubular plates and straight plates but also distal fibular anatomic plates as well as medial and lateral hook plate options. The screw selection is extremely comprehensive as well with everything from a 2.7 mm locking to 4.0 mm cannulated screws. Not only do I have a vast implant selection but the set has all the instruments I could need including Lobster Claws, pointed Reduction Forceps, dental picks and even a new syndesmosis clamp giving me full confidence I have all the tools necessary for a great case. I also will typically have BioCartilage in the room available in case we note a large osteochondral defect. In the high-impact athlete, I now perform an arthroscopy on these severe ankle fractures to evaluate the syndesmosis, as well as examine for chondral injuries.
Q. What is your response to those who might be concerned about using the TightRope on an elite or high-impact athlete?
A. There is increasing evidence and confidence with treating these athletes with a TightRope rather than screw fixation. In fact, many players with similar injuries in the NFL have returned to play with a TightRope in place. Placement of the TightRope at the time of the initial procedure obviates the need for an additional hardware removal procedure and may return the athlete to his sport more quickly. For those surgeons who remain skeptical, placement of one screw with a TightRope may offer a compromise with screw removal around week eight.
Q. The Arthrex Ankle Fracture System has only been available since 2010. Was there a learning curve in dealing with a new system for you or your operating room staff?
A. There really is no learning curve other than familiarizing yourself with the tray and the various plate constructs and instruments. Everything is color-coded in the set, making it very easy and straightforward for my operating room staff.
Q. What is your postoperative protocol after using the TightRope with an associated ankle fracture?
A. The ankle fracture typically dictates the post-op protocol here. In this case, we treated him initially with a splint and then advanced him to a cast for a few weeks. Following this, he was placed into a CAMboot at the four week mark and allowed to begin active range-of-motion exercises. He was advanced to full weight-bearing at six weeks out from surgery and started formal physical therapy at that time. He was placed into an ankle brace and shoe at ten weeks from surgery and continued to advance his activity in physical therapy. He returned to training four months after surgery with a full release.