Ligamentotaxis

Following fixation of the fibular fracture, reduction of the Volkmann’s triangle may be attempted through ligamentotaxis by dorsiflexing the foot.

If necessary, hold the Volkmann’s fragment in place with a dental hook through the lower extent of the lateral approach used for the fixation of the fibula.

If anatomic reduction of the Volkmann fragment is achieved with these methods, it can be fixed with screws inserted anteriorly.

If anatomic reduction is not achieved, the fragment should be exposed directly to obtain reduction and it can then be fixed with screws inserted posteriorly.


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Preliminary fixation

Provisional fixation of the Volkmann's fragment is achieved with two K-wires, or two 1.25 mm guide wires for the cannulated screws, inserted through the stab incision from anteromedial to posterolateral. The guide wires should be perpendicular to the fracture plane, at the desired positions of the planned screws. The thread of the cannulated guide wire must be engaged just through the far cortex.

Note
Care must be taken not to damage the neurovascular bundle and the tendons that lie on the anterior surface of the tibia.

Check reduction and position of guide wires under image intensification.