How To Enhance Efficiency With The Modified Brostrom Ankle Stabilization

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By Bradly W. Bussewitz, DPM, and Christopher F. Hyer, DPM, FACFAS

   A small stab through the peroneal sheath at the distal most aspect of the fibula allows quick examination and protection of the peroneal tendons. If excessive, often discolored fluid is present or the integrity of the tendon is poor or tears are present, carry the incision proximally. Full visualization of the tendons is warranted.

   Bluntly delineate the extensor retinaculum anteriorly and inferiorly, and tag it for later incorporation into the repair. Introduce a curved hemostat from the distal aspect of the fibula coursing parallel to the anterior border. This protects the peroneal tendons as well as the lateral talar cartilage as one transects the capsule and anterior talofibular ligament. Be sure to leave a cusp of tissue on the distal anterior aspect of the fibula. One should excise the impinging tissue in the lateral gutter or synovitis.

   In addition, surgeons can drill visible lateral shoulder talar osteochondral defects and remove loose bodies. If the cusp of tissue is loose, usually from the presence of a loose body, one can reattach the tissue with an anchor in the area of the anterior talofibular ligament insertion onto the fibula.

   Move the stack of towels to the forefoot to allow dorsiflexion and eversion of the foot. Employ multiple pants-over-vest sutures utilizing the residual anterior talofibular ligament and associated capsule. Throw all the sutures at once and then individually tie and tension them. Reef the extensor retinaculum up onto the cusp of tissue on the distal anterior aspect of the fibula. Close the subcutaneous tissue and skin in standard fashion. Place a posterior splint with the foot dorsiflexed and everted to support the repair.

   When one performs this procedure in isolation, it is typically complete in less than 30 minutes with no assistance necessary.

Final Words

It is to the surgeon’s benefit to remain as efficient as possible. Simple, often overlooked intraoperative maneuvers can facilitate ease of the procedure. Techniques such as foot position and choice of anesthetic administration during the case make the procedure flow smoother. A surgeon can gain “style” points for accomplishing procedures in a timely and effective manner when other surgeons may struggle.

   Dr. Bussewitz is an Advanced Foot and Ankle Surgical Fellow at the Orthopedic Foot and Ankle Center in Westerville, Ohio.

   Dr. Hyer is a Fellow of the American College of Foot and Ankle Surgeons. He is the Director of the Advanced Foot and Ankle Reconstruction Fellowship at the Orthopedic Foot and Ankle Center in Westerville, Ohio.

References

1. Brostrom L. Sprained ankles. VI. Surgical treatment of “chronic” ligament ruptures. Acta Chir. 1966; 132(5):551-565.
2. Bell SJ, Mologne TS, Sitler DF, Cox JS. Twenty six year results after Brostom procedure for chronic lateral ankle instability. Am J Sports Med. 2006; 34(6):975-978.
3. Hamilton WG, Thompson FM, Snow SW. The Modified Brostrom procedure for lateral ankle instability. Foot Ankle. 1993; 14(1):1-7.
4. Hennrikus WL, Mapes RC, Lyons PM, Lapoint JM. Outcomes of the Chrisman-Snook and modified-Brostrom procedures for chronic lateral ankle instability. A prospective randomized comparison. Am J Sports Med. 1996; 24(4):400-404.

   For further reading, see “A Guide To Addressing Lateral Ankle Instability” in the December 2009 issue of Podiatry Today. To access the archives, visit www.podiatrytoday.com.

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