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Modified Brostrom Lateral Ligament Repair and Calcaneal Dwyer Osteotomy Operative Example

DESCRIPTION OF OPERATION: Under mild sedation, the patient was brought in and placed on the operating table in the lateral position. Following general anesthesia, approximately 20 mL of 0.5% Marcaine with epinephrine was injected about the left lateral foot and ankle. The leg was then scrubbed, prepped, and draped in aseptic manner. The left leg was then elevated and exsanguinated. The left thigh tourniquet was inflated to 300 mmHg. Attention was then directed to the lateral aspect of the left heel where a 7 cm curvilinear Ollier incision was made from the anterolateral ankle to the lateral posterior heel. The incision was then deepened down through subcutaneous tissue. The sural nerve and lesser saphenous vein were identified and retracted. The pronator tendons were identified and retracted. The calcaneofibular ligament was identified and noted to be attenuated and partially ruptured. The lateral ankle ligaments and joint capsule were also noted to be attenuated; this was incised. There was a moderate amount of synovial fluid expressed in the ankle joint. There were no signs of loose body or damage to the lateral aspect of the talus and talar dome. The incision was then flushed with copious amounts of normal saline and Kantrex. Attention was then directed to the lateral aspect of the calcaneus, where a Dwyer calcaneal osteotomy was performed along the lateral aspect of the heel. An approximately 6 mm wedge bone was taken from the lateral heel, leaving the medial cortex intact. The osteotomy was reduced and then fixated with two percutaneous screws in the posterior aspect of the heel, Acutrak Plus screws. Good compression of the osteotomy was noted clinically and radiographically. The incision had been flushed once again with copious amounts of normal saline and Kantrex. The percutaneous incisions were closed with 4-0 nylon and then the anterior and lateral and calcaneofibular ligaments were repaired with #2 FiberWire. The foot was dorsiflexed and everted and then was reinforced along the joint capsule with 0 Vicryl and the skin and subcutaneous tissues were closed with 3-0 Vicryl and 4-0 nylon. Good alignment of the foot and ankle was noted with the foot slightly everted. The foot was injected with an additional 10 mL and 0.5% Marcaine with epinephrine and then bandaged with bandages, Adaptic, 4 x 4's, fluffs, KIing, cast padding, and a short leg 3-way splint. The left thigh tourniquet was deflated approximately 80 minutes, and prompt hyperemic response was noted to all digits of the left foot. The patient left the operating room for the PACU with vital signs stable.

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