Table 2.

Pearls and Pitfalls

Pearls -Place an ipsilateral hip bump prior to applying surgical drapes to allow for adequate internal rotation and visualization of the lateral aspect of the ankle. -Obtain multiple radiographic images with the mini-C-arm to ensure correct trajectory to properly ream the inner posterior cortex of the distal fibula. -While reaming the inner cortex of the fibula, gradually increase the side of the reamer until cortical chatter is appreciated. -Gently tamp the outer cortex of the distal fibula to preserve fibrocartilage. -Place an adequate amount of FiberWire suture through the drill holes of the distal fibula and superior retinaculum, repairing the superior retinaculum and providing additional stability to the peroneal tendons.

Pitfalls -Avoid posterior dissection past the fibular groove and peroneal tendons to prevent injury to the sural nerve. -Incorrect trajectory of the reamer may cause inner cortical thinning of an inappropriate segment of the distal fibula. -Excessive tamping, inadequate reaming, and incomplete sagittal cuts over the posterior distal fibula may cause inadvertent damage of the fibrocartilage, eliminating the advantages with this technique.