Hi, this is Dr. Lam here talking about high ankle sprains.
Now from these Alabama football players there's been a lot of press about high ankle sprains.
What is it? Let me explain it.
We've been dealing with high ankle sprains for a very long time and I would say, you know,
one of the most neglected sprains that we tend to see.
So the high ankle sprain, what is it? Let me explain it with an ankle model.
So obviously we have the lateral ankle ligaments right here,
lateral meaning outside on the fibula side you have three ankle ligaments on the fibula side,
you have one, two and three.
This is the most common side that sprains when you sprain your ankle ligament.
That's what is sprained. One, two, and three, okay?
The more common one being the front one, middle and then the last one is the one in the back.
So these are three ankle ligaments right here on the outside. That's called a lateral.
Lateral, meaning that it's on the outside. Now this side is the deltoid ligament.
This is very, very strong on this side, it's on the medial malleolus
which is the big bone at the tibia side, very strong.
We see that being compromised in sports but a lot of times we see that in flat foot deformity
where the tendon gives out and you're expecting on the ankle ligament to hold you together.
So let's move on to the high ankle sprain. What is it?
One other set of ankle ligament that we did not talk about right here.
This is called syndesmosis, the connection between tibia and the fibula.
It's not talked about a lot. We see this in specialty care, we see this in ankle fractures
where the ankle goes out this way,
so you can see when it goes like this it wedges the two bones apart,
acts almost like a wedge and breaks these two bones apart and
it tears this membrane all the way up.
So you have a couple of, three ligaments in here and then you have a membrane going
all the way up the leg and sometimes we see with what we call pronatory eversion
where we go out pronatory eversion going out type of injury.
This is going in type of injury, going out type of injury, going like this,
show it to the camera, like this, it wedges so you can see the talus bone
which is this bone right here causing a wedge pushing this bone apart, basically. Okay?
And that's how you get that kind of fracture pattern or if it's just a sprain,
same exact thing, going out causing that sprain, causing these two ligaments to spread apart,
these two bones to spread apart. That's what a high ankle sprain is.
It's been getting a lot of press because now we're dealing with football players and now
you know very important games and they have these high ankle sprains, so what is it?
That's what it is. Now how do we fix it?
Now in the old days we put screws across and sometimes we still put screws across it
but you put a screw across there and you hold these two bones together
and these ligaments typically scar down.
I mean, we don't make new ankle ligaments for you within these two bones.
A lot of times they scar down, it's all gonna hold it in position.
So we put a clamp on these two ends, on these two bones and then we put a screw right through it
or in the case of these two football players how do we get them back on their feet again quicker?
We stick what we call fiber Tightrope, made of fiber wire, Tightrope, basically two buttons
and a very, very heavy wire called fiber wire, very very strong to act as a fixation point
between the two buttons to hold these two bones together.
Now the whole point of that is the reason why we use those buttons and that flexible wire
instead of a hard titanium screw, that allows flexibility.
That flexibility allows the tibia and fibula to move back and forth.
Now it's not fixed like this, in an Anatomy it's not fixed like this.
There's constant motion, very small motion but
there's constant motion between these two bones,
that's why the fiber wire along the Tightrope, Arthrex, comes in handy
because it allows the movement but yet it does not allow for separation of the tibia and the fibula
and that's why these football players are able to get back on their feet a lot quicker
because we're not afraid of them going on their feet and ankle because the tightrope itself,
the button on each side, one on this side and one on this side with this wire
or we call fiber wire basically it's almost like a Kevlar type of fixation wire
that is almost indestructible -- I said almost, I've broken one before,
made it to two buttons on each side to hold these two bones together
so the tibia and fibula stays together while still allows this motion,
the shearing motion, back and forth.
So back in days when we used to put screws and they say hey don't weight bear
for about 8, 9, 12 weeks just so the ligaments can scar down
so you do not have the separation or the shearing forces, you want it steady
so that ligaments can scar down.
Now with the fiber wire the reason why we're getting them back up the speed faster
for young active patients, pro athletes, etc. because it still allows this compression right here
but it still allows stable compression with the wire and the two buttons
but does not allow the motion back and forth.
It allows the motion -- take that back -- allows the motion back and forth
but does not allow the separation to happen because of the two buttons
and a flexible wire in between, the flexible Tightrope in between.
So that's what a high ankle sprain is guys we went through the lateral ankle ligament
which is on the outside, the medial deltoid ligament on the medial side
which is big bone and now we're talking about syndesmosis, high ankle sprain,
that high ankle sprain right here.
You have three, you have the anterior, you have central and then you have the posterior.
Same as on the lateral. Anterior, middle and the posterior calcaneofibular
that's the actual name of it. Over here we have three ligaments.
One and then there's one in the middle and then there's one in the back, syndesmosis.
So that's what high ankle sprain is, it's very you know, very often misdiagnosed,
very often under diagnosed. So how do you know?
You have pain upon weight-bearing. You have pain right here.
On the x-ray, on the weight-bearing x-ray and on the weight-bearing CT scan
you'll see the separation of these two bones, very subtle.
A lot of times only specialists can really appreciate that separation.
An MRI can help you but mainly, it is the weight-bearing film, sometimes a stress film
where we put the patient on the x-ray and we crank that ankle out to see it.
So then during surgery when we deal with a fractured ankle, we check that syndesmosis
at the high ankle sprain area, we really stress it to make sure that it doesn't separate.
If it separates, fine, we put a screw or a fiber wire through it.
By fiber wire, made from Arthrex right here in Naples, guys.
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