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everyone is different. some patients have been really improved after just a few weeks - if there isnt any associated arthritis. others take longer to settle. most people are getting back to normal after about six weeks when the pain from the operation has mostly settled.

it probably doesnt matter too much which plates you use, so long as you get an anatomical reduction. the stainless steel implants at the end of the video are JnJ but my perference now is stryker variax, as the plates are low profile and contour nicely. also, the H locking plates for the medial malleolus can be contoured to wrap around the medial mal to give a really solid fix for immediate weight bearing. i use straight plates now for the post mal rather than the T plate - its just not necessary and is far more demanding to get 2 or 3 screws in the horizontal component.

OMG WHAT?!!! They took yours out WITHOUT PAIN MEDICINE?! I got put into a surgery and knocked out with anesthesia. The pain was still there after the fact the surgery was over and I was fully awake.

It’s cause I was an angsty high schooler and requested to have no medicine so I could “bear it” lol

May I asked how it happened? That's crazy I'm very sorry you had to go through that

@@anibolotus yeah of course. Was riding around with some friends after going camping. Was around 10pm October 29th 2016. We were in my friend’s black suburban and he decided to go speeding down a backroad in rural Georgia. He lost control on a curve, over corrected, and smashed sideways into a guardrail before careening off the road into a small ravine. I was in the passenger seat and the guard rail lined up perfectly with my hip. The thing crunched through the door and broke my hip and pelvis and fractured a bunch more. Nose got broken and face slashed up when I head butted through the passenger side window. Went to Grady Memorial ICU in Atlanta and was put to sleep. Woke up alone in the ICU with this contraption protruding from my hips. Was honestly horrifying. Had PTSD for a while from it when riding in cars. Thankfully had it removed a few days after Christmas that same year and by God’s grace I walked by March. Taught me the dangers of speeding and driving like a reckless teenager in the most visceral way. Stay safe on the roads

​@@nicholasphillips5406oh bro we have the same story, i broke my pelvic last june 2023 And woke up at hospital icu. I stay at hospital about 2 month and after that i can walk again within 1 month after go home. Thank god By the way, im from south east asia, indonesia. So im sorry for my terrible english🤣. Hope you can understand what im saying

i dont think you have ever done this for real. maybe you should stick to teaching english

its a pleasure - i have a list of videos to make and pilon fractures is on it.

in orthopaedics, every day is a school day. we carry on learning until we retire. it's a really good question. unfortunately, i cant upload images to this reply to illustrate it. however, if you look at the orthocycle website www.orthocycle.org/wp/peroneal-artery/ , i will put the images up from my goto books - Sarrafian's Anatomy of the Foot and Ankle, and Henry's Extensile Exposure . the peroneal artery lies tucked in behind the interosseous membrane. there is often an anterior perforating branch that goes through the interosseous membrane to eventually lie anterior to it and deep to peroneus tertius. if there is syndesmotic disruption, this may be already damaged. the posterior (proper) terminal peroneal artery should be on the posterior aspect of the syndesmosis and under the fhl. there is a nice picture in Sarrafian that shows this. Henry describes feeling the 'lucky' inverted V shaped interval between the pb and fhl with a finger and then passing the finger up behind the fhl. this finger should protect the artery as the fhl is stripped off the fibula - it is essentially bipennate and partly arises from the fibula itself. the dissection aims to avoid stripping soft tissues from the posteromedial aspect of the fibula as we try to preserve the posterior syndesmotic ligament attached to the posterior malleolus. occasionally the artery looks pretty impressive, but most of the time it isnt very evident. if i dont see it, i dont go looking for it. inevitably, we damage it sometimes by not being aware to be careful. the end artery perforates the distal fibula and calcaneus. I havent seen any complications related to an injury of the peroneal artery this distal, but we should be careful not to injure it anyway. i have sometimes come across a variant where there is an anastomosis going across from the peroneal artery to the posterior tibial. this can be a bit intimidating. if you find this, then the traversing branch will get in the way of your posterior malleolar plating and needs to be ligated. posterior plating of the posterior malleolus and posterior plating of the fibula should not compromise the artery as it is out of harms way in the recess posterior to the syndesmosis.

Thanks Cuong! i hope that you have seen that it isnt a difficult approach. pulling the peroneals anteriorly to expose the second fascia is the key. best of luck!! please subscribe and i hope to publish some more videos soon!

I got my external fixator mounted one month ago and I remember my surgeon saying "we did a wonderful and clean job" after surgery had finished by looking at this video it seems like it wasn't clean at all 😬

Same. Wild stuff.