Very interesting to see a presentation showing syndesmosis fixation with screws in the IMAGES, but the presenter says he uses flexible fixation now instead! About the "xray versus cast" debate: in my ER in 2023, my trimalleolar fracture was imaged TWICE at two different times before ever getting treated, and after several hours it was treated with a common plaster cast. Surgery was done a few days later when a slot became available. I was fine and not in pain in the ER, and I luckily never impacted anything while waiting and rolling around in my chair. But I can see both sides of an argument here: 1) let's image first so we know what we're dealing with, or 2) let's treat it first because we probably know what we're dealing with, and it's probably bad to risk hurting something again while waiting for imaging. I think my doctors meant well, but the time pressures of reality don't match up with their imagination, and then suddenly it's 10 hours later and you still don't have a 10 minute cast on. IDEALLY facilities would have air cast boots -- and in hindsight, I would have bought one for myself and used it while waiting, had I known that I should have been reduced the whole time.
Very interesting to see a presentation showing syndesmosis fixation with screws in the IMAGES, but the presenter says he uses flexible fixation now instead!
About the "xray versus cast" debate: in my ER in 2023, my trimalleolar fracture was imaged TWICE at two different times before ever getting treated, and after several hours it was treated with a common plaster cast. Surgery was done a few days later when a slot became available. I was fine and not in pain in the ER, and I luckily never impacted anything while waiting and rolling around in my chair.
But I can see both sides of an argument here: 1) let's image first so we know what we're dealing with, or 2) let's treat it first because we probably know what we're dealing with, and it's probably bad to risk hurting something again while waiting for imaging. I think my doctors meant well, but the time pressures of reality don't match up with their imagination, and then suddenly it's 10 hours later and you still don't have a 10 minute cast on. IDEALLY facilities would have air cast boots -- and in hindsight, I would have bought one for myself and used it while waiting, had I known that I should have been reduced the whole time.
Can anyone share the link to the British study Dr Smith is referring to. 8:48