540863
research-article2014
FAIXXX10.1177/1071100714540863Foot & Ankle International
Letter to the Editor Foot & Ankle International® 2014, Vol. 35(8) 841 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1071100714540863 fai.sagepub.com
Author Response
Dear Editor: We appreciate the interest and comments of Drs Liu and Li regarding our study. We agree that inadequate internal fixation and malreductions of the articular surface and syndesmosis in this challenging patient cohort should be avoided especially in those without fixation of the proximal fibula fracture. In response to the question, all posterior malleolus fractures in our PER IV study group were treated with plate fixation as described in our methods section. Although there is great variability1 as to how surgeons address posterior malleolus fractures, it is our opinion that rigid plate fixation is best regardless of fragment size to restore the integrity of the PITFL. We agree that 2 lag screws would be inadequate fixation for the large posterior fracture fragment seen in Figure 2 of our article. That is why we chose to stabilize the
fragment with a posteriorly placed antiglide plate. Unfortunately the single sagittal CT slice does not adequately show the entire plate, but that is what was used. We again thank Drs Liu and Li for their inquiry, and we hope our response has appropriately answered their question. Patrick C. Schottel, MD Dean G. Lorich, MD Hospital for Special Surgery New York, NY, USA Reference 1. Gardner MJ, Streubel PN, McCormick JJ, et al. Surgeon practices regarding operative treatment of posterior malleolus fractures. Foot Ankle Int. 2011;32(4):385-393.
Downloaded from fai.sagepub.com at UTSA Libraries on June 14, 2015
research-article2014
FAIXXX10.1177/1071100714540863Foot & Ankle International
Letter to the Editor Foot & Ankle International® 2014, Vol. 35(8) 841 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1071100714540863 fai.sagepub.com
Author Response
Dear Editor: We appreciate the interest and comments of Drs Liu and Li regarding our study. We agree that inadequate internal fixation and malreductions of the articular surface and syndesmosis in this challenging patient cohort should be avoided especially in those without fixation of the proximal fibula fracture. In response to the question, all posterior malleolus fractures in our PER IV study group were treated with plate fixation as described in our methods section. Although there is great variability1 as to how surgeons address posterior malleolus fractures, it is our opinion that rigid plate fixation is best regardless of fragment size to restore the integrity of the PITFL. We agree that 2 lag screws would be inadequate fixation for the large posterior fracture fragment seen in Figure 2 of our article. That is why we chose to stabilize the
fragment with a posteriorly placed antiglide plate. Unfortunately the single sagittal CT slice does not adequately show the entire plate, but that is what was used. We again thank Drs Liu and Li for their inquiry, and we hope our response has appropriately answered their question. Patrick C. Schottel, MD Dean G. Lorich, MD Hospital for Special Surgery New York, NY, USA Reference 1. Gardner MJ, Streubel PN, McCormick JJ, et al. Surgeon practices regarding operative treatment of posterior malleolus fractures. Foot Ankle Int. 2011;32(4):385-393.
Downloaded from fai.sagepub.com at UTSA Libraries on June 14, 2015
