Positioning tips for distal fibula ankle fracture fixation

Patient positioning is key to successful fixation of distal fibula fractures. When supine, the leg rests in an externally rotated or neutral position. The leg must be rotated internally throughout the operation to enable adequate visualisation of the lateral ankle. Exposure is improved by elevating the ipsilateral hip with a sandbag. However, in patients with a stiff hip or excessive external rotation, this is not enough. In these cases, exposure can be improved further by placing a size 7.5 or greater glove over the foot and securing the glove fingers over the contralateral foot. This provides internal rotation throughout the operation and covers dirty toes.