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https://www.readbyqxmd.com/read/27903794/accuracy-and-measurement-error-of-the-medial-clear-space-of-the-ankle
#1
Ogheneochuko Metitiri, Mohammad Ghorbanhoseini, David Zurakowski, Mary G Hochman, Ara Nazarian, John Y Kwon
BACKGROUND: Measurement of the medial clear space (MCS) is commonly used to assess deltoid ligament competency and mortise stability when managing ankle fractures. Lacking knowledge of the true anatomic width measured, previous studies have been unable to measure accuracy of measurement. The purpose of this study was to determine MCS measurement error and accuracy and any influencing factors. METHODS: Using 3 normal transtibial ankle cadaver specimens, deltoid and syndesmotic ligaments were transected and the mortise widened and affixed at a width of 6 mm (specimen 1) and 4 mm (specimen 2)...
November 29, 2016: Foot & Ankle International
https://www.readbyqxmd.com/read/27900268/management-of-syndesmotic-injuries-what-is-the-evidence
#2
REVIEW
Marc Schnetzke, Sven Y Vetter, Nils Beisemann, Benedict Swartman, Paul A Grützner, Jochen Franke
Ankle fractures are accompanied by a syndesmotic injury in about 10% of operatively treated ankle fractures. Usually, the total rupture of the syndesmotic ligaments with an external rotation force is associated with a Weber type B or C fracture or a Maisonneuve fracture. The clinical assessment should consist of a comprehensive history including mechanism of injury followed by a specific physical examination. Radiographs, and if in doubt magnetic resonance imaging, are needed to ascertain the syndesmotic injury...
November 18, 2016: World Journal of Orthopedics
https://www.readbyqxmd.com/read/27890337/a-double-button-adjustable-loop-device-is-biomechanically-equivalent-to-tension-band-wire-in-the-fixation-of-transverse-patellar-fractures-a-cadaveric-study
#3
Fucai Han, Christopher Jon Pearce, David Q K Ng, Amit K Ramruttun, Desmond Y R Chong, Diarmuid Murphy, Chin Tat Lim, Bernard C S Lee
INTRODUCTION: Tension-band wire fixation of patellar fractures is associated with significant hardware-related complications and infection. Braided polyester suture fixation is an alternative option. However, these suture fixations have higher failure rates due to the difficulty in achieving rigid suture knot fixation. The Arthrex syndesmotic TightRope, which is a double-button adjustable loop fixation device utilizing a 4-point locking system using FibreWire, may not only offer stiff rigid fixation using a knotless system, but may also obviate the need for implant removal due to hardware related problems...
November 17, 2016: Injury
https://www.readbyqxmd.com/read/27886685/posterior-malleolus-fractures
#4
REVIEW
Shay Tenenbaum, Nachshon Shazar, Nathan Bruck, Jason Bariteau
Posterior malleolus fractures vary in morphology. A computed tomography scan is imperative to evaluate fragment size, comminution, articular impaction, and syndesmotic disruption. Despite an increasing body of literature regarding posterior malleolus fractures, many questions remain unanswered. Although, historically, fragment size guided surgical fixation, it is becoming evident that fragment size should not solely dictate treatment. Surgical treatment should focus on restoring ankle joint structural integrity, which includes restoring articular congruity, correcting posterior talar translation, addressing articular impaction, removing osteochondral debris, and establishing syndesmotic stability...
January 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27810152/syndesmosis-reduction-by-computer-assisted-orthopaedic-surgery-with-navigation-feasibility-and-accuracy-in-a-cadaveric-study
#5
Victor Dubois-Ferrière, Axel Gamulin, Ashwin Chowdhary, Jean Fasel, Richard Stern, Mathieu Assal
INTRODUCTION: Syndesmotic disruption may be difficult to reduce and fix, and malreduction is associated with inferior outcomes. Intraoperative computed tomography (CT) can provide accurate assessment of syndesmotic reduction. We hypothesized that three-dimensional (3-D) computer-assisted orthopaedic surgery (CAOS) with navigation of syndesmotic reduction could avoid malreduction. Our goal was to assess feasibility and accuracy of such a technic in a cadaveric study. METHOD: Eleven through-the-knee cadaveric specimens were used...
December 2016: Injury
https://www.readbyqxmd.com/read/27803225/should-syndesmotic-screws-be-removed-after-surgical-fixation-of-unstable-ankle-fractures-a-systematic-review
#6
S A Dingemans, S Rammelt, T O White, J C Goslings, T Schepers
AIMS: In approximately 20% of patients with ankle fractures, there is an concomitant injury to the syndesmosis which requires stabilisation, usually with one or more syndesmotic screws. The aim of this review is to evaluate whether removal of the syndesmotic screw is required in order for the patient to obtain optimal functional recovery. MATERIALS AND METHODS: A literature search was conducted in Medline, Embase and the Cochrane Library for articles in which the syndesmotic screw was retained...
November 2016: Bone & Joint Journal
https://www.readbyqxmd.com/read/27768629/fibular-fixation-in-distal-tibia-fractures-reduction-aid-or-nonunion-generator
#7
Daniel Torino, Samir Mehta
The role of fibular fixation in patients with distal tibia fractures is controversial. Although the stability of the fibula is critical in patients with syndesmotic instability or highly comminuted pilon fractures, fibular fixation in extraarticular distal tibia fractures or elementary intraarticular distal tibia fractures is more controversial. Biomechanical studies, as performed in sawbones or cadaveric models, denote advantages to fibular fixation with respect to specific uniplanar motion. However, the increased stability is susceptible to the fracture pattern of the tibia, fixation strategy for the tibia, fixation strategy for the fibula, and loading pattern of the entire construct...
November 2016: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27738709/-lateral-instability-of-the-upper-ankle-joint
#8
N Harrasser, K Eichelberg, F Pohlig, H Waizy, A Toepfer, R von Eisenhart-Rothe
Because of their frequency, ankle sprains are of major clinical and economic importance. The simple sprain with uneventful healing has to be distinguished from the potentially complicated sprain which is at risk of transition to chronic ankle instability. Conservative treatment is indicated for the acute, simple ankle sprain without accompanying injuries and also in cases of chronic instability. If conservative treatment fails, good results can be achieved by anatomic ligament reconstruction of the lateral ankle ligaments...
October 13, 2016: Der Orthopäde
https://www.readbyqxmd.com/read/27737281/foot-and-ankle-injuries-in-american-football
#9
Andrew R Hsu, Robert B Anderson
Physicians need to be aware of a variety of foot and ankle injuries that commonly occur in American football, including turf toe, Jones fractures, Lisfranc injuries, syndesmotic and deltoid disruption, and Achilles ruptures. These injuries are often complex and require early individual tailoring of treatment and rehabilitation protocols. Successful management and return to play requires early diagnosis, a thorough work-up, and prompt surgical intervention when warranted with meticulous attention to restoration of normal foot and ankle anatomy...
September 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/27733557/mri-quantification-of-the-impact-of-ankle-position-on-syndesmosis-anatomy
#10
Marie-Lyne Nault, Melissa Marien, Jonah Hébert-Davies, G Yves Laflamme, Vincent Pelsser, Dominique M Rouleau, Nayla Gosselin-Papadopoulos, Stéphane Leduc
BACKGROUND: Despite the common occurrence of syndesmotic injuries in ankle trauma, the distal tibiofibular relationship remains poorly understood. The aim of this study was to evaluate the anatomical impact of ankle sagittal positioning on the tibiofibular relationship in intact ankles by using a validated magnetic resonance imaging (MRI)-based measurement system. METHODS: In this radiologic study, 34 healthy volunteers underwent a series of ankle MRIs with the ankle stabilized in 3 positions: neutral position (NP), dorsiflexion (DF), and plantarflexion (PF)...
October 12, 2016: Foot & Ankle International
https://www.readbyqxmd.com/read/27733556/a-3-d-ct-analysis-of-screw-and-suture-button-fixation-of-the-syndesmosis
#11
Jason M Schon, Brady T Williams, Melanie B Venderley, Grant J Dornan, Jonathon D Backus, Travis Lee Turnbull, Robert F LaPrade, Thomas O Clanton
BACKGROUND: Historically, syndesmosis injuries have been repaired with screw fixation; however, some suggest that suture-button constructs may provide a more accurate anatomic and physiologic reduction. The purpose of this study was to compare changes in the volume of the syndesmotic space following screw or suture-button fixation using a preinjury and postoperative 3-D computed tomography (CT) model. The null hypothesis was that no difference would be observed among repair techniques...
October 12, 2016: Foot & Ankle International
https://www.readbyqxmd.com/read/27723566/correlation-and-comparison-of-syndesmosis-dimension-on-ct-and-mri
#12
Fabian Wong, Rebecca Mills, Nadeem Mushtaq, Roland Walker, Samrendu K Singh, Ali Abbasian
INTRODUCTION: Various methods using CT scan have been described to diagnose distal tibiofibular syndesmotic injuries. However, CT scan does not take into account the amount of cartilage within the distal tibiofibular joint and could therefore lead to false positive results. We present the first study correlating the findings of the distal tibiofibular syndesmosis on CT and MRI scans. METHODS: CT and MRI scan of consecutive patients over a period of 18 months, and of a time lapsed less than 12 months between the two imaging modalities, were reviewed...
June 23, 2016: Foot
https://www.readbyqxmd.com/read/27681857/biomechanical-analysis-of-the-individual-ligament-contributions-to-syndesmotic-stability
#13
Thomas O Clanton, Brady T Williams, Jonathon D Backus, Grant J Dornan, Daniel J Liechti, Scott R Whitlow, Adriana J Saroki, Travis Lee Turnbull, Robert F LaPrade
BACKGROUND: Biomechanical data and contributions to ankle joint stability have been previously reported for the individual distal tibiofibular ligaments. These results have not yet been validated based on recent anatomic descriptions or using current biomechanical testing devices. METHODS: Eight matched-pair, lower leg specimens were tested using a dynamic, biaxial testing machine. The proximal tibiofibular joint and the medial and lateral ankle ligaments were left intact...
September 28, 2016: Foot & Ankle International
https://www.readbyqxmd.com/read/27672016/biomechanical-comparison-of-3-current-ankle-syndesmosis-repair-techniques
#14
Thomas O Clanton, Scott R Whitlow, Brady T Williams, Daniel J Liechti, Jonathon D Backus, Grant J Dornan, Adriana J Saroki, Travis Lee Turnbull, Robert F LaPrade
BACKGROUND: Significant debate exists regarding optimal repair for unstable syndesmosis injuries. Techniques range from screw fixation, suture-button fixation, or a combination of the two. In this study, 3 common repairs were compared using a simulated weightbearing protocol with internal and external rotation of the foot. METHODS: Twenty-four lower leg specimens with mean age 54 years (range, 38-68 years) were used for testing. Following creation of a complete syndesmotic injury (AITFL, ITFL, PITFL, interosseous membrane), specimens were repaired using 1 of 3 randomly assigned techniques: (1) one 3...
September 25, 2016: Foot & Ankle International
https://www.readbyqxmd.com/read/27645618/distal-tibiofibular-synostosis-after-surgically-resolved-ankle-fractures-an-epidemiological-clinical-and-morphological-evaluation-of-a-patient-sample
#15
Jiri Marvan, Valer Dzupa, Martin Krbec, Jiri Skala-Rosenbaum, Radek Bartoska, David Kachlik, Vaclav Baca
INTRODUCTION: Ankle fractures comprise a highly morphologically and etiologically diverse group of injuries, which includes various degrees of impairment of bone and ligamentous structures. The complete synostosis and incomplete bony bridging of tibiofibular syndesmosis are among the local late complications after surgically treated ankle fractures. PATIENTS AND METHOD: 269 patients were evaluated, including 203 patients with Weber type-B fractures, and 66 patients with Weber type-C fractures...
September 7, 2016: Injury
https://www.readbyqxmd.com/read/27628500/a-biomechanical-comparison-study-of-a-modern-fibular-nail-and-distal-fibular-locking-plate-in-ao-ota-44c2-ankle-fractures
#16
Paul J Switaj, Daniel Fuchs, Mohammed Alshouli, Avinash G Patwardhan, Leonard I Voronov, Muturi Muriuki, Robert M Havey, Anish R Kadakia
BACKGROUND: A lateral approach with open reduction and internal fixation with a plate is a very effective technique for the majority of distal fibular fractures. However, this open approach for ankle fixation may be complicated by wound dehiscence and infection, especially in high-risk patients. An alternative to plating is an intramedullary implant, which allows maintenance of length, alignment, and rotation and which allows for decreased soft tissue dissection. While there has been clinical data suggesting favorable short-term outcomes with these implants, there is no current biomechanical literature investigating this technology in this particular fracture pattern...
September 15, 2016: Journal of Orthopaedic Surgery and Research
https://www.readbyqxmd.com/read/27623865/modification-of-distal-tibiofibular-relationship-after-a-mild-syndesmotic-injury
#17
Marie-Lyne Nault, Laurence Gascon, Jonah Hébert-Davies, Stéphane Leduc, G Yves Laflamme, Dennis Kramer
BACKGROUND: The hypothesis of this study is that a sprain or tear of 1 or more of the 3 syndesmotic ligaments will result in a significant change in the osseous anatomy relationship when comparing injured to uninjured syndesmosis. Our secondary objective was to determine whether injuries to the syndesmosis as diagnosed on magnetic resonance imaging (MRI) could be found using static imaging. METHODS: This is a descriptive radiological study of ankle MRI reports over a 12-year period, from 2 different institutions, and divided in two groups: normal and injured syndesmotic ligaments...
September 13, 2016: Foot & Ankle Specialist
https://www.readbyqxmd.com/read/27613816/arthroscopic-evaluation-of-syndesmotic-instability-and-malreduction
#18
Douglas E Lucas, B Collier Watson, G Alex Simpson, Gregory C Berlet, Christopher F Hyer
: Ankle fractures are a common injury treated by orthopaedic surgeons. The distal tibiofibular syndesmosis can be injured during these fractures as well as in isolation. They pose a significant challenge with regard to the diagnosis of instability as well as evaluating reduction after fixation. Multiple studies have demonstrated that traditional radiographic analysis fails to accurately identify syndesmotic diastasis, instability, or malreduction. Ankle arthroscopy has been proposed as an alternative way to evaluate the syndesmosis...
September 9, 2016: Foot & Ankle Specialist
https://www.readbyqxmd.com/read/27601151/suture-button-fixation-versus-syndesmotic-screws-in-supination-external-rotation-type-4-injuries-a-cost-effectiveness-analysis
#19
Kaitlin C Neary, Matthew A Mormino, Hongmei Wang
BACKGROUND: In stress-positive, unstable supination-external rotation type 4 (SER IV) ankle fractures, implant selection for syndesmotic fixation is a debated topic. Among the available syndesmotic fixation methods, the metallic screw and the suture button have been routinely compared in the literature. In addition to strength of fixation and ability to anatomically restore the syndesmosis, costs associated with implant use have recently been called into question. PURPOSE: This study aimed to examine the cost-effectiveness of the suture button and determine whether suture button fixation is more cost-effective than two 3...
September 6, 2016: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/27567618/the-use-of-tightrope-fixation-for-ankle-syndesmosis-injuries-our-experience
#20
M Bondi, N Rossi, A Pizzoli, L Renzi Brivio
PURPOSE: Ten percentage of all ankle fractures sustain an associated syndesmotic injury. TightRope is a relatively new technique for syndesmosis fixation, characterized by a non-absorbable FibreWire held tight between two cortical metal buttons. The purpose of this study was to evaluate the results obtained with the use of this device. METHODS: From January 2011 to December 2015, 54 patients with ankle diastases were treated. Eighteen patients were excluded from the study...
December 2016: Musculoskeletal Surgery
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