Anatomic Fixation of Supination External Rotation Type IV Equivalent Ankle Fractures

Little, Milton M. T.; Berkes, Marschall B.; Schottel, Patrick C.; Garner, Matthew R.; Lazaro, Lionel E.; Birnbaum, Jacqueline F.; Helfet, David L.; Lorich, Dean G.

doi:10.1097/bot.0000000000000318

Cited by 41 publications

(27 citation statements)

References 24 publications

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“… 25 In other data, no significant difference was observed in postoperative maintenance of reduction between anatomical and trans-syndesmotic fixation. 22 The findings highlight the ability of posterior malleolar fracture fixation to be as good, if not superior, at achieving a postoperatively stable syndesmosis while avoiding the risk of malreduction. The promising results seen in terms of reduction and stability make this new fixation strategy a feasible alternative to the traditional trans-syndesmotic fixation and may render the use of the syndesmosis screw or suture-button unnecessary.…”

Section: Anatomical Approachmentioning

confidence: 79%

“…One study where the anatomical approach was used to fix supination external rotation type IV ankle fractures demonstrated a significant decrease in syndesmosis malreduction rate from 33.3% to 7.4% compared with trans-syndesmotic fixation. 22 Primary repair of the deltoid ligament, a key stabilizer of the talus within the ankle mortise, effectively restores congruity of the mortise comparable with syndesmosis screw fixation. 23 , 30 In the assessment of ankle and syndesmotic rotational stability, a biomechanical cadaveric study has shown that combined repair of the PITFL and deltoid ligament restores equivalent stability in resisting external rotation forces compared with syndesmosis screw fixation, with the repaired deltoid ligament functioning as a medial checkrein.…”

Section: Anatomical Approachmentioning

confidence: 99%

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Repair of syndesmosis injury in ankle fractures

2018

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Conventional treatment of syndesmosis injuries in rotationally unstable ankle fractures is associated with an unacceptably high rate of malreduction, and this has led to a paradigm shift in the approach to a newer concept of anatomical repair.In the anatomical approach, the principle is to ‘directly fix what is broken and repair what is torn’. The approach is effective in reducing the rate of syndesmosis malreduction, increasing the biomechanical strength of syndesmosis fixation and avoiding the need for trans-syndesmotic fixation and its secondary removal.The objective of this review article is to compare the conventional treatment of these injuries (accepted usage, general consent, traditional, generally accepted) with a newer anatomical approach to be considered as a shift in thinking.Cite this article: EFORT Open Rev 2018;3:24-29. DOI: 10.1302/2058-5241.3.170017

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Section: Anatomical Approachmentioning

confidence: 79%

Section: Anatomical Approachmentioning

confidence: 99%

Repair of syndesmosis injury in ankle fractures

2018

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“…have not yet been well established. Some studies have shown that repair of the ruptured ligament is beneficial and can produce satisfactory results [11,12,14,20]. By contrast, other studies showed repair of the deltoid ligament to be unnecessary [1,4,10,17,21].…”

Section: Discussionmentioning

confidence: 99%

Strain pattern of each ligamentous band of the superficial deltoid ligament: a cadaver study

Takao¹,

Ozeki

Oliva

et al. 2020

Preprint

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BackgroundThere are few reports on the detailed biomechanics of the deltoid ligament, and no studies have measured the biomechanics of each ligamentous band because of the difficulty in inserting sensors into the narrow ligaments. This study aimed to measure the strain pattern of the deltoid ligament bands directly using a Miniaturization Ligament Performance Probe (MLPP) system. MethodsThe MLPP was sutured into the ligamentous bands of the deltoid ligament in 6 fresh-frozen lower extremity cadaveric specimens. The strain was measured using a round metal disk (clock) fixed on the plantar aspect of the foot. The ankle was manually moved from 15° dorsiflexion to 30° plantar flexion, and a 1.2-N-m force was applied to the ankle and subtalar joint complex. Then the clock was rotated every 30° to measure the strain of each ligamentous band at each endpoint. ResultsThe tibionavicular ligament (TNL) began to tense at 10° plantar flexion, and the tension becomes stronger as the angle increased; the TNL worked most effectively in plantar flex-abduction. The tibiospring ligament (TSL) began to tense gradually at 15° plantar flexion, and the tension became stronger as the angle increased. The TSL worked most effectively in abduction. The tibiocalcaneal ligament (TCL) began to tense gradually at 0° dorsiflexion, and the tension became stronger as the angle increased. The TCL worked most effectively in pronation (dorsiflexion-abduction). The superficial posterior tibiotalar ligament (SPTTL) began to tense gradually at 0° dorsiflexion, and the tension became stronger as the angle increased, with the SPTTL working most effectively in dorsiflexion. ConclusionOur results show the biomechanical function of the superficial deltoid ligament and may contribute to determining which ligament is damaged during assessment in the clinical setting. Ethics approval and consent to participateThis cadaveric study was approved by the Institutional Review Board of the University of Barcelona and conducted in accordance with the bylaws of the Bioethics Committee of the "Unitat d' Anatomia i Embriologia humana"

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“…In recent years, suture-anchor was widely used for patients treated with deltoid ligament repair (DLR) [9][10][11], and plaster casts were most often used in treatment without DLR. Previous studies had shown that transarticular external fixators might raplace the plaster casts well by offering the opportunity for self-healing of deltoid ligament and allowing early weight bearing [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Transarticular external fixation versus deltoid ligament repair in treating SER IV ankle fractures: a comparative study

Wang

Zhang

et al. 2019

Preprint

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Background The topic that whether the injured deltoid ligament should be repaired when associated with ankle joint fractures is still discussed. The objective of this study was to compare the clinical effect of open reduction and internal fixation (ORIF) with deltoid ligament repair (DLR) or transarticular external fixation (TEF) in treating supination-external rotation type IV (SER IV) ankle fractures. Methods Between January 2012 and December 2015, 43 patients were diagnosed as SER IV ankle fractures, 20 underwent ORIF and transarticular external fixation (TEF) without DLR (group 1), 23 were treated with ORIF and DLR (group 2). The pre- and post-operative radiographic examination were performed, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the visual analog scale (VAS), the Medical Outcomes Short Form 36-item questionnaire score (SF-36), and the ankle range of motion (ROM) were used for functional evaluation. Results In both groups, the three scores improved significantly after surgery, but there was no significant difference between the two groups. At 6 weeks after surgery, patients in group 2 had better ankle ROM than group 1 (29.35 ± 2.033 vs. 40.35 ± 3.550, P < 0.001), but there was no difference at 12 months postoperatively. No cases of bone nonunion or post-traumatic arthritic changes were seen during the follow-up. Patients in group 1 required a shorter time to achieve fracture union than patients in group 2. Conclusions ORIF with TIF is an optional strategy to manage SER IV ankle fractures as it achieves comparable functional results to ORIF with DLR. It also allows patients to start relatively earlier weight-bearing and may promote fracture union. Keywords Transarticular external fixation; ORIF; Deltoid ligament repair; Supination-external rotation; Ankle fracture

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Anatomic Fixation of Supination External Rotation Type IV Equivalent Ankle Fractures

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 41 publications

References 24 publications

Repair of syndesmosis injury in ankle fractures

Repair of syndesmosis injury in ankle fractures

Strain pattern of each ligamentous band of the superficial deltoid ligament: a cadaver study

Transarticular external fixation versus deltoid ligament repair in treating SER IV ankle fractures: a comparative study

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