Biomechanical Study of Screw Fixation and Plate Fixation of a Posterior Malleolar Fracture in a Simulation of the Normal Gait Cycle

Wang, Xu; Yin, Jianwen; Zhang, Chao; Wang, Chen; Geng, Xin; Ma, Xin; Huang, Jiazhang; Wang, Chengwei; Wang, Xue

doi:10.1177/1071100717719531

Cited by 20 publications

(21 citation statements)

References 17 publications

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“…Wang et al performed a mechanically loaded cadaveric gait analysis comparing the strength of multiple fixation devices and found no difference between two 3.5-mm parallel cannulated screws and a posterior malleolus 4-hole anatomic plate. 30 In a biomechanical and clinical study evaluating early weightbearing after posterior malleolus fixation with posterior-anterior–directed 3.5mm screws, the patients demonstrated an uneventful recovery. 26 In our study, we had no subsequent fracture migration or hardware failure using 2 posterior-anterior–directed 3.5-mm partially thread cannulated screws for the posterior malleolar fracture, despite initiating range-of-motion exercises at 2 weeks and partially progressive weightbearing at 4 weeks postoperatively.…”

Section: Discussionmentioning

confidence: 96%

Outcomes of Posterior Arthroscopic Reduction and Internal Fixation (PARIF) for the Posterior Malleolar Fragment in Trimalleolar Ankle Fractures

2020

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Background: Posterior malleolar fractures within a trimalleolar ankle fracture pattern are challenging to manage. Posterior ankle arthroscopy provides a means to assess the intra-articular and syndesmotic reductions, while removing loose bodies. The purpose of this study was to determine the radiographic and patient reported outcomes of posterior arthroscopic reduction and internal fixation (PARIF) in trimalleolar ankle fractures. Methods: From November 2015 to March 2019, we prospectively enrolled consecutive trimalleolar ankle fractures that underwent PARIF by a single surgeon. Preoperative and postoperative computed tomography (CT) scans were interpreted by 2 blinded musculoskeletal radiologists for articular reduction, syndesmosis congruity, and presence of ossific loose bodies. Patient outcomes were assessed using the Foot and Ankle Disability Index (FADI), American Orthopaedic Foot & Ankle Society (AOFAS) ankle score, Olerud-Molander Ankle Score (OMAS), and visual analog scale (VAS). A total of 28 trimalleolar ankle fractures were treated with PARIF. Mean patient age was 36 years (range, 19-69). Results: Preoperative CT identified 18 intra-articular loose bodies (range, 0-4) in 36% of ankles and 75% (n = 21) syndesmosis incongruity. Postoperative CT scans demonstrated anatomic intra-articular reduction in all fractures, 41.7% (5/12) syndesmosis incongruity without fixation, and 0% (0/9) with suture-button fixation. At mean 2-year follow-up, the results were good to excellent with mean VAS score 1 (range, 0-4), AOFAS score 84 (range, 63-100), FADI 85 (range, 59-100), and OMAS 76 (range, 40-100). Conclusion: The PARIF technique for displaced posterior malleolar fractures was effective in achieving anatomic intra-articular reduction, syndesmosis congruity, and intra-articular loose body removal, while safely preserving the soft tissues. Level of Evidence: Level IV, prospective case series.

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Section: Discussionmentioning

confidence: 96%

Outcomes of Posterior Arthroscopic Reduction and Internal Fixation (PARIF) for the Posterior Malleolar Fragment in Trimalleolar Ankle Fractures

2020

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“…That is, the fracture height, as well as its area, is an important prognostic factor, and it can also reveal the characters of the violence and determine the type of ankle injuries. Furthermore, the fracture height may help guide surgeons with regard to fixation requirements for PMFs [ 38 ]. To some degree, the height of fracture can provide effective diagnostic information; meanwhile, it may be helpful to surgical interventions, such as the surgical indications, the incisions, and the internal fixations.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Study on the Morphology of Posterior Malleolar Fractures Based on a CT Scan: Whether We Ignore the Importance of Fracture Height

Wang

Yuan

Zhu

et al. 2020

BioMed Research International

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Objective. The aim of this study was to investigate the respective correlation between the height (H) of a posterior malleolar fracture (PMF) and the involved area (S) of an articular surface and the presence of “die-punch.” Methods. Patients with closed posterior malleolar fractures admitted to our hospital from January 2015 to December 2017 were selected, with complete X-ray and 3D reconstruction CT imaging data. The gender, age, injured side, and surgical fixation methods of the patients were recorded. A preoperative ankle CT scan was performed, and the images were viewed through the PACS (Picture Archiving and Communication Systems). Simultaneously, the involved joint surface area (S) by the posterior malleolar fracture was measured, as well as the proportion of the fracture area to the total ankle joint area. On the sagittal reconstruction CT images, the height (H) of the posterior malleolar fracture was measured to compare the correlation between the height of the fracture and the area of the fracture, as well as the area ratio. Besides, according to the presence or absence of “die-punch,” patients were divided into two groups: A and B. And each group was further divided into three subgroups according to age (16-39 years old, 40-59 years old, and ≥60 years old). The statistical differences in the height of fracture between the subgroups were compared. Results. A total of 48 patients, aged 16-82 years, with an average age of 48.9 years, were included in this study, including 13 males and 35 females. There were 20 cases of left ankle injury and 28 cases of right ankle injury. The average height of the posterior malleolar fractures was 18.19 mm, the average area of the fracture was 202.28 mm2, and the average ratio of the fracture area to the total articular surface area was 17.84%. Besides, die-punch was seen in 27 cases and not in 21 cases. The average height of fractures was 21.33±5.38 mm in group A1, 14.38±9.01 mm in group B1, 18.30±7.95 mm in group A2, 14.48±5.37 mm in group B2, 26.26±6.73 mm in group A3, and 12.77±3.07 mm in group B3. Conclusion. The height (H) of the posterior malleolar fractures is positively correlated with the fracture area (S) and the fracture area ratio (FAR). The posterior malleolar fractures with “die-punch” tend to have a greater average height than that without “die-punch.” In clinical work, orthopedic surgeons should not only pay attention to the size of the posterior malleolus fracture but also value its height, which hopefully could provide insight into the treatment and prognosis of PMF patients.

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“…Moreover, specific methods of posterior malleolar fixation (plate vs screw fixation) were not stratified although reports indicate that fixation strength may not significantly differ between the 2 modalities. 25 Finally, all patients were tested at 6 months postoperatively, which may be too early to accurately characterize any differences; conversely, the earlier time point may instead accentuate differences between healthy controls and the trimalleolar fracture cohort.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Spatiotemporal Gait Parameters Following Operative Treatment of Trimalleolar Ankle Fractures vs Healthy Controls

Tyler

Rose

Day

et al. 2020

Foot & Ankle Orthopaedics

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Background: Controversy continues regarding appropriate indications for posterior malleolus fracture fixation in unstable rotational trimalleolar ankle injuries, with limited data comparing gait in operatively treated trimalleolar ankle fractures vs control populations. The purpose of this study was to evaluate the effect of trimalleolar ankle fracture fixation on gait parameters in the early postoperative period as compared to a healthy control population. Methods: Adult patients having undergone operative treatment of isolated trimalleolar ankle fractures were eligible for inclusion. A total of 10 patients met the inclusion criteria and participated in the analysis. Patients were evaluated using standard parameters of human gait 6 months after their index procedures, with gait values compared to a population of 17 non–age-matched healthy control subjects in addition to literature values of healthy populations of younger and older subjects. Results: Significant differences were noted between the spatiotemporal gait parameters of healthy control subjects and patients who had undergone operative treatment of trimalleolar ankle fractures. However, within the fracture group itself, no differences were found between patients with or without posterior malleolar fixation for any of the tested gait parameters. When patients were compared to literature values of younger and older healthy control populations, they were found to have gait patterns more similar to older rather than younger individuals. Conclusion: Operative fixation of trimalleolar ankle fracture does not restore normal gait function in the early postoperative period. Fixation of the posterior malleolus in particular also does not appear to improve gait characteristics. Patients who undergo surgery for these injuries demonstrate gait patterns similar to those of healthy older adults. Level of Evidence: Level II, Therapeutic (prospective cohort study).

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Biomechanical Study of Screw Fixation and Plate Fixation of a Posterior Malleolar Fracture in a Simulation of the Normal Gait Cycle

Abstract: These findings may help guide surgeons with regard to fixation requirements for posterior malleolar fractures.

Cited by 20 publications

References 17 publications

Outcomes of Posterior Arthroscopic Reduction and Internal Fixation (PARIF) for the Posterior Malleolar Fragment in Trimalleolar Ankle Fractures

Outcomes of Posterior Arthroscopic Reduction and Internal Fixation (PARIF) for the Posterior Malleolar Fragment in Trimalleolar Ankle Fractures

A Retrospective Study on the Morphology of Posterior Malleolar Fractures Based on a CT Scan: Whether We Ignore the Importance of Fracture Height

Comparison of Spatiotemporal Gait Parameters Following Operative Treatment of Trimalleolar Ankle Fractures vs Healthy Controls

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