Evaluation of a New Method of Small Fragment Fixation in a Medial Malleolus Fracture Model

Rovinsky, David; Haskell, Andrew; Liu, Qi; Paiement, Guy D.; Robinovitch, Stephen N.

doi:10.1097/00005131-200008000-00007

Cited by 54 publications

(41 citation statements)

References 18 publications

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“…Mohammed et al [14] in their study have opined that the tension-band wiring is more technically advantageous for small fragment fixation of medial malleolar fractures and may be more available and its usage could translate into overall cost saving when applied to the large number of ankle fractures treated surgically in our country. We agree with their study however it is not recommended for the fixation of vertical fracture medial malleolus [15] . In our study of 96 fractures treated, 10% of patients had syndesmotic screw fixation.…”

Section: Medial Malleolus Fixationsupporting

confidence: 58%

A retrospective study of functional outcome of surgically managed malleolar fracture at the ankle joint by subjective, objective and radiological assessment

Sultanpurkar¹,

Haranadh²,

Vikram³

et al. 2017

Int. J. Orthop. Sci.

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Objective: To study the functional outcome of surgically managed malleolar fractures at ankle and to assess the results of complication. Introduction: Ankle fracture is a common injury with potentially significant morbidity associated with it. Regardless of the method of the intervention, main goal is to restore normal anatomy. Complications associated with both conservative and operative management are an important consideration in decision making. Patient selection is very important in deciding the type of management. This paper provides an update to surgical management of ankle fractures. Methodology: Medical records of 96 patients were studied and data was collected which includes the demographic data, fracture details, intraoperative and postoperative details. Then patients were called up for follow-up. The functional outcome of these patients was assessed subjectively using OLERUD MOLANDER ANKLE SCORE (OMA) score. Objective and radiological outcome was assessed using cedell's criteria. Results: Among the 96 patients we achieved excellent and good subjective results in 60 (62.5%) patients; Good objective result in 72 (75%) patients; Good radiographic results in 80 (83.4%) patients. In our study, patients with unimalleolar fractures had the best outcome. Trimalleolar fractures had the worst outcome. Bimalleolar fracture had intermediate outcome. With regards to lateral malleolar fracture fixation modality, patients with rush nail achieved good to fair radiological and objective outcome with no poor outcomes With regards to medial malleolar fracture fixation modality, patients with Tension band achieved good objective and radiological outcome and there were no poor outcomes. In patients with malleolar screw fixation 62.5 % patients achieved good objective and 75 % patients achieved good radiological outcome. Patients with complications has poorer outcome. In patients with superficial infection the outcome was poorer.

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Section: Medial Malleolus Fixationsupporting

confidence: 58%

A retrospective study of functional outcome of surgically managed malleolar fracture at the ankle joint by subjective, objective and radiological assessment

Sultanpurkar¹,

Haranadh²,

Vikram³

et al. 2017

Int. J. Orthop. Sci.

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“…The toothed plate approach has important advantages. First, the toothed plate expands the fixed area, (21) while the teeth around the plate are embedded into the bone and surface of the ligament to allow the fracture fragments to be fixed using a large torque. Therefore, rotational dislocation was effectively avoided, and the downward and outward stresses caused by the screw tail were dispersed without fear of disintegration of the fracture fragments.…”

Section: Discussionmentioning

confidence: 99%

Treatment of posterior cruciate ligament avulsion fractures of the tibia using a toothed plate and hollow lag screw

Chen¹,

Luo²,

Chen³

et al. 2016

smedj

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INTRODUCTIONTo investigate the feasibility and clinical efficacy of using a toothed plate and hollow lag screw in the surgical treatment of posterior cruciate ligament (PCL) avulsion fractures of the tibia. METHODSA total of 21 patients were treated with open reduction and internal fixation using a toothed plate and hollow lag screw, through a posteromedial approach using an inverted L-shaped incision. The patients were allowed appropriate functional exercises, including knee flexion and extension, after removal of the plaster at postoperative weeks 3-6. The follow-up period was between six months and two years. RESULTSThis was a retrospective study of patients with PCL avulsion fractures of the tibia caused by road traffic accidents (n = 9), sports-related injuries (n = 6), falls (n = 5) and machinery-related injuries (n = 1). 20 patients presented with fresh fractures and one with an old fracture. The patients (13 men, eight women) had a mean age of 41.5 (range 19-72) years. Anatomical reduction of the fracture and satisfactory fixation were achieved in all 21 patients. Bony union was achieved in all patients at 8-12 weeks after surgery. Six months after surgery, knee flexion was 121.9° ± 10.4° and extension was 0°. According to the Lysholm Knee Scoring Scale, 19 patients were rated as 'excellent' and two as 'good'. CONCLUSIONThe use of a toothed plate and hollow lag screw could be a simple and reliable approach for PCL avulsion fractures of the tibia. Patients achieved good knee function after surgery.

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“…The chosen polyurethane foam has a density and mechanical characteristics close to those of osteoporotic bone, and its porous structure is interconnected, which makes it a good model of trabecular bone for cement injection studies (Rovinsky et al, 2000). However no physiological liquids were present in the foam cells, which is likely to permit more cement penetration that would happen in vivo.…”

Section: Discussionmentioning

confidence: 99%

Calcium phosphate cement augmentation of cancellous bone screws can compensate for the absence of cortical fixation

Stadelmann

Bretton

Terrier

et al. 2010

Journal of Biomechanics

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a b s t r a c tAn obvious means to improve the fixation of a cancellous bone screw is to augment the surrounding bone with cement. Previous studies have shown that bone augmentation with Calcium Phosphate (CaP) cement significantly improves screw fixation. Nevertheless, quantitative data about the optimal distribution of CaP cement is not available. The present study aims to show the effect of cement distribution on the screw fixation strength for various cortical thicknesses and to determine the conditions at which cement augmentation can compensate for the absence of cortical fixation in osteoporotic bone. In this study, artificial bone materials were used to mimic osteoporotic cancellous bone and cortical bone of varying thickness. These bone constructs were used to test the fixation strength of cancellous bone screws in different cortical thicknesses and different cement augmentation depths. The cement distribution was measured with microCT. The maximum pullout force was measured experimentally. The microCT analysis revealed a pseudo-conic shape distribution of the cement around the screws. While the maximum pullout strength of the screws in the artificial bone only was 30 7 7 N, it could increase up to approximately 1000 N under optimal conditions. Cement augmentation significantly increased pullout force in all cases. The effect of cortical thickness on pullout force was reduced with increased cement augmentation depth. Indeed, cement augmentation without cortical fixation increased pullout forces over that of screws without cement augmentation but with cortical fixation. Since cement augmentation significantly increased pullout force in all cases, we conclude that the loss of cortical fixation can be compensated by cement augmentation.

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Evaluation of a New Method of Small Fragment Fixation in a Medial Malleolus Fracture Model

Abstract: Threaded K-wires show substantial pullout strength and similar resistance to offset axial load when compared with partially threaded cancellous screws. These threaded K-wires offer an alternative for the internal fixation of medial malleolus fractures.

Cited by 54 publications

References 18 publications

A retrospective study of functional outcome of surgically managed malleolar fracture at the ankle joint by subjective, objective and radiological assessment

A retrospective study of functional outcome of surgically managed malleolar fracture at the ankle joint by subjective, objective and radiological assessment

Treatment of posterior cruciate ligament avulsion fractures of the tibia using a toothed plate and hollow lag screw

Calcium phosphate cement augmentation of cancellous bone screws can compensate for the absence of cortical fixation

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