Minimally-invasive alternatives in the treatment of distal articular tibial fractures

Pellegrini, Manuel J.; Cuchacovich, Natalio; Lagos, Leonardo; Henríquez, Hugo; Carcuro, Giovanni; Bastías, Christian

doi:10.1016/j.fuspru.2012.01.015

Cited by 8 publications

(10 citation statements)

References 37 publications

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“…[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] It has also been used for arthrodesis or resection arthrodesis with or without segment transport in cases with permanent articular surface destruction with or without bone loss. [5][6][7][8][9][10][11][12][13][14][15][16][17] Ankle arthrodesis has several disadvantages. Although there is controversy regarding the effect of ankle arthrodesis on adjacent-joint arthritic changes, adverse effects of ankle fusion have been reported, including decreased walking speed and stride length.…”

Section: Discussionmentioning

confidence: 99%

“…5 Moreover, soft tissue fibrosis and contractures of the tendons and ligaments of the lower leg and ankle may cause unforeseen problems after bone realignment. [5][6][7][8][9][10] In addition, if the fibula is intact and the syndesmotic ligaments are intact, the ankle is pushed to varus deformity, and if these ligaments are disrupted, it leads to a fibula plus deformity, resulting in impingement of lateral malleolus on the lateral wall of the calcaneus and peroneal tendons. 11 All these problems should be addressed at the time of treatment.…”

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confidence: 99%

“…11 All these problems should be addressed at the time of treatment. [5][6][7][8][9][10][11] Treatment options for very low tibial nonunion are limited, and regaining an acceptable function for a limb is challenging. 5 The most favorable results are to get fracture union, with infection-free tibial plafond and ankle joint, with the restoration of the articular surface and reasonable joint function.…”

mentioning

confidence: 99%

“…The most common techniques described in the literature are the Ilizarov fixator and blade plate reconstruction. [5][6][7][8][9] Blade plate fixation has various benefits, including the ability to accomplish stable fixation in small, osteopenic distal fragments. Also, this fixed-angle implant can help in deformity correction and compression across the nonunion site, and it can allow early ankle motion.…”

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confidence: 99%

“…The small osteopenic distal bone fragment cannot provide secure fixation, the segmental bone loss adds extra challenges, and the potential presence of infection aggravates the problem. [7][8][9] Periarticular nonunion can be a combination of angular, rotational, and translational malalignments with or without shortening all required correction for successful reconstruction. 5 Moreover, soft tissue fibrosis and contractures of the tendons and ligaments of the lower leg and ankle may cause unforeseen problems after bone realignment.…”

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confidence: 99%

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Management of Nonunion of Distal Tibial Periarticular Fractures Using Ilizarov External Fixator

Zayda,

Badr

2023

Techniques in Foot &Amp; Ankle Surgery

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Nonunion of the periarticular distal tibial fractures is a challenging issue with limited options for treatment. The study aims to evaluate the outcomes of treatment of non-united periarticular distal tibial fractures using Ilizarov external fixation. A retrospective study included 16 patients with distal tibial fracture nonunion treated with Ilizarov fixator from 2014 to 2019 with a minimum 1-year follow-up after frame removal. Fibular plating was done in 8 cases and supplementary interfragmentary screws at the nonunion site in 5 cases. Primary or delayed bone graft was used in 11 patients. The ASAMI protocol was used to assess the bone and functional results. The American Orthopaedic Foot and Ankle Society (AOFAS) scale was used to assess the functional outcomes. Study included 9 males and 7 females, mean age of 47.4±14.1 years. 15 cases had previous surgeries for nonunion. 7 had active infection. duration of nonunion was 24.1±13.2 months. Mean duration of fixation was 5.7±1.0 months. Mean follow-up was 21.8±8.5 months. Mean AOFAS score improved from 52.4±3.7 preoperatively to 85.4±9.8 at the latest follow-up (P<0.001). Finally, the infection was resolved, and union was achieved in all patients. Bone results were excellent in 3 cases and good in 13, whereas functional results were excellent in 6 cases, good in 8, fair in 1, and poor in 1. Ilizarov fixator is a reliable option for treating nonunion in the periarticular distal tibial fractures. It provides secure fixation for short distal fragments, especially with history of infection, those with bad skin conditions, previous failed internal fixation, and osteopenic bone. Level of Evidence: Level IV.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Management of Nonunion of Distal Tibial Periarticular Fractures Using Ilizarov External Fixator

Zayda,

Badr

2023

Techniques in Foot &Amp; Ankle Surgery

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Tibial Pilon Fracture

Bastías

Lagos

2022

Foot and Ankle Disorders

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Biomechanical features of six design of the delta external fixator for treating Pilon fracture: a finite element study

Ramlee

Sulong

García-Nieto

et al. 2018

Med Biol Eng Comput

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Pilon fractures can be caused by high-energy vertical forces which may result in long-term patient immobilization. Many experts in orthopedic surgery recommend the use of a Delta external fixator for type III Pilon fracture treatment. This device can promote immediate healing of fractured bone, minimizing the rate of complications as well as allowing early mobilization. The characteristics of different types of the Delta frame have not been demonstrated yet. By using the finite element method, this study was conducted to determine the biomechanical characteristics of six different configurations (Model 1 until Model 6). CT images from the lower limb of a healthy human were used to reconstruct three-dimensional models of foot and ankle bones. All bones were assigned with isotropic material properties and the cartilages were assigned to exhibit hyperelasticity. A linear link was used to simulate 37 ligaments at the ankle joint. Axial loads of 70 and 350 N were applied at the proximal tibia to simulate the stance and swing phase. The metatarsals and calcaneus were fixed distally in order to prevent rigid body motion. A synthetic ankle bone was used to validate the finite element model. The simulated results showed that Delta3 produced the highest relative micromovement (0.09 mm, 7 μm) during the stance and swing phase, respectively. The highest equivalent von Mises stress was found at the calcaneus pin of the Delta4 (423.2 MPa) as compared to others. In conclusion, Delta1 external fixator was the most favorable option for type III Pilon fracture treatment. Graphical abstract ᅟ.

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Minimally-invasive alternatives in the treatment of distal articular tibial fractures

Cited by 8 publications

References 37 publications

Management of Nonunion of Distal Tibial Periarticular Fractures Using Ilizarov External Fixator

Management of Nonunion of Distal Tibial Periarticular Fractures Using Ilizarov External Fixator

Tibial Pilon Fracture

Biomechanical features of six design of the delta external fixator for treating Pilon fracture: a finite element study

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