A clinical evaluation of alternative fixation techniques for medial malleolus fractures

Fifty embalmed human tibias were osteotomized to create a simulated vertical shear (supination-adduction) fracture of the medial malleolus and were stabilized using one of five internal fixation techniques. In offset axial testing, which simulated supination-adduction loading, the fixation strength of tibias stabilized with either cortical or cancellous lag screws placed perpendicular to the osteotomy was over five times greater than the strength of those treated with an antiglide plate and nearly two and a half times greater than those treated with cancellous lag screws placed oblique to the osteotomy. The tibias stabilized with cancellous lag screws placed perpendicular to the osteotomy exhibited twice the fixation strength of the tibias stabilized with an antiglide plate and distal lag screw. The tibias stabilized with an antiglide plate and distal lag screw and perpendicularly placed cortical or cancellous lag screws demonstrated three times greater resistance to displacement to the applied supination-adduction load than those stabilized with an antiglide plate alone. In offset transverse testing, to simulate loading in external rotation, the mean failure load of the tibias stabilized with cancellous lag screws placed perpendicular to the osteotomy was over two and a half times greater than those stabilized with an antiglide plate and distal lag screw. No significant differences were observed in the resistance to displacement for these tests. These results support the use of lag screws placed perpendicular to the fracture surface for stabilization of vertical shear fractures of the medial malleolus and indicate that the use of an antiglide plate, with or without a distal lag screw, does not offer any advantage over lag screw fixation.

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Lateral Malleolus Hook-Plate Fixation in the Treatment of Herscovici Type B Medial Malleolar Fractures: The Clinical Evaluation of an Alternative Fixation Technique

Orthopedic & Muscular System ◽

10.4172/2161-0533.1000250 ◽

2018 ◽

Vol 07 (01) ◽

Author(s):

Kai Xiao ◽

Zhen hua Fang ◽

Cheng Hao

Keyword(s):

Clinical Evaluation ◽

Plate Fixation ◽

Lateral Malleolus ◽

Hook Plate ◽

Type B ◽

Fixation Technique ◽

Malleolar Fractures ◽

Alternative Fixation

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Traumatic Craniocervical Dissociation in Patients with Congenital Assimilation of the Atlas to the Occiput

Case Reports in Orthopedics ◽

10.1155/2019/2617379 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Celeste Tavolaro ◽

Hector Pulido ◽

Richard Bransford ◽

Carlo Bellabarba

Keyword(s):

Computer Tomography ◽

General Rule ◽

Vertebral Arteries ◽

Risk Of Injury ◽

Segmental Instrumentation ◽

Fixation Techniques ◽

Alternative Fixation ◽

Computer Tomography Angiography ◽

Neurologically Intact ◽

Abnormal Anatomy

Traumatic atlantooccipital dissociation (AOD) is a severe and usually fatal injury. Patients with assimilation of the atlas to the skull are exposed to a higher risk of injury and delay diagnosis due to the abnormal anatomy. We report two cases of acute traumatic craniocervical dislocation in patients with baseline congenital assimilation of the atlas to the skull. Computer tomography (CT) was used to identify the injury. Computer tomography angiography (CTA) showed variations of the vertebral arteries’ location on both patients. Assimilation of the atlas was complete in patient one and partial in patient two. Emergent surgical instrumentation and fusion were performed with a very careful and meticulous posterior dissection. As general rule, most of the patients with CCD will undergo occiput to C2 posterior segmental instrumentation and fusion. In the presented cases, a more extensive fusion was necessary based on the type and severity of the CCJ injury and the anatomical anomalies associated. Postoperatively, patient one remained neurologically intact and patient two died. Alternative fixation techniques should be used to minimize risk of VA injury during the surgical procedures.

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A comparative study of three commonly used fixation techniques for isolated medial malleolus fracture

Joint Diseases and Related Surgery ◽

10.5606/ehc.2018.61449 ◽

2018 ◽

Vol 29 (2) ◽

pp. 104-109 ◽

Cited By ~ 3

Author(s):

Alauddin Kochai

Keyword(s):

Comparative Study ◽

Medial Malleolus ◽

Fixation Techniques ◽

Medial Malleolus Fracture

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Medial Malleolus Fracture Fixation in the Setting of Concomitant Tibial Shaft Fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000106 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001

Author(s):

Stephen Barchick ◽

Samuel Adams ◽

Andrew Matson

Keyword(s):

Shaft Fracture ◽

Medial Malleolus ◽

Tibial Shaft Fracture ◽

Tibial Shaft ◽

Shaft Fractures ◽

Tibial Nail ◽

Fixation Techniques ◽

Medial Malleolus Fracture ◽

Buttress Plate ◽

Tibial Shaft Fractures

Category: Ankle, Trauma Introduction/Purpose: The association between tibial shaft fractures and concomitant posterior malleolus fractures has been well-studied; however less is known about tibial shaft fractures and concomitant medial malleolus fractures. Treatment of tibial shaft fractures with a plate or intramedullary nail in the setting of concomitant medial malleolus fracture may pose obstacles to standard medial malleolus fractures fixation due to hardware that impedes optimal screw placement. The purpose of this study is to report the presentation and management strategies used to treat medial malleolus fractures in the setting of concomitant tibial shaft fractures. Methods: From 2011 to 2015, seven (1.4%) patients were identified with concomitant tibial shaft fractures and isolated medial malleolus fractures. Data was collected through review of patient charts, radiographs, and operative reports including the following variables: demographics, injury patterns, fixation techniques, and outcomes. Five male patients and two female patients with a mean age of 39.1 years (range, 13.9-67.9 years) were included. Three patients reported tobacco use. Mechanisms of injury included motor vehicle accident (n=4), fall from standing (n=2), and pedestrian versus vehicle (n=1). Average medial malleolus fracture fragment length was 19.1 mm (range, 14.3-29.4 mm). Tibial shaft fractures were open in four cases, and included five transverse patterns, one spiral pattern, and one segmental fracture. All patients were treated surgically for tibial shaft and medial malleolus fractures simultaneously. All medial malleolus reductions were anatomic. The average time to union for medial malleolus fractures was 3.12 months (range 1.53 to 5.93 months). Results: Fixation techniques included screw (n=5) or buttress plate (n=2) fixation for the medial malleolus, and intramedullary nailing (6) or blade plate fixation (n=1, prior TKA) for the tibial shaft. Of the five medial malleolus fractures treated with screw fixation, screws were positioned anteriorly (n=2) or medially (n=2) to tibial shaft fixation implant in four cases; in one case the distal extent of the tibial nail was proximal to the medial malleolar screws. One buttress plate was placed with screws distal to the tibial nail, another was placed angling one proximal screw anterior and one posterior to the tibial nail. Two patients reported complications following surgery: one with chronic pain and one with wound dehiscence and delayed union at the open tibial shaft fracture site. Conclusion: Seven patients were treated operatively for concomitant tibial shaft and medial malleolus fractures, requiring careful attention to placement of medial malleolar screws or buttress plate due to the presence of implant used to treat the tibial shaft fracture. Medial malleolar screws can safely be redirected anteriorly or medially to accommodate the tibial shaft fracture implant, with acceptable fracture union outcomes in this small case series. Further biomechanical and long-term data may help to validate these adjustments to standard techniques.

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An Alternative Fixation Technique for Small Medial Malleolus Fractures

Orthopedics ◽

10.3928/01477447-20101021-17 ◽

2010 ◽

Vol 33 (12) ◽

pp. 888-889 ◽

Cited By ~ 4

Author(s):

Derek F. Amanatullah ◽

Philip R. Wolinsky

Keyword(s):

Medial Malleolus ◽

Fixation Technique ◽

Alternative Fixation

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Structural aspects of tracheary element differentiation in suspension cultures of Zinnia elegans

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100155815 ◽

1989 ◽

Vol 47 ◽

pp. 768-769

Author(s):

C. H. Haigler ◽

A. W. Roberts

Keyword(s):

Tracheary Element ◽

Vesicle Fusion ◽

Zinnia Elegans ◽

Cellulose Synthesis ◽

Tracheary Elements ◽

Animal Cells ◽

Mesophyll Cells ◽

Fixation Techniques ◽

Localized Patterns ◽

Structural Aspects

Tracheary elements, the water-conducting cells in plants, are characterized by their reinforced walls that became thickened in localized patterns during differentiation (Fig. 1). The synthesis of this localized wall involves abundant secretion of Golgi vesicles that export preformed matrix polysaccharides and putative proteins involved in cellulose synthesis. Since the cells are not growing, some kind of endocytotic process must also occur. Many researchers have commented on where exocytosis occurs in relation to the thickenings (for example, see), but they based their interpretations on chemical fixation techniques that are not likely to provide reliable information about rapid processes such as vesicle fusion. We have used rapid freezing to more accurately assess patterns of vesicle fusion in tracheary elements. We have also determined the localization of calcium, which is known to regulate vesicle fusion in plant and animal cells.Mesophyll cells were obtained from immature first leaves of Zinnia elegans var. Envy (Park Seed Co., Greenwood, S.C.) and cultured as described previously with the following exceptions: (a) concentration of benzylaminopurine in the culture medium was reduced to 0.2 mg/l and myoinositol was eliminated; and (b) 1.75ml cultures were incubated in 22 x 90mm shell vials with 112rpm rotary shaking. Cells that were actively involved in differentiation were harvested and frozen in solidifying Freon as described previously. Fractures occurred preferentially at the cell/planchet interface, which allowed us to find some excellently-preserved cells in the replicas. Other differentiating cells were incubated for 20-30 min in 10(μM CTC (Sigma), an antibiotic that fluoresces in the presence of membrane-sequestered calcium. They were observed in an Olympus BH-2 microscope equipped for epi-fluorescence (violet filter package and additional Zeiss KP560 barrier filter to block chlorophyll autofluorescence).

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