Design and Use of an Ankle Joint-Bridging Two-Frame External Fixator for the Management of Complex Fractures and Dislocations in and Around the Ankle Joint

Abstract Background: Advanced to end-stage ankle osteoarthritis in highly active older individuals has traditionally been treated using tibiotalar arthrodesis. With tibiotalar arthrodesis, high levels of pain-free function are possible; however, there is a loss of ankle joint movement and a risk of future arthrosis in the adjacent joints. Distraction arthroplasty is a simple method that allows joint cartilage repair; however, the results are currently mixed, with some reports showing improved pain scores and others showing no improvement. Distal tibial osteotomy (DTO) without fibular osteotomy, a type of joint preservation surgery, has garnered attention in recent years. However, to our knowledge, there are no reports on DTO with joint distraction using a circular external fixator. Therefore, the purpose of this study was to examine the effect of DTO with joint distraction using a circular external fixator on ankle osteoarthritis. Methods: A total of 21 patients with medial ankle arthritis were examined. Arthroscopic synovectomy and a microfracture procedure were performed. Subsequently, angled osteotomy and correction of the distal tibia were performed. After ankle conditions improved, stabilization of the ankle joint was performed. An external fixator was used in all patients. In addition, joint distraction of about 5.8 mm was performed. All patients were allowed full weight-bearing walking immediately after surgery. Results: The anteroposterior mortise angle during weight-bearing, lateral mortise angle during weight-bearing, and talar tilt angle and anterior translation of the talus on ankle stress radiography significantly improved (P < 0.05). In addition, signal changes on magnetic resonance imaging improved in all patients. Visual analogue scale and American Orthopedic Foot & Ankle Society scores also improved significantly (P < 0.05). No severe complications were observed. Conclusion: DTO with joint distraction may be useful for older patients with a high physical activity level as a joint-preserving surgery for medial ankle osteoarthritis. Level of evidence: Level IV, retrospective case series Key words : distal tibial osteotomy, medial ankle arthritis, joint distraction, circular external fixator

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The effect of stress distribution and displacement of open subtalar dislocation in using titanium alloy and stainless steel mitkovic external fixator – a finite element analysis

Malaysian Journal of Fundamental and Applied Sciences ◽

10.11113/mjfas.v13n4-2.804 ◽

2017 ◽

Vol 13 (4-2) ◽

pp. 477-482 ◽

Cited By ~ 2

Author(s):

Muhammad Hanif Hanif Ramlee ◽

Abdul Hadi Abd Wahab ◽

Asnida Abd Wahab ◽

Hadafi Fitri Mohd Latip ◽

Siti Asmah Daud ◽

...

Keyword(s):

Finite Element ◽

Stainless Steel ◽

Titanium Alloy ◽

Stress Distribution ◽

Ankle Joint ◽

External Fixator ◽

Healing Process ◽

Foot And Ankle ◽

Subtalar Dislocation ◽

Tibia Bone

An external fixator is normally used by medical surgeons in treating subtalar dislocation due to its biomechanical characteristics that can providing an adequate stability, preventing deformity (mal-union and non-union), reduce rate of infections, and promoting fast healing process as compared to coventional internal fixator. Apart from the configurations and fixation techniques, previous studies has mentioned that the stability of external fixator can be altered and manipulated by using different materials, e.g. stainless steel, titanium alloy and polymer. To be noted, the current available research works that have been investigated on different materials of external fixator are still lacking, therefore, the present study is aims to conduct related study. The main objective of the research work is to simulate finite element model of foot and ankle joint associated with open subtalar dislocation in which treated with Mitkovic external fixator by using two different material properties; titanium alloy (Model 1) and stainless steel (Model 2). The three-dimensional model of foot and ankle joint were reconstructed using images of CT dataset. For the soft tissues, cartilages at the ankle joint were developed by offsetting the bone surfaces with 1 mm thickness while ligaments were modelled with linear links. Homogeneous and isotropic properties were assigned to the bone, Mooney-Rivlin model for cartilage and specific stiffness value for ligaments. In order to simulate stance phase during walking condition, an axial load of 350 N was applied to the proximal tibia bone. The results of von Mises stress demonstrated that Model 2 has a low magnitude (127 MPa) at the pin-bone interface of tibia bone, compared with Model 1 (369 MPa). As for the local displacement at the bony segment of fibula, Model 2 (3.3 mm) indicated high stability of the external fixator than Model 1 (7.4 mm). In conclusion, the use of stainless steel material for Mitkovic external fixator can provide adequate stability and optimum stress distribution.

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Effectiveness of distal tibial osteotomy with distraction arthroplasty in varus ankle osteoarthritis

10.21203/rs.2.17170/v3 ◽

2020 ◽

Author(s):

Koji Nozaka ◽

Naohisa Miyakoshi ◽

Takeshi Kashiwagura ◽

Yuji Kasukawa ◽

Hidetomo Saito ◽

...

Keyword(s):

Ankle Joint ◽

External Fixator ◽

Weight Bearing ◽

Tibial Osteotomy ◽

Ankle Arthritis ◽

Ankle Osteoarthritis ◽

Distraction Arthroplasty ◽

Circular External Fixator ◽

Joint Distraction ◽

Tibiotalar Arthrodesis

Abstract Background: Advanced to end-stage ankle osteoarthritis in highly active older individuals has traditionally been treated using tibiotalar arthrodesis. With tibiotalar arthrodesis, high levels of pain-free function are possible; however, there is a loss of ankle joint movement and a risk of future arthrosis in the adjacent joints. Distraction arthroplasty is a simple method that allows joint cartilage repair; however, the results are currently mixed, with some reports showing improved pain scores and others showing no improvement. Distal tibial osteotomy (DTO) without fibular osteotomy, a type of joint preservation surgery, has garnered attention in recent years. However, to our knowledge, there are no reports on DTO with joint distraction using a circular external fixator. Therefore, the purpose of this study was to examine the effect of DTO with joint distraction using a circular external fixator on ankle osteoarthritis. Methods: A total of 21 patients with medial ankle arthritis were examined. Arthroscopic synovectomy and a microfracture procedure were performed. Subsequently, angled osteotomy and correction of the distal tibia were performed. After ankle conditions improved, stabilization of the ankle joint was performed. An external fixator was used in all patients. In addition, joint distraction of about 5.8 mm was performed. All patients were allowed full weight-bearing walking immediately after surgery. Results: The anteroposterior mortise angle during weight-bearing, lateral mortise angle during weight-bearing, and talar tilt angle and anterior translation of the talus on ankle stress radiography significantly improved (P < 0.05). In addition, signal changes on magnetic resonance imaging improved in all patients. Visual analogue scale and American Orthopedic Foot & Ankle Society scores also improved significantly (P < 0.05). No severe complications were observed. Conclusion: DTO with joint distraction may be useful for older patients with a high physical activity level as a joint-preserving surgery for medial ankle osteoarthritis. Level of evidence: Level IV, retrospective case series Key words : distal tibial osteotomy, medial ankle arthritis, joint distraction, circular external fixator

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Arthroscopic Findings of the Joint Distraction for the Patient With Chondrolysis of the Ankle

Diagnostic and Therapeutic Endoscopy ◽

10.1155/dte.4.101 ◽

1997 ◽

Vol 4 (2) ◽

pp. 101-105 ◽

Cited By ~ 5

Author(s):

Katsuaki Kanbe ◽

Atsushi Hasegawa ◽

Kenji Takagishi ◽

Hiroyuki Kaneko ◽

Yasuyuki Nakajima

Keyword(s):

Case Report ◽

Ankle Joint ◽

External Fixator ◽

Articular Surfaces ◽

Arthroscopic Findings ◽

Joint Distraction

This case report describes arthroscopic findings of the effect on articular distraction of ankle joint by means of external fixator for the patient with chondrolysis. Arthroscopy showed fibrocartilage tissue lying between the talus and tibia to protect damaged articular surfaces although apparent repair of surface cartilage failed to find.

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