Distal Fibular Length Needed for Ankle Stability

2006 ◽  
Vol 27 (3) ◽  
pp. 185-189 ◽  
Author(s):  
Eiichi Uchiyama ◽  
Daisuke Suzuki ◽  
Hideji Kura ◽  
Toshihiko Yamashita ◽  
Gen Murakami
Keyword(s):  
Ankle Joint ◽  
External Rotation ◽  
Traction Force ◽  
Distal Fibula ◽  
Rotational Angle ◽  
Clear Cut ◽  
Long Term Stability ◽  
Ankle Stability ◽  
Fresh Frozen ◽  
The Stability

Background: The fibula is commonly used for bone grafts. Previous clinical and biomechanical studies have suggested that the length of the residual portion of the distal part of the fibula has an important effect on the long-term stability of the ankle joint. However, we cannot find clear-cut guidelines for the amount of bone that can be harvested safely. Methods: Using six normal fresh-frozen cadaver legs, motions of the tibia, talus and calcaneus were measured. The fibula was cut sequentially 3 cm from the proximal tip of the fibula and distally 10 cm, 6 cm, and 4 cm from the distal tip of the lateral malleolus. The angular motion of each bone was measured while a medial and lateral traction force of 19.6 N was applied to the proximal tibia. Angles of the tibia, talus, and calcaneus were measured. Results: Sequential resection of the fibula increased the inversion angles of the ankle joint. The proximal 3-cm cut increased the inversion angle from 42.1 ± 6.2 degrees to 49.6 ± 3.6 degrees, and the distal 4-cm cut increased the angle from 57.6 ± 6.6 degrees to 67.4 ± 5.9 degrees. The rotational angles were almost constant with sequential resections of the fibula; however, the distal 4-cm cut increased the rotational angle from 11.3 ± 25.1 degrees to 78.7 ± 37.5 degrees. Conclusions: The whole fibula including the head is essential for the stability of the ankle joint complex, and the distal fibula is responsible for stabilizing the ankle mortise during external rotation and inversion. We recommend fixation of the syndesmosis or bracing to prevent ankle joint instability with rotation of the talus in the mortise, especially when the distal fibula is shortened 6 cm or more.

Three-Dimensional Analysis of Ankle Instability after Tibiofibular Syndesmosis Injuries

2007 ◽  
Vol 36 (2) ◽  
pp. 348-352 ◽  
Author(s):  
Atsushi Teramoto ◽  
Hideji Kura ◽  
Eiichi Uchiyama ◽  
Daisuke Suzuki ◽  
Toshihiko Yamashita
Keyword(s):  
Ankle Joint ◽  
Ankle Instability ◽  
External Rotation ◽  
Tracking System ◽  
Three Dimensional ◽  
Traction Force ◽  
Tibiofibular Syndesmosis ◽  
Tibiofibular Ligament ◽  
Distal Tibiofibular Syndesmosis ◽  
Fresh Frozen

Background Rupture of the distal tibiofibular syndesmosis commonly occurs with extreme external rotation. Most studies of syndesmosis injuries have concentrated only on external rotation instability of the ankle joint and have not examined other defects. Hypothesis Syndesmosis injuries cause multidirectional ankle instability. Study Design Controlled laboratory study. Methods Ankle instability caused by distal tibiofibular syndesmosis injuries was examined using 7 normal fresh-frozen cadaveric legs. The anterior tibiofibular ligament, interosseous membrane, and posterior tibiofibular ligament, which compose the distal tibiofibular syndesmosis, were sequentially cut. Anterior, posterior, medial, and lateral traction forces, as well as internal and external rotation torque, were applied to the tibia; the diastasis between the tibia and fibula and the angular motion among the tibia, fibula, and talus were measured using a magnetic tracking system. Results A medial traction force with a cut anterior tibiofibular ligament significantly increased the diastasis from 1.1 to 2.0 mm ( P = .001) and talar tilt angles from 9.6° to 15.2° ( P < .001). External rotation torque significantly increased the diastasis from 0.5 to 1.8 mm ( P= .009) with a complete cut; external rotation torque also significantly increased rotational angles from 7.1° to 9.4° ( P = .05) with an anterior tibiofibular ligament cut. Conclusion Syndesmosis injuries caused ankle instability with medial traction force and external rotation torque to the tibia. Clinical Relevance Both physicians and athletes should be aware of inversion instability of the ankle joint caused by tibiofibular syndesmosis injuries.

scholarly journals Do weight bearing radiographs estimate the stability of an isolated distal fibula fracture?

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0052
Author(s):  
Sohail Yousaf ◽  
Daniel Hay
Keyword(s):  
Systematic Review ◽  
External Rotation ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
Controlled Trials ◽  
Distal Fibula ◽  
Fibula Fracture ◽  
Stress Radiographs ◽  
The Stability ◽  
Supination External Rotation

Category: Trauma Introduction/Purpose: Differentiating stable isolated fibula fractures consistent with supination external rotation (SER) II ankle fractures from unstable SER IV fractures is essential in determining the need for surgical stabilisation. Stress radiographs are usually required to assess stability including gravity stress views (GSV) and external rotation views (ER). There is no clear consensus as to which modality is most useful to determine stability in a fracture clinic or emergency setting. In last, few years clinical uncertainty about the reliability has led researcher to focus on weight bearing radiographs (WB) .We aim to review recent literature regarding reliability of WB radiographs to estimate the stability of supination external rotation ankle fractures. Methods: A systematic review of the literature relating to radiological assessment of stability of supination external rotation ankle fractures was conducted according to PRISMA guidelines. The systematic review was prospectively registered with PROSPERO. It involved the following steps: Researching the question-Do weight bearing radiographs estimate the stability of an isolated distal fibula fracture? Setting inclusion and exclusion criteria-All English language articles published in the including any Randomised controlled trials (RCT’s) and cohort studies. Data collection)– A literature search of Medline (PubMed), the Cochrane Bone, Joint, and Muscle Trauma Group trial register, the Cochrane central register of controlled trials, Embase and CINAHL was undertaken. The grey literature was searched. Key terms ‘supination external rotation fracture’, ‘stability’. Other variations to the key words were ‘weight bearing’, “axial load”, ‘stress x-rays’, ‘systematic reviews’ and ‘meta-analysis’. Results: A total of six studies met the inclusion criteria including 601 patients. No previous systematic review on stress radiographs including weight bearing was published. All studies concluded weight bearing radiographs is an easy, pain-free, safe and reliable method to estimate stability of isolated distal fibula fractures. No serious concerns or complications were reported. Conclusion: The evidence base contained many methodological limitations and most of the evidence was either level III or IV, and so any conclusion drawn from the research must be done so with caution. The studies suggest that GSV overestimates the instability which should be assessed with studies should focus on randomized controlled trials with narrow range of clinically useful outcome measures.

Peroneus Longus Ligamentoplasty for Chronic Instability of the Distal Tibiofibular Syndesmosis

2003 ◽  
Vol 24 (5) ◽  
pp. 392-397 ◽  
Author(s):  
Rene Grass ◽  
Stefan Rammelt ◽  
Achim Biewener ◽  
Hans Zwipp
Keyword(s):  
Pain Relief ◽  
Ankle Joint ◽  
External Rotation ◽  
Tendon Graft ◽  
Surgical Reconstruction ◽  
Distal Fibula ◽  
Chronic Instability ◽  
Peroneus Longus ◽  
Fracture Dislocations

The distal tibiofibular syndesmosmotic ligament complex is important for dynamic stability and congruency of the ankle joint. Syndesmotic lesions in the ankle fracture-dislocations are well recognized and classified systematically. Chronic insufficiency of the syndesmosis leads to a lateral shift of the talus and under eversion stress permits a pathological rotation of the talus. There is also retroversion of the distal fibula representing a painful deformity. Little experience exists with surgical reconstruction of the syndesmosis. This article describes a new ligamentoplasty with a split peroneus longus tendon graft that mimics the normal anatomic conditions of the syndesmotic complex in 16 patients with symptomatic chronic syndesmotic insufficiency after pronation-external rotation and pronation abduction injuries to the ankle joint. Postoperatively, no infections or hematomas were seen. One patient had asymptomatic breakage of the syndesmosis screw; one patient had a 10° decrease of dorsiflexion at the ankle because of a partial anterior tibiofibular synostosis. Fifteen of 16 patients had pain relief at a mean follow-up period of 16.4 months (range, 13–29 months); all patients had relief of the chronic swelling of the ankle and the giving way. The mean Karlsson score at follow-up was 88 (range, 70–100) points. It may be concluded that peroneus longus ligamentoplasty in a preliminary series resulted in reliable ankle stability and considerable pain relief in patients with chronic syndesmotic instability.

KINEMATIC AND KINETIC ADAPTATIONS IN THE LOWER EXTREMITIES OF EXPERIENCED WEARERS DURING HIGH-HEELED GAIT

2014 ◽  
Vol 26 (03) ◽  
pp. 1450042 ◽  
Author(s):  
Hui-Lien Chien ◽  
Tung-Wu Lu ◽  
Ming-Wei Liu ◽  
Shih-Wun Hong ◽  
Chien-Chung Kuo
Keyword(s):  
Ground Reaction Force ◽  
External Rotation ◽  
Center Of Mass ◽  
Reaction Force ◽  
Lower Extremities ◽  
Heel Strike ◽  
Ankle Stability ◽  
Flexion Extension ◽  
Hip Abduction ◽  
The Stability

High-heeled shoes are associated with falling, leading to injuries such as fracture and ankle sprain. The study aimed to investigate the kinematic and kinetic adaptations in the lower extremities resulting from habitual use of high-heeled shoes. A total of 15 female experienced wearers and 15 matched controls walked with high-heeled shoes (7.3 cm) while kinematic and ground reaction force data were measured and used to calculate the joint angles and moments, as well as the temporal-distance parameters. Compared with inexperienced wearers, experienced wearers appeared to adopt a specific control strategy to improve the stability of the support ankle and knee while preventing excessive loading at the knee and hip. Increased hip abduction during early stance phase and increased pelvis rotation toward the ipsilateral side at contralateral heel-strike appeared to contribute toward the reduced step width for a better adjustment of the medio-lateral motion of the body's center of mass in order to maintain stability. At the hip, increased abductor moments may help to increase the pelvis stability and prevent excessive loading at the knee, and reduced internal rotator moments may reduce the torsional loading at the hip. At the knee, reduced ranges of flexion-extension and adduction-abduction motions may increase its stability. At the ankle, increased external rotation angles, together with increased pronator and external rotator moments through increased ground reaction force, may enhance the ankle stability. The current results identified the changes in the kinematics and kinetics of the lower extremities in females after long-term use of high-heeled shoes, providing a basis for future development of training programs and design of new high-heeled shoes to help those who have higher risks of falling and injuries during high-heeled gait.

Comparison of Suture-Augmented Ligamentplasty to Transarticular Screws in a Lisfranc Cadaveric Model

2020 ◽  
Vol 41 (6) ◽  
pp. 735-743
Author(s):  
Caio Nery ◽  
Daniel Baumfeld ◽  
Tiago Baumfeld ◽  
Marcelo Prado ◽  
Eric Giza ◽  
...  
Keyword(s):  
External Rotation ◽  
Treatment Options ◽  
High Energy ◽  
Lisfranc Injury ◽  
New Information ◽  
Injury Model ◽  
Fresh Frozen ◽  
Lower Variability ◽  
The Stability ◽  
Lisfranc Injuries

Background: Lisfranc injuries represent a spectrum of trauma from high-energy lesions, with significant instability of the midfoot, to low-energy lesions, with subtle subluxations or instability without gross displacement. Recently, treatment options that allow for physiologic fixation of this multiplanar joint are being evaluated. The purpose of this study was to analyze the stability of a cadaveric Lisfranc injury model fixed with a novel suture-augmented neoligamentplasty in comparison with a traditional transarticular screw fixation construct. Methods: Twenty-four fresh-frozen, matched cadaveric leg and foot specimens (12 individuals younger than 65 years of age) were used for this study. Two different types of Lisfranc ligament injuries were tested: partial and complete. Two different methods of fixation were compared: transarticular screws and augmented suture ligamentplasty with FiberTape. Specimens were fixed to a rotation platform in order to stress the joints while applying 400 N of axial load and internal and external rotation. Six distances were measured and compared between the intact, injured, and fixed states with a 3D Digitizer arm, in order to evaluate the stability between them. Analysis of variance was used with P < .05 considered significant. Results: Using distribution graphs and analyzing the grouped data, it was observed that there was no difference between the 2 stabilization methods, but the augmented suture ligamentplasty presented lower variability and observed distance shortenings were more likely to be around the mean. The variability of the stabilization with screws was 2.9 times higher than that with tape ( P < .001). Conclusion: We suggest that augmented suture ligamentplasty can achieve similar stability to classic transarticular screws, with less variability. Clinical Relevance: This cadaveric study adds new information on the debate about Lisfranc lesions treatment. Flexible fixations, such as the synthethic ligamentplasty used, can restore good stability such as conventional transarticular screws.

Effect of an Anterior Glenoid Defect on Anterior Shoulder Stability

2009 ◽  
Vol 37 (5) ◽  
pp. 949-954 ◽  
Author(s):  
Nobuyuki Yamamoto ◽  
Eiji Itoi ◽  
Hidekazu Abe ◽  
Kazuma Kikuchi ◽  
Nobutoshi Seki ◽  
...  
Keyword(s):  
External Rotation ◽  
Force Transducer ◽  
Joint Stability ◽  
Glenoid Defect ◽  
Stability Ratio ◽  
Anterior Glenoid ◽  
Fresh Frozen ◽  
Osseous Defect ◽  
The Stability ◽  
Shoulder Stability

Background There have been few biomechanical studies to clarify which size of a glenoid defect is critical. However, those studies have assumed that the defect occurred anteroinferiorly. Recent studies have reported that the defect is located anteriorly rather than anteroinferiorly. Therefore, the effect of the anterior, not anteroinferior, glenoid defect on shoulder stability needs to be investigated. Hypothesis The anterior glenoid defect would have a similar effect on anterior shoulder stability as that of the anteroinferior glenoid defect. Study Design Controlled laboratory study. Methods Eight fresh-frozen cadaveric shoulders were used (mean age, 74 years). The specimen was attached to a shoulder-testing device with the arm in abduction and external rotation. An osseous defect was created stepwise with a 2-mm increment of the defect width. The stability ratio was used to evaluate joint stability. With a 50-N axial force, the translational force applied to the humeral head was measured by a force transducer. Results The stability ratio without a defect (32% ± 6%) significantly decreased after creating a 6-mm defect (17% ± 5%; P = .0001), which was equivalent to 20% of the glenoid length. Conclusion An osseous defect at 3 o'clock with a width that was equal to or greater than 20% of the glenoid length significantly decreased anterior stability. Clinical Relevance The results suggest that reconstruction of the glenoid concavity might be necessary in shoulders with an anterior glenoid defect of at least 20% of the glenoid length.

An Anatomic Study of the Short Oblique Fracture of the Distal Fibula and Ankle Stability

Foot & Ankle ◽  
1983 ◽  
Vol 4 (1) ◽  
pp. 23-29 ◽  
Author(s):  
Marion C. Harper
Keyword(s):  
External Rotation ◽  
Deltoid Ligament ◽  
Medial Malleolus ◽  
Anatomic Study ◽  
Distal Fibula ◽  
Rotational Displacement ◽  
Oblique Fracture ◽  
Ankle Stability ◽  
Joint Incongruity ◽  
Supination External Rotation

The short oblique fracture of the distal fibula occurring as a stage 2 supination-external rotation injury was investigated in respect to its effect on ankle stability in a series of cadaver dissections. Approximately 25 and 20 degrees of external rotational displacement of the distal fibula and talus, respectively, as well as approximately 1 mm of direct lateral talar shift were noted to be possible with this injury. This degree of rotational or lateral talar displacement was seen to result in tibiotalar joint incongruity. The deltoid ligament effectively prevented talar eversion but not the initial 2 to 3 mm of lateral talar displacement. Ankle stability in respect to medial talar shift was not compromised by removal of the medial malleolus.

The Stability of the WHO Reference Thromboplastin NIBS & C 67/40

1979 ◽  
Vol 42 (04) ◽  
pp. 1135-1140 ◽  
Author(s):  
G I C Ingram
Keyword(s):  
Human Brain ◽  
Collaborative Study ◽  
Calibration Constant ◽  
Long Term Stability ◽  
Freeze Dried ◽  
Show Evidence ◽  
Human Material ◽  
Reference Preparation ◽  
The Stability

SummaryThe International Reference Preparation of human brain thromboplastin coded 67/40 has been thought to show evidence of instability. The evidence is discussed and is not thought to be strong; but it is suggested that it would be wise to replace 67/40 with a new preparation of human brain, both for this reason and because 67/40 is in a form (like Thrombotest) in which few workers seem to use human brain. A �plain� preparation would be more appropriate; and a freeze-dried sample of BCT is recommended as the successor preparation. The opportunity should be taken also to replace the corresponding ox and rabbit preparations. In the collaborative study which would be required it would then be desirable to test in parallel the three old and the three new preparations. The relative sensitivities of the old preparations could be compared with those found in earlier studies to obtain further evidence on the stability of 67/40; if stability were confirmed, the new preparations should be calibrated against it, but if not, the new human material should receive a calibration constant of 1.0 and the new ox and rabbit materials calibrated against that.The types of evidence available for monitoring the long-term stability of a thromboplastin are discussed.

Stability as a constraint in sagittal plane human force exertion modeling

1998 ◽  
Vol 1 (1) ◽  
pp. 23-39
Author(s):  
Carter J. Kerk ◽  
Don B. Chaffin ◽  
W. Monroe Keyserling
Keyword(s):  
Muscle Strength ◽  
Ankle Joint ◽  
Coefficient Of Friction ◽  
Sagittal Plane ◽  
Biomechanical Model ◽  
Whole Body ◽  
The Stability ◽  
Joint Center ◽  
Static Conditions ◽  
Stability Limits

The stability constraints of a two-dimensional static human force exertion capability model (2DHFEC) were evaluated with subjects of varying anthropometry and strength capabilities performing manual exertions. The biomechanical model comprehensively estimated human force exertion capability under sagittally symmetric static conditions using constraints from three classes: stability, joint muscle strength, and coefficient of friction. Experimental results showed the concept of stability must be considered with joint muscle strength capability and coefficient of friction in predicting hand force exertion capability. Information was gained concerning foot modeling parameters as they affect whole-body stability. Findings indicated that stability limits should be placed approximately 37 % the ankle joint center to the posterior-most point of the foot and 130 % the distance from the ankle joint center to the maximal medial protuberance (the ball of the foot). 2DHFEC provided improvements over existing models, especially where horizontal push/pull forces create balance concerns.

scholarly journals Biomechanical Evaluation of Tarsometatarsal Fusion Comparing Crossing Lag Screws and Lag Screw With Locking Plate

2021 ◽  
pp. 107110072110335
Author(s):  
Sarah Ettinger ◽  
Lisa-Christin Hemmersbach ◽  
Michael Schwarze ◽  
Christina Stukenborg-Colsman ◽  
Daiwei Yao ◽  
...  
Keyword(s):  
Locking Plate ◽  
Screw Fixation ◽  
Operative Procedure ◽  
Fixation Technique ◽  
Lag Screw ◽  
Group 15 ◽  
Fresh Frozen ◽  
Biomechanical Evaluation ◽  
The Stability ◽  
End Stage

Background: Tarsometatarsal (TMT) arthrodesis is a common operative procedure for end-stage arthritis of the TMT joints. To date, there is no consensus on the best fixation technique for TMT arthrodesis and which joints should be included. Methods: Thirty fresh-frozen feet were divided into one group (15 feet) in which TMT joints I-III were fused with a lag screw and locking plate and a second group (15 feet) in which TMT joints I-III were fused with 2 crossing lag screws. The arthrodesis was performed stepwise with evaluation of mobility between the metatarsal and cuneiform bones after every application or removal of a lag screw or locking plate. Results: Isolated lag-screw arthrodesis of the TMT I-III joints led to significantly increased stability in every joint ( P < .05). Additional application of a locking plate caused further stability in every TMT joint ( P < .05). An additional crossed lag screw did not significantly increase rigidity of the TMT II and III joints ( P > .05). An IM screw did not influence the stability of the fused TMT joints. For TMT III arthrodesis, lag-screw and locking plate constructs were superior to crossed lag-screw fixation ( P < .05). TMT I fusion does not support stability after TMT II and III arthrodesis. Conclusion: Each fixation technique provided sufficient stabilization of the TMT joints. Use of a lag screw plus locking plate might be superior to crossed screw fixation. An additional TMT I and/or III arthrodesis did not increase stability of an isolated TMT II arthrodesis. Clinical Relevance: We report the first biomechanical evaluation of TMT I-III arthrodesis. Our results may help surgeons to choose among osteosynthesis techniques and which joints to include in performing arthrodesis of TMT I-III joints.

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