Early Weight-Bearing After Percutaneous Reduction and Screw Fixation for Low-Energy Lisfranc Injury

2013 ◽  
Vol 34 (7) ◽  
pp. 978-983 ◽  
Author(s):  
Emilio Wagner ◽  
Cristian Ortiz ◽  
Ignacio E. Villalón ◽  
Andrés Keller ◽  
Pablo Wagner
Keyword(s):  
Screw Fixation ◽  
Weight Bearing ◽  
Low Energy ◽  
Early Weight Bearing ◽  
Lisfranc Injury ◽  
Percutaneous Reduction

Percutaneous Reduction and 2.7-mm Cortical Screw Fixation for Low-Energy Lisfranc Injuries

2020 ◽  
Vol 59 (5) ◽  
pp. 914-918 ◽  
Author(s):  
Young Hwan Park ◽  
Jeong Hwan Ahn ◽  
Gi Won Choi ◽  
Hak Jun Kim
Keyword(s):  
Screw Fixation ◽  
Low Energy ◽  
Percutaneous Reduction ◽  
Cortical Screw ◽  
Lisfranc Injuries

scholarly journals Cement-augmented screw fixation for calcaneal fracture treatment: a biomechanical study comparing two injectable bone substitutes

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Konrad F. Fuchs ◽  
Philipp Heilig ◽  
Miriam McDonogh ◽  
Sebastian Boelch ◽  
Uwe Gbureck ◽  
...  
Keyword(s):  
Bone Cement ◽  
Screw Fixation ◽  
Weight Bearing ◽  
Calcaneal Fracture ◽  
Fracture Treatment ◽  
Peak Displacement ◽  
Early Weight Bearing ◽  
Screw Osteosynthesis ◽  
Total Displacement ◽  
With Screws

Abstract Background The role of cement-augmented screw fixation for calcaneal fracture treatment remains unclear. Therefore, this study was performed to biomechanically analyze screw osteosynthesis by reinforcement with either a calcium phosphate (CP)-based or polymethylmethacrylate (PMMA)-based injectable bone cement. Methods A calcaneal fracture (Sanders type IIA) including a central cancellous bone defect was generated in 27 synthetic bones, and the specimens were assigned to 3 groups. The first group was fixed with four screws (3.5 mm and 6.5 mm), the second group with screws and CP-based cement (Graftys® QuickSet; Graftys, Aix-en-Provence, France), and the third group with screws and PMMA-based cement (Traumacem™ V+; DePuy Synthes, Warsaw, IN, USA). Biomechanical testing was conducted to analyze peak-to-peak displacement, total displacement, and stiffness in following a standardized protocol. Results The peak-to-peak displacement under a 200-N load was not significantly different among the groups; however, peak-to-peak displacement under a 600- and 1000-N load as well as total displacement exhibited better stability in PMMA-augmented screw osteosynthesis compared to screw fixation without augmentation. The stiffness of the construct was increased by both CP- and PMMA-based cements. Conclusion Addition of an injectable bone cement to screw osteosynthesis is able to increase fixation strength in a biomechanical calcaneal fracture model with synthetic bones. In such cases, PMMA-based cements are more effective than CP-based cements because of their inherently higher compressive strength. However, whether this high strength is required in the clinical setting for early weight-bearing remains controversial, and the non-degradable properties of PMMA might cause difficulties during subsequent interventions in younger patients.

scholarly journals Early Weight Bearing on Weber C Fractures with Retained Syndesmotic Screws

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Cristian Ortiz ◽  
Andres Keller Díaz ◽  
Pablo Mococain ◽  
Pablo Wagner ◽  
Ruben Radkievich ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
X Rays ◽  
Aofas Score ◽  
Early Weight Bearing ◽  
Clear Space ◽  
Screw Breakage ◽  
The Mean

Category: Ankle, Sports, Trauma Introduction/Purpose: There is no consensus about when to allow weight bearing in ankle fractures treated with syndesmotic screw fixation. There has been no evaluation of the radiographic fate of the syndesmosis when syndesmotic screws are retained and early weight bearing is encouraged, or the clinical result depending on the screw status, which can be intact, broken or loose. Our objective was to evaluate the radiographic and clinical parameters of patients who had a screw fixation of the syndesmosis and early weight bearing was allowed. Our hypothesis was that no difference would be observed on syndesmotic reduction or clinical function depending on the screw status. Methods: We analyzed 42 patients with ankle fractures treated with syndesmotic screws in which early weight bearing was allowed (3 weeks postoperatively). Weight bearing radiographs were obtained at 2 weeks, 2 months and at final follow up (41.2 months). Radiologically we measured medial clear space (MCS), tibiofibular overlap (OL), tibiofibular clear space (CS), talar shift (TS) and screw condition (intact, broken, loose). Clinical function was measured with the AOFAS score and stratified by the screw condition. Statistical analysis was performed with the SPSS software and a non-inferiority confidence interval for the mean was calculated. Results: At final follow up, 66,6% of the screws were broken, 30,9% showed significant loosening and only 1 patient (4,7%) had a screw that remained solid with no signs of osteolysis. MCS at 2 weeks, 2 months and at final follow up was 2,94 mm; 3,03 mm; 3,02, respectively. OL was 6,76 mm; 6,78 mm; 6,83 and CS was 4,26 mm; 4,66 mm; 4,6 mm. No TS was detected. There was no difference in measurements along time (p>0,05). Relative to clinical function, the mean AOFAS score was 95 points. No difference was found between the clinical scores of patients stratified by the screw condition (p>0,05). Conclusion: Early weight bearing on a fixed syndesmosis appears to be safe, with no measurable radiographic or clinical consequences regarding ankle joint function. Despite screw breakage or loosening on x-rays, loss of reduction is seldom observed. We suggest that routine removal of syndesmotic screws is not necessary in these group of patients.

scholarly journals Simulated Weight Bearing and Articular Injury From Transarticular Screws In A Lisfranc Injury Model

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001 ◽  
Author(s):  
Robert Dekker ◽  
Stephan Zmugg ◽  
Anish Kadakia ◽  
Robert Havey ◽  
Avinash Patwardhan ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Screw Fixation ◽  
Weight Bearing ◽  
Relative Increase ◽  
Transarticular Screw ◽  
Lisfranc Injury ◽  
Transarticular Screw Fixation ◽  
Articular Surfaces ◽  
Injury Model ◽  
Articular Damage

Category: Midfoot/Forefoot, Trauma Introduction/Purpose: Successful treatment of Lisfranc injuries, relies upon anatomic reduction [1-3] and rigid fixation until bony or ligamentous healing has occurred and inherent stability has been restored. Historically, transarticular screw fixation has been the most common method of fixation, but optimal treatment remains controversial. Articular injury from transarticular screw fixation may lead to arthritis of the Lisfranc joints and future morbidity. To our knowledge only two studies have evaluated articular injury from transarticular screws [6,7]. Neither of these studies, and no other study to our knowledge has investigated relative increase in articular damage after simulated weight bearing. The aims of this study were: (1) create a ligamentous Lisfranc injury model and (2) compare relative increase in articular injury pre- and post-simulated weight bearing from screw toggle. Methods: 10 cadaver specimens underwent transarcticular screw fixation with 3.5 mm cortical screws in a ligamentous Lisfranc injury model. Digital photographs of the articular surfaces of the first and second tarsometatarsal joints were taken before and after cycling. Simulated weight bearing was performed with each specimen cycled 1,000 cycles at 222.4 N in a custom jig fixed in approximately 20 degrees of plantar flexion. After creation of the Lisfranc injury and prior to cycling with screw fixation, each specimen was cycled for 20 cycles to ensure we had created a reliable injury model. At each stage we assessed total relative rotation and diastasis between each of the bones of the Lisfranc complex. After simulated weight bearing hardware was removed and digital photographs were again taken. Articular injury was measured as a percentage of total articular surface pre- and post-cycling and was compared and statistical analysis performed. Results: Our model produced motion consistent with a ligamentous Lisfranc injury. Overall, the articular injury increased by 44.22% (p<0.001) after cyclic loading. With respect to each individual surface, the second metatarsal (M2) showed the greatest increase in articular injury (53.89%, p=0.0047) whereas the first metatarsal (M1) showed the least (34.71%, p=0.0083). The increases seen at the medial cuneiform (43.51%, p=0.0387) and the middle cuneiform (44.24%, p=0.0292) were intermediate between the values seen at M2 and M1 (Table 1). Conclusion: Our model produced motion consistent with a ligamentous Lisfranc injury. The articular injury from transarticular screw fixation showed a significant increase in articular injury with cyclic loading at each of the articular surfaces of interest and a 44% overall increase in articular damage with simulated weight bearing. This relative increase in articular injury has never previously been studied. This increase in articular injury from screw toggle with simulated weight bearing with use of trans- articular screw fixation is significant and may increase the risk of arthritis and future morbidity when using this fixation strategy.

An intact fibula may contribute to allow early weight bearing in surgically treated tibial plateau fractures

2017 ◽  
Vol 26 (3) ◽  
pp. 756-761 ◽  
Author(s):  
Ion Carrera ◽  
Pablo Eduardo Gelber ◽  
Gaetan Chary ◽  
Mireia Gomez Masdeu ◽  
Miguel A. González Ballester ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Weight Bearing ◽  
Tibial Plateau Fractures ◽  
Early Weight Bearing

scholarly journals Effect of Weight-Bearing in Conservative and Operative Management of Fractures of the Base of the Fifth Metatarsal Bone

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Jae-Yong Park ◽  
Hyong-Nyun Kim ◽  
Yoon-Suk Hyun ◽  
Jun-Sik Park ◽  
Hwan-Jin Kwon ◽  
...  
Keyword(s):  
Bone Resorption ◽  
Weight Bearing ◽  
Operative Management ◽  
Foot And Ankle ◽  
Early Weight Bearing ◽  
Group A ◽  
Vas Scores ◽  
American Orthopaedic ◽  
Group B ◽  
Underlying Diseases

Background. There is no established principle regarding weight-bearing in conservative and operative management of fifth metatarsal base fractures. Methods. We reviewed 86 patients with acute fifth metatarsal base fractures. Conservatively treated late or early weight-bearing patients were assigned to Group A or C, respectively. Operatively treated late or early weight-bearing patients were assigned to Group B or D, respectively. Results were evaluated by clinical union, bone resorption, and the American Orthopaedic Foot and Ankle Society (AOFAS) and Visual Analogue Scale (VAS) scores. Results. All 4 groups had bone union at a mean of 6.9 weeks (range, 5.1–15.0). There were no differences between the groups in the AOFAS and VAS scores. In the early weight-bearing groups, there were fewer cases of bone resorption, and the bone unions periods were earlier. Conclusions. Early weight-bearing may help this patient population. Moreover, conservative treatment could be an option in patients with underlying diseases.

scholarly journals Distal Tibia Metaphyseal Fractures: Which is Better, Intra-medullary Nailing or Minimally Invasive Plate Osteosynthesis?

2018 ◽  
Vol 24 (1) ◽  
pp. 66-71
Author(s):  
Kawalkar Abhijit Chandrakant ◽  
Badole Chandrashekher Martand
Keyword(s):  
Intramedullary Nailing ◽  
Weight Bearing ◽  
Distal Tibia ◽  
Tibial Fractures ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Early Weight Bearing ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Tibia Fractures ◽  
Distal Tibia Fractures

Introduction Tibia fractures are the most common long bone fractures encountered by the orthopedic surgeons and distal tibia fractures have the second highest incidence of all tibia fractures after the middle third of tibia the distal tibial fractures are unique and are considered as most challenging fractures to treat due to its proximity to the ankle joint and its superficial nature. The objective of this study is to compare two osteosynthesis systems developed for surgical treatment of distal tibia fractures: the intramedullary nailing and the MIPPO technique. Methods The study was conducted between Jan 2011 to Dec 2012. 63 patients with extra-articular distal tibia fracture treated with intramedullary nailing and MIPPO technique were reviewed retrospectively and clinical outcome was evaluated according to American Orthopaedic Foot and Ankle Score. Results 31 patients were treated with intramedullary nail & 32 with MIPPO technique. Fibular fixation was done in cases where fibular fracture was at or below the level of tibial fractures. We found no difference in terms of time for fracture union, mal-union, non-union, duration of surgery and amount of blood loss. But there was significant difference in terms of infection and duration of hospital stay. Also weight bearing was possible much earlier in intramedullary group as compared to the MIPPO group. Conclusion Thus we conclude that intramedullary nailing is better choice of implant in patients with extra- articular distal tibia fractures & helps in early weight bearing and ambulation of patient with fewer complications.

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