The Use of Modern Intramedullary Nailing in Distal Fibula Fracture Fixation

2018 ◽  
Vol 12 (4) ◽  
pp. 322-329 ◽  
Author(s):  
Joseph Tracey ◽  
Tyler J. Vovos ◽  
Danny Arora ◽  
Samuel Adams ◽  
Selene G. Parekh
Keyword(s):  
Case Series ◽  
Lateral Malleolus ◽  
Wound Complications ◽  
Peroneal Tendon ◽  
Syndesmotic Injury ◽  
Fixation Device ◽  
Distal Fibula ◽  
Minimal Incision ◽  
Lateral Incision ◽  
Incision Wound

Background. Lateral malleolus (LM) fixation is necessary for unstable ankle fractures. Traditional fixation relies on the use of plates through a lateral incision, wound healing can be an issue for such incisions. A novel intramedullary (IM) fixation device has been developed that can be placed through a minimal incision. The purpose of this study was to demonstrate the clinical efficacy of this device. Methods. A retrospective analysis was performed on patients who received IM fixation for isolated fibula, bimalleolar (BM), and trimalleolar (TM) fractures. Pertinent demographic information, operative factors, complications, and clinical outcomes were recorded. Results. Sixteen patients were included in the study with an average age of 59 years (range 35-86 years). Six patients presented with isolated LM fractures, four patients had a BM fracture with a syndesmotic injury, 2 patients sustained a LM fracture with an associated syndesmotic injury, 2 patients had a BM fracture, and 2 patients had a TM fracture with a syndesmotic injury. There was a 100% healing rate of the lateral malleolus without any cases of malunion or shortening. There were no cases of sural nerve or peroneal tendon injuries, nor any wound complications found. Conclusion. These findings demonstrate the safe and efficacious use of a novel intramedullary fixation device for fibula fractures with lower wound complications compared with published outcomes found with lateral fibular plating. The features of this device allow for reliable fixation of the fibula, maintaining length and minimizing wound issues. Levels of Evidence: Level IV: Case series

scholarly journals The Use of Modern Intramedullary Nailing in Distal Fibula Fracture Fixation

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0049
Author(s):  
Joseph Tracey ◽  
Tyler Vovos ◽  
Samuel Adams ◽  
Selene Parekh
Keyword(s):  
Wound Complication ◽  
Lateral Malleolus ◽  
Wound Complications ◽  
Peroneal Tendon ◽  
Syndesmotic Injury ◽  
Fixation Device ◽  
Distal Fibula ◽  
Minimal Incision ◽  
Lateral Incision ◽  
Incision Wound

Category: Trauma Introduction/Purpose: Lateral malleolus (LM) fixation is necessary for unstable ankle fractures. Traditional fixation relies on the use of plates through a lateral incision, wound healing can be an issue for such incisions. A novel intramedullary (IM) fixation device has been developed that can be placed through a minimal incision. The purpose of this study was to demonstrate the clinical efficacy of this device. Methods: A retrospective analysis was performed on patients who received IM fixation for isolated fibula, bimalleolar (BM), and trimalleolar (TM) fractures. Pertinent demographic information, operative factors, complications, and clinical outcomes were recorded. Results: Sixteen patients were included in the study with an average age of 59 (Range of 35 to 86). Six patients presented with isolated LM fractures, four patients had a BM fracture with a syndesmotic injury, two patients sustained a LM fracture with an associated syndesmotic injury, two patients had a BM fracture, and two patients had a TM fracture with a syndesmotic injury. There was a 100% healing rate of the lateral malleolus without any cases of malunion or shortening. There were no cases of sural nerve or peroneal tendon injuries, nor any wound complications found. Conclusion: These findings demonstrate the safe and efficacious use of a novel intramedullary fixation device for fibula fractures with a lower wound complication and infection rates compared to published outcomes found with lateral fibular plating. The features of this device allow for reliable fixation of the fibula, maintaining length and minimizing wound issues.

Percutaneous Triple and Double Osteotomies for the Treatment of Hallux Valgus

2016 ◽  
Vol 38 (2) ◽  
pp. 159-166 ◽  
Author(s):  
Rodrigo Díaz Fernández
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Wound Complications ◽  
Percutaneous Technique ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Minimal Incision ◽  
Valgus Angle ◽  
Before And After ◽  
American Orthopaedic

Background: Percutaneous surgery to correct deformities of the forefoot presents the advantages of using a minimal incision, which involves less soft tissue damage and less risk of wound complications. For severe deformities, percutaneous techniques have not been proven as effective. We propose a technique for the treatment of severe hallux valgus. Methods: In a sample of 52 feet operated on 48 patients, we performed a double percutaneous osteotomy (closure proximal osteotomy and a distal Akin) or triple when a Reverdin-Isham osteotomy was added. We measured preoperatively the American Orthopaedic Foot & Ankle Society (AOFAS) score at the 1-year and 2-year follow-up, as well as the values of hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular ankle (DMAA), and shortening and elevation of the first metatarsal. The presence of metatarsalgia was recorded before and after the surgery. Results: HVA, IMA, and DMAA improved from 39.3 ± 7.1, 17.0 ± 2.0, and 16 ± 8.7 to 11.2 ± 6.2, 8.4 ± 3.4, and 8.3 ± 6.2, respectively. In 5 cases (10%), there was an elevation of the distal metatarsal bone, but only in 2 cases did a transfer metatarsalgia develop. There were no significant correlations between the amount of shortening and the presence of postoperative metatarsalgia. Scores on the AOFAS scale improved from 47.6 ± 5.6 to 89.7 ± 10.1 points. Conclusion: The results are comparable to those reported with other more established techniques. Transfer metatarsalgia did not correlate with lifting or shortening of the metatarsal. We indicate the percutaneous technique for IMA above 15 degrees and increased DMAA or congruent joints. Level of Evidence: Level IV, retrospective case series.

scholarly journals Pes Planus and Distal FIbular Stress Fractures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Jet Liu ◽  
William Granberry
Keyword(s):  
Stress Fracture ◽  
Inclination Angle ◽  
Case Series ◽  
Stress Fractures ◽  
Lateral Malleolus ◽  
Foot Deformities ◽  
Distal Fibula ◽  
Pes Planus ◽  
Independent Observer ◽  
Radiographic Measurements

Category: Ankle, Hindfoot Introduction/Purpose: Fibular stress fractures accounts for 4.6% to 21% of all stress fractures. There have been isolated reports of distal third fibular stress fractures within 4-7 cm of the tip of the lateral malleolus in young and athletic patients related to overuse injuries. We examine a case series of middle aged female patients with planovalgus foot deformities and associated hindfoot valgus who presented with distal third fibular stress fractures. We propose that this type of distal fibular stress fracture is a result of increased stress loading of the distal fibula at the superior margin of tibio-fibular interosseous ligaments. Methods: From October 2015 through September 2016, we evaluated six patients (six cases) who presented to Baylor College of Medicine foot and ankle specialty clinic. These patients were found to have distal fibular stress fractures. Detailed initial history was documented. The diagnosis of distal fibular stress fracture was confirmed with both clinical examination and radiographic evidence among all patients. Additionally, all patients were found to have planovalgus deformity with associated hindfoot valgus. Radiographic measurements were taken in all patients, including lateral talo-calcaneal angle, Meary’s angle, calcaneal inclination angle, and AP tibio-talar angle. Distance of distal fibular stress fracture location to tip of lateral malleolus, as well as the distance between medial cuneiform and 5th metatarsal were measured. Single independent observer performed all measurements. Results: Among the six patients in the study, all were female, with average age of 58 years (45-64). Four patients carried the diagnosis of osteopenia and/or osteoporosis from DEXA scan. There is no evidence of association with tobacco use or alcohol use. The mean radiographic distance between location of stress fracture to tip of lateral malleolus is 5.8 cm (4.2cm-7 cm). There was evidence of pes planus from Meary’s angle, which averaged 6.7° (3°-11°) convex downward, and measurement of calcaneal inclination angle averaged 19° (13°-30°). Furthermore, measurement of tibio-talar angle averaged 1.7° valgus alignment consistent with chronic hindfoot valgus deformity. While all patients were treated successfully with immobilization, one patient underwent medial calcaneal osteotomy to correct the hindfoot valgus after recurrent fracture. Conclusion: It is hypothesized that increased stress loading of the fibula due to lateralization of the load axis contributes to this condition. The apex of this stress culminates in the lateral aspect of the fibula above the distal tibio-fibular ligament complex and results in a characteristic valgus fracture of the fibula. The increased stress from deformity results in the fracture rather than increased load from exercise or other repetitive stress. The significance of this proposition is that recognition of this type of fracture should lead the clinician to address the underlying planovalgus deformity in the treatment of this fracture type.

Intramedullary Fixation of Distal Fibula Fractures

2021 ◽  
pp. 193864002199173
Author(s):  
Benjamin D. Umbel ◽  
B. Dale Sharpe ◽  
Christopher Reynolds ◽  
Terrence M. Philbin
Keyword(s):  
Weight Bearing ◽  
Case Series ◽  
Ankle Fractures ◽  
Fracture Reduction ◽  
Wound Complications ◽  
Fracture Union ◽  
Retrospective Case ◽  
Distal Fibula ◽  
Unique Challenge ◽  
Percutaneous Reduction

Background Ankle fractures pose a unique challenge to the treating orthopedic surgeon. Intramedullary (IM) distal fibula fixation is a relatively newer entity offering a viable option to minimize wound complications while providing similar outcomes. Our study utilizes an IM nail featuring proximal fixation via IM talons ensuring maintenance of fracture reduction this is the largest case series utilizing this novel device assessing time to weight-bearing (WB) and fracture union in addition to the safety and reproducibility of percutaneous reduction. Methods A retrospective case series was conducted on 51 ankle fractures treated with a single IM device for lateral malleolar fixation. Postoperative radiographs were assessed, qualifying reductions as good, fair, or poor based on a reduction classification. Patient charts were reviewed for fracture characteristics, reduction method, fracture union, time to WB, and complications. Results Mean follow-up time was 32.2 weeks; 47 fracture reductions (92%) were classified as good, and 4 (8%) were fair. All but 1 fracture (98%) went onto union. Average time to union was 10.3 weeks. Average time to WB with and without a walking boot was 6.8 and 11.2 weeks, respectively. Two patients experienced painful hardware. One patient had a superficial wound infection; Conclusion When evaluating this novel IM device, fracture union and time to union were found to be acceptable, with minimal wound or other complications. Percutaneous reduction permitted good fracture reduction quality. Consistent time to WB for a variety of fractures was reliably demonstrated following operative fixation with this device, including those in the elderly population. Levels of Evidence: Level IV: Clinical case series

An Alternate Technique of Applying Lag Screw for Fixation of Distal Fibula Fracture: Posterior to Anterior Interfragmentary Compression Screw

2017 ◽  
Vol 10 (6) ◽  
pp. 555-559
Author(s):  
Suganth Jayaraman Vijimohan ◽  
Syed Haque ◽  
David Ellis
Keyword(s):  
Lateral Malleolus ◽  
Peroneal Tendon ◽  
Compression Screw ◽  
Distal Fibula ◽  
Lag Screw ◽  
Lower Limb Fractures ◽  
Choice Of Treatment ◽  
Limb Fractures ◽  
Interfragmentary Compression ◽  
Anterior Posterior

Ankle fractures are one of the most common lower limb fractures, representing a significant portion of the trauma workload. Marked proportion of these is isolated intraarticular lateral malleolus fractures. Anatomical reduction and rigid internal fixation using lag screw (interfragmentary screw) to provide interfragmentary compression has remained the choice of treatment in selected lateral malleolus fractures. Applying interfragmentary compression screw from anterior to the posterior surface of the fibula has been the traditional method of performing this. In this article, we describe an alternate method of applying posterior-anterior interfragmentary compression screw to the fibula fractures. We will also discuss the benefits it provides such as minimizing the chances of hardware-related peroneal tendon irritation. Further argument will focus on the mechanical benefit this will render while providing equal clinical outcome of the time tested anterior-posterior interfragmentary compression screw. Levels of Evidence: Level V: Therapeutic comparison

scholarly journals An Accuracy of Syndesmotic Reduction by Direct Visualization Technique

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0046
Author(s):  
Yantarat Sripanich ◽  
Chamnanni Rungprai
Keyword(s):  
Ankle Fracture ◽  
Case Series ◽  
Contralateral Side ◽  
Direct Visualization ◽  
Syndesmotic Injury ◽  
Visualization Technique ◽  
Distal Fibula ◽  
Poor Prognostic Factor ◽  
Cortical Screw

Category: Trauma Introduction/Purpose: Syndesmotic injury is commonly seen associated with acute ankle fracture. Syndesmotic malreduction was proven be a poor prognostic factor. Many methods have been purposed to assess the quality of reduction such as direct visualization, comparing radiographic parameters to contralateral ankle fluoroscopy, and intra-operative computed tomography. In this study, we demonstrated syndesmotic malreduction rate using bilateral CT after using direct visualization technique for syndesmotic fixation. Methods: A prospective case series of 34 patients (13 left and 21 right sides) with an average age of 42 years who had rotational ankle fractures with syndesmotic injury confirmed by arthroscopic examination. All patients were treated with an open reduction and internal fixation of distal fibula using either 1/3 tubular plate or distal anatomical locking plate. Syndesmosis was fixed by one or two of 3.5-mm cortical screw with three or four cortices. Before syndesmotic fixation, syndesmotic reduction is made by using a large point reduction clamp and quality of the reduction was checked by direct visualization at anterior tibiofibular line. The accuracy of syndesmotic reduction is then evaluated by post-operative bilateral CT. A widening of distance between anterior tibia and fibular at 1-cm above the ankle joint more than 2 mm compared to uninjured sides considered a malreduction of syndesmosis. Results: The accuracy of syndesmotic reduction was 97.1 percent (33/34) compare to contralateral ankle. An average of BMI was 27.2 and an average of operative time was 98.2 minutes. One malreduction, was diagnosed on the criteria of a 2 mm difference from the contralateral side occurred due to a small fragment interposition at the syndemosis. This patient underwent revision surgery to remove the fragment and then fixation of syndesmosis with same manner to achieve anatomical reduction. In all cases, the screws are removed at 12 weeks. Neither breakage nor migration of screws is observed and no wound or nerve complications following this technique. Conclusion: A syndesmotic fixation using direct visualization technique demonstrate lower rate of malreduction as demonstrated by poster-operative bilateral CT scan and no complications. This technique is effective, safe, and should be considered for treatment of syndesmotic injury associated ankle fracture.

Marginal Fractures of the Lateral Malleolus in Association with other Fractures in the Ankle Region

Foot & Ankle ◽  
1992 ◽  
Vol 13 (4) ◽  
pp. 171-175 ◽  
Author(s):  
Nabil A. Ebraheim ◽  
Jacob Zeiss ◽  
Martin C. Skie ◽  
Richard Dwight
Keyword(s):  
Avulsion Fracture ◽  
Lateral Malleolus ◽  
Ct Scans ◽  
Peroneal Tendon ◽  
Associated Injuries ◽  
Distal Fibula ◽  
Proper Management ◽  
Type Fracture ◽  
Fracture Of The Calcaneus ◽  
Tendon Pathology

Eight cases of avulsion-type fracture of the distal fibula associated with fracture of the calcaneus, talus, or ankle region were identified. This avulsion fracture can be identified on routine radiographs as well as on CT scans of the ankle and is pathognomonic of rupture of the superior peroneal retinaculum with or without peroneal tendon displacement. Recognition of this avulsion fracture, with subsequent proper management of the underlying peroneal tendon pathology by immobilization or surgery, may prevent future tendon dysfunction. It may also alter the treatment of other associated injuries.

scholarly journals Functional assessment of foot and ankle tendinopathies treated with tendoscopy

2021 ◽  
Vol 15 (2) ◽  
pp. 128-132
Author(s):  
Rodrigo Guimarães Huyer ◽  
Mário Sérgio Paulillo Cillo ◽  
Carlos Daniel Cândido Castro Filho ◽  
Hallan Douglas Bertelli ◽  
Renato Morelli Berg
Keyword(s):  
Functional Assessment ◽  
Descriptive Analysis ◽  
Case Series ◽  
P Value ◽  
Peroneal Tendon ◽  
Foot And Ankle ◽  
Treatment Results ◽  
Duration Of Treatment ◽  
Aofas Score ◽  
Level Of Evidence

Objective: To assess postoperative clinical functional outcomes, based on the American Orthopaedic Foot & Ankle Society (AOFAS) score, of tendoscopies performed in the treatment of foot and ankle pathologies. Methods: Our comparative assessment used AOFAS scores obtained preoperatively and at early and late postoperative stages - 1 month and 6 to 12 months after surgery - of 14 patients with foot and ankle tendinopathies. These included peroneal tendon dislocation, peroneal tendonitis, and tearing of the peroneus longus or brevis, all treated with tendoscopy for peroneal reconstruction and tenorrhaphy. The AOFAS score was obtained by functional assessment during outpatient physical examination. We presented a descriptive analysis of cases, comparing scores over time through the Friedman test followed by Dunn’s test. The relationship between score variations and sex was assessed using the Mann-Whitney test; their comparison with age used Spearman’s linear correlation coefficient. Significance levels were 5%.Results: The AOFAS score showed important improvements such as preoperative scores of 56 and 67 followed by postoperative scores of 100 both in the early and late stages, supporting the efficacy and persistence of this treatment strategy. The p-value obtained after statistical analysis was <0.0001. Conclusion: We concluded that the treatment of foot and ankle comorbidities with tendoscopy, in addition to being less invasive, shows consistency and efficacy as demonstrated by the AOFAS score and functional assessment via postoperative physical examinations. AOFAS scores were increased and maintained at high levels in the postoperative period, demonstrating the efficacy of this procedure and the duration of treatment results. Level of Evidence IV; Case Series; Therapeutic Studies - Investigation of Treatment Results.

Hybrid Fixation for Danis-Weber Type C Fractures With Syndesmosis Injury

2020 ◽  
pp. 107110072096479
Author(s):  
Gi Beom Kim ◽  
Chul Hyun Park
Keyword(s):  
External Rotation ◽  
Case Series ◽  
Ankle Fractures ◽  
Syndesmotic Injury ◽  
Hybrid Fixation ◽  
Alternative Treatment Option ◽  
Syndesmosis Injury ◽  
Weber Type ◽  
Type C

Background: This study aimed to assess the clinical and radiological outcomes of hybrid fixation for Danis-Weber type C ankle fractures with a syndesmotic injury. Methods: From January 2016 to April 2018, we retrospectively reviewed consecutive patients who underwent hybrid fixation for Danis-Weber type C ankle fractures with syndesmotic injury with a minimum follow-up of 12 months. We excluded patients who achieved syndesmosis stability after fracture fixation. In all patients, we allowed partial weightbearing at 4 weeks postoperatively. We evaluated the visual analog scale for ankle pain, the Olerud-Molander ankle score, and the American Orthopaedic Foot & Ankle Society score. Malreduction of the syndesmosis was defined based on 2 previously reported methods. Fourteen patients (11 men and 3 women) were included in this study. There were 11 patients with pronation external rotation-type fractures and 3 patients with Maisonneuve fractures. The average age at operation was 37.2 years (range, 18-70 years). Results: Clinical scores were significantly improved at the last follow-up. Postoperative malreduction was observed only in 1 patient (7.1%). Conclusion: Hybrid fixation using a suture-button device combined with a syndesmotic screw in Danis-Weber type C fractures with syndesmosis injury showed a high accuracy of reduction, a low rate of diastasis, and favorable clinical outcomes. This combined method could be a good alternative treatment option for Danis-Weber type C ankle fractures with a syndesmosis injury. Level of Evidence: Level IV, case series.

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