scholarly journals Safe Zone for Insertion of a Fibular Lag Screw in Ankle Fracture Fixation

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0033
Author(s):  
Lyndon Mason ◽  
Angus Kaye ◽  
William Marlow ◽  
Geraint Williams ◽  
Andrew Molloy
Keyword(s):  
Achilles Tendon ◽  
Fracture Fixation ◽  
Ankle Fracture ◽  
Flat Surface ◽  
Safe Zone ◽  
Screw Placement ◽  
Exit Point ◽  
Lag Screw ◽  
Anterior Aspect ◽  
Mri Scans

Category: Ankle Introduction/Purpose: Fibular lag screw placement during ankle fracture fixation is not without risk. The screw placement endangers either the tendons of the peronei or the posterior rim of the incisura if misplaced. Our aim was to identify a predictable safe zone for screw placement. Methods: 45 radiographs of Weber B fractures were reviewed to determine the typical height of lag screw entry and exit points. 63 MRI scans of anatomically normal ankles were reviewed to evaluate tendon position and syndesmosis location. The safe zone could then be determined using composite images. Results: On review of the 45 ankle fracture radiographs; the typical lag screw exit point was found to be 14.2 mm above the ankle joint (95% Confidence Interval: 11.3-17.1 mm). Using the composite MRI images, there was a consistent flat anterior aspect of the fibula at this level. A safe zone trajectory was seen to occur between 31 and 45 degrees taken from the anterior aspect of the flat fibular surface at this level. The minimum distance to at-risk structures using this trajectory was 4 mm. If this consistent entry point is used, the MRI scans demonstrated that if the drill was aimed towards the medial edge of the Achilles tendon, the correct trajectory would be performed. Conclusion: The flat surface of the fibula is a constant landmark on MRI and is visible during surgery. The peroneal tendons and posterior rim of the incisura have a constant predictable position related to this. The safe zone for insertion of a lag screw is between 31 and 45 degrees medial to the anterior aspect of this flat surface. This represents aiming the drill towards the medial aspect of the Achilles tendon.

scholarly journals A practical ‘safe zone’ technique for lag screw fixation of the fibula

2018 ◽  
Vol 100 (5) ◽  
pp. 409-412 ◽  
Author(s):  
AR Kaye ◽  
W Marlow ◽  
G Williams ◽  
AP Molloy ◽  
LW Mason
Keyword(s):  
At Risk ◽  
Magnetic Resonance ◽  
Achilles Tendon ◽  
Ankle Joint ◽  
Safe Zone ◽  
Magnetic Resonance Images ◽  
Exit Point ◽  
Simple Method ◽  
Lag Screw ◽  
Medial Edge

Introduction During ankle fracture fixation, iatrogenic trauma to retro fibula structures can result in morbidity and reoperation. We describe a safe zone for lag screw insertion. Materials and methods This study was completed in three sections. We identified the average entry and exit points for the lag screw using 45 Weber B ankle fractures identified from our trauma database. We then analysed 26 sequentially presented ankle magnetic resonance images, concentrating on axial sections at 4, 8, 12 and 16 mm above the ankle joint. Finally, we used 63 sequentially performed magnetic resonance scans to confirm the safe zone from these consistent structures. Results The typical lag screw exit point was 14.2 mm above the ankle joint (95% confidence Interval 11.3–17.1 mm). A safe zone trajectory occurred between 31 and 45 degrees taken from the anterior aspect of the flat fibular surface at this level. The obvious palpable landmark to direct screw trajectory and avoid ‘at risk’ structures was found to be the medial edge of the Achilles tendon. Our final dataset confirmed in 63 scans, the medial aspect of the Achilles tendon to be a consistent safe zone with a minimum distance of at risk structures of 4 mm. Conclusion This simple method of directing the fibula lag screw towards the palpable medial edge of the Achilles tendon is practical, easy to teach and directs the screw on a safe trajectory away from the most commonly injured structures around the back of the fibula.

Accuracy and awareness of lag screw placement when using the dynamic hip screw for fracture fixation

Trauma ◽  
2014 ◽  
Vol 17 (1) ◽  
pp. 39-46
Author(s):  
Gulraj S Matharu ◽  
Mohammad Shahid ◽  
Paul B Pynsent ◽  
Tom Rowlands
Keyword(s):  
Fracture Fixation ◽  
Dynamic Hip Screw ◽  
Screw Placement ◽  
Lag Screw ◽  
Hip Screw

A Retrospective Case Series of Carbon Fiber Plate Fixation of Ankle Fractures

2017 ◽  
Vol 11 (3) ◽  
pp. 223-229 ◽  
Author(s):  
Zachariah W. Pinter ◽  
Kenneth S. Smith ◽  
Parke W. Hudson ◽  
Caleb W. Jones ◽  
Ryan Hadden ◽  
...  
Keyword(s):  
Carbon Fiber ◽  
Fracture Fixation ◽  
Complication Rate ◽  
Ankle Fracture ◽  
Case Series ◽  
Complication Rates ◽  
Union Rate ◽  
Retrospective Case ◽  
Retrospective Case Series

Distal fibula fractures represent a common problem in orthopaedics. When fibula fractures require operative fixation, implants are typically made from stainless steel or titanium alloys. Carbon fiber implants have been used elsewhere in orthopaedics for years, and their advantages include a modulus of elasticity similar to that of bone, biocompatibility, increased fatigue strength, and radiolucency. This study hypothesized that carbon fiber plates would provide similar outcomes for ankle fracture fixation as titanium and steel implants. A retrospective chart review was performed of 30 patients who underwent fibular open reduction and internal fixation (ORIF). The main outcomes assessed were postoperative union rate and complication rate. The nonunion or failure rate for carbon fiber plates was 4% (1/24), and the union rate was 96% (23/24). The mean follow-up time was 20 months, and the complication rate was 8% (2/24). Carbon fiber plates are a viable alternative to metal plates in ankle fracture fixation, demonstrating union and complication rates comparable to those of traditional fixation techniques. Their theoretical advantages and similar cost make them an attractive implant choice for ORIF of the fibula. However, further studies are needed for extended follow-up and inclusion of larger patient cohorts. Levels of Evidence: Level IV: Retrospective Case series

scholarly journals Reduction and fixation of anterior inferior tibiofibular ligament avulsion fracture without syndesmotic screw fixation in rotational ankle fracture

2019 ◽  
Vol 48 (4) ◽  
pp. 030006051988255
Author(s):  
Kee Jeong Bae ◽  
Seung-Baik Kang ◽  
Jihyeung Kim ◽  
Jaewoo Lee ◽  
Tae Won Go
Keyword(s):  
Fracture Fixation ◽  
Ankle Fracture ◽  
Avulsion Fracture ◽  
Screw Fixation ◽  
Malleolar Fracture ◽  
Tibiofibular Ligament ◽  
Radiographic Parameters ◽  
Syndesmotic Screw ◽  
Anterior Inferior Tibiofibular Ligament ◽  
American Orthopaedic

Objective We aimed to present the radiographic and functional outcomes of anatomical reduction and fixation of anterior inferior tibiofibular ligament (AITFL) avulsion fracture without syndesmotic screw fixation in rotational ankle fracture. Methods We retrospectively reviewed 66 consecutive patients with displaced malleolar fracture combined with AITFL avulsion fracture. We performed reduction and fixation for the AITFL avulsion fracture when syndesmotic instability was present after malleolar fracture fixation. A syndesmotic screw was inserted only when residual syndesmotic instability was present even after AITFL avulsion fracture fixation. The radiographic parameters were compared with those of the contralateral uninjured ankles. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were assessed 1 year postoperatively. Results Fifty-four patients showed syndesmotic instability after malleolar fracture fixation and underwent reduction and fixation for AITFL avulsion fracture. Among them, 45 (83.3%) patients achieved syndesmotic stability, while 9 (16.7%) patients with residual syndesmotic instability needed additional syndesmotic screw fixation. The postoperative radiographic parameters were not significantly different from those of the uninjured ankles. The mean AOFAS score was 94. Conclusion Reduction and fixation of AITFL avulsion fracture obviated the need for syndesmotic screw fixation in more than 80% of patients with AITFL avulsion fracture and syndesmotic instability.

Pseudoaneurysm of the Perforating Peroneal Artery After Ankle Fracture Fixation: Case Report and Review of the Literature

2016 ◽  
Vol 55 (5) ◽  
pp. 1083-1086 ◽  
Author(s):  
Ilias Alexandros I. Kosmidis ◽  
Konstantinos Kourkoutas ◽  
Styliani Stouki ◽  
Maria Flokatoula
Keyword(s):  
Case Report ◽  
Fracture Fixation ◽  
Ankle Fracture ◽  
Peroneal Artery ◽  
Review Of The Literature

Bone density correlates with clinical outcomes after ankle fracture fixation

2018 ◽  
Vol 138 (12) ◽  
pp. 1653-1657 ◽  
Author(s):  
Stephen J. Warner ◽  
Matthew R. Garner ◽  
Peter D. Fabricant ◽  
Dean G. Lorich
Keyword(s):  
Bone Density ◽  
Clinical Outcomes ◽  
Fracture Fixation ◽  
Ankle Fracture

Variability in the Reporting Terminology of Adverse Events and Complications in Ankle Fracture Fixation: A Systematic Review

2019 ◽  
Vol 41 (2) ◽  
pp. 170-176
Author(s):  
Stefan A. St George ◽  
Hooman Sadr ◽  
Chayanin Angthong ◽  
Murray Penner ◽  
Peter Salat ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Fracture Fixation ◽  
Ankle Fracture ◽  
Soft Tissue Injuries ◽  
Classification Systems ◽  
Level Of Evidence ◽  
Implant Complications ◽  
Frequency Of Use ◽  
Standardized Reporting

Background: Classification systems for the reporting of surgical complications have been developed and adapted for many surgical subspecialties. The purpose of this systematic review was to examine the variability and frequency of reporting terms used to describe adverse events and complications in ankle fracture fixation. We hypothesized that the terminology used would be highly variable and inconsistent, corroborating previous results that have suggested a need for standardized reporting terminology in orthopedics. Methods: Ankle fracture outcome studies meeting predetermined inclusion and exclusion criteria were selected for analysis by 2 independent observers. Terms used to define adverse events and complications were identified and recorded. Discrepancies were resolved by consensus with the aid of a third observer. All terms were then compiled and assessed for variability and frequency of use throughout the studies involved. Reporting terminology was subsequently grouped into 10 categories. Results: In the 48 studies analyzed, 301 distinct terms were utilized to describe complications or adverse events. Of these terms, 74.4% (224/301) were found in a single study each. Only 1 term, “infection,” was present in 50% of studies, and only 19 of 301 terms (6.3%) were used in at least 10% of papers. The category that was most frequently reported was “infection,” with 89.6% of studies reporting on this type of adverse event using 25 distinct terms. Other categories were “wound healing complications” (72.9% of papers, 38 terms), “bone/joint complications” (66.7% of papers, 35 terms), “hardware/implant complications” (56.3% of papers, 47 terms), “revision” (56.3% of papers, 35 terms), “cartilage/soft tissue injuries” (45.8% of papers, 31 terms), “reduction/alignment issues” (45.8% of papers, 29 terms), “medical complications” (43.8% of papers, 32 terms), “pain” (29.2% of papers, 16 terms), and “other complications” (20.8% of papers, 13 terms). There was a 78.6% interobserver agreement in the identification of terms across the 48 studies included. Conclusion: The reporting terminology utilized to describe complications and adverse events in ankle fracture fixation was found to be highly variable and inconsistent. This variability prevents accurate reporting of complications and adverse events and makes the analysis of potential outcomes difficult. The development of standardized reporting terminology in orthopedics would be instrumental in addressing these challenges and allow for more accurate and consistent outcome reporting. Level of Evidence: Level III; systematic review of Level III studies and above.

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