scholarly journals Atypical Maisonneuve’s Fracture: A Case Report

2018 ◽  
Vol 14 (2) ◽  
pp. 173
Author(s):  
Alwi Rachman ◽  
Respati Suryanto Dradjat
Keyword(s):  
Range Of Motion ◽  
Closed Reduction ◽  
Fracture Dislocation ◽  
Interosseous Membrane ◽  
Deltoid Ligament ◽  
Tibiofibular Syndesmosis ◽  
Membrane Rupture ◽  
Distal Tibiofibular Syndesmosis ◽  
Left Ankle ◽  
Posterior Malleolus

Abstract: A Maisonneuve’s Fracture is a fracture of proximal third fibula associated with a disruption of the distal tibiofibular syndesmosis, the interosseous membrane and associated injuries (eg, fracture of the medial malleolus, fracture of the posterior malleolus, and rupture of the deltoid ligament). The mechanism for the fracture is an external rotation force to the ankle with transmission of the force through the interosseous membrane which causes a proximal fibular fracture.In a very rare form, we can found an unusual pattern of the level of the involved fibula, such as middle third of fibula. A 19 year old male  presented to us with pain and swelling of his left ankle after felt while playing futsal. Physical examination showed deformity, swelling and tenderness on his left ankle. Range of motion was decreased. On imaging, plain radiographs of left ankle showed dislocation of the ankle, with disruption of syndesmotic and fracture comminutive middle third of fibula. We performed operation which are consists of three procedures; closed reduction, percutaneous fixation of syndesmotic by using a single transfixing screw, and plate-screw for the fibula. Normal range of motion is achieved well after 8 weeks, without pain on full weightbearing. The pattern of the fracture-dislocation of the ankle discussed is very rare. The mechanism of the injury is a twisting motion of the upperbody inward, while the foot is planted, resulting a more higher energy impacted to the ankle and fibula. We performed closed reduction easily by reverse the mechanism of injury. Keywords: Maisonneuve’s Fracture, distal tibiofibular syndesmosis, interosseous membrane, rupture of the deltoid ligament

Impact of Torque on Assessment of Syndesmotic Injuries Using Weightbearing Computed Tomography Scans

2019 ◽  
Vol 40 (6) ◽  
pp. 710-719 ◽  
Author(s):  
Nicola Krähenbühl ◽  
Travis L. Bailey ◽  
Maxwell W. Weinberg ◽  
Nathan P. Davidson ◽  
Beat Hintermann ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Axial Load ◽  
External Rotation ◽  
Ct Scans ◽  
Deltoid Ligament ◽  
Tibiofibular Syndesmosis ◽  
Tibiofibular Ligament ◽  
Distal Tibiofibular Syndesmosis ◽  
Axial Ct ◽  
The Impact

Background: The diagnosis of subtle injuries to the distal tibiofibular syndesmosis remains elusive. Conventional radiographs miss a large subset of injuries that present without frank diastasis. This study evaluated the impact of torque application on the assessment of syndesmotic injuries when using weightbearing computed tomography (CT) scans. Methods: Seven pairs of male cadavers (tibia plateau to toe-tip) were included. CT scans with axial load application (85 kg) and with (10 Nm) or without torque to the tibia (corresponding to external rotation of the foot and ankle) were taken during 4 test conditions. First, intact ankles (native) were scanned. Second, 1 specimen from each pair underwent anterior inferior tibiofibular ligament (AITFL) transection (condition 1A), while the contralateral underwent deltoid transection (condition 1B). Third, the lesions were reversed on the same specimens and the remaining intact deltoid or AITFL was transected (condition 2). Finally, the distal tibiofibular interosseous membrane (IOM) was transected in all ankles (condition 3). Measurements were performed to assess the integrity of the distal tibiofibular syndesmosis on digitally reconstructed radiographs (DRRs) and on axial CT scans. Results: Torque impacted DRR and axial CT scan measurements in almost all conditions. The ability to diagnose syndesmotic injuries using axial CT measurements improved when torque was applied. No significant syndesmotic morphological change was observed with or without torque for either isolated AITFL or deltoid ligament transection. Discussion: Torque application had a notable impact on two-dimensional (2-D) measurements used to diagnose syndesmotic injuries for both DRRs and axial CT scans. Because weightbearing conditions allow for standardized positioning of the foot while radiographs or CT scans are taken, the combination of axial load and torque application may be desirable. Clinical Relevance: Application of torque to the tibia impacts 2-D measurements and may be useful when diagnosing syndesmotic injuries by DRRs or axial CT images.

scholarly journals Biomechanics of the Distal Tibiofibular Syndesmosis: A Systematic Review of Cadaveric Studies

2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110127
Author(s):  
Pranav Khambete ◽  
Ethan Harlow ◽  
Jason Ina ◽  
Shana Miskovsky
Keyword(s):  
Systematic Review ◽  
Range Of Motion ◽  
Internal Rotation ◽  
External Rotation ◽  
Stress Test ◽  
Tibiofibular Syndesmosis ◽  
Interosseous Ligament ◽  
Distal Tibiofibular Syndesmosis ◽  
Anatomic Reduction ◽  
Ankle Biomechanics

Background: This investigation’s purpose was to perform a systematic review of the literature examining the biomechanics of the ligaments comprising the distal tibiofibular syndesmosis with specific attention to their resistance to translational and rotational forces. Although current syndesmosis repair techniques can achieve an anatomic reduction, they may not reapproximate native ankle biomechanics, resulting in loss of reduction, joint overconstraint, or lack of external rotation resistance. Armed with a contemporary understanding of individual ligament biomechanics, future operative strategies can target key stabilizing structure(s), translating to a repair better equipped to resist anatomic displacing forces. Study design: Systematic review. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines using a PRISMA checklist. Biomechanical studies testing cadaveric lower limb specimens in the intact and injured state measuring the distal tibiofibular syndesmosis resistance to translational and rotational forces were included in this review. Only studies that included numerical data were included in this review; studies that only reported figures and graphs were excluded. Results: Twelve studies met the inclusion and exclusion criteria. Two studies determined the mechanical properties of syndesmotic ligaments, finding superior strength and stiffness of the interosseous ligament (IOL), as compared to the anterior (AITFL) or posteroinferior tibiofibular ligament (PITFL). Four studies examined native ankle biomechanics establishing physiologic range of motion of the fibula relative to the tibia. Fibular range of motion was found to be up to 2.53 mm of posterior translation (Markolf et al), 1.00 mm lateral translation (Xenos et al), 3.6 degrees of external rotation (Burssens et al), and 1.4 degrees of internal rotation (Clanton et al). Four studies evaluated syndesmotic biomechanics under physiological loading and found that the AITFL, IOL, and PITFL provide the majority of resistance to external rotation, diastasis, and internal rotation, respectively. Two studies investigated the biomechanics of clinically and intraoperatively used tests for syndesmotic injuries and found increased sensitivity of sagittal plane posterior fibular translation, as opposed to coronal plane lateral fibular translation for unstable injuries. Conclusions: Study findings suggest that although the IOL is the strongest syndesmotic ligament, the AITFL has a dominant role stabilizing the distal tibiofibular syndesmosis to external rotation force. Because of these characteristics, operative repair of the AITFL along its native vector may provide a more biomechanically advantageous construct and should be investigated clinically. Additionally, evaluation of clinical stress tests revealed that the external rotation stress test is the most sensitive test to recognize an AITFL tear, and that a 3-ligament disruption is needed to cause diastasis greater than 2 mm.

scholarly journals Ankle arthroscopy–assisted closed reduction in Bosworth fracture dislocation

2020 ◽  
Vol 8 ◽  
pp. 2050313X2097452
Author(s):  
Shuangjian He ◽  
Jian Zhu
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Closed Reduction ◽  
Fracture Dislocation ◽  
Deltoid Ligament ◽  
Resonance Imaging ◽  
Distal Fibula ◽  
X Ray ◽  
X Ray Computed

The Bosworth fracture dislocation is a rare type of ankle fracture and is usually unrecognized on initial radiographs, therefore early open reduction is recommended. This study reports a 51-year-old female with uncommon imaging and clinical features. Preoperative X-ray, computed tomography, and magnetic resonance imaging of the ankle showed posterior detached dislocation of the intact distal fibula, the loose osteochondral fragments located in the tibiotalar joint, and the rupture of the deltoid ligament. Due to the initial infected wound on the severely swollen ankle, delayed arthroscopy-assisted closed reduction and internal fixation, removal of loose bodies, and repair of the deltoid ligament were performed, 19 days after injury. Postoperative imaging, including the X-ray, computed tomography, and magnetic resonance imaging, demonstrated the anatomic reduction of the ankle joint. After 6 months of follow-up, the patient gained a pain-free motion of the ankle with a range of passive 10° dorsiflexion and 40° plantar flexion, and resumed her normal gait and activity. This report indicates that the detached posterior dislocation of the intact distal fibula is a rare variant of the Bosworth fracture dislocation, and suggests that arthroscopy-assisted closed reduction and removal of loose osteochondral fragments in joint space are useful technique for this special type of the Bosworth lesions.

scholarly journals Closed Reduction of an Acute Volar Dislocation of the Distal Radio-Ulnar Joint by a Modified Technique

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Samuel Larrivée ◽  
Graeme Matthewson ◽  
Laurie Barron
Keyword(s):  
Range Of Motion ◽  
Closed Reduction ◽  
Surgical Intervention ◽  
Conventional Technique ◽  
Wrist Pain ◽  
Interosseous Membrane ◽  
Modified Technique ◽  
Ulnar Head

There is scarce literature describing treatment of volar dislocation of the distal radio-ulnar joint (DRUJ). Irreducible dislocation is usually treated surgically. We present the case of a 37-year-old male with acute right wrist pain and loss of pronation. A diagnosis of volar DRUJ dislocation was made. Reduction using conventional technique was unsuccessful. A second attempt was successful by applying pressure over the interosseous membrane of the forearm and manipulating the ulnar head. At three weeks, the patient had minimal pain, a stable DRUJ, and near complete range of motion. This modified technique for reduction of a locked anterior DRUJ dislocation can be used to avoid an unnecessary surgical intervention.

Maisonneuve fracture

2020 ◽  
Vol 99 (2) ◽  
pp. 77-85
Keyword(s):  
Open Reduction ◽  
Lower Leg ◽  
Fracture Dislocation ◽  
Deltoid Ligament ◽  
Ct Reconstruction ◽  
Distal Fibula ◽  
Ct Examination ◽  
Maisonneuve Fracture ◽  
Fibular Fracture ◽  
Wide Range

Introduction: Maisonneuve fracture (MF) is a generally known entity in ankle trauma. However, details about this type of injury can be found only rarely in the literature. For these reasons we have decided to perform a study on MF epidemiology and pathoanatomy. Methods: The group comprised 70 patients (47 men, 23 women), with the mean age of 48 years, who sustained an ankle fracture-dislocation involving the proximal quarter of the fibula. Ankle radiographs in three views and lower leg radiographs in two views were performed in all patients. A total of 59 patients underwent CT examination in three views, including 3D CT reconstruction in 49 of these patients. MRI was performed in 4 patients. Operative treatment was used in 67 patients; open reduction of the distal fibula into the fibular notch was opted for in 54 of them. Results: The highest MF incidence rate was recorded in the 5th decade in the whole group and in men, while in women the peak incidence was in the 6th decade. After the age of 50, the share of women significantly increased. In 64 cases, the fibular fracture was subcapital, and in 6 cases it involved the fibular head. In 24% of the patients, the fibular fracture was seen only in the lateral radiograph of the lower leg. Widening of the tibiofibular clear space was shown by radiographs in 40 cases. Posterior dislocation of the fibula (Bosworth fracture) and tibiofibular diastasis were recorded in 2 cases each. An injury to the anterior and posterior tibiofibular ligaments was found in all 54 patients with open reduction of the distal fibula. A fracture of the medial malleolus was identified in 27 cases (39%) and a complete lesion of the deltoid ligament in 36 cases (51%); in 7 cases (10%) the medial structures were intact. A fracture of the posterior malleolus occurred in 54 (77%) patients. Osteochondral fracture of the talar dome was diagnosed in 2 patients and compression of the articular surface of the distal tibia in the region of the fibular notch in 1 patient. Conclusion: Maisonneuve fracture includes a wide range of injuries both to bone and ligamentous structures of the ankle. Therefore, CT examination is an indispensable part of assessment of this type of fracture.

scholarly journals Transtrapezial Peritrapezoidal Transcapital Axial Radial Fracture Dislocation of the Carpus

Hand ◽  
2009 ◽  
Vol 4 (3) ◽  
pp. 319-322 ◽  
Author(s):  
Jürg Häcki ◽  
Ladislav Nagy ◽  
Andreas Schweizer
Keyword(s):  
Internal Fixation ◽  
Range Of Motion ◽  
Open Reduction ◽  
Dislocation Line ◽  
Fracture Dislocation ◽  
Radial Fracture ◽  
Unique Pattern

We report a unique pattern of an axial radial fracture dislocation of the carpus. The fracture dislocation line runs transtrapezial peritrapezoidal transcapital transmetacarpal III/IV. Open reduction and internal fixation was performed 11 days after the accident. The result at 9 months is moderate, with a range of motion of 63% and strength of 46% compared to the opposite side.

Predisposing Factors for Posttraumatic Osteoarthritis After Malleolus Fracture Fixation in Patients Younger Than 50 Years

2021 ◽  
pp. 107110072110500
Author(s):  
Jong Seok Beak ◽  
Yeong Tae Kim ◽  
Sung Hyun Lee
Keyword(s):  
Risk Factors ◽  
Articular Surface ◽  
Binary Logistic Regression ◽  
Ankle Fractures ◽  
Fracture Dislocation ◽  
Posttraumatic Arthritis ◽  
Level Of Evidence ◽  
Posttraumatic Osteoarthritis ◽  
Posterior Malleolus

Background: The purpose of this study was to identify the risk factors for posttraumatic osteoarthritis (OA) after surgery for ankle fractures in patients aged ≤50 years. Methods: We performed a retrospective review of consecutive patients who underwent surgery for ankle fractures and were followed up for a minimum period of 5 years. The patients were assigned to 2 groups according to the presence of advanced OA at the last follow-up. Binary logistic regression was used to model the correlation between risk factors and OA. Functional outcomes were assessed using the Foot and Ankle Outcome Score. Results: The data of 332 patients who met the inclusion criteria were included in the analysis. The overall rate of posttraumatic arthritis was 27.7% (nonarthritis group: 240 patients, arthritis group: 92 patients). The arthritic change was significantly affected by BMI (95% confidence interval [CI] 1.29-19.76; adjusted odds ratio [OR] ≥ 30, 6.56), fracture-dislocation injury (CI 1.66-11.57; adjusted OR, 4.06), posterior malleolus (PM) fracture (CI 1.92-12.73, adjusted OR > 25% of the articular surface, 5.72), and postoperative articular incongruence (CI 1.52-18.10; adjusted OR, 7.21). The mean scores of the arthritis group were lower than those in the nonarthritis group ( P < .05). Conclusion: Obesity, fracture-dislocation injury, concomitant large PM fracture, and articular incongruence were risk factors of posttraumatic OA after surgery for ankle fractures. Surgeons should be aware that accurate reduction is critical in patients with ankle fractures with associated large PM fractures, especially those with obesity or severe initial injuries such as fracture-dislocation. Level of Evidence: Level III, case control study.

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