scholarly journals Towards Automated Ligamentous Injury Evaluation in Syndesmotic Ankle Lesions

2021 ◽  
Author(s):  
Matthias Peiffer ◽  
Arne Burssens ◽  
Sophie De Mits ◽  
Thibault Heintz ◽  
Michiel Van Waeyenberge ◽  
...  
Keyword(s):  
External Rotation ◽  
Distal Tibia ◽  
Three Dimensional ◽  
Statistical Shape Model ◽  
Ankle Injuries ◽  
Shape Model ◽  
Clinical Patient ◽  
Joint Congruency ◽  
Significant Difference ◽  
Tibiofibular Joint

Abstract PurposeForced external rotation is hypothesized as the key mechanism of syndesmotic ankle injuries. This complex trauma pattern ruptures the syndesmotic ligaments, inducing a three-dimensional deviation from the normal distal tibiofibular joint configuration. However, current diagnostic imaging modalities are impeded by a two-dimensionalassessment, without taking into account ligamentous stabilizers. Therefore, our aim is two-fold: (1) to construct an articulated statistical shape model of the normal ankle with inclusion of ligamentous morphometry and (2) to apply this model in the assement of a clinical cohort of paient with syndesmotic ankle injuries.Methods Three-dimensional models of the distal tibiofibular joint were analyzed in asymptomatic controls (N= 76; Mean age 63 +/- 19 years),patients with syndesmotic ankle injury (N = 13; Mean age 35 +/- 15 years), and their healthy contralateral equivalent (N = 13). Subsequently, the statiscal shape model was generated after aligning all ankles based on the distal tibia. The position of the syndesmotic ligaments was predicted based on previously validated iterative shortest path calculation methodology. Evaluation of the model was described by means of accuracy, compactness and generalization. Canonical Correlation Analysis was performed to assess the influence of syndesmotic lesions on the distal tibiofibular joint congruency.ResultsOur presented model contained an accuracy of 0.23 +/- 0.028 mm. Mean prediction accuracy of ligament insertions was 0.53 +/- 12 mm. A statistically significant difference in anterior syndesmotic distance was found between ankles with syndesmotic lesions and healthy controls (95% CI [ 0.32 , 3.29], p = 0.017). There was a significant correlation between presence of syndesmotic injury and the morphological distal tibiofibular configuration (r = 0.873, p <0,001). ConclusionIn this study, we constructed a bony and ligamentous statistical model representing the distal tibiofibular joint Furthermore, the presented model was able to detect an elongation injury of the anterior inferior tibiofibular ligament after traumatic syndesmotic lesions in a clinical patient cohort.

Kinematics of the Axially Loaded Ankle

1995 ◽  
Vol 16 (9) ◽  
pp. 577-582 ◽  
Author(s):  
James D. Michelson ◽  
Stephen L. Helgemo
Keyword(s):  
Axial Load ◽  
Sagittal Plane ◽  
External Rotation ◽  
Three Dimensional ◽  
Axial Rotation ◽  
Ankle Injuries ◽  
Knee Amputation ◽  
Precise Understanding ◽  
Ankle Biomechanics

An apparatus that allowed the application of a 900 N axial load and the simultaneous measurement of rotation in the sagittal, coronal, and axial planes was used to study the normal kinematics of the ankle in 13 below-knee amputation specimens. Two testing routines were done on all specimens. In the first sequence, specimens were moved through a dorsiflexion (DF) and plantarflexion (PF) arc of 60° (25° DF and 35° PF). DF was associated with an average of 2.5° of external rotation, and PF was associated with an average of <1° of internal rotation. In the coronal plane, PF and DF were both associated with <1° of varus. In the second part of the testing, the ankle position in the sagittal plane (DF/PF) was fixed and the axial load was increased from 50 N to 750 N in 100-N intervals. Increasing the axial load caused an increase in external rotation and valgus of 1° to 2°. For axial rotation, external rotation was more pronounced in PF than DF. The effect of load on the increase on valgus was not affected by sagittal ankle position. The effect of increasing axial load on sagittal rotation was to increase DF or PF <2° over the entire range of loads and sagittal positions. The understanding of ankle biomechanics is essential to the formulation of rational guidelines for the treatment of ankle pathology and the prediction of the long-term consequences of ankle injuries. The incomplete understanding of this subject is evident when the disparate recommendations for a number of common conditions are considered. By examining the three-dimensional motion of the stable ankle, a more precise understanding of the abnormal three-dimensional motions associated with instability can be achieved. This knowledge will permit a logical approach to treatment of ankle fractures.

scholarly journals Restoration of Tibiofibular Kinematics with a Tricortical Screw or Suture Button Fixation After Syndesmotic Ankle Injuries

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Conor Murphy ◽  
Thomas Pfeiffer ◽  
Jason Zlotnicki ◽  
Volker Musahl ◽  
Richard Debski ◽  
...  
Keyword(s):  
Screw Fixation ◽  
External Rotation ◽  
Tracking System ◽  
Optical Tracking ◽  
Ankle Injuries ◽  
Suture Button ◽  
Tibiofibular Ligament ◽  
Cortical Screw ◽  
Significant Difference ◽  
Posterior Translation

Category: Ankle, Sports, Trauma Introduction/Purpose: Anterior inferior tibiofibular ligament (AITFL), Posterior inferior tibiofibular ligament (PITFL) and Interosseous membrane (IOM) disruption is a predictive measure of residual symptoms after ankle injury. In unstable injuries, the syndesmosis is treated operatively with cortical screw fixation or a suture button apparatus. Biomechanical analyses of suture button versus cortical screw fixation methods show contradicting results regarding suture button integrity and maintenance of fixation. The objective of this study is to quantify tibiofibular joint motion in syndesmotic screw and suture button fixation models compared to the intact ankle. Methods: Five fresh-frozen human cadaveric specimens (mean age 58 yrs.; range 38-73 yrs.) were tested using a 6-degree-of- freedom robotic testing system. The tibia and calcaneus were rigidly fixed to the robotic manipulator and the subtalar joint was fused. The full fibular length was maintained and fibular motion was unconstrained. Fibular motion with respect to the tibia was tracked by a 3D optical tracking system. A 5 Nm external rotation moment and 5 Nm inversion moment were applied to the ankle at 0°, 15°, and 30° plantarflexion and 10° dorsiflexion. Outcome variables included fibular medial-lateral (ML) translation, anterior-posterior (AP) translation, and external rotation (ER) in the following states: 1) intact ankle, 2) AITFL transected, 3) PITFL and IOM transected, 4) 3.5 mm cannulated tricortical screw fixation, 5) suture button fixation. An ANOVA with a post-hoc Tukey analysis was performed for statistical analysis (*p<0.05). Results: Significant differences in fibular motion were only during the inversion moment. Fibular posterior translation was significantly higher with complete syndesmosis injury compared to the intact ankle at 0°, 15°, and 30° plantarflexion and the tricortical screw at 15° and 30°. Significantly higher fibular posterior translation was observed with the suture button compared to the intact ankle at 15° and 30 plantarflexion and to the tricortical screw at 15°. ER was significantly increased with complete injury compared to the tricortical screw at 0° and 30° plantarflexion. The suture button demonstrated significantly greater ER at 0° plantarflexion and 10° dorsiflexion compared to the intact ankle. The only significant difference in ML translation exists between the tricortical screw and complete injury at 30° plantarflexion. Conclusion: The suture button did not restore physiologic motion of the syndesmosis. It only restored fibular ML translation. Significant differences in AP translation and ER persisted compared to the intact ankle. The tricortical screw restored fibular motion in all planes. No significant differences were observed compared to the intact ankle. These findings are consistent with previous studies. This study utilized a novel setup to measure unconstrained motion in a full length, intact fibula. Physicians should evaluate AP translation and ER as critical fibular motions when reconstructing the syndesmosis with suture button fixation.

scholarly journals The Role of Fibular Fixation in Distal Tibia-Fibula Fractures: A Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Chengxin Li ◽  
Zhizhuo Li ◽  
Qiwei Wang ◽  
Lijun Shi ◽  
Fuqiang Gao ◽  
...  
Keyword(s):  
External Rotation ◽  
Meta Analysis ◽  
Distal Tibia ◽  
Valgus Deformity ◽  
Cochrane Library ◽  
Control Group ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
Fibular Fixation ◽  
Anterior Posterior

Objectives. The necessity of fibular fixation in distal tibia-fibula fractures remains controversial. This study aimed to assess its impact on radiographic outcomes as well as rates of nonunion and infection. Methods. A systematic search of the electronic databases of PubMed, Embase, and Cochrane library was performed to identify studies comparing the outcomes of reduction and internal fixation of the tibia with or without fibular fixation. Radiographic outcomes included malalignment and malrotation of the tibial shaft. Data regarding varus/valgus angulation, anterior/posterior angulation, internal/external rotation deformity, and the rates of nonunion and infection were extracted and then polled. A meta-analysis was performed using the random-effects model for heterogeneity. Results. Additional fibular fixation was statistically associated with a decreased rate of rotation deformity (OR = 0.13; 95% CI 0.02–0.82,p=0.03). However, there was no difference in the rate of malreduction between the trial group and the control group (OR = 0.86; 95% CI 0.27–2.74,p=0.80). There was also no difference in radiographic outcomes of varus-valgus deformity rate (OR = 0.17; 95% CI 0.03–1.00,p=0.05) or anterior-posterior deformity rate (OR = 0.76; 95% CI 0.02–36.91,p=0.89) between the two groups. Meanwhile, statistical analysis showed no significant difference in the nonunion rate (OR = 0.62; 95% CI 0.37–1.02,p=0.06) or the infection rate (OR = 0.81; 95% CI 0.18–3.67,p=0.78) between the two groups. Conclusions. Additional fibular fixation does not appear to reduce the rate of varus-valgus deformity, anterior-posterior deformity, or malreduction. Meanwhile, it does not appear to impair the union process or increase the odds of infection. However, additional fibular fixation was associated with decreased odds of rotation deformity compared to controls.

Templating of Syndesmotic Ankle Lesions by Use of 3D Analysis in Weightbearing and Nonweightbearing CT

2018 ◽  
Vol 39 (12) ◽  
pp. 1487-1496 ◽  
Author(s):  
Arne Burssens ◽  
Hannes Vermue ◽  
Alexej Barg ◽  
Nicola Krähenbühl ◽  
Jan Victor ◽  
...  
Keyword(s):  
External Rotation ◽  
Imaging Techniques ◽  
Ankle Injuries ◽  
Control Group ◽  
3D Analysis ◽  
Anatomical Landmarks ◽  
Distal Fibula ◽  
Fracture Group ◽  
Significant Difference ◽  
The Mean

Background: Diagnosis and operative treatment of syndesmotic ankle injuries remain challenging due to the limitations of 2-dimensional imaging. The aim of this study was therefore to develop a reproducible method to quantify the displacement of a syndesmotic lesion based on 3-dimensional computed imaging techniques. Methods: Eighteen patients with a unilateral syndesmotic lesion were included. Bilateral imaging was performed with weightbearing cone-beam computed tomography (CT) in case of a high ankle sprain (n = 12) and by nonweightbearing CT in case of a fracture-associated syndesmotic lesion (n = 6). The healthy ankle was used as a template after being mirrored and superimposed on the contralateral ankle. The following anatomical landmarks of the distal fibula were computed: the most lateral aspect of the lateral malleolus and the anterior and posterior tubercle. The change in position of these landmarks relative to the stationary, healthy fibula was used to quantify the syndesmotic lesion. A control group of 7 studies was used. Results: The main clinical relevant findings demonstrated a statistically significant difference between the mean mediolateral diastasis of both the sprained (mean [SD], 1.6 [1.0] mm) and the fracture group (mean [SD], 1.7 [0.6] mm) compared to the control group ( P < .001). The mean external rotation was statistically different when comparing the sprained (mean [SD], 4.7 [2.7] degrees) and the fracture group (mean [SD], 7.0 [7.1] degrees) to the control group ( P < .05). Conclusion: This study evaluated an effective method for quantifying a unilateral syndesmotic lesion of the ankle. Applications in clinical practice could improve diagnostic accuracy and potentially aid in preoperative planning by determining which correction needs to be achieved to have the fibula correctly reduced in the syndesmosis. Level of Evidence: Level III, retrospective comparative study.

The three-dimensional shape symmetry of the lunate and its implications

2021 ◽  
pp. 175319342110040
Author(s):  
Nazlı Tümer ◽  
Olivier Hiemstra ◽  
Yvonne Schreurs ◽  
Gerald A. Kraan ◽  
Johan van der Stok ◽  
...  
Keyword(s):  
Intraclass Correlation ◽  
Three Dimensional ◽  
Dorsal Side ◽  
Statistical Shape Model ◽  
Patient Specific ◽  
Shape Model ◽  
Patient Specific Implants ◽  
Statistical Shape ◽  
Dimensional Shape ◽  
Three Dimensional Shape

We studied the three-dimensional (3-D) shape variations and symmetry of the lunate to evaluate whether a contralateral shape-based approach to design patient-specific implants for treatment of Kienböck’s disease is accurate. A 3-D statistical shape model of the lunate was built using the computed tomography scans of 54 lunate pairs and shape symmetry was evaluated based on an intraclass correlation analysis. The lunate shape was not bilaterally symmetrical in (1) the angle scaphoid surface – radius-ulna surface, (2) the dorsal side and the length of the side adjacent to the triquetrum, (3) the orientation of the volar surface, (4) the width of the side adjacent to the scaphoid, (5) the skewness in the coronal plane and (6) the curvature of bone articulating with the hamate and capitate. These findings suggest that using the contralateral lunate to design patient-specific lunate implants may not be as accurate as it is intended.

scholarly journals Three-dimensional MRI-based statistical shape model and application to a cohort of knees with acute ACL injury

2015 ◽  
Vol 23 (10) ◽  
pp. 1695-1703 ◽  
Author(s):  
V. Pedoia ◽  
D.A. Lansdown ◽  
M. Zaid ◽  
C.E. McCulloch ◽  
R. Souza ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Acl Injury ◽  
Statistical Shape Model ◽  
Shape Model ◽  
Statistical Shape

scholarly journals In vivo three-dimensional kinematics of normal knees during different high-flexion activities

2018 ◽  
Vol 100-B (1) ◽  
pp. 50-55 ◽  
Author(s):  
K. Kono ◽  
T. Tomita ◽  
K. Futai ◽  
T. Yamazaki ◽  
S. Tanaka ◽  
...  
Keyword(s):  
Computer Aided Design ◽  
External Rotation ◽  
Three Dimensional ◽  
Lateral Side ◽  
3D Registration ◽  
High Flexion ◽  
Valgus Angle ◽  
Significant Difference ◽  
Medial Pivot

Aims In Asia and the Middle-East, people often flex their knees deeply in order to perform activities of daily living. The purpose of this study was to investigate the 3D kinematics of normal knees during high-flexion activities. Our hypothesis was that the femorotibial rotation, varus-valgus angle, translations, and kinematic pathway of normal knees during high-flexion activities, varied according to activity. Materials and Methods We investigated the in vivo kinematics of eight normal knees in four male volunteers (mean age 41.8 years; 37 to 53) using 2D and 3D registration technique, and modelled the knees with a computer aided design program. Each subject squatted, kneeled, and sat cross-legged. We evaluated the femoral rotation and varus-valgus angle relative to the tibia and anteroposterior translation of the medial and lateral side, using the transepicodylar axis as our femoral reference relative to the perpendicular projection on to the tibial plateau. This method evaluates the femur medially from what has elsewhere been described as the extension facet centre, and differs from the method classically applied. Results During squatting and kneeling, the knees displayed femoral external rotation. When sitting cross-legged, femurs displayed internal rotation from 10° to 100°. From 100°, femoral external rotation was observed. No significant difference in varus-valgus angle was seen between squatting and kneeling, whereas a varus position was observed from 140° when sitting cross-legged. The measure kinematic pathway using our methodology found during squatting a medial pivoting pattern from 0° to 40° and bicondylar rollback from 40° to 150°. During kneeling, a medial pivot pattern was evident. When sitting cross-legged, a lateral pivot pattern was seen from 0° to 100°, and a medial pivot pattern beyond 100°. Conclusion The kinematics of normal knees during high flexion are variable according to activity. Nevertheless, our study was limited to a small number of male patients using a different technique to report the kinematics than previous publications. Accordingly, caution should be observed in generalizing our findings. Cite this article: Bone Joint J 2018;100-B:50–5.

The Short Oblique Fracture of the Distal Fibula Without Medial Injury: An Assessment of Displacement

1995 ◽  
Vol 16 (4) ◽  
pp. 181-186 ◽  
Author(s):  
Marion C. Harper
Keyword(s):  
External Rotation ◽  
Distal Tibia ◽  
Joint Space ◽  
Fracture Site ◽  
Ankle Injuries ◽  
Distal Fibula ◽  
Avulsion Fractures ◽  
Plain Radiographs ◽  
Fracture Displacement ◽  
Rotation Stage

Eighteen patients with ankle injuries presenting as short oblique fractures of the distal fibula with no clinical or radiographic evidence of injury to the medial ankle were studied for fracture displacement. Plain radiographs and computed tomography were used for analysis. All fractures were clinically diagnosed as supination-external rotation stage 2 (SE-II) injuries under the Lauge-Hansen scheme. All exhibited slight displacement on plain radiographs and were treated nonoperatively. Computerized tomography using axial cuts across the fracture site and ankle mortise revealed normal positioning of the talus beneath the tibial plafond, as evidenced by no abnormality of the medial joint space in all patients. In the majority of patients, the relationship between the talus and distal fibula also appeared undisturbed, with fracture displacement being confined to a change in position of the proximal fibular fragment relative to the tibia as compared with the contralateral ankle. In a minority of cases, in addition to the above-described displacement of the proximal fibular fragment, the distal fibular fragment was noted to shift slightly laterally relative to the talus, with mild widening of the lateral joint space. Occult-associated avulsion fractures off the distal tibia were present in 39% of the cases.

scholarly journals Diagnostic capability of dynamic ultrasound evaluation of supination-external rotation ankle injuries: a cadaveric study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Cara L. Fisher ◽  
Tebyan Rabbani ◽  
Katelyn Johnson ◽  
Rustin Reeves ◽  
Addison Wood
Keyword(s):  
External Rotation ◽  
Stress Test ◽  
Statistical Significance ◽  
Definitive Diagnosis ◽  
Ankle Injuries ◽  
Stress Evaluation ◽  
Clear Space ◽  
Significant Difference ◽  
Stage 1 ◽  
Supination External Rotation

Abstract Background Ankle syndesmosis injuries are common and range in severity from subclinical to grossly unstable. Definitive diagnosis of these injuries can be made with plain film radiographs, but are often missed when severity or image quality is low. Computed tomography (CT) and magnetic resonance imaging (MRI) can provide definitive diagnosis, but are costly and introduce the patient to radiation when CT is used. Ultrasonography may circumvent many of these disadvantages by being inexpensive, efficient, and able to detect injuries without radiation exposure. The purpose of this study was to evaluate the ability of ultrasonography to detect early stage supination-external rotation (SER) ankle syndesmosis injuries with a dynamic external rotational stress test. Methods Nine, all male, fresh frozen specimens were secured to an ankle rig and stress tested to 10 Nm of external rotational torque with ultrasonography at the tibiofibular clear space. The ankles were subjected to syndesmosis ligament sectioning and repeat stress measurements of the tibiofibular clear space at peak torque. Stress tests and measurements were repeated three times and averaged and analyzed using a repeated one-way analysis of variance (ANOVA). There were six ankle injury states examined including: Intact State, 75% of AITFL Cut, 100% of AITFL Cut, Fibula FX - Cut 8 cm proximal, 75% PITFL Cut, and 100% PITFL Cut. Results Dynamic external rotation stress evaluation using ultrasonography was able to detect a significant difference between the uninjured ankle with a tibiofibular clear space of 4.5 mm and the stage 1 complete injured ankle with a clear space of 6.0 mm (P < .02). Additionally, this method was able to detect significant differences between the uninjured ankle and the stage 2–4 injury states. Conclusion Dynamic external rotational stress evaluation using ultrasonography was able to detect stage 1 Lauge-Hansen SER injuries with statistical significance and corroborates criteria for diagnosing a syndesmosis injury at ≥6.0 mm of tibiofibular clear space widening.

Sign in / Sign up

Export Citation Format

Share Document