Research of functional mobility in tibiofibular syndesmosis and its changes under fixation of various implants (experimental research)

2021 ◽  
Vol 19 (3) ◽  
pp. 20-23
Author(s):  
G. V. BOGATSKIY ◽  
◽  
A. M. FAYN ◽  
A. Yu. VAZA ◽  
S. F. GNETETSKIY ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Experimental Research ◽  
Functional Mobility ◽  
Fixation Method ◽  
Tibiofibular Syndesmosis ◽  
Functional Rehabilitation ◽  
Intact State ◽  
Cortical Screw ◽  
Tight Rope ◽  
Rope System

For fixing tibiofibular syndesmosis, a full-threaded cortical screw 0 3.5 mm, or a Tight Rope system is often used. Fixing with a screw restricts the amplitude of movements of the foot. A fracture or loosening of the screw before the onset of fusion of the ligaments of tibiofibular syndesmosis is possible. The screw must be removed to avoid the formation of persistent limitations of the function of the ankle joint. The Tight Rope dynamically fixes the syndesmosis, does not limit the amplitude of movements and does not require removal, but its efficiency is insufficiently proven. The purpose — to study the physiological mobility in the tibiofibular syndesmosis for the subsequent more accurate choice of the fixation method. Material and methods. On 5 cadaver samples, 10 studies of fibular mobility were performed with intact ligaments of tibiofibular syndesmosis and after their dissection under conditions of fixation with a full-threaded screw 0 3.5 mm, a partial-threaded screw 0 4.0 mm, and a Tight Rope system. Results. The amplitudes of mobility in the tibiofibular syndesmosis were determined in an intact state and in a state of fixation with different implants; the best fixator and the technique of its installation were determined. Conclusion. During the experiment, the assumption was confirmed that a partial-threaded screw installed without the effect of tightening does not limit the volume of movements in the tibiofibular syndesmosis, which allows starting early functional rehabilitation and excludes the need for a staged removal of the screw.

scholarly journals Tibial Tuberosity Transposition Stabilization Using a Cortical Screw Placed Adjacent to the Tuberosity in Dogs with Patellar Luxation

VCOT Open ◽  
2019 ◽  
Vol 02 (01) ◽  
pp. e43-e49
Author(s):  
Barbro Filliquist ◽  
Sivert Viskjer ◽  
Susan M. Stover
Keyword(s):  
Medical Records ◽  
Screw Fixation ◽  
Tibial Tuberosity ◽  
Fixation Method ◽  
Bone Screw ◽  
Cortical Screw ◽  
Implant Complications ◽  
Tibial Tuberosity Fracture ◽  
Fracture Development ◽  
Fissure Formation

Objectives The aim of this study was to describe a screw fixation method of the tibial tuberosity after transposition during surgical treatment of patellar luxation and to report complications and outcome of the procedure. Materials and Methods Medical records (2010–2016) of dogs treated for patellar luxation with tibial tuberosity transposition stabilization using a cortical bone screw placed adjacent to the tuberosity were retrospectively reviewed. Radiographs acquired immediately after surgery were evaluated for fissures. Proximal tibial dimensions and tibial tuberosity segments were measured. Intraoperative and postoperative complications were recorded. Results One-hundred and six dogs and 131 stifle surgeries were included. Implant complications associated with the screw occurred in 2/106 dogs (1.9%). Two dogs developed tibial tuberosity fracture and proximal displacement within 1 week of surgery and required stabilization with pin and tension band. Patellar reluxation rate following surgery was 6.9% (9/131 procedures). Presence of a fissure on postoperative radiographs increased the odds of tibial tuberosity fracture development (p < 0.001), while greater tibial tuberosity size (p = 0.023) and larger distal cortical attachment (p = 0.018) decreased the odds of fissure formation. Clinical significance Tibial tuberosity transposition can be achieved with a cortical screw placed lateral or medial to the tibial tuberosity.

A 3-D CT Analysis of Screw and Suture-Button Fixation of the Syndesmosis

2016 ◽  
Vol 38 (2) ◽  
pp. 208-214 ◽  
Author(s):  
Jason M. Schon ◽  
Brady T. Williams ◽  
Melanie B. Venderley ◽  
Grant J. Dornan ◽  
Jonathon D. Backus ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Joint Space ◽  
Intact State ◽  
Suture Button ◽  
Repair Technique ◽  
Cortical Screw ◽  
Tibiofibular Joint ◽  
Ct Analysis ◽  
Mean Differences ◽  
Repair Techniques

Background: Historically, syndesmosis injuries have been repaired with screw fixation; however, some suggest that suture-button constructs may provide a more accurate anatomic and physiologic reduction. The purpose of this study was to compare changes in the volume of the syndesmotic space following screw or suture-button fixation using a preinjury and postoperative 3-D computed tomography (CT) model. The null hypothesis was that no difference would be observed among repair techniques. Methods: Twelve pairs of cadaveric specimens were dissected to identify the syndesmotic ligaments. Specimens were imaged with CT prior to the creation of a complete syndesmosis injury and were subsequently repaired using 1 of 3 randomly assigned techniques: (a) one 3.5-mm cortical screw, (b) 1 suture-button, and (c) 2 suture-buttons. Specimens were imaged postoperatively with CT. 3-D models of all scans and tibiofibular joint space volumes were calculated to assess restoration of the native syndesmosis. Analysis of variance and Tukey’s method were used to compare least squares mean differences from the intact syndesmosis among repair techniques. Results: For each of the 3 fixation methods, the total postoperative syndesmosis volume was significantly decreased relative to the intact state. The total mean decreases in volume compared with the intact state for the 1-suture-button construct, 2-suture-button construct, and syndesmotic screw were −561 mm3 (95% CI, −878 to −244), −964 mm3 (95% CI, −1281 to −647) and −377 mm3 (95% CI, −694 to −60), respectively. Conclusion: All repairs notably reduced the volume of the syndesmosis beyond the intact state. Fixation with 1 suture-button was not significantly different from screw or 2-suture-button fixation; however, fixation with 2 suture-buttons resulted in significantly decreased volume compared with screw fixation. Clinical Relevance: The results of this study suggest that the 1-suture-button repair technique and the screw fixation repair technique were comparable for reduction of syndesmosis injuries, although both may overcompress the syndesmosis.

scholarly journals Distal tibial pilon fractures (AO/OTA type B, and C) treated with the external skeletal and minimal internal fixation method

2013 ◽  
Vol 70 (9) ◽  
pp. 836-841 ◽  
Author(s):  
Sasa Milenkovic ◽  
Milorad Mitkovic ◽  
Ivan Micic ◽  
Desimir Mladenovic ◽  
Stevo Najman ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Ankle Joint ◽  
Fixation Method ◽  
Universal Method ◽  
Type B ◽  
Tibial Pilon ◽  
Post Surgery ◽  
Articular Fractures ◽  
Type C ◽  
Pilon Fractures

Background/Aim. Distal tibial pilon fractures include extra-articular fractures of the tibial metaphysis and the more severe intra-articular tibial pilon fractures. There is no universal method for treating distal tibial pilon fractures. These fractures are treated by means of open reduction, internal fixation (ORIF) and external skeletal fixation. The high rate of soft-tissue complications associated with primary ORIF of pilon fractures led to the use of external skeletal fixation, with limited internal fixation as an alternative technique for definitive management. The aim of this study was to estimate efficacy of distal tibial pilon fratures treatment using the external skeletal and minimal internal fixation method. Methods. We presented a series of 31 operated patients with tibial pilon fractures. The patients were operated on using the method of external skeletal fixation with a minimal internal fixation. According to the AO/OTA classification, 17 patients had type B fracture and 14 patients type C fractures. The rigid external skeletal fixation was transformed into a dynamic external skeletal fixation 6 weeks post-surgery. Results. This retrospective study involved 31 patients with tibial pilon fractures, average age 41.81 (from 21 to 60) years. The average follow-up was 21.86 (from 12 to 48) months. The percentage of union was 90.32%, nonunion 3.22% and malunion 6.45%. The mean to fracture union was 14 (range 12-20) weeks. There were 4 (12.19%) infections around the pins of the external skeletal fixator and one (3.22%) deep infections. The ankle joint arthrosis as a late complication appeared in 4 (12.90%) patients. All arthroses appeared in patients who had type C fractures. The final functional results based on the AOFAS score were excellent in 51.61%, good in 32.25%, average in 12.90% and bad in 3.22% of the patients. Conclusion. External skeletal fixation and minimal internal fixation of distal tibial pilon fractures is a good method for treating all types of inta-articular pilon fractures. In fractures types B and C dynamic external skeletal fixation allows early mobility in the ankle joint.

scholarly journals 751 Preoperative Factors Influencing Functional Rehabilitation After Major Lower Limb Amputation

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Premnath ◽  
M Cox ◽  
A Hostalery ◽  
G Kuhan ◽  
T Rowlands ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Lower Limb ◽  
Arterial Disease ◽  
Functional Mobility ◽  
Limb Amputation ◽  
P Value ◽  
Rehabilitation Centre ◽  
Functional Rehabilitation ◽  
Peripheral Arterial ◽  
Preoperative Factors

Abstract Introduction To identify the preoperative factors that influence functional rehabilitation after Major Lower Limb (MLL) amputation. Method This retrospective study analyzed all patients referred post-amputation to an amputee rehabilitation centre over a period of 1 year. The level of functional outcome at 6 and 12 months were recorded using SIGAM (Special Interest Group in Amputee Medicine) grading. Data on various preoperative factors were collected and analyzed for association with functional outcome. Results A total of 71 cases were analyzed. The mean age was 65.18 (range 24 - 91) years and 45 were males (63.4 %). Peripheral arterial disease was the major cause of amputation (80.3%). The level of amputation was above / through knee in 60.6%. Contralateral limb problems were present in 28.2%. Functional mobility was achieved by 38% of the MLL amputees within 6 months of rehabilitation, which increased to 46.5% at 12 months. Pre amputation mobility was a significant factor for a good functional outcome (p-value 0.002). An increasing value of BLARt (Blatchford Leicester Allman-Russell Tool) score showed a significant correlation with poor functional outcome. Conclusions Pre amputation mobility and BLARt score can be used in the prediction of functional outcome and can aid in better pre-operative decision making and rehabilitation planning.

scholarly journals Terapia Ocupacional em grupo de pacientes reumatológicos em serviço ambulatorial/ Occupational Therapy in a Group of Reumatological Patients in Ambulatory Service

2020 ◽  
Vol 4 (1) ◽  
pp. 107-115
Author(s):  
Lucas De Paiva Silva ◽  
Amanda Cavalcanti Belo ◽  
Kátia Magdala Lima Barreto
Keyword(s):  
Occupational Therapy ◽  
Well Being ◽  
Performance Measure ◽  
Functional Mobility ◽  
University Hospital ◽  
Therapeutic Interventions ◽  
Metropolitan Region ◽  
Functional Rehabilitation ◽  
Care Health ◽  
Rheumatological Diseases

A presente análise da prática discute experiências de intervenções terapêuticas ocupacionais junto a grupo de seis pacientes com doenças reumatológicas, em Hospital Universitário de referência da Região Metropolitana do Recife, entre Abril e Maio de 2019, totalizando oito encontros de oficinas artesanais. A aplicação dos instrumentos Medida Canadense de Desempenho Ocupacional e Score for Assessment and Quantification of Chronic Rheumatic Affections of the Hands apontaram desde manutenções a diminuições das queixas de dificuldade de mobilidade funcional manual. Os atendimentos em grupo promoveram reabilitação funcional manual, a construção de um espaço de bem-estar, interação social e educação em saúde. Abstract: This practice analysis discusses experiences of occupational therapeutic interventions with a group of six patients with rheumatological diseases, at a referral University Hospital of the Recife Metropolitan Region, between April and May 2019, totaling eight artisan workshops meetings. The application of the instruments Canadian Ocupational Performance Measure and Score for Assessment and Quantification of Chronic Rheumatic Affections of the Hands pointed from maintenance to decreases of complaints of manual functional mobility. The group approach promoted manual functional rehabilitation, the construction of a space for well-being, social interaction and health education.Keywords: Ambulatory Care; Health Education; Occupational Therapy; Rheumatology. Resumen: Este análisis de práctica discute las experiencias de intervenciones terapéuticas ocupacionales con un grupo de seis pacientes con enfermedades reumatológicas, en un hospital universitario de la Región Metropolitana de Recife, entre abril y mayo de 2019, totalizando ocho reuniones de talleres de artesanos. La aplicación de los instrumentos Medida de Desempeño Ocupacional Canadiense y Puntaje para la Evaluación y Cuantificación de Afecciones Reumáticas Crónicas de las Manos señaló desde el mantenimiento a la disminución de quejas de movilidad funcional manual. El atención grupal promovió rehabilitación funcional manual, un espacio para el bienestar, interacción social y la educación para la salud.Palabras clave: Atención Ambulatoria; Educación en Salud; Reumatología; Terapia Ocupacional.

Comparison of the Syndesmotic Staple to the Transsyndesmotic Screw: A Biomechanical Study

2005 ◽  
Vol 26 (3) ◽  
pp. 224-230 ◽  
Author(s):  
Timothy Marqueen ◽  
John Owen ◽  
Gregg Nicandri ◽  
Jennifer Wayne ◽  
James Carr
Keyword(s):  
External Rotation ◽  
Biomechanical Study ◽  
Tibial Rotation ◽  
Intact State ◽  
Cortical Screw ◽  
Torsional Testing ◽  
Load To Failure ◽  
Posterior Translation ◽  
Fresh Frozen ◽  
Torsional Loads

Background: Controversy still exists about treatment of syndesmotic injuries. This study compared the fixation strengths and biomechanical characteristics of two types of ankle fracture syndesmotic fixation devices: the barbed, round staple and the 4.5-mm cortical screw. Methods: Cadaveric testing was done on 21 fresh-frozen knee disarticulation specimens in biaxial servohydraulic Instron testing equipment. Submaximal torsional loads were applied to specimens in intact and Weber C bimalleolar fracture states. The specimens were then fixed with one of two techniques and again subjected to submaximal torsion and torsion to failure. Biomechanical parameters measured included tibiofibular translation and rotation, maximal torque to failure, and degrees of rotation at failure. Results: Compared to the intact state before testing, the staple held the fibula in a more anatomic position than the screw for mediolateral and anterior displacements (p < 0.01). With submaximal torsional testing, the staple restored 85% of the tibiofibular external rotation and all of the posterior translation values as compared to the intact state. The screw resulted in 203% more tibiofibular medial translation and 115% more external rotation than the intact state. The degree of tibial rotation during submaximal torsional loading was restored to within 15% of intact values but was 21% less with the screw. There was no statistical difference between the screw and staple when tested in load to failure. Tibio-talar rotation at failure was statistically different with the staple construct, allowing more rotation as compared to the screw. Conclusion: The staple restored a more physiologic position of the fibula compared to the syndesmotic screw. Both provided similar performance for the load to failure testing, while the screw reduced tibial rotation more after cyclic loading. There was more tibial rotation before failure for the staple, suggesting a more elastic construct. This study provides biomechanical data to support the clinical use of the syndesmotic staple.

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