Reconstruction of Medial Malleolus and Deltoid Ligament using Bone - Patella Tendon Graft in a Child: Case Report

Introduction. A Bosworth fracture-dislocation is a rare lesion resulting in a fixed dislocation of the distal fibula behind the posterior tibial tubercle. Only few cases have been reported showing an associated consequent fracture, namely, a pilon or a medial malleolus fracture. Case Report. We present a case report of a patient with an unusual combination of a Bosworth injury with a pilon fracture and an open multifragmentary talus fracture and our approach for open reduction and internal fixation. At one year postoperative, the patient developed an invalidating tibiotalar and subtalar arthrosis that eventually required an ankle-hindfoot arthrodesis. A Bosworth injury is an infrequent entity and is even rarer when associated with other fractures. Careful preoperative planning is necessary, as the combination of these fractures is a surgical challenge. Special care must be taken to preserve the neurovascular bundle. Discussion. The present case highlights a Bosworth injury involving a severity that has never been described before and suggests adding an eighth stage to the classification presented by Perry et al.

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Time of remodelling of the patella tendon graft in anterior cruciate ligament surgery: an histological and immunohistochemical study in a rabbit model

The Knee ◽

10.1016/s0968-0160(97)00018-5 ◽

1998 ◽

Vol 5 (1) ◽

pp. 9-19 ◽

Cited By ~ 7

Author(s):

Espregueira-Mendes ◽

J.M. Lopes ◽

C. Castro ◽

J. Oliveira

Keyword(s):

Anterior Cruciate Ligament ◽

Immunohistochemical Study ◽

Cruciate Ligament ◽

Rabbit Model ◽

Tendon Graft ◽

Patella Tendon ◽

Anterior Cruciate ◽

Anterior Cruciate Ligament Surgery

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Finite Element Analysis of Fixed Medial Malleolar Fractures

Volume 1B: Extremity; Fluid Mechanics; Gait; Growth, Remodeling, and Repair; Heart Valves; Injury Biomechanics; Mechanotransduction and Sub-Cellular Biophysics; MultiScale Biotransport; Muscle, Tendon and Ligament; Musculoskeletal Devices; Multiscale Mechanics; Thermal Medicine; Ocular Biomechanics; Pediatric Hemodynamics; Pericellular Phenomena; Tissue Mechanics; Biotransport Design and Devices; Spine; Stent Device Hemodynamics; Vascular Solid Mechanics; Student Paper and Design Competitions ◽

10.1115/sbc2013-14632 ◽

2013 ◽

Author(s):

Ruchi D. Chande ◽

John R. Owen ◽

Robert S. Adelaar ◽

Jennifer S. Wayne

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Mechanical Performance ◽

External Rotation ◽

Weight Bearing ◽

High Stress ◽

Ankle Injuries ◽

Deltoid Ligament ◽

Medial Malleolus ◽

Element Analysis

The ankle joint, comprised of the distal ends of the tibia and fibula as well as talus, is key in permitting movement of the foot and restricting excessive motion during weight-bearing activities. Medial ankle injury occurs as a result of pronation-abduction or pronation-external rotation loading scenarios in which avulsion of the medial malleolus or rupture of the deltoid ligament can result if the force is sufficient [1]. If left untreated, the joint may experience more severe conditions like osteoarthritis [2]. To avoid such consequences, medial ankle injuries — specifically bony injuries — are treated with open reduction and internal fixation via the use of plates, screws, wires, or some combination thereof [1, 3–4]. In this investigation, the mechanical performance of two such devices was compared by creating a 3-dimensional model of an earlier cadaveric study [5], validating the model against the cadaveric data via finite element analysis (FEA), and comparing regions of high stress to regions of experimental failure.

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Acute Traumatic Open Posterolateral Dislocation of the Ankle Without Tearing of the Tibiofibular Syndesmosis Ligaments

Journal of the American Podiatric Medical Association ◽

10.7547/0980469 ◽

2008 ◽

Vol 98 (6) ◽

pp. 469-472 ◽

Cited By ~ 2

Author(s):

Bahtiyar Demiralp ◽

Mahmut Komurcu ◽

Cagatay Ozturk ◽

Kutay Ozturan ◽

Ersin Tasatan ◽

...

Keyword(s):

Motor Vehicle ◽

Motor Vehicle Accident ◽

Degenerative Change ◽

Deltoid Ligament ◽

Medial Malleolus ◽

Tibiofibular Syndesmosis ◽

Mechanical Instability ◽

Rare Injury ◽

Fibular Fracture ◽

Long Term Follow Up

Pure open dislocation of the ankle, or dislocation not accompanied by rupture of the tibiofibular syndesmosis ligaments or fractures of the malleoli or of the posterior border of the tibia, is an extremely rare injury. A 62-year-old man injured his right ankle in a motor vehicle accident. Besides posterolateral ankle dislocation, there was a 7-cm transverse skin cut on the medial malleolus, and the distal end of the tibia was exposed. After reduction, we made a 2- to 2.5-cm longitudinal incision on the lateral malleolus; the distal fibular fracture was exposed. Two Kirschner wires were placed intramedullary in a retrograde manner, and the fracture was stabilized. The deltoid ligament and the medial capsule were repaired. The tibiofibular syndesmosis ligaments were intact. At the end of postoperative year 1, right ankle joint range of motion had a limit of approximately 5° in dorsiflexion, 10° in plantarflexion, 5° in inversion, and 0° in eversion. The joint appeared normal on radiographs, with no signs of osteoarthritis or calcification. The best result can be obtained with early reduction, debridement, medial capsule and deltoid ligament restoration, and early rehabilitation. Clinical and radiographic features at long-term follow-up also confirm good mobility of the ankle without degenerative change or mechanical instability. (J Am Podiatr Med Assoc 98(6): 469–472, 2008)

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The Arterial Anatomy of the Deltoid Ligament: A Cadaveric Study

Foot & Ankle International ◽

10.1177/1071100717702464 ◽

2017 ◽

Vol 38 (7) ◽

pp. 785-790 ◽

Cited By ~ 3

Author(s):

Jacob A. Haynes ◽

Michelle Gosselin ◽

Brian Cusworth ◽

Jeremy McCormick ◽

Jeffrey Johnson ◽

...

Keyword(s):

Operative Treatment ◽

Tibialis Anterior ◽

Ankle Instability ◽

Chronic Ankle Instability ◽

Vascular Supply ◽

Tibialis Posterior ◽

Deltoid Ligament ◽

Medial Malleolus ◽

Ankle Sprains ◽

India Ink

Background: There is an increasing interest in the operative treatment of deltoid ligament disruption in the setting of chronic ankle instability. Understanding the vascular anatomy of the deltoid complex is beneficial when considering operative procedures on the medial ankle and may provide insight into factors that lead to chronic deltoid insufficiency and ankle instability. Methods: Thirty-two pairs of cadaveric specimens (64 total legs) were amputated below the knee, and the tibialis anterior, tibialis posterior, and peroneal arteries were injected with India ink and Ward’s blue latex. Specimens then underwent chemical debridement to identify the vascular supply to the deltoid ligament. A subset of specimens also underwent intraosseous debridement using the modified Spalteholz technique. Results: The vascular supply to the deltoid ligament was clearly visualized in 60 (93.8%) specimens. Fifty-eight specimens (96.7%) had arterial supply with an origin from the medial tarsal artery, 57 specimens (95%) had supply from the tibialis posterior artery, and 23 (38.3%) specimens had supply from the tibialis anterior artery. All specimens had at least 1 location of intraosseous vascular supply, either at the medial malleolus or medial talus. Conclusion: There were 3 separate extraosseous sources and 2 intraosseous sources of vascular supply to the deltoid ligament. Clinical Relevance: Knowledge of the vascular supply may aid in identifying factors that predispose a subset of patients with medial ankle sprains to failure of conservative treatment, as well as provide useful anatomic information when considering operative treatment for chronic ankle instability.

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