ABSTRACT
BACKGROUND: Tibiotalar joint fusion ways are various, and it is a difficulty in necrotic tibiotalar joint fusion. There are few comparative studies on the repair outcomes of each implant. OBJECTIVE: To compare the effectiveness and safety of modified sliding chute bone graft plus hollow screw fixation with simple screw internal fixation and plate internal fixation for tibiotalar joint fusion. METHODS: Fifty-six patients who underwent tibiotalar joint fusion were Included, Including 16 cases of screw fixation, 22 cases of plate fixation and 18 cases of modified sliding chute bone graft plus hollow screw fixation. Ankle function was compared after simple screw internal fixation, plate internal fixation and modified sliding chute bone graft plus hollow screw fixation. The ankle foot scoring system of American Orthopedic Foot and Anlde Society was used for evaluation. At the same time, the operation time, brace fixation time and fusion time of the three surgical methods ware compared. The gait at the last follow-up was compared. The average follow-up time was 2.4 years. The experiment met the ethical requirements of the First Affiliated Hospital of Harbin Medical University. All patients provided written informed consent for study participation. RESULTS AND CONCLUSION: (1) All the patients obtained exactly bony fusion. Compared with the plate fixation group, the slide bone grafting group had significant advantages in the fusion time and the last gait (P < 0.05), and the screw fixation group had significant advantages in the operation time (P < 0.05). (2) Using the ankle foot scoring system of American Orthopedic Foot and Ankle society, there was no significant difference between the sliding chute bone graft group and the plate fixation group, but both groups were significantly better than the screw fixation group (P < 0.05). (3) Adverse events had not been found in each group. (4) These results suggest that modified sliding chute bone graft plus hollow screw fixation for anlde joint lusion can effectively improve ankle joint fusion rate compared with single screw fixation, which is effective and safe.
ABSTRACT
[Objective]To evaluate the effect of fibula shortening on biomechanical characters of tibiotalar joint and prescribe the most acceptable extent of fibula shortening.[Method]Six fresh cadaveric specimens were disarticulated though the knee,and the soft tissues were removed from the knee to the level of the ankle joint.The position of the ankle joint during testing simulated the single leg stance phase of gait.Every group of specimen carried out a biomechanical test in the turn of intact,fibula 2mm shortening,4mm shortening,6mm shortening.The biomechanical change of the tibiotalar joint after fibular shortening was found.[Result]The total contact area of the tibiotalar joint tended to decrease in the fibular shortening model.The contact area and contact pressure in anteromedial and posteromedial quadrant tended to decrease,while,the contact area and contact pressure in anterolateral and posterolateral quadrant tended to increase.[Conclusion]The 2 mm fibular shortening(including 2 mm) significantly alter the biomechanical characters in tibiotalar joint.