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Among ankle injuries, the injury to the distal tibiofibular syndesmosis is common and likely neglected. The stability of the distal tibiofibular syndesmosis is related to the depth of the fibular notch. In imaging diagnosis, X-ray examination cannot be used for a definite diagnosis of the injury to the distal tibiofibular syndesmosis. For diagnosis of the distal tibiofibular separation>3 mm, CT scan can be accurate but is not sensitive enough for a separation<1 mm while MRI is more sensitive in diagnosis of the injury. Arthroscopy has gradually been used as the "gold standard" in diagnosis of the injury to the distal tibiofibular syndesmosis due to its advantage of direct vision. The distal tibiofibular separation occurs in the injuries of pronation external rotation Ⅳ°, supination external rotation Ⅲ° and Ⅳ°, and pronation abduction Ⅱ° and Ⅲ° by the Lange-Hansen classification. Most patients with simple stable injury to the distal tibiofibular syndesmosis may have a good prognosis after nonoperative treatment. Surgical anatomic reduction and maintenance of stability of the distal tibiofibular syndesmosis are the basic management principles for unstable distal tibiofibular syndesmosis or the injury to the distal tibiofibular syndesmosis combined with ankle fracture. Screw fixation is the most commonly used in the surgical treatment of the injury. Elastic fixation has the advantages of maintaining the biological characteristics of the distal tibiofibular syndesmosis fretting joint, better reduction fault tolerance, and lower rates of complications and long-term reduction loss. The angle of nail placement is the key to maintaining good reduction of the distal tibiofibular syndesmosis, but there has been little description of the specific methods to ensure the theoretical angle of nail placement in practice. This article also reviews the prospects of the future treatment of the injury to the distal tibiofibular syndesmosis.
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Objective To study mechanical properties of the novel micro-movement elastic implant of distal tibiofibular syndesmosis in dorsiflexion position.Methods A combination of simulation and experiment was used. The normal ankle dorsiflexion model, the bone nail repaired model and the micro-movement elastic implant repaired model were established by using Mimics and CT data. Besides, ANSYS Workbench was used for finite element analysis. Mechanical experiments on lower limb specimens were conducted on Instron E10000 mechanical test instrument, and five sets of experimental data were measured and analyzed.Results Mechanical properties of the micro-movement elastic implant repaired model were closer to those of the normal ankle dorsiflexion model, but stress of the micro-movement elastic implant repaired mode was greater than that of the bone nail repaired model. The results of two-sample heteroscedasticity t test indicated that there was no significant difference in resistance torque between the micro-movement elastic implant repaired model and the normal ankle dorsiflexion model.Conclusions For dorsiflexion position, repairing mechanical properties of the novel micro-movement elastic implant are much better than those of the bone nail, and there is still room for optimizing the micro-movement elastic implant.
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Objective To explore the surgical efficacy of trans-syndesmotic ankle fracture dislocation (the "Logsplitter" injury) plus the Tillaux-Chaput fracture / the Wagstaffe-Lefort fracture and the Volkmann fracture without tibiofibular joint screwing.Methods Between January 2015 and December 2018,16 adult patients with the "Logsplitter" injury plus avulsion fractures were treated by open reduction and internal fixation at Department of Orthopaedics,The Sixth Affiliated Hospital,Xinjiang Medical University.They were 11 males and 5 females with an average age of 36.4 years (range,from 27 to 56 years).There were 2 open fractures (one type Ⅱ and one type ⅢA by the Anderson-Gustilo classification) and 14 closed ones;all fractures were type 44-C by the AO/OTA classification;according to the Lauge-Hansen classification,there were 9 cases of pronation-abduction rotation,3 cases of pronation-external rotation and 4 cases of supination-external rotation.The fibular fractures were treated through a single lateral approach followed by plate fixation.The Volkmann fractures were fixed with screws and the Tillaux-Chaput fractures / the Wagstaffe-Lefort fractures with screws or Kirschner wires.The ankle functions were assessed postoperatively using the ankle-hindfoot rating system of the American Orthopaedic Foot and Ankle Society (AOFAS),and the dysfunction index and bother index of Short Musculoskeletal Function Assessment (SMFA).Results All the patients were followed up for 8 to 27 months (average,21.3 months).X-ray films showed complete fracture healing in all cases after 12 to 18 weeks postoperatively (mean,14.8 weeks).At the last follow up,13 patients walked normally and 2 with mild discomfort.Their AOFAS scores averaged 96.3 (range,from 86 to 100),giving 12 excellent,3 good and one poor cases;their SMFA dysfunction index was 15.9 (range,from 8 to 17)and SMFA bother index 6.5 (range,from 3 to 9)at the last follow-up.Conclusions In the treatment of trans-syndesmotic ankle fracture dislocation — the "Logsplitter" injury,open reduction and internal fixation of the Tillaux-Chaput fracture / the Wagstaffe-Lefort fracture and the Volkmann fracture to reconstruct the lower tibiofibular horizontal stable "ring",without tibiofibular joint screwing,can obtain satisfactory clinical results.
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Objective: To review the research progress in the diagnosis and treatment of distal tibiofibular syndesmosis injury. Methods: The recent literature about distal tibiofibular syndesmosis injury was reviewed and analyzed. Results: Distal tibiofibular syndesmosis injury is commonly seen in ankle joint injury, the anatomical complexities make diagnosis and treatment difficult. Preoperative physical examination, radiologic evaluation, and intraoperative stress-testing are important for the diagnosis. Aggressive treatment is also recommended for these injuries to prevent long-term chronic instability. Internal fixation is the main treatment, including metal screw, degradable screw, elastic fixation, and hybrid techniques. Metal screw fixation is still the current mainstream, but elastic fixation represented by Suture-button is more in line with the physiological characteristics of ankle joint, and the rate of secondary operation is low while the clinical outcome is satisfactory. The application prospect of elastic fixation is worthy of expectation. Conclusion: It's crucial for patient with ankle fracture to repair the distal tibiofibular syndesmosis injury. How to diagnose the injury more accurately and simply, how to increase the success rate of reduction, and how to reduce the complications of surgery are still worthy for further exploration.
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BACKGROUND: In the clinical treatment of distal tibiofibular syndesmosis injury, Suture-Button fixation technique can achieve similar results to, even better results than, those of screws, but it cannot fully recover the anatomical reduction and activity to those before injury. However, the optimal treatment of distal tibiofibular syndesmosis injury is still controversial. OBJECTIVE: To systematically evaluate Suture-Button fixation and screw fixation for the treatment of distal tibiofibular syndesmosis injury. METHODS: EMBASE, Cochrane database, PubMed database, Wanfang database, and CNKI were searched to retrieve randomized or non-randomized controlled trials regarding Suture-Button fixation and screw fixation for the treatment of distal tibiofibular syndesmosis injury published from January 2005 to January 2019. The quality of the included studies was strictly evaluated. Relevant data were extracted. A meta-analysis of all outcome measures was performed using RevMan 5. 3 software. RESULTS AND CONCLUSION: (1) Twelve studies were included, including 4 randomized controlled trials and 8 cohort studies, involving 564 patients. (2) Meta-analysis results showed that Suture-Button fixation had shorter full weight-bearing time [WMD=-1. 50, 95%CI(-2. 08, -0. 92), P 0. 05). (3) These findings suggest that compared with screw fixation, Suture-Button fixation for the treatment of distal tibiofibular syndesmosis injury leads to better recovery of ankle joint function and an earlier time point for full weight bearing and does not need to consider the risk of screw fracture during the surgery. In addition to screw fixation, Suture-Button fixation is an effective way to treat distal tibiofibular syndesmosis injury.
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Logsplitter injury is an ankle joint injury caused by high-energyaxial violence with significant separation of inferior tibiofibularsyndesmosis. Surgery is the mainstay treatment. The fractureshould be treated in stages depending on the condition of thesoft tissue. The integrity and smoothness of the ankle jointsurface should be restored as much as possible during thesurgery. This article discusses the treatment strategies oflogsplitter injuries. Thorough research of the availableliteratures was done aiming to provide a standard treatmentprotocol. When combined with posterior malleolus fracture,anatomical reduction of posterior malleolus is necessary toreconstruct posterior tibial notch and then lateral malleolus.This reduction sequence is very important. Anatomical lockingplates have been widely used in the fixation of fibular fractures.Anatomical reduction and fixation of the inferior tibiofibularsyndesmosis is the key factor to achieve good functionalresults. There are still some controversies on how to accuratelyjudge the stability of the inferior tibiofibular syndesmosis.Screws are the main method of fixing the inferior tibiofibularsyndesmosis at present. Ankle arthroplasty or anklearthrodesis may be necessary if the cartilage of the ankle jointis extensively damaged or if the ankle joint is severelycomminuted. At present, the therapeutic and prognostic effectsof these injuries are poor. The main influencing factors includethe degree of injury, anatomical reduction of the fracture anddislocation, recovery of ankle stability and the reconstruction ofankle joint surface.
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Objective: To investigate the effectiveness of open reduction and internal fixation on high-energy ankle Logsplitter injuries (a kind of transsyndesmotic ankle fracture dislocation), and compare the prognosis between open and closed Logsplitter fracture. Methods: The clinical data of 36 Logsplitter fractures treated with open reduction and internal fixation between April 2011 and May 2016 were retrospectively analyzed. Among them, 15 cases were open fracture and dislocation (open group) and 21 cases were closed fracture and dislocation (closed group). There was no significant difference between the two groups in gender, age, combined injury, injury to hospital admission time, and other general data ( P>0.05), with comparability. The wound healing, ankle mobility recovery, complications, and fracture healing were observed after operation. The ankle function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) score. Results: Both groups were followed up 12-29 months (mean, 19 months). There was no significant difference in the follow-up time between the open group and the closed group ( t=1.169, P=0.251). In the open group, there were 3 cases of postoperative infection, 3 cases of nonunion, and 5 cases of post-traumatic osteoarthritis; the above complications occurred in 1 case in the closed group; there was no significant difference in complications between the two groups ( P=0.41) except post-traumatic osteoarthritis ( P=0.02). At last follow-up, there was no significant difference in AOFAS score between the two groups ( t=1.981, P=0.056). According to AOFAS score criterion, the results were good in 10 cases and general in 5 cases in the open group, and good in 13 cases and general in 8 cases in the closed group, showing no significant difference ( P=0.45). There was no significant difference in the fracture healing time and ankle flexion, dorsal extension, varus, and valgus motion between the two groups ( P>0.05). Conclusion: Open reduction and internal fixation for open or closed Logsplitter fractures can achieve satisfactory results, improve fracture healing rate, effectively reduce the incidence of complications, and improve ankle function.
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Objective To evaluate the clinical value of ankle arthroscopy in diagnosis and treatment of Danis-Weber type B ankle fracture associated with injury to the distal tibiofibular syndesmosis.Methods A retrospective study was conducted of the 35 patients who had been treated at Department of Orthopaedics,Ruijin Hospital North for Danis-Weber type B ankle fracture from February 2014 to December 2016.They were 23 males and 12 females,with an average age of 43.1 years (from 18 to 65 years).Each of them underwent 4 examinations to detect whether injury to the distal tibiofibular syndesmosis was complicated or not:preoperative CT and MRI,C-ann roentgenography and ankle arthroscopy before and after internal fixation of the ankle.The diagnostic rates of the complicated injury by the 4 examinations were compared.The patients complicated with injury to the distal tibiofibular syndesmosis received surgical repair of the injury using TightRope in addition to internal fixation of the ankle,and injury to the deltoid ligament was repaired simultaneously using 3.5 mm anchor nails in case the injury was concomitant.The repair and stability of the distal tibiofibular syndesmosis were observed using ankle arthroscopy again.Results The Cotton and external rotation tests under C-arm roentgenography before surgery and after internal fixation of the ankle demonstrated that 13 cases were complicated with injury to the distal tibiofibular syndesmosis.Of the other 22 patients who had not been diagnosed with the injury by C-arm roentgenography,6,13 and 11 were diagnosed with the injury respectively by CT,MRI and ankle arthroscopy.The diagnostic rates of Danis-Weber type B ankle fracture associated with injury to the distal tibiofibular syndesmosis were 37.1％ (13/35),54.3％ (19/35),74.3％ (26/35) and 68.6％ (24/35) respectively by C-arm roentgenography,CT,MRI and ankle arthroscopy.In the sensitivity to the injury,MRI ＞ ankle arthroscopy ＞ CT ＞ C-arm roentgenography,with significant differences between them (P ＜ 0.05).The ankle arthroscopy confirmed the repair efficacy in the 24 patients complicated with injury to the distal tibiofibular syndesmosis and negative results of Cotton and external rotation tests in them.Additionally,ankle arthroscopy revealed 16 cases of injury to the deltoid ligament at the medial ankle.Conclusions Ankle arthroscopy can provide evidence for correct diagnosis and treatment of Type B ankle fracture complicated with injury to the distal tibiofibular syndesmosis,because it allows direct observation of the medial deltoid ligament of the ankle and the distal tibiofibular syndesmosis.It can be also used to assess the stability of the tibiofibular syndesmosis after repair of the injury.
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<p><b>OBJECTIVE</b>To compare the clinical effectiveness for Tight rope fixation and traditional screw fixation in treating injury of distal tibiofibular syndesmosis in ankle fractures.</p><p><b>METHODS</b>A retrospective study was carried out in patients with injury of distal syndesmosis in ankle fractures who received 2 surgical operations(observation group: 33 cases with Tight rope fixation; control group: 35 cases with traditional screw fixation) from May 2014 to February 2016. There were 18 males and 15 females, aged from 20 to 55 years old with an average of(32.4±5.2) years old in observation group; of them, 19 cases were caused by traffic accidents, 10 by sprain, and 4 by falling; according to Lauge-Hansen typing of ankle fractures, all of the 33 cases were pronation-extorsion fracture, 12 cases were III degree and 21 cases were IV degree. There were 19 males and 16 females, aged from 21 to 54 years old with an average of (32.8±5.5) years old in control group; of them, 20 cases were caused by traffic accidents, 11 by sprain, 4 by falling; according to Lauge-Hansen typing of ankle fractures, 1 case was with pronation-outreach, 34 cases with pronation-extorsion, 13 cases were III degree and 21 cases were IV degree. Fixation time and complication were compared between two groups and AOFAS scores were observed in two groups 3 and 6 months after the operation as well as final follow-up.</p><p><b>RESULTS</b>All the patients were followed up from 8 to 24 months with an average of (16.3±3.8) months. Fixation time of observation group and control group were (10.1±2.8) min and (9.5±2.3) min(>0.05) respectively. There were significant difference in complication and AOFAS of 3, 6 months postoperatively between two groups(<0.05). In observation group, 23 case got excellent result, 9 good, 1 fair; and in control group, 18 cases got excellent results, 12 good, 5 fair; there was no significant difference between two groups(>0.05).</p><p><b>CONCLUSIONS</b>Tight rope for the treatment of injury of distal tibiofibular ligament union in ankle fractures has advantages such as easier techniques, earlier weight-bearing exercises without risk of screw breakage, thus is a new choice. However, it is still necessary to further study the angle, direction and tension of button steel plate.</p>
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Objective To investigate the guidance of a new intraoperative classification of distal tibiofibular syndesmosis injury in the selection of internal fixation for ankle fractures.Methods Between January 2010 and January 2015 our department treated 116 patients with displaced closed ankle fracture (Weber type B or C).They were 60 men and 56 women,aged from 18 to 78 years (average,45.6 years).After reduction and fixation of the fibular fracture,we assessed the syndesmosis stability using the fibular hook traction test and radiological findings.We classified the distal tibiofibular syndesmosis injury into 3 grades (grade Ⅰ:＜ 4 mm displacement;grade Ⅱ:4-7 mm displacement;grade Ⅲ:＞ 7 mm displacement).Selection of proper screwing was determined by our new classification.Results Of the 116 cases,82 (70.7％) demonstrated distal tibiofibular syndesmosis injury.Screwing of the distal tibiofibular syndesmosis was not conducted for 30 (25.9％) of them who were of stable grade Ⅰ.52 (44.8％) cases were of unstable grades Ⅱ and Ⅲ.Of the 48 cases of grade Ⅱ,44 were fixated with one screw and the rest 4 became stable grade Ⅰ after Volkmann block fixation and received no screwing.Fixation of the distal tibiofibular syndesmosis with 2 screws was conducted for the 4 cases of unstable grade Ⅲ.All the patients were followed up for 12 to 60 months.No non-union,screw breakage,or syndesmosis separation after screw removal occurred.The American Orthopaedic Foot and Ankle Society ankle-hindfoot scoring showed a good/excellent rate of 93.1％ (108/116).Conclusion Our new intraoperative classification can provide correct judgment of the severity of distal tibiofibular syndesmosis injury,thus guiding the selection of proper screw fixation to enhance the outcomes of ankle fractures.
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Objective To investigate the guidance of a new intraoperative classification of distal tibiofibular syndesmosis injury in the selection of internal fixation for ankle fractures.Methods Between January 2010 and January 2015 our department treated 116 patients with displaced closed ankle fracture (Weber type B or C).They were 60 men and 56 women,aged from 18 to 78 years (average,45.6 years).After reduction and fixation of the fibular fracture,we assessed the syndesmosis stability using the fibular hook traction test and radiological findings.We classified the distal tibiofibular syndesmosis injury into 3 grades (grade Ⅰ:＜ 4 mm displacement;grade Ⅱ:4-7 mm displacement;grade Ⅲ:＞ 7 mm displacement).Selection of proper screwing was determined by our new classification.Results Of the 116 cases,82 (70.7％) demonstrated distal tibiofibular syndesmosis injury.Screwing of the distal tibiofibular syndesmosis was not conducted for 30 (25.9％) of them who were of stable grade Ⅰ.52 (44.8％) cases were of unstable grades Ⅱ and Ⅲ.Of the 48 cases of grade Ⅱ,44 were fixated with one screw and the rest 4 became stable grade Ⅰ after Volkmann block fixation and received no screwing.Fixation of the distal tibiofibular syndesmosis with 2 screws was conducted for the 4 cases of unstable grade Ⅲ.All the patients were followed up for 12 to 60 months.No non-union,screw breakage,or syndesmosis separation after screw removal occurred.The American Orthopaedic Foot and Ankle Society ankle-hindfoot scoring showed a good/excellent rate of 93.1％ (108/116).Conclusion Our new intraoperative classification can provide correct judgment of the severity of distal tibiofibular syndesmosis injury,thus guiding the selection of proper screw fixation to enhance the outcomes of ankle fractures.
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Objective To explore the clinical characteristics of and surgical strategies for distal tibiofibular syndesmosis separation based on ankle axial CT scan.Methods From January 2009 to January 2016,63 patients with injury to the distal tibiofibular syndesmosis were treated.Their injuries were characterized according to the anatomic characteristics on their ankle axial CT scan images as pronation-extorsion type (28 cases),supination-extorsion type (11 cases) and abduction type (24 cases).Specific strategies of reduction and fixation depended on the specific characteristics of distal tibiofibular syndesmosis separation.After 12 months postoperatively,the reduction quality was assessed by Burwell-Charnley's radiological evaluation system and the function of ankle joint was assessed using American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score system.Results The patients were followed up for 6 to 48 months (average,19.3 months).Anatomical reduction was achieved in 19 cases,good reduction in 7 and fair reduction in 2 in the pronation-extorsion type,yielding an excellent to good rate of 92.8％;anatomical reduction was achieved in 6 cases,good reduction in 4 and fair reduction in one in the supination-extorsion type,yielding an excellent to good rate of 90.9％;anatomical reduction was achieved in 17 cases,good reduction in 6 and fair reduction in one in the abduction type,yielding an excellent to good rate of 95.8％.By the AOFAS system,the pronation-extorsion type scored 88.6 points,the supination-extorsion type 89.4 points and the abduction type 86.6 points.Conclusion In the treatment of distal tibiofibular syndesmosis separation,reduction and fixation strategies should depend on analysis of the characteristics on the ankle axial CT scan,so as to achieve positive outcomes.
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<p><b>OBJECTIVE</b>To analyze the treatment effect of Endobutton plate cable system for the treatment of the distal tibiofibular syndesmosis injury.</p><p><b>METHODS</b>Total 38 patients with tibiofibular syndesmosis separation treated by surgical operation from October 2011 to October 2013 were analyzed retrospectively. According to internal fixation, 38 cases were divided into two groups involving group A (cortical screw fixation) and group B (Endobutton plate cable system fixation). In group A, there were 26 patients including 16 males and 10 females with an average age of (37.90±4.67) years old ranging from 19 to 63 years old; 14 cases were on the left and 12 on the right;involving 8 cases of Weber-Denis type B, 18 cases of Weber-Denis type C; according to Lauge-Hanson typing, 9 cases of supination external rotation (SER), 10 cases of pronation abduction (PAB), 7 cases of pronation external rotation (PER). In group B, there were 12 cases including 7 males and 5 females, with an average age of (38.70±6.03) years old ranging from 20 to 55 years old;6 cases were on the left and 6 cases on the right;involving 4 cases of Weber-Denis type B and 8 cases of Weber-Denis; involving 7 cases of PER, 3 cases of SER, 2 cases of PAB. The operative time, intraoperative blood loss, surgery cost, hospital stay time, the wound healing, pain score at 1 month after operation, and the load time were recorded and evaluated. According to reviewing of X rays regulary, the healing of fracture were assessed, the function outcomes of ankle was evaluated according to the Ankle Hind Foot Scale of American Orthopaedic Foot and Ankle Society.</p><p><b>RESULTS</b>All patients were followed up for 8 to 18 months with an average of 13.5 months. There were no statistical significance in intraoperative blood loss, hospital stay time, average load time and postoperative pain score at 1 month after operation between two groups (>0.05). Duration of operation, the operative time were significantly shorter in cortical screw group;however, the average cost of hospitalization was significantly higher in Endobutton group. No significant differences were found between two groups in outcome of radiographic measurement. The X rays of 36 patients showed well healing of fracture, normal mortise and no distal tibiofibular syndesmosis separation. AOFAS score at the final follow up in group A was (87.50±8.67) scores, 18 cases got excellent result, 4 cases were good, and 4 cases were fair. AOFAS score at the final follow up in group B was (86.23±7.42) scores, 7 cases obtained excellent result, 4 cases were good and 1 case was fair; AOFAS score between two groups were no significant difference (>0.05).</p><p><b>CONCLUSIONS</b>Endobutton plate cable system is a dynamic capital equipment in treating the tibiofibular syndesmosis separation, it has a similar outcome compared with the screw, but without screw fractured and do not regular remove after operation. The patients could take the functional exercises earlier.</p>
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OBJECTIVE: To evaluate the difference between using and not using syndesmotic screw to treat pronation external rotation (PER) ankle fracture combined with separation of distal tibiofibular syndesmosis. METHODS: Between April 2011 and October 2014, 46 cases of PER ankle fracture combined with separation of distal tibiofibular syndesmosis were treated, and syndesmotic screw was used in 24 cases (fixation group) and syndesmotic screw was not used in 22 cases (non-fixation group). There was no significant difference in gender, age, weight, cause of injury, side, injury to operation time, and fracture type between 2 groups (P>0.05). The time for full weight-bearing, fracture healing time, and complications were recorded after operation. Anteroposterior and lateral X-ray films were taken to measure the tibiofibular overlap (TBOL) and tibiofibular clear space (TBCS). Baird-Jackson score was used to evaluate functional recovery of the ankle. RESULTS: All incision healed by first intention without complications. The cases were followed up 13-18 months (mean, 15.2 months) in 2 groups. The time for full weight-bearing was 8-12 weeks (median, 11 weeks) in fixation group, which was significantly later than that in non-fixation group (range, 6-10 weeks; median, 8 weeks) (Z=-5.049, P=0.000). X-ray examination showed reduction of separation of distal tibiofibular syndesmosis. All fractures healed. The fracture healing time was (13.83±1.37) weeks in fixation group, and was (13.91±1.31) weeks in non-fixation group, showing no significant difference (t=-0.191, P=0.945). No separation of distal tibiofibular syndesmosis, delayed union, nonunion, loosening, or breakage of fixation devices was observed in 2 groups. There was no significant difference in TBOL, TBCS, Baird-Jackson score and the excellent and good rate between 2 groups (P>0.05). CONCLUSIONS: If the medial, lateral, and posterior structures of the ankle could be repaired according to injury, no significant influence on functional outcome of ankle or radiologic findings could be detected whether syndesmotic fixation is given or not in treating PER ankle fracture (exclude Maisonneuve fracture) combined with separation of distal tibiofibular syndesmosis.
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Objective The article aims at evaluating the biological properties of tibiofibular titanium cable fixation device in terms of both anti-separation and stress shielding by comparison to the interior fixation with lag screw based on experimental observation. Methods Six corpse ankle specimens were first tested of pressure-separation and stress measurement, the data from which were compared to the normal group, and then a syndesmosis injury model was established. All the samples are randomly divided into 2 groups of 3 specimens each, which were treated with tibiofibula locked titanium cable and lag screw fixation respectively for syndesmosis injury. Then, the samples were tested for pressure-separation and stress measurement. The biomechanical properties as anti-separation ability and stress shielding were analyzed and compared between the two fixation method. Results Both tibiofibula locked titanium cables and lag screws were able to provide enough strong lateral anti-separation ability, but strong fixation screws were inferior to tibiofibular titanium cable fixation device in fibular longitudinal stress transduction. Conclusion Tibiofibular titanium cable fixation device not only provide sufficient lateral anti-separation, but also reduces the tibial and fibular longitudinal stress shielding, thus being superior to the traditional lag screw in biomechanical properties.
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Objective To explore the effect of polyethylene terephthalate artificial ligament revascularization on the treatment of distal tibiofibular syndesmosis injury .Methods The data of 18 patients with distal tibiofibular syndesmosis injury in our hospital from March 2013 to March 2014 were retrospectively analyzed .Fourteen patients received the bilateral suspension fixed technology ,and 4 cases were fixed with unilateral suspension fixation by extrusion screw which could be absorbed .The ankle joint mobility was measured during the follow-up,which were evaluated by American orthopedic foot and ankle society ( AOFAS) .Results Eighteen patients with distal tibiofibular syndesmosis in-jury were followed up for 12~17 months,with an average of 13.5 months.Imagings showed that the tibiofibular space was normal on postop-erative X-ray films,and there was no lost in 1 year.The PET of artificial ligaments were taken out ,and the artificial ligament and bone tissue were combined with a good ligament toughness .The pathological examination revealed the fibrous tissue grew in the artificial ligaments .Ac-cording to AOFAS ankle function grading evaluation of curative effect ,11 cases were excellent ,6 cases were good ,and 1 case was not obvious . Conclusion PET artificial ligament revascularization can recover the hinge functions of tibiofibular syndesmosis for patients with early recov -ery of ankle plantar flexion range in a short time .Different ways of fixed ligament had no obvious effect on functional recovery ,however,the extrusion screw technology can shorten the time of surgery .
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BACKGROUND:The traditional surgical method have large trauma in the treatment of tibiofibular syndesmosis injury, and cannot wel complete the repair of ligament. But the suture anchor has clear effect for ligament repair, ligament reconstruction and bone connection. OBJECTIVE:To investigate the biomechanical properties of the suture anchor in the treatment of tibiofibular syndesmotic injury, and to compare with lag screw internal fixation. METHODS:Eight ankle joint specimens were col ected, and the biomechanical experiment was performed for stress analysis. The suture anchor technology and lag screw internal fixation were used respectively to treat the tibiofibular syndesmotic injury. The biomechanical properties of the stress strength, stiffness and stability were compared. RESULTS AND CONCLUSION:The biomechanical properties of the stress strength, stiffness and stability of suture anchor technology for the treatment of tibiofibular syndesmotic injury were better than those of lag screw internal fixation, and there were significant differences in the strength and stiffness between two methods (P<0.05);the stress shielding rate of suture anchor technology was lower than that of lag screw internal fixation, and the difference was significant (P<0.05);the tibiofibular syndesmosis separated displacement of suture anchor technology was lower than that of lag screw internal fixation, and the difference was significant (P<0.05). The results indicate that the suture anchor technology is a minimal invasion and good method to realize physiological reconstruction and elastic fixation with stable fixation strength and less trauma, and without secondary operation.
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10.3969/j.issn.2095-4344.2013.26.016
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Objective To evaluate the effect and potential risks of two types of materials ( taitanum versus polylevolactic acid,PLLA) screws on fixation of distal tibiofibular syndesmosis by a prospective randomized comparative clinical study.Methods From January 2007 to May 2008,48 patients with ankle fractures combined with a verified syndesmotic rupture were randomly allocated to receive either bioabsorbable PLLA (n =28 ) or titanium (n =20) screw fixation.The patients were assessed in aspects of radiography,function recovery and complication during follow-up.Results The total followup rate was 98％.The demographic information of the two groups showed no statistical difference ( P ＞0.05).After 1-2 years of follow-up,the indexes including Baird score,total score,and Baird grade were not statistically different between the two groups ( P ＞ 0.05).At the end of follow-up,there was significant difference in regard of joint motion between the injured and uninjured ankle in both groups ( P ＜0.05).Moderate rejection occurred in two patients and tibiofibular heterotopic ossification in two in PLLA group.Conclusions There is no significant difference between the bioabsorbable and metallic screws with regard to ankle function recovery,but the bioabsorbable screw fixation can avoid a second operation for taking out the screw.However,the complication risk of the bioabsorbable screws should not be ignored,such as rejection reaction,heterotopic ossification.
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Objective To investigate the different effects of different resection position of fibula on shape of tibiofibular syndesmosis,and explore the best position of cut fibula,providing reference for clinical surgeon to use fibula reasonably.Methods Ten adult male cadaverie specimens 172-176 cm long were used for 20 shank-ankle specimens.10 cm long fibula was cut proximally at the lower point 1/6,lower point 1/4,lower point 1/3,middle point 1/2 respectively,which was compared with the nornlal one to analyze the changes of shape of tibiofibular syndesmosis.Results Normally,the distance oftibiofibular syndesmosiswas(0.30±0.10)mm.Underthe condition of cut at the lower point 1/6,the distance of tibiofibular syndesmosis was enlarged[(0.54±0.20)mm](P＜0.05).In contrast,under the condition of cut 10 cm long fibula proximally at the middle point 1/2.the distance of tibioffbu1ar syndesmosis hadlittle effect[(0.31±0.20)mm](P＞0.05).Conclusion The best resection position of fibula is in the proximity of the fibula at the point 1/2.