Correlation of tibial and fibular fractures in Pilon fractures / 中国组织工程研究

BACKGROUND:The Pilon fracture has a complex fracture line and a comminuted fracture fragment.It is often associated with bone loss and soft tissue damage and is one of the most difficult fractures to treat clinically. OBJECTIVE:To analyze the correlation between tibial and fibular fractures in Pilon fractures. METHODS:A retrospective analysis was conducted on 188 patients with Pilon fracture in the Department of Trauma Orthopedics,The Second People's Hospital of Lianyungang City from January 2014 to January 2022.Imaging data of these patients were collected.Fibular fracture level,fibular fracture type,number of fibular fracture blocks,tibial position status,main fracture blocks of the tibia,size of medial fracture blocks of the tibia,tibial fracture angle,Topliss classification(sagittal plane)and Topliss classification(coronal plane)were summarized into a database.SPSS 25.0 was used to analyze the data of tibia and fibula in Pilon fractures by Spearman correlation analysis.On the basis of the correlation,multiple disordered Logistic regression was used to further analyze the correlation. RESULTS AND CONCLUSION:(1)Spearman correlation analysis showed that tibial fracture angle was positively correlated with fibular fracture type,fibular fracture level and fibular fracture number.Tibial position status was positively correlated with tibial fracture angle and Topliss classification(coronal plane),but negatively correlated with major tibial fracture blocks and Topliss classification(sagittal plane).The level of fibular fracture was positively correlated with the type of fibular fracture and the number of fibular fractures.The main fracture blocks of the tibia were positively correlated with Topliss classification(coronal plane)and negatively correlated with Topliss classification(sagittal plane).(2)Multiple Logistic regression analysis showed that:the level of fibular fracture was correlated with the type of fibular fracture(P<0.05);the number of fibular fractures was correlated with the main fracture block of tibia(P<0.05).(3)It is indicated that the more inclined the ankle joint was to the valgus,the more likely it was to lead to fibular fracture,and the higher the fibular fracture level,the more serious the fibular fracture degree,the more complex the fibular fracture type,the larger the tibial fracture angle,the more the tibia presented Topliss classification(coronal plane)fracture.(4)When the ankle joint was more inclined to be in varus or varus + dorsiflexion,the fibula often did not fracture or simple fracture occurred,and the lower the fracture level,the smaller the tibial fracture angle,the more Topliss classification of the tibia(sagittal plane),the more main fracture blocks of the tibia,the larger the medial fracture block.When the ankle joint is in the dorsiflexion,it often results in a simple fibular fracture with a posterolateral tibial fracture.

Finite element analysis of effect of proximal fibular fracture on knee joint stress in an extended state / 中国组织工程研究

BACKGROUND:The traditional view is that proximal fibular fractures do not require fixation.Others and our research suggest that the proximal fibular structure plays an important role in the stability of the posterolateral structure of the knee joint,and its mechanism of action is worth studying. OBJECTIVE:To investigate the biomechanical effects of proximal fibular fractures on various structures of the knee joint in an extended state. METHODS:Finite element method was used to conduct simulated biomechanical experiments.A healthy young male volunteer was selected to establish a finite element model of the knee joint in an extended state using MRI and CT image data,and four proximal fibular shapes were simulated(Model A:intact,Model B:1 cm fracture below the fibular head,Model C:1 cm tip defect fracture from the proximal end of the fibula to the distal end,and Model D:2 cm bone defect from the proximal end of the fibula).A longitudinal concentrated load of 1 500 N was applied to the femoral shaft to compare and analyze the distribution and changing trend of the maximum equivalent stress and maximum first principal stress of each structure of the knee joint in an extended state under four working conditions. RESULTS AND CONCLUSION:(1)In Model A,the maximum equivalent stress in the tibial cartilage and lateral compartment of the meniscus was greater than that in the medial compartment,while the maximum first principal stress in the tibial plateau and medial compartment of the meniscus was greater than that in the lateral compartment.The maximum equivalent stress of the medial condyle of the femoral cartilage was greater than that of the lateral condyle,and the maximum first principal stress of the medial condyle of the femoral cartilage was greater than that of the medial condyle.(2)Compared to Model A,there was no significant difference in the magnitude and distribution of the maximum equivalent stress and maximum first principal stress in the cartilage and meniscus of Model C.(3)Compared to Model A,the maximum equivalent stress increase amplitude of Model B was in the order of medial tibial cartilage(14.9％),medial condyle of femoral cartilage(13.6％),and medial meniscus(6.6％).The maximum first principal stress increase amplitude was the medial meniscus(11.06％),the medial tibial cartilage(8.65％),and the medial condyle of the femoral cartilage(7.46％).The maximum equivalent stress increase amplitude of the ligament was as follows:popliteal arch ligament(33.2％)>anterior cruciate ligament(21.3％)>fibular collateral ligament(17％)>posterior cruciate ligament(14.3％)>anterior lateral collateral ligament(13.2％)>medial collateral ligament(10.1％).(4)Compared to Model A,the maximum equivalent stress increasing trend of Model D followed the medial tibial cartilage(19.5％),femoral cartilage medial condyle(17.9％),and medial meniscus(9.9％).The maximum first principal stress in sequence was the medial meniscus(14.04％),the medial tibial cartilage(13.03％),and the medial condyle of the femoral cartilage(11.37％).The increasing trend of maximum equivalent stress in ligaments was as follows:anterior cruciate ligament(25.2％)>posterior cruciate ligament(18.9％)>medial collateral ligament(18.5％)>anterior lateral collateral ligament(12.7％).(5)It is suggested that when the knee joint is extended,a 1 cm fracture below the fibular head and a 2 cm fibular tip bone defect have a significant impact on the structure of the medial ventricular cartilage,anterior cruciate ligament,and posterior lateral ligament complex.

Curative effect contrast of three different methods in treatment of frac-ture of tibia and fibula / 中国现代医生

Objective To investigate the effect of three different methods in treatment of fracture of tibia and fibula. Methods A total of 84 cases of patients with fracture of tibia and fibula in our hospital from January 2013 to January 2015 hospitalized patients were selected, according to the different internal fixation methods were divided into group A (external fixation) 24 cases, group B (compression plate) 30 cases, group C (intramedullary nail) 30 cases, the blood loss, time of fracture healing and curative effect were compared. Results The amount of bleeding in group C was the largest, which was significantly more than that of the group A, group B. There were significant differences of amount of bleed-ing in three groups (F=11.237, P<0.01). The fracture healing time in group C was the fastest, which was faster than group A, group B. There were significant differences of fracture healing time in three groups (F=23.865, P<0.01). Fol-low up of patients: The excellent and good rate of group C was highest, was significantly higher than group A, group B. There were significant differences of excellent and good rate in three groups (χ2=6.138, P<0.05). Group A of 3 cases of soft tissue infection, 3 cases of osteomyelitis, nonunion in 1 cases, no skin necrosis, malunion, joint stiffness. Group B had no soft tissue infection, 2 cases of osteomyelitis, nonunion in 3 cases, skin necrosis in 1 cases, joint stiffness in 2 cases, 3 cases of malunion. In group C, no case of osteomyelitis, soft tissue infection, skin necrosis, joint stiffness, and only 1 cases of nonunion, malunion occurred in 1 cases. Conclusion External fixation, compression plate, in-tramedullary nail for treatment are effective methods in the treatment of fracture of tibia and fibula with interlocking intramedullary nail, but compare with other methods of internal fixation has more advantages.

Analysis of Risk Factors for the Posterolateral Articular Depression and Status of Posterolateral Fragment in Lateral Condylar and Bicondylar Tibial Plateau Fractures with Joint Depression

PURPOSE: To evaluate risk factors of posterolateral articular depression and characteristics of the posterolateral fragment in lateral condylar and bicondylar tibial plateau fractures with joint depression. MATERIALS AND METHODS: We reviewed 48 patients of Schatzker type II and type V (type II 34, type V 14) and evaluated risk factors of posterolateral articular depression according to the posterolateral fragment, fibular fracture, and Schatzker classification. We evaluated the position of articular depression and anterolateral fracture line of the posterolateral fragment and measured anterior to posterior lengths of the posterolateral fragment. RESULTS: Posterolateral articular depression was found in 20 of 34 cases (59%) with coexisting posterolateral fragment and in 16 of 21 cases (76%) with coexisting fibular fracture. There was a significant difference in the occurrence of posterolateral articular depression with the existence of the posterolateral fragment and fibular fracture (p<0.001). Multivariate regression analysis revealed that fibular fracture increased the occurrence of posterolateral articular depression (odds ratio 24.5, 95% confidence interval 2.2-267.2). Fifty-seven percentage of the anterolateral fracture line of the posterolateral fragment existed posterior to the anterior margin of the fibular head. CONCLUSION: This study showed that fibular fracture affects posterolateral articular depression in Schatzker type II and V tibial plateau fractures. Selecting a fixation device and performing fracture reduction requires a careful consideration since the anterolateral fracture line of the posterolateral fragment exists posterior to the anterior margin of the fibular head.

Operative Treatment with Anatomically Preshaped Locking Compression Plate in Distal Fibular Fracture / 대한족부족관절학회지

PURPOSE: Preshaped Locking compression plate(LCP) has holes with fixed angle between screw and plate and have advantage firm fixation because it has stability of angular and axial deformity. We evaluated usefulness of LCP after open reduction and internal fixation in distal fibular fracture. MATERIALS AND METHODS: Between December 2011 and May 2012, 23 patients with fracture of distal fibula were followed up at least 12 months underwent open reduction and internal fixation with LCP. There were 15 males and 8 females with a mean age 39.8(20~69) years. According to Danis-Weber classification, there were 20 cases of type B and 3 cases of type C. There were 13 cases of isolated lateral malleolus fractures, 1 case of bimalleolar fracture, 6 cases of trimalleolar fractures and 3 cases of distal tibia fractures with proximal fibula fracture. Intraoperatively, we assessed whether preshaped LCP fit lateral margin of distal fibula or not and evaluated quality of reduction and postoperative complications. The cases were analyzed by radiological bone union time and clinical results according to the criteria of Meyer. RESULTS: Of all cases, complete bone union was achieved and average radiological bone union time was 7.3(6~12) weeks. The clinical results were excellent in 18 cases(78%), good in 5 cases(22%). There were 5 cases of plate with 3 holes, 13 cases of plate with 4 holes, 2 cases of plate with 5 holes, 1 case of plate with 6 holes and 2 cases of plate with 7 holes. The average number of screws at proximal fragement was 2.5 and at distal fragment was 3.5. In 14 cases (60.8%), we needed re-bending of plate because the distance between plate and lateral cortical margin of distal fibula was more than 5 mm at anteroposterior X-ray after reduction. All cases have anatomical reduction and there were no complications of wound infections. There were no complaint about hardware irritation. CONCLUSION: At fractures of distal fibula,preshaped LCP had a excellent stability although far cortex was not fixed with screw and bending of plate. And there are less complications of hardware irritation and wound problems. But, Some complement would be needed because there were no complete fitting between precontour of LCP and lateral cortical margin of distal fibula.

Extensive Metallosis Caused by Plate and Screw Construct for Distal Fibular Fracture - A Case Report -

Metallosis has been reported in the setting of weight-bearing joint arthroplasties, like the hip and knee joints. However, the prevalence of metallosis in non-articular portions is very uncommon. We report a rare case of a patient who had metallosis secondary by fibular nonunion after fixation with plate and screw. In addition, we discuss the clinical and the operative findings, as well as the outcome of this uncommon complication.

Tratamento das fraturas do terço distal da tíbia: fixar ou não a fíbula? / Treatment of the distal fractures of the tibia: shall we fix the fibula?

OBJETIVO: Comparar os resultados da fixação ou não da fíbula no tratamento das fraturas do terço distal da tíbia, com haste intramedular e placa em ponte. MÉTODOS: Foram 47 fraturas em 47 pacientes, sendo que em 21 pacientes foi utilizada a haste intramedular bloqueada não fresada e em 26 a placa em ponte (placa de compressão dinâmica larga ou estreita) pela técnica minimamente invasiva. Todas as fraturas da fíbula se encontravam no mesmo nível ou abaixo da fratura da tíbia. RESULTADOS: No grupo tratado com fixação da fíbula, a média do tempo de consolidação foi de 14,6 semanas. No grupo tratado sem fixação da fíbula, a média do tempo de consolidação foi de 14,3 semanas. No grupo de pacientes tratados com fixação da fíbula observou-se uma proporção de desvio angular em varo (6,3 por cento) significativamente menor que o subgrupo sem fixação de fíbula (32,3 por cento), e com desvio angular em valgo (62,5 por cento) significativamente maior que o grupo sem fixação de fíbula (32,3 por cento). CONCLUSÃO: Os benefícios da fixação da fíbula permanecem ainda controversos quando ocorrem fraturas associadas com a tíbia. Em relação à consolidação, não houve diferença significativa entre os grupos.

OBJECTIVE: To compare the results of fibula fixation (or not fixation) in the treatment of fractures located in the distal third part of the tibia, by using intramedullary nailing and bridge plate. METHOD: 47 fractures in 47 patients were studied. Twenty-one patients were treated with non-reammed, interlocking intramedullary nailing, and 26 patients were treated with wide or narrow dynamic compressional plates (using a minimally invasive technique). All of the fibula fractures are located at the same level or below the tibia fractures. RESULTS: in the group of patients treated with fibula fixation, the average healing time was 14.6 weeks. In the group of patients treated without fibula fixation, the average healing time was 14.3 weeks. In the group of patients treated with fibula fixation it was observed a significantly smaller proportion of valgus angular deviation (6.3 percent) than in the group of patients treated without fibula fixation (32.3 percent). CONCLUSIONS: The benefits of fibula fixation still keeping controversial when tibial fractures are associates. Regarding fracture healing, there was no significant difference between the studied fracture groups.

Posterior Plating in Distal Fibular Fracture

PURPOSE: To report the technical experience of posterior plating for the distal fibular fracture. MATERIALS AND METHODS: 20 Weber type-B fibular fractures were included in this study, which were treated with the posterior plating. 1/3 semitubular plate was used and orientation of all screws were intended to be perpendicular to the plate as possible. Fixation stability and maintenance of reduction after plating was assessed manually in the operating field. Clinical results were evaluated at least 1 year after operation, using American Orthopaedic Foot and Ankle Society (AFOAS) Ankle-Hindfoot score. RESULTS: 5 cases were firmly stabilized without using any lag screw or fixation of distal fragment. For improving stability or achieving proper reduction, a lag screw was placed posteroanteriorly through the plate in 14 cases. Anteroposterior interfragmentary fixation in 1 case before plating, and contouring of the plate in 3 cases were needed in cases of which the posterior plating impeded reduction of distal fibular fracture. In all cases, fracture was stabilized without fixation through the most distal hole. There were no major postoperative complications. AFOAS score was 95.5±5.2. CONCLUSION: The posterior plating technique for distal fibular fracture is regarded as a recommendable option. Additional fixation with interfragmentary screw or contouring of the plate, however, would be needed in some cases to achieve anatomical reduction or sufficient stability.

Biomechanical effect of mid-upper fibular fracture on ankle joint / 中国矫形外科杂志

[Objective]To investigate the biomechanical effect of mid-upper fibular fracture on ankle joint.[Method]From January 2005 to June 2006,20 cases of mid-upper fibular fracture were collected.Normal anterior film of bilateral ankle joint was photographed,ankle mortise width and distal fibula upper shift were measured to observe the effect on stability of ankle joint.Foot-scan pressure analyzer was used to detect the central track of footplate pressue,subtalar joint angle,in order to compare the difference between normal ankle and the sick.[Result]Dislocated mid-upper fibular fracture could lead to ankle mortise widening,lateral malleolus up shift ( averaged,1.260?0.339mm,1.045?0.276mm).the central track of footplate pressure offset and the fracture sides subtalar joint angle were larger than those in normal feet(P

External fixator combined with vaccum sealing drainage for the infection after internal fixation in tibial and fibular fracture / 中国矫形外科杂志

[Objective]To explore the effect of external fixator combined with vaccum sealing drainage(VSD) for the treatment of infection after internal fixation in tibial and fibular fracture.[Method]Thirty-six patients with infection after internal fixation in tibial and fibular fracture were treated by external fixator combined with VSD from June 2004 to June 2008.[Result]During the following-up period from 8-30 months in thirty-two patients,the infection in all cases were controlled effectively,no case of recurrence was found in all patients,and satisfactory healing were found in 32 cases.The average time of fracture union were 4.5 months;the removal time of external fixation were 5 months on average.[Conclusion]The combined operative procedure is simple,reliable and less traumatic and allow to early functional exercises.Therefore,it is a satisfactory measure for the infection after internal fixation in tibial and fibular fracture.

Comparison of Results Between Internal Fixation of Both Bones and Internal Fixation of the Only Tibia for Distal Tibial and Fibular Fractures / 대한정형외과학회잡지

PURPOSE: This study undertaken to evaluate the clinical results between the fixation of both bones and the fixation of the only tibia for extra-articular distal tibial and fibular fracture, and to know if the fixation of both bones could be needed. MATERIALS AND METHODS: In a retrospective study from 1994 to 1999, thirty-seven patients who underwent internal fixation with plate and screws for both bones (Group I : 17 cases) and only tibia (Group II : 20 cases) for extra-articular distal 1/3 tibial and distal 1/4 fibular fractures, which were above distal tibio-fibular syndesmosis, were evaluated the period of union, range of motion and operative time. RESULTS: The union period of tibia was 124 days (Group I) and 126 days (Group II) and the cases of full ROM were 16 / 17 cases (94.1%) in Group I and 18 / 20 cases (90.0%) in Group II. The mean score was 94.6 points in Group I and 91.3 points in Group II by Baird scoring system (P>0.05), and the operative time was 147 minutes (Group I) and 106 minutes (Group II) (P<0.05). CONCLUSION: The clinical results in extra-articular distal tibial and fibular fractures, which were distal 1/4 and above distal tibio-fibular syndemosis, treated with internal fixation of the only tibia were as good as internal fixation of both bones. We thought that there is no need to fix distal fibular fracture in these cases.

Ligament Injuries Combined with Proximal Tibia and Fibula Fracture / 대한정형외과학회잡지

It is well known that fractures around the knee joint are usually combined with ligament injuries but it is easy to miss the ligament injuries during the treatment of fractures. The invention of the MRI and the development of arthroscopic techniques has made it easy to diagnose and care for ligament injuries. Authors reviewed the patients who had fractures around the knee joint to evaluate the frequencies, types, treatments and the results of combined ligaments injuries. There were 57 cases with the fracture of the proximal tibia and fibula which could be follwed up at least one year: from January 1992 to June 1995. There were 19 cases (33%) which had combined ligament injuries. The ligament injuries were diagnosed by stress X-ray & MRI evaluation and confirmed by arthroscopic examination. Single lateral rim avulsion fracture of proximal tibia was the most common type of fractures (7 cases, 37%). There were 11 cases (57%) of combined injuries of anterior cruciate ligament and medial collateral ligament. It was the most common combined ligament injury. Except for one, eleven cases that were combined with lateral rim avulsion of proximal tibia had anterior cruciate ligament injury. There were ten cases (53%) of fibula head and neck fractures which were combined with ligament injuries. The total number of the injured ligament was 35 and the common rupture sites of the injured ligaments was the attachment site of femur (13 cases) and tibia (16 cases). There were seven meniscal injury cases (37%). The interval from injury to operation averaged 14.1 days because many cases were acute injuries. Primary repairs for ruptured ligament were done in 31 cases (88%) because of their attachment site injuries. There were no instabilities except one case which was treated with posterior cruciate ligament reconstruction using semitendinosus ligament. It had a grade I posterior instability at the last follow-up. Early diagnosis and proper treatment on the ruptured ligaments and the torn meniscus combined with proximal tibia and fibular fractures seem to be important for a good prognosis.

An Effect of Fibular Fracture in Healing of Tibial Shaft Fracture / 대한정형외과학회잡지

Three hundred and fourty two patients with a fracture of tibial shaft were treated and managed in the Department of Orthopaedic Surgery, Soon Chun Hyang University Hospital from January 1981 to December 1985. In 147 cases, 62 cases had only tibial shaft fracture and 85 tibial and fibular shaft fracture. All of these were treated conservatively by manipulation and cast immibilization. We analyzed the initial fracture characteristics, the treatment employed, and the subsequent complications in fracture healing in a series of patients who had sustained a tibial shaft fracture with and without a fibular fracture. The results were as follows; 1. Duration of average bone healing was more slowly in the patients more than twenty years old who were treated for a tibial shaft fracture with and without a concomitant fibular fracture than in the patients less than twenty years old. 2. Duration of average bone healing was more slowly by one or two weeks in the the group of tibial shaft fracture without fibular fracture than in than in those with fibular fracture. 3. The frequency of delayed union, nonunion, varus malunion and pain in the ipsilateral ankle joint were more increased in the group of the tibial shaft fractures without fibular fracture in than those with fibular fracture. 4. The frequency of valgus malunion was more increased in the group of the tibial shaft fractures with fibular fracture than in those without fibular fracture.