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1.
Unfallchirurg ; 124(3): 175-180, 2021 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-33570673

RESUMO

Stable ankle fractures can be successfully managed nonoperatively. Unstable fractures on the other hand should be treated surgically as operative management consistently leads to better outcomes. How to define stability in ankle fractures continues to be a controversial issue. Better understanding of the mechanism of injury as well as improved knowledge of ankle biomechanics now enables surgeons to define stability after isolated fractures of the distal fibula with high accuracy. The following article describes commonly used methods to assess ankle stability after isolated fractures of the lateral malleolus, including stress tests and the use of weight-bearing radiographs. By adhering to the described criteria more than 90% of all isolated nondisplaced fractures of the distal fibula can be managed nonoperatively with excellent results.


Assuntos
Fraturas do Tornozelo , Traumatismos do Tornozelo , Fraturas Ósseas , Instabilidade Articular , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/cirurgia , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo , Fíbula/diagnóstico por imagem , Fíbula/cirurgia , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos
2.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(5): 938-942, 2020 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-33047733

RESUMO

OBJECTIVE: To investigate the position change of the fibular bone after maxillary reconstruction by free fibular flap and to analyze the factors affecting the position change. METHODS: Patients who underwent maxillary reconstruction by free fibular flap in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from November 2012 to November 2016 were enrolled in this study. CT scans 1 week and 1 year postoperatively were collected and stored in DICOM format. The ProPlan CMF software was used to reconstruct the CT scans and separate the maxilla and each segment of the fibular flap. The Geomagic Control software was used to measure the long axis direction vector of each fibular segment. And the position change direction was recorded. The patients were divided into groups according to the use of the fibula or titanium plate to reconstruct the zygomaticmaxillary buttress. RESULTS: A total of 32 patients were enrolled. Among them, 21 were in the titanium plate group and 11 in the fibula bone group. The angle between the long axis of the fibular segment and the X axis in the X-Y plane was 95.65°±53.49° and 95.53°±52.77°, 1 week and 1 year postoperatively, and there was no statistical difference (P>0.05). The angle between the long axis of the fibular segment and the X axis in the X-Z plane was 96.88°±69.76° and 95.33°±67.42°, respectively, with statistical difference (P=0.0497). The angular changes of the long axis of the fibular segment in the titanium plate group and the fibular bone group were 3.23°±3.93° and 1.94°±1.78°, respectively, and the angular changes in the X-Z plane were 6.02°±9.89° and 3.27°±2.31°, respectively. There was no significant difference between the groups (P>0.05). The long axis changes of the fibular segment in the X-Y plane for reconstruction of the anterior alveolar, posterior alveolar, and buttress were 3.13°±3.78°, 2.56°±3.17°, and 5.51°±4.39°, respectively. There was a statistical difference (P = 0.023) between the posterior and buttress. In the X-Z plane, theses were 4.94°±4.75°, 5.26°±10.25°, 6.69°±6.52°, respectively. There was no statistical difference among the three groups (P>0.05). The main positional deviation directions of the titanium plate group and the fibular bone group were interior and superior sides, and there was no statistical difference between the two groups (P>0.05). CONCLUSION: One year postoperatively, the position of the free fibular flap was changed compared with 1 week postoperatively. The position of the free fibular flap was mainly changed to the interior and superior sides.


Assuntos
Retalhos de Tecido Biológico , Reconstrução Mandibular , Transplante Ósseo , Fíbula/diagnóstico por imagem , Humanos , Maxila/diagnóstico por imagem , Maxila/cirurgia
3.
Rozhl Chir ; 99(2): 77-85, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32349489

RESUMO

INTRODUCTION: Maisonneuve fracture (MF) is a generally known entity in ankle trauma. However, details about this type of injury can be found only rarely in the literature. For these reasons we have decided to perform a study on MF epidemiology and pathoanatomy. METHODS: The group comprised 70 patients (47 men, 23 women), with the mean age of 48 years, who sustained an ankle fracture-dislocation involving the proximal quarter of the fibula. Ankle radiographs in three views and lower leg radiographs in two views were performed in all patients. A total of 59 patients underwent CT examination in three views, including 3D CT reconstruction in 49 of these patients. MRI was performed in 4 patients. Operative treatment was used in 67 patients; open reduction of the distal fibula into the fibular notch was opted for in 54 of them. RESULTS: The highest MF incidence rate was recorded in the 5th decade in the whole group and in men, while in women the peak incidence was in the 6th decade. After the age of 50, the share of women significantly increased. In 64 cases, the fibular fracture was subcapital, and in 6 cases it involved the fibular head. In 24% of the patients, the fibular fracture was seen only in the lateral radiograph of the lower leg. Widening of the tibiofibular clear space was shown by radiographs in 40 cases. Posterior dislocation of the fibula (Bosworth fracture) and tibiofibular diastasis were recorded in 2 cases each. An injury to the anterior and posterior tibiofibular ligaments was found in all 54 patients with open reduction of the distal fibula. A fracture of the medial malleolus was identified in 27 cases (39%) and a complete lesion of the deltoid ligament in 36 cases (51%); in 7 cases (10%) the medial structures were intact. A fracture of the posterior malleolus occurred in 54 (77%) patients. Osteochondral fracture of the talar dome was diagnosed in 2 patients and compression of the articular surface of the distal tibia in the region of the fibular notch in 1 patient. CONCLUSION: Maisonneuve fracture includes a wide range of injuries both to bone and ligamentous structures of the ankle. Therefore, CT examination is an indispensable part of assessment of this type of fracture.


Assuntos
Fraturas do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo , Fraturas Ósseas , Articulação do Tornozelo , Feminino , Fíbula/diagnóstico por imagem , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Tíbia
4.
Int J Oral Maxillofac Surg ; 49(11): 1408-1415, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32404244

RESUMO

The aim of this study was to present a treatment protocol for the individual repair of post-traumatic maxillofacial bone defects with vascularized flaps assisted by digital techniques. This study reviewed 20 patients with post-traumatic maxillofacial bone defects who underwent reconstruction with composite vascularized bone flaps assisted by digital techniques between April 2009 and July 2019. Preoperative computed tomography (CT) data were imported into ProPlan CMF software to complete virtual fracture reduction and reconstruction. Surgical navigation, three-dimensionally (3D) printed surgical plates, and prefabricated titanium mesh/plates were used to guide the actual surgery. All patients underwent open reduction and internal fixation and reconstruction surgery in one stage. CT data obtained at 1 week postoperative were imported into Geomagic Control software to evaluate the accuracy of the virtual surgical plan. The mean follow-up interval was 24 months (range 6-96 months). Donor and recipient site morbidity and second-stage procedures to rehabilitate the dentition and cosmetic organs were recorded. The flap success rate was 100%. Nine patients had deep circumflex iliac artery flaps and eleven patients had fibula flaps. The accuracy of computer-assisted surgery was 4.4±0.8mm. There were no postoperative complications. This study is novel in presenting a treatment protocol for individual computer-assisted reconstruction for post-traumatic maxillofacial bone defects with vascularized flaps.


Assuntos
Reconstrução Mandibular , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Assistida por Computador , Transplante Ósseo , Fíbula/diagnóstico por imagem , Fíbula/cirurgia , Humanos , Retalhos Cirúrgicos , Tomografia Computadorizada por Raios X
5.
Unfallchirurg ; 123(6): 479-490, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32399649

RESUMO

Shaft fractures of the tibia and fibula mainly affect younger patients and are therefore of great socioeconomic importance. Due to the high proportion of high-energy direct trauma mechanisms and the thin soft tissue covering layer of the ventromedian tibia, open factures occur in up to 39%. A structured diagnostic and therapeutic approach is essential for successful treatment. Reamed intramedullary nailing is currently the gold standard surgical procedure. The suprapatellar approach, representing an interesting alternative to the popular infrapatellar approach, postoperative complications, such as anterior knee pain as well as the management of non-unions are discussed in this article. Furthermore, the indications and the application of minimally invasive plate osteosynthesis (MIPO) and external fixators are described. Every trauma surgeon should be familiar with the etiology and the surgical treatment of compartment syndrome. A firm knowledge of the classifications of open and closed soft tissue injury is mandatory.


Assuntos
Síndromes Compartimentais/cirurgia , Fíbula/lesões , Fraturas da Tíbia/cirurgia , Adulto , Placas Ósseas , Síndromes Compartimentais/etiologia , Fíbula/diagnóstico por imagem , Fíbula/cirurgia , Fixação Intramedular de Fraturas , Consolidação da Fratura , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/terapia , Fraturas Expostas/diagnóstico , Fraturas Expostas/cirurgia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Lesões dos Tecidos Moles/classificação , Lesões dos Tecidos Moles/cirurgia , Fraturas da Tíbia/diagnóstico , Resultado do Tratamento
6.
Medicine (Baltimore) ; 99(14): e19646, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243395

RESUMO

Discoid lateral meniscus is one of the most common knee problems in clinical practice. Several radiographic findings have been reported to screen discoid lateral meniscus, but the diagnostic value of those signs varies.We introduce a new method of measurement on plain radiograph for initial screening discoid lateral meniscus and describe its efficacy and correlation to symptomatic discoid lateral meniscus.This is a retrospective case-control study.Seventy-eight arthroscopic proven symptomatic discoid lateral meniscus adult patients plus 73 patients of matched control group were retrospectively reviewed at our institution between 2012 and 2017. We studied their standardized non-weight-bearing knee radiograph anterior-posterior view and measured the following parameters: lateral joint space height, lateral tibia spine height, fibular head height, lateral tibia plateau obliquity (LTPO), and lateral condyle convex angle (LCCA).Significant statistical differences were found in the lateral joint space height, lateral tibia spine height, fibular head height, LTPO and LCCA measurements between the 2 groups (P < .05). Also, we found the phenomenon that angle parameters such as LTPO and LCCA had high sensitivities with relatively low specificities compared with height parameters.We propose that LCCA is a new measurement which is statistically larger in discoid meniscus patients. Furthermore, it can be useful for screening discoid lateral meniscus on plain radiograph with its relative high sensitivity.Level of Evidence: Level III, Case-control study.


Assuntos
Programas de Rastreamento/métodos , Meniscos Tibiais/diagnóstico por imagem , Radiografia/métodos , Lesões do Menisco Tibial/diagnóstico por imagem , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Fíbula/diagnóstico por imagem , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Masculino , Meniscos Tibiais/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Tíbia/diagnóstico por imagem , Lesões do Menisco Tibial/patologia , Adulto Jovem
7.
Actual. osteol ; 16(1): 26-34, Ene - abr. 2020. ilus, graf
Artigo em Espanhol | LILACS | ID: biblio-1130074

RESUMO

La expansión modeladora de la geometría cortical de un hueso inducida por su entorno mecánico podría ser difícil de modificar por estímulos ulteriores con diferente direccionalidad. Este estudio, que por primera vez combina datos tomográficos del peroné (pQCT) y dinamométricos de la musculatura peronea lateral, intenta demostrar que, en individuos jóvenes no entrenados, el entrenamiento en fútbol produce cambios geométricos peroneos expansivos, similares a los del rugby, que podrían interferir en los efectos de un entrenamiento ulterior direccionalmente diferente (carrera larga). Confirmando la hipótesis, los resultados indican, con evidencias originales, 1) la relevancia creciente del uso del pie (rotación externa y eversión provocadas por los peroneos laterales) para la determinación de la geometría peronea (incremento del desarrollo de los indicadores de masa y de diseño óseos), evidenciada por la secuencia creciente de efectos: carrera < fútbol < rugby; 2) la predominancia de esos efectos sobre el desarrollo centro-proximal del peroné para resistir a la flexión lateral, y en la región distal para resistir el buckling (principal sitio y causa de fractura del hueso) y 3.) la relevancia de la anticipación de esos efectos para interferir en la manifestación de los cambios producidos por un entrenamiento ulterior (carrera), cuando los del primero (fútbol) afectan la modelación cortical de modo expansivo. Esta última deducción demuestra, en forma inédita, que un cambio modelatorio expansivo tempranamente inducido sobre la estructura cortical ósea 'delimitaría el terreno'para la manifestación de cualquier otro efecto ulterior por estímulos de distinta direccionalidad. (AU)


The modeling-dependent, geometrical expansion of cortical bone induced by the mechanical environment could be hard to modify by subsequent stimulations with a different directionality. The current study aimed to demonstrate that in young, untrained individuals, training in soccer or rugby enhances the geometric properties of the fibula cortical shell in such a way that the geometrical changes could interfere on the effects of a second training in which the loads are induced in a different direction, e.g. long-distance running. The original findings reported herein confirm our hypothesis and support 1) The relevance of the use of the foot (external rotation and eversion produced by peroneus muscles) to determine fibula geometry (improved development of indicators of bone mass and design) as evidenced by the increasing nature of the effects induced by running < soccer < rugby trainings; 2) The predominance of those effects on the ability of the fibula to resist lateral bending in the centralproximal region (insertion of peroneus muscles), and to resist buckling in the distal region (the main cause and site of the most frequent bone fractures), and 3) The interaction of the effects of a previous training with those of a subsequent training with a different orientation of the loads when the former induced a modeling-dependent expansion of the cortex. Our results support the proposed hypothesis with original arguments by showing that a first, expansive effect induced on cortical bone modeling would set the stage the manifestation of any subsequent effect derived from mechanical stimuli. (AU)


Assuntos
Humanos , Masculino , Adolescente , Adulto , Adulto Jovem , Exercício Físico/fisiologia , Fíbula/crescimento & desenvolvimento , Corrida/fisiologia , Futebol/fisiologia , Esportes/fisiologia , Tomografia , Densidade Óssea , Fraturas Ósseas/prevenção & controle , Força Muscular/fisiologia , Dinamômetro de Força Muscular , Fíbula/diagnóstico por imagem , Osso Cortical/diagnóstico por imagem , Pé/crescimento & desenvolvimento , Pé/fisiologia , Pé/diagnóstico por imagem , Futebol Americano/fisiologia
8.
J Craniofac Surg ; 31(4): 950-955, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32149975

RESUMO

BACKGROUND: Mandibular reconstruction is considered one of the most complex reconstructive surgeries in the field of craniomaxillofacial surgery. With the introduction of microvascular reconstructive surgery, free fibula flap become the gold standard for reconstruction of mandibular defects. For optimum restoration of the patient's esthetics and function, the free fibular flap should be recontoured to follow the natural premorbid state of the mandible. Virtual surgical planning using preoperative computed tomographic (CT) data can be rendered into 3-dimensional (3D) model for digitalized simulation of the bony resection and reconstruction with reported high accuracy. METHODS: Ten patients were included in the study for delayed mandibular reconstruction using free fibular flap. For all the patients, preoperative CT scan for the skull and lower limbs were obtained and integrated into the software for virtual planning and guides fabrications. Postoperative CT was obtained and rendered 3D model to be superimposed on the preoperative record for assessment of the virtual planning accuracy by different linear and angular measurements. RESULTS: No statistically significant difference was found between virtual group and postoperative group where P = 0.067, regarding average of linear measurements of all patients. Statistically significant difference was found between virtual group and postoperative group in measurements from axial plane where P = 0.004. No statistically significant difference was found between virtual group and postoperative group where P = 0.723, regarding angles between fibular segments. CONCLUSION: Virtual surgical planning for mandibular reconstruction offers high reproducibility and precision, reducing the side errors, besides its time saving advantage for both the operator and the patient.


Assuntos
Retalhos de Tecido Biológico/cirurgia , Imageamento Tridimensional , Mandíbula/cirurgia , Reconstrução Mandibular , Cirurgia Assistida por Computador , Adolescente , Adulto , Feminino , Fíbula/diagnóstico por imagem , Fíbula/cirurgia , Humanos , Imageamento Tridimensional/instrumentação , Imageamento Tridimensional/métodos , Masculino , Mandíbula/diagnóstico por imagem , Período Pós-Operatório , Reprodutibilidade dos Testes , Software , Cirurgia Assistida por Computador/instrumentação , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Adulto Jovem
9.
J Pediatr Orthop ; 40(4): 203-209, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32132450

RESUMO

BACKGROUND: Deformity of the tibia, including shortening and angulation, may accompany severe forms of postaxial hypoplasia (fibular deficiency). The current literature reflects varying opinions on the appropriate management for tibial deformity in the setting of fibular deficiency. METHODS: We performed a retrospective review to determine outcomes of tibial deformity correction in patients with a primary diagnosis of fibular deficiency. Clinical and radiographic outcomes of patients treated with foot ablation were reviewed to establish indications for tibial deformity correction, identify occurrence of additional surgical procedures related to limb alignment or deformity, and characterize difficulties with prosthetic wear potentially related to residual or recurrent tibial deformity. RESULTS: From 1989 to 2016, 51 patients (57 extremities) with fibular deficiency were managed with a foot ablation procedure. Twenty-five (44%) had simultaneous correction of the tibial deformity. The initial tibial deformity measured 42.5 degrees, was corrected to 5.6 degrees intraoperatively, and measured 18.6 degrees at follow-up, suggesting recurrent deformity. In follow-up, approximately half of the patients complained of redness and one third complained of a continued prominence along the anterior tibia. Thirty-two extremities had an isolated foot ablation procedure without tibial osteotomy. Radiographic review demonstrated mild tibial bowing at the time of amputation with a mean angular deformity of 15.4 degrees and remained unchanged during the follow-up period (mean, 12.7 degrees). Similar to the osteotomy group, approximately half of the patients complained of redness and erythema over the anterior bow, with one fourth noting prominence, and only 2 reporting significant pain. CONCLUSIONS: Tibial osteotomies in patients with more significant degrees of angular deformity can be safely performed at the same setting as foot ablative procedures for fibular deficiency. Recurrent deformity with growth may occur. Patients and their caregivers should be aware that rebound deformity may occur, but typically can be managed with prosthetic adjustment and without significant disruption to the child's daily activities. LEVEL OF EVIDENCE: Level IV (case series).


Assuntos
Fíbula , Deformidades Adquiridas do Pé , Osteotomia , Complicações Pós-Operatórias , Tíbia , Adolescente , Criança , Feminino , Fíbula/anormalidades , Fíbula/diagnóstico por imagem , Fíbula/cirurgia , Deformidades Adquiridas do Pé/diagnóstico , Deformidades Adquiridas do Pé/etiologia , Deformidades Adquiridas do Pé/cirurgia , Humanos , Masculino , Osteotomia/efeitos adversos , Osteotomia/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Tíbia/diagnóstico por imagem , Tíbia/patologia , Tíbia/cirurgia
11.
Oper Orthop Traumatol ; 32(5): 467-474, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32100068

RESUMO

OBJECTIVE: Functional and sensible regeneration of deficits related to common peroneal nerve palsy. INDICATIONS: Functional deficits like foot drop, malfunctioning pronation, foot in supination and sensible deficits located at the anterior and lateral lower leg, the dorsum of the foot, the extension side of toes 1-4 and the interdigital space between toe 1 and 2, for positive Hoffmann-Tinel sign located at the fibular head and steppage gait. CONTRAINDICATIONS: Infection, spinal cord damage and spinal cord tumors with related sensitivity disorders and paralysis, advanced multiple sclerosis, amyotrophic lateral sclerosis, pAVK IV, reinnervation refractory muscles with denervation >15-18 months, polyneuropathy, previous nerve lesions by direct trauma. SURGICAL TECHNIQUE: Surgery in lateral position and thigh tourniquet. L­Shaped incision made in accordance with the marking. Nerve release by fasciotomy first proximal, then distal up to the branching. Opening of the thigh tourniquet, careful coagulation. Insertion of a Mini Redovac Drainage, subcutaneous and skin sutures. Compression bandage. POSTOPERATIVE MANAGEMENT: Full mobilization on postoperative day 1. An electric stimulation therapy can be considered after drainage removal. After suture removal physio- and ergotherapy indicated. Check ups should be performed every 3 months with clinical exams, photo and video documentation. Four months after surgery an electroneurographic exam should be done. Follow-up should be performed for 24 months. RESULTS: From 2010-2018 15 patients received decompression of the common peroneal nerve. Sensibility, functionality and subjective feeling were evaluated. In 12 patients (80%) a full recovery, in one case (6.67%) a partial recovery and in 2 cases (13.33%) no recovery was observed.


Assuntos
Nervo Fibular , Descompressão Cirúrgica , Fíbula/diagnóstico por imagem , Fíbula/cirurgia , Humanos , Nervo Fibular/cirurgia , Neuropatias Fibulares/diagnóstico , Neuropatias Fibulares/cirurgia , Resultado do Tratamento
12.
Orthopedics ; 43(3): e141-e146, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32077963

RESUMO

A previously undescribed pitfall of lateral distal fibular locking plates is the risk of violating the lateral malleolar fossa (MF). No previous study has described the dimensions of this fossa. All cases using a lateral distal fibular plate for a fibula fracture from December 2012 to December 2015 (n=365) at a single institution were reviewed. Screws that violated the medial fibular cortical density corresponding to the MF were identified as "at-risk" screws. Available preoperative computed tomography (CT) scans were reviewed (n=69) to measure MF dimensions. Of 365 patients, 115 (31.5%) patients had distal fibular screws at risk of MF violation. There were no significant differences between MF violation and non-violation groups in terms of age, sex, open fracture, syndesmotic fixation, and Weber classification. The MF dimensions were measured on CT scans. Mean height was 12.96 mm (SD, 2.09 mm; range, 9.0-17.3 mm). Mean width was 7.52 mm (SD, 1.37 mm; range, 4.2-10.4 mm). Mean depth was 8.32 mm (SD, 1.59 mm; range, 5.3-11.8 mm). Mean ratio of MF to total fibular width was 0.46 mm (SD, 0.07 mm; range, 0.3-0.65 mm). Mean MF to total fibular depth was 0.42 mm (SD, 0.07 mm; range, 0.28-0.58 mm). There was a difference in dimensions of patients with screws at risk of MF violation compared with those without (MF height: 13.77 vs 12.56, P=.02; MF width: 7.98 vs 7.30, P=.05; MF to fibula width ratio: 0.49 vs 0.44, P=.01; MF to fibula depth ratio: 0.43 vs 0.42, P=.05). The MF violation is a previously unreported but potentially prevalent pitfall of lateral distal fibular plate fixation. Surgeons should be aware of the MF size and exhibit caution when placing screws in the distal locking holes during fibula fixation. [Orthopedics. 2020;43(3):e141-e146.].


Assuntos
Fraturas do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/diagnóstico por imagem , Fíbula/diagnóstico por imagem , Fixação Interna de Fraturas/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Placas Ósseas , Feminino , Fíbula/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Adulto Jovem
13.
Knee ; 27(3): 930-933, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32089394

RESUMO

BACKGROUND: To investigate the morphological changes in the tibiofibular joint following open wedge high tibial osteotomy (OWHTO). METHODS: We studied 397 joints in 341 patients. Standing femorotibial angle (FTA), %mechanical axis (%MA), corrected tibial angle, distance (D) to tibial joint surface (T) and fibular head (F) and angle (A; proximal, distal), proximal tibiofibular joint (PTFJ) osteoarthritis (OA) onset, and tibiofibular joint-related complications were the parameters assessed. RESULTS: FTA improved from 181.1° to 168.8° and %MA from 28.7 to 68.7, whereas the mean tibia corrected angle was 10.4°. Proximal TFD changed from 9.4 mm preoperatively to 7.8 mm during the investigation. The fibular head was displaced 1.6 mm upwards, and proximal tibial femoral angle (TFA) moved approximately 10° in the valgus direction from 82.5° to 92.4°. However, no significant changes were noted for the distal TFD or TFA. PTFJ OA was observed in 57 cases (14.7%), and lateroposterior knee pain in 11 cases (2.8%). Additional resection of the fibula was performed in cases with marked pain. CONCLUSIONS: With OWHTO, increased load is placed on the PTFJ postoperatively. In rare cases, this can cause pain and is therefore a complication that physicians should be aware of.


Assuntos
Fíbula/cirurgia , Artropatias/cirurgia , Articulação do Joelho/cirurgia , Osteotomia/efeitos adversos , Tíbia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fíbula/diagnóstico por imagem , Fíbula/patologia , Humanos , Artropatias/diagnóstico por imagem , Artropatias/etiologia , Artropatias/patologia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Tíbia/diagnóstico por imagem , Tíbia/patologia , Adulto Jovem
14.
Injury ; 51(2): 537-541, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31703958

RESUMO

OBJECTIVES: Posterior malleolar fractures (PM) have been linked to inferior outcome in malleolar fractures. This study aims to analyze the prevalence and pathoanatomy of PM fractures in Bosworth fracture-dislocations (BF). MATERIALS & METHODS: Radiographs and computed tomography (CT) scans of 13 patients treated at our institution and 97 cases published between 1947 and 2018, identified in a systematic literature search, were evaluated with respect to the pathoanatomy of BF. In all 13 cases from the present study and in 10 cases from the literature, axial CT scans were performed. RESULTS: All 13 patients (100%) with BF from the present series and 61 of 97 documented cases (63%) of BF from the literature were associated with a PM fracture. In patients with a complete CT analysis, dislocation of the fibula behind the posterior tibial rim was associated with extraincisural (Bartonícek / Rammelt type 1) PM fractures. Displacement of the fibula between the displaced PM fragment and the tibia was associated with Bartonícek / Rammelt types 2 and 3 PM fractures. CONCLUSIONS: Seventy prevent of all reported BF are associated with a PM fracture. The true prevalence may be even higher because of the historically infrequent use of CT imaging. The pathoanatomy of the PM fragment is highly variable as is the kind of fibular displacement in BF. Therefore, CT scanning should be performed routinely in BF. Displaced PM fractures in BF involving the incisura should be treated operatively via a direct posterolateral approach.


Assuntos
Fraturas do Tornozelo/diagnóstico por imagem , Fíbula/diagnóstico por imagem , Fratura-Luxação/diagnóstico por imagem , Ossos do Tarso/diagnóstico por imagem , Fraturas da Tíbia/diagnóstico por imagem , Adulto , Idoso , Fraturas do Tornozelo/patologia , Feminino , Fíbula/lesões , Fíbula/fisiologia , Fratura-Luxação/patologia , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Ossos do Tarso/lesões , Ossos do Tarso/patologia , Fraturas da Tíbia/patologia , Tomografia Computadorizada por Raios X , Adulto Jovem
15.
Injury ; 51(2): 527-531, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31711653

RESUMO

BACKGROUND: Surgical fixation of syndesmotic instability using quadricortical fixation, whether screws or suture-button devices, places structures on the medial side of the tibia at iatrogenic risk. This study aims to radiographically map the anatomic course of structures on the medial aspect of the distal tibia to be able to at-risk zones (ARZs) for syndesmotic fixation. METHODS: Eighteen fresh-frozen cadaveric ankle specimens were dissected. The saphenous neurovascular bundle (SNVB) and the posterior tibial tendon (PTT) were identified and marked with copper wiring. Standardized and calibrated lateral radiographs of the distal tibia and fibula were analyzed using a grid system consisting of 3 columnar zones from anterior to posterior and five 1-cm rows to chart the anatomic course of the SNVB and the PTT. RESULTS: The SNVB was located in the more anterior zones (1, 2, or anterior to Zone 1) in 97.3% of specimens. The SNVB traversed from posterior to anterior as it descended proximal to distal. The PTT was found in Zone 3 (most posterior zone) for all specimens. The PTT was noted to pass behind (radiographically overlap) the tibia in 83.3% (15 of 18) of specimens between 1 and 3 cm above the tibiotalar joint. CONCLUSIONS: Placement of quadricortical syndesmotic fixation places structures on the medial ankle at risk. The SNVB is at considerable risk along the anterior course of the distal tibial while the PTT is only at risk in zone 3 at the distal extent of the tibia.


Assuntos
Articulação do Tornozelo/cirurgia , Fíbula/cirurgia , Tíbia/cirurgia , Traumatismos do Tornozelo/cirurgia , Parafusos Ósseos/efeitos adversos , Cadáver , Fíbula/anatomia & histologia , Fíbula/diagnóstico por imagem , Humanos , Ligamentos Articulares/cirurgia , Pessoa de Meia-Idade , Radiografia/métodos , Medição de Risco , Veia Safena/cirurgia , Técnicas de Sutura/efeitos adversos , Tíbia/anatomia & histologia , Tíbia/diagnóstico por imagem
16.
Injury ; 51(2): 505-509, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31672245

RESUMO

INTRODUCTION: To determine the optimal entry point (EP) of intramedullary nail (IMN) fixation and introduce a consistent landmark for practical application by analyzing three-dimensional (3D) modeling and virtual implantation. MATERIALS AND METHODS: A total of 104 cadaveric femurs (50 males and 54 females) underwent continuous 1.0 mm slice computed tomography (CT) scans. CT images were imported into Mimics® software to reconstruct 3D model of tibiofibular bone with medullary canal. Expert Tibial Nail (ETN®, Ø12mm/Length 315 mm) was processed into a 3D model at the actual size and optimally implanted in the tibia. After IMN was aligned in a neutral position, it was defined as a true AP projection. In the true AP projection, optimal EP and relationship with adjacent structures were assessed based on the degree of tibial rotation. RESULTS: EP was placed eccentrically around the lateral tibial spine in cephalad view and in true AP projection in all models. In true AP projection, the overlapping point between fibular tip and cortical margin of lateral condyle was placed lateral to the fibular tip in 62 models, and exactly matched with fibular tip in 42 models. As tibia rotates, the position of EP in the AP view changes. When tibia was externally rotated, EP was located to the lateral, not the medial side of the lateraltibialspine. The obliquity of guide wire also changed withtibialrotation; the obliquity of guide wire aligned in a straight in true AP projection. CONCLUSION: Optimal determination of EP and guide wire direction should be performed by considering the overlapping point that should be placed to just or lateral side of fibular tip in AP projection. Compared with fibular bisector line, the overlapping point is also useful as a practical landmark for making true AP projection and determining optimal EP.


Assuntos
Fíbula/cirurgia , Fixação Intramedular de Fraturas/instrumentação , Imageamento Tridimensional/instrumentação , Tíbia/cirurgia , Fraturas da Tíbia/cirurgia , Adulto , Pinos Ortopédicos/efeitos adversos , Cadáver , Simulação por Computador , Feminino , Fêmur/cirurgia , Fíbula/diagnóstico por imagem , Fixação Intramedular de Fraturas/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Rotação , Software , Tíbia/diagnóstico por imagem , Fraturas da Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
17.
Foot Ankle Surg ; 26(2): 198-204, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30853391

RESUMO

BACKGROUND: Injuries to the distal tibio-fibular ligaments are common. While pronounced injuries can be reliably diagnosed using conventional radiographs, assessment of subtle syndesmotic injuries is challenging. This cadaver study determines the impact of loading on the assessment of incomplete and more complete syndesmotic injuries when using weightbearing computed tomography (CT) scans. METHODS: Fourteen paired male cadavers (tibial plateau to toe-tip) were included. A radiolucent frame held specimens in a plantigrade position while both non-weightbearing and weightbearing computed tomography (CT) scans were taken. The following conditions were tested: First, intact ankles (Native) were scanned. Second, one specimen from each pair underwent anterior inferior tibio-fibular ligament (AITFL) transection (Condition 1A), while the contralateral underwent deltoid transection (Condition 1B). Third, the remaining intact deltoid or AITFL was transected from each specimen (Condition 2). Finally, the distal tibiofibular interosseous membrane (IOM) was transected in all ankles (Condition 3). Eight different measurements were performed to assess the integrity of the distal tibio-fibular syndesmosis on axial CT scans. RESULTS: Load application had no impact on most measurements. While incomplete syndesmotic injuries could not be identified, cadavers with more complete injuries differentiated from native ankles when assessed using axial CT images. No significant difference was evident between discrete AITFL or deltoid ligament transection. CONCLUSIONS: In a cadaver model, load application had no effect on the assessment of the distal tibio-fibular syndesmosis in incomplete and more complete syndesmotic injuries. Only more complete injuries of the distal tibio-fibular syndesmosis could be identified using axial CT images.


Assuntos
Traumatismos do Tornozelo/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Suporte de Carga , Cadáver , Fíbula/diagnóstico por imagem , Humanos , Ligamentos Articulares , Masculino , Ossos do Tarso/diagnóstico por imagem , Tíbia/diagnóstico por imagem
18.
Knee Surg Sports Traumatol Arthrosc ; 28(1): 124-131, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31240379

RESUMO

PURPOSE: A bone tunnel is often used during the reconstruction of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). The purpose of this study is to compare proposed directions for drilling this fibular tunnel and to assess potential tunnel length, using a 5-mm-diameter tunnel and surrounding bone. METHODS: Anonymous DICOM data from spiral CT-scan images of the ankle were obtained from 12 Caucasian patients: 6 females and 6 males. Virtual tunnels were generated in a 3D bone model with angles of 30°, 45°, 60° and 90° in relation to the fibular long axis. Several measurements were performed: distance from entrance to perforation of opposing cortex, shortening of the tunnel, distance from tunnel centre to bone surface. RESULTS: A tunnel in a perpendicular direction resulted in an average possible tunnel length of 16.8 (± 2.7) mm in the female group and 20.3 (± 3.4) mm in the male group. A tunnel directed at 30° offered the longest length: 30.9 (± 2.5) mm in the female group and 34.4 (± 2.9) mm in the male group. The use of a 5-mm-diameter tunnel in a perpendicular direction caused important shortening of the tunnel at the entrance in some cases. The perpendicular tunnel was very near to the digital fossa while the most obliquely directed tunnels avoided this region. CONCLUSION: An oblique tunnel allows for a longer tunnel and avoids the region of the digital fossa, thereby retaining more surrounding bone. In addition, absolute values of tunnel length are given, which can be useful when considering the use of certain implants. We recommend drilling an oblique fibular tunnel when reconstructing the ATFL and CFL.


Assuntos
Articulação do Tornozelo/cirurgia , Fíbula/cirurgia , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Procedimentos Ortopédicos/métodos , Adulto , Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Feminino , Fíbula/diagnóstico por imagem , Humanos , Ligamentos Laterais do Tornozelo/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/lesões , Masculino , Pessoa de Meia-Idade , Entorses e Distensões/cirurgia , Tomografia Computadorizada Espiral , Adulto Jovem
19.
Arch Orthop Trauma Surg ; 140(1): 25-31, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31134373

RESUMO

BACKGROUND: The purpose of this study was to evaluate the effect of ankle plantarflexion and the axial location of measurement on quantitative syndesmosis assessment. METHODS: Twelve fresh-frozen cadaveric specimens were secured in three positions of ankle plantarflexion (0°, 15°, and 30°) using an ankle-spanning external fixator and underwent CT scans at each position. Syndesmotic measurements were obtained on axial images using three previously described methods (six measurements) at the level of the tibial plafond and 1 cm proximal to the plafond. Method 1 evaluated the distance between the most anterior and posterior aspects of the fibula and tibia. Method 2 measured medial-lateral diastasis of the anterior and posterior aspects of the fibula, and fibular anterior-posterior translation. Method 3 evaluated axial rotation of the fibula. All measurements were performed by two independent observers. Inter-rater reliability of each measurement was evaluated using intra-class coefficients. Repeated measures analysis of variance (RM-ANOVA) was performed to evaluate within-specimen differences in measurements obtained at varying ankle positions. RESULTS: The anterior incisura component of method 1 demonstrated poor-to-moderate inter-rater reliability across all ankle positions and at both measurement locations. Inter-rater reliability was highest for method 2, especially when measured 1 cm proximal to the plafond. Method 3 demonstrated moderate reliability 1 cm proximal to the plafond. After correcting for multiple comparisons, RM-ANOVA and pairwise analysis revealed that none of the measurements changed significantly with varying ankle position. CONCLUSION: The inter-rater reliability of the most common method of syndesmotic evaluation (method 1) was found to be lower than in previous studies. The most reliable syndesmotic evaluation can be made by measuring diastasis and anteroposterior translation 1 cm proximal to the plafond (method 2). Ankle position from 0° to 30° of plantarflexion did not change the measurements obtained. LEVEL OF EVIDENCE: IV.


Assuntos
Tornozelo/diagnóstico por imagem , Postura/fisiologia , Tomografia Computadorizada por Raios X , Fíbula/diagnóstico por imagem , Humanos , Reprodutibilidade dos Testes , Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/normas
20.
Sci Rep ; 9(1): 17629, 2019 11 26.
Artigo em Inglês | MEDLINE | ID: mdl-31772277

RESUMO

Human cortical bone contains two types of tissue: osteonal and interstitial tissue. Growing bone is not well-known in terms of its intrinsic material properties. To date, distinctions between the mechanical properties of osteonal and interstitial regions have not been investigated in juvenile bone and compared to adult bone in a combined dataset. In this work, cortical bone samples obtained from fibulae of 13 juveniles patients (4 to 18 years old) during corrective surgery and from 17 adult donors (50 to 95 years old) were analyzed. Microindentation was used to assess the mechanical properties of the extracellular matrix, quantitative microradiography was used to measure the degree of bone mineralization (DMB), and Fourier transform infrared microspectroscopy was used to evaluate the physicochemical modifications of bone composition (organic versus mineral matrix). Juvenile and adult osteonal and interstitial regions were analyzed for DMB, crystallinity, mineral to organic matrix ratio, mineral maturity, collagen maturity, carbonation, indentation modulus, indicators of yield strain and tissue ductility using a mixed model. We found that the intrinsic properties of the juvenile bone were not all inferior to those of the adult bone. Mechanical properties were also differently explained in juvenile and adult groups. The study shows that different intrinsic properties should be used in case of juvenile bone investigation.


Assuntos
Osso Cortical/crescimento & desenvolvimento , Fíbula/crescimento & desenvolvimento , Adolescente , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/metabolismo , Fenômenos Biomecânicos , Calcificação Fisiológica , Carbono/análise , Criança , Pré-Escolar , Colágeno/análise , Osso Cortical/química , Osso Cortical/diagnóstico por imagem , Osso Cortical/ultraestrutura , Cristalização , Matriz Extracelular/fisiologia , Feminino , Fíbula/química , Fíbula/diagnóstico por imagem , Fíbula/ultraestrutura , Osteon/diagnóstico por imagem , Osteon/crescimento & desenvolvimento , Osteon/ultraestrutura , Humanos , Masculino , Pessoa de Meia-Idade , Minerais/análise , Modelos Biológicos , Estresse Mecânico
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