scholarly journals Reconstruction of tibiofibular syndesmosis using autologous semitendinosus graft and lengthening derotational osteotomy of the distal fibula

2020 ◽  
Author(s):  
Henrique Mansur ◽  
Sandro Danilo da Silva ◽  
Daniel Augusto Maranho
Keyword(s):  
Tibiofibular Syndesmosis ◽  
Distal Fibula ◽  
Derotational Osteotomy ◽  
Semitendinosus Graft

Can Syndesmosis Screws Displace the Distal Fibula?

2020 ◽  
pp. 193864002091209
Author(s):  
Nicholas G. Vance ◽  
Robert C. Vance ◽  
William T. Chandler ◽  
Vinod K. Panchbhavi
Keyword(s):  
Finite Element ◽  
Finite Element Model ◽  
Element Model ◽  
Contact Forces ◽  
Tibiofibular Syndesmosis ◽  
Distal Fibula ◽  
Element Analysis ◽  
Clear Space ◽  
Distal Tibiofibular Syndesmosis ◽  
Level I

Background. There has been historical debate as to whether the distal tibiofibular syndesmosis can be overtightened during operative fixation. We used finite-element analysis to determine if overtightening of syndesmotic screws can cause widening of the lateral gutter clear space in the ankle joint. Methods. A 3D finite-element model was constructed and analyzed using geometries from a computed tomography scan of a cadaveric lower leg. Starting 2 cm from the plafond, screw fixation was simulated at 5-mm increments to a distance of 5 cm from the plafond. The fibula was compressed 2 mm toward the tibia at each interval, and the change in distance between the lateral talus and distal fibula was measured. Results. Medial deflection of the fibula resulted in widening of the lateral clear space, which was proportional to the amount of deflection. The effect increased as screws were placed closer to the plafond, with 1.5 mm of widening at 2 cm (0.76 mm/mm) versus 0.7 mm at 5 cm (0.34 mm/mm). Conclusion. Our finite-element model demonstrated that overtightening of the distal tibiofibular syndesmosis with medial fibular displacement can cause widening of the lateral clear space. Clinical relevance. The results suggest that screws placed farther from the plafond widen the lateral clear space to a lesser degree, which may be advantageous during surgical fixation to prevent clear space widening and increased tibiotalar contact forces. Levels of Evidence: Level I

Arthroscopic diagnosis of tibiofibular syndesmosis disruption

2001 ◽  
Vol 17 (8) ◽  
pp. 836-843 ◽  
Author(s):  
Masato Takao ◽  
Mitsuo Ochi ◽  
Kohei Naito ◽  
Atsushi Iwata ◽  
Kenzo Kawasaki ◽  
...  
Keyword(s):  
Tibiofibular Syndesmosis

Congenital Syphilis Simulating Bone Neoplasm in 2-Month Old Infant – Case Report

2017 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Case Report ◽  
Congenital Syphilis ◽  
Eosinophilic Granuloma ◽  
Osteolytic Lesion ◽  
Lower Limbs ◽  
Upper Body ◽  
Elective Cesarean Section ◽  
Distal Fibula ◽  
X Ray

Introduction: Congenital Syphilis (CS) occurs through the transplacental transmission of Treponema pallidum in inadequately treated or non-treated pregnant women, and is capable of severe consequences such as miscarriage, preterm birth, congenital disease and/or neonatal death. CS has been showing an increasing incidence worldwide, with an increase of 208% from 2009 to 2015 in Brazil. Case report: 2-month old infant receives care in emergency service due to edema of right lower limb with pain in mobilization. X-ray with osteolytic lesion in distal fibula. Infant was sent to the Pediatrics Oncology clinic. Perinatal data: 7 prenatal appointments, negative serology at 10 and 30 weeks of gestation. End of pregnancy tests were not examined and tests for mother’s hospital admission were not requested. Mother undergone elective cesarean section at 38 weeks without complications. During the pediatric oncologist appointment, patient showed erythematous-squamous lesions in neck and other scar-like lesions in upper body. A new X-ray of lower limbs showed lesions in right fibula with periosteal reaction associated with aggressive osteolytic lesion compromising distal diaphysis, with cortical bone rupture and signs of pathological fracture, suggestive of eosinophilic granuloma. She was hospitalized for a lesion biopsy. Laboratory tests: hematocrit: 23.1 / hemoglobin 7.7 / leukocytes 10,130 (without left deviation) / platelets 638,000 / Negative Cytomegalovirus IgG and IgM and Toxoplasmosis IgG and IgM / VDRL 1:128. Congenital syphilis diagnosis with skin lesions, bone alterations and anemia. Lumbar puncture: glucose 55 / total proteins 26 / VDRL non reagent / 13 leukocytes (8% neutrophils; 84% monomorphonuclear; 8% macrophages) and 160 erythrocytes / negative VDRL and culture. X-ray of other long bones, ophthalmological evaluation and abdominal ultrasound without alterations. Patient was hospitalized for 14 days for treatment with Ceftriaxone 100mg/kg/day, due to the lack of Crystalline Penicillin in the hospital. She is now under outpatient follow-up. Discussion: CS is responsible for high rates of morbidity and mortality. The ongoing increase of cases of this pathology reflects a severe health issue and indicates failures in policies for the prevention of sexually transmitted diseases, with inadequate follow-up of prenatal and maternity protocols.

Maisonneuve fracture

2020 ◽  
Vol 99 (2) ◽  
pp. 77-85
Keyword(s):  
Open Reduction ◽  
Lower Leg ◽  
Fracture Dislocation ◽  
Deltoid Ligament ◽  
Ct Reconstruction ◽  
Distal Fibula ◽  
Ct Examination ◽  
Maisonneuve Fracture ◽  
Fibular Fracture ◽  
Wide Range

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.

scholarly journals Graft Preparation for Combined ACL and ALL Reconstruction With a Single Femoral Tunnel

2021 ◽  
Vol 1 (3) ◽  
pp. 263502542110045
Author(s):  
Camilo Partezani Helito ◽  
Tales Mollica Guimarães ◽  
Marcel Faraco Sobrado
Keyword(s):  
Anterior Cruciate Ligament ◽  
High Risk ◽  
Cruciate Ligament ◽  
Anterolateral Ligament ◽  
Anatomical Landmarks ◽  
High Risk Patients ◽  
Risk Patients ◽  
Anterior Cruciate ◽  
Semitendinosus Graft ◽  
Lemaire Procedure

Background: Combined reconstruction of the anterolateral ligament (ALL) and anterior cruciate ligament (ACL) has shown excellent results. It could potentially reduce graft failure and improve outcomes in high-risk patients. There are several surgical techniques described. Hamstrings are the most frequently used graft for ALL reconstruction. The distal portion of the iliotibial band is used for the modified Lemaire procedure. Indications: Anterior cruciate ligament reconstructions associated with the following risk factors: pivoting sports, high-demand athletes, high-grade pivot-shift, chronic ACL injury, lateral femoral condyle notch, Segond fractures, young patients (<20 years), ACL revision, generalized hyperlaxity, and Lachman >7 mm. Technique Description: Semitendinosus and gracilis tendons are harvested and their extremities are prepared with continuous suture. The semitendinosus graft is folded in 3 parts leaving the ends of the graft internalized. The triple semitendinosus will be the main component of the ACL and the single gracilis will be used for both ACL and ALL. Anterolateral ligament anatomical landmarks are proximal and posterior to the lateral epicondyle in the femur, and in the mid distance from the fibular head and the Gerdy tubercle in the tibia. The ALL is fixed in knee extension with interference screws. This video also includes a brief demonstration of graft preparation for the modified Lemaire procedure. Results: Results from our group using this technique have shown excellent clinical outcomes, minimal complications, and low failure rates in high-risk populations. This graft preparation shows excellent diameter and length for combined ACL and ALL reconstruction. Conclusion: This technique is easy to perform, with minimal complications, and should be considered in high-risk patients undergoing ACL reconstruction.

scholarly journals Non-locking buttress plate in distal tibial metaphyseal fractures

2018 ◽  
Vol 1 (2) ◽  
pp. 87-91
Author(s):  
Norman Lamichhane ◽  
Bhogendra Bahadur KC ◽  
Chandra Bahadur Mishra ◽  
Sabita Dhakal
Keyword(s):  
Soft Tissue ◽  
Weight Bearing ◽  
Delayed Union ◽  
Full Weight Bearing ◽  
Distal Fibula ◽  
Fibula Fracture ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Metaphyseal Fractures

Background: Treatment of distal tibial metaphyseal fractures is often challenging and no single technique has been unanimously advocated. Open reduction and internal fixation with plates and screws allows better restoration of anatomical alignment but with more soft tissue complication. Simultaneous fixation of the fibula is not universally carried out. This study aims at evaluation of the outcome of plating technique and the effect of fixation of fibula fracture in treatment of distal tibial metaphyseal fractures. Material and methods: Thirty-one cases (14 cases in Group A with concomitant distal fibula fracture and 17 cases in Group B without distal fibula fracture) were analyzed retrospectively for the mean duration of full weight bearing, mean union time and complications, and compared. Results: The mean time for full weight bearing and radiological union in our study was 14.2 weeks (15.9 in Group A and 13.1 in Group B) and 23.8 weeks (26.6 in Group A and 21.5 in Group B) respectively. 16.1% of cases had post-operative complications including one case of deep infection and malalignment of 6 degree varus (following delayed union) was seen in one case of Group A. Range of motion (ROM) at ankle was not problem in any of the cases except the one delayed union which had 5 degrees of dorsiflexion and 15 degrees of plantiflexion. Conclusion: Open reduction and internal fixation with plate and screws in distal tibial metaphyseal fracture is more economic means of treatment modality with comparable incidence of post-union malalignment and union time,though more soft tissue complications compared to other modalities. Fixation of fibula fracture aids in reducing the incidence of malalignment.

Diastasis With Low Distal Fibula Fractures

2001 ◽  
Vol 382 ◽  
pp. 197-205 ◽  
Author(s):  
Michael H. Snedden ◽  
John P. Shea
Keyword(s):  
Distal Fibula

Biomechanical Analysis of an Isolated Fibular (Lateral) Collateral Ligament Reconstruction Using an Autogenous Semitendinosus Graft

2007 ◽  
Vol 35 (9) ◽  
pp. 1521-1527 ◽  
Author(s):  
Benjamin R. Coobs ◽  
Robert F. LaPrade ◽  
Chad J. Griffith ◽  
Bradley J. Nelson
Keyword(s):  
Internal Rotation ◽  
Knee Flexion ◽  
Ligament Reconstruction ◽  
External Rotation ◽  
Anatomic Reconstruction ◽  
Ligament Injury ◽  
Collateral Ligament ◽  
Fibular Collateral Ligament ◽  
Normal Stability ◽  
Semitendinosus Graft

Background The fibular collateral ligament is the primary stabilizer to varus instability of the knee. Untreated fibular collateral ligament injuries can lead to residual knee instability and can increase the risk of concurrent cruciate ligament reconstruction graft failures. Anatomic reconstructions of the fibular collateral ligament have not been biomechanically validated. Purpose To describe an anatomic fibular collateral ligament reconstruction using an autogenous semitendinosus graft and to test the hypothesis that using this reconstruction technique to treat an isolated fibular collateral ligament injury will restore the knee to near normal stability. Study Design Controlled laboratory study. Methods Ten nonpaired, fresh-frozen cadaveric knees were biomechanically subjected to a 10 N·m varus moment and 5 N·m external and internal rotation torques at 0°, 15°, 30°, 60°, and 90° of knee flexion. Testing was performed with an intact and sectioned fibular collateral ligament, and also after an anatomic reconstruction of the fibular collateral ligament with an autogenous semitendinosus graft. Motion changes were assessed with a 6 degree of freedom electromagnetic motion analysis system. Results After sectioning, we found significant increases in varus rotation at 0°, 15°, 30°, 60°, and 90°, external rotation at 60° and 90°, and internal rotation at 0°, 15°, 30°, 60°, and 90° of knee flexion. After reconstruction, there were significant decreases in motion in varus rotation at 0°, 15°, 30°, 60°, and 90°, external rotation at 60° and 90°, and internal rotation at 0°, 15°, and 30° of knee flexion. In addition, we observed a full recovery of knee stability in varus rotation at 0°, 60°, and 90°, external rotation at 60° and 90°, and internal rotation at 0° and 30° of knee flexion. Conclusion An anatomic fibular collateral ligament reconstruction restores varus, external, and internal rotation to near normal stability in a knee with an isolated fibular collateral ligament injury. Clinical Significance An anatomic reconstruction of the fibular collateral ligament with an autogenous semitendinosus graft is a viable option to treat nonrepairable acute or chronic fibular collateral ligament tears in patients with varus instability.

Biomechanical Evaluation of Plate Versus Lag Screw Only Fixation of Distal Fibula Fractures

2015 ◽  
Vol 54 (5) ◽  
pp. 896-899 ◽  
Author(s):  
Amirhossein Misaghi ◽  
Josh Doan ◽  
Tracey Bastrom ◽  
Andrew T. Pennock
Keyword(s):  
Plate Versus ◽  
Distal Fibula ◽  
Lag Screw ◽  
Biomechanical Evaluation
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