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Roesner M, Zankovic S, Kovacs A, Benner M, Barkhoff R, Seidenstuecker M. Mechanical Properties and Corrosion Rate of ZnAg3 as a Novel Bioabsorbable Material for Osteosynthesis. J Funct Biomater 2024; 15:28. [PMID: 38391881 PMCID: PMC10890006 DOI: 10.3390/jfb15020028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/12/2024] [Accepted: 01/20/2024] [Indexed: 02/24/2024] Open
Abstract
Osteosynthesis in fracture treatment typically uses hardware that remains in the patient's body, which brings a permanent risk of negative side effects such as foreign body reactions or chronic inflammation. Bioabsorbable materials, however, can degrade and slowly be replaced by autologous bone tissue. A suitable material is requested to offer great biocompatibility alongside excellent mechanical properties and a reasonable corrosion rate. Zinc-silver alloys provide these characteristics, which makes them a promising candidate for research. This study investigated the aptitude as a bioabsorbable implant of a novel zinc-silver alloy containing 3.3 wt% silver (ZnAg3). Here, the tensile strength as well as the corrosion rate in PBS solution (phosphate buffered solution) of ZnAg3 were assessed. Furthermore, shear tests, including fatigue and quasi-static testing, were conducted with ZnAg3 and magnesium pins (MAGNEZIX®, Syntellix AG, Hannover, Germany), which are already in clinical use. The detected corrosion rate of 0.10 mm/year for ZnAg3 was within the proposed range for bioabsorbable implants. With a tensile strength of 237.5 ± 2.12 MPa and a shear strength of 144.8 ± 13.2 N, ZnAg3 satisfied the mechanical requirements for bioabsorbable implants. The fatigue testing did not show any significant difference between ZnAg3 and magnesium pins, whereas both materials withstood the cyclic loading. Thus, the results support the assumption that ZnAg3 is qualified for further investigation.
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Affiliation(s)
- Maria Roesner
- G.E.R.N. Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Sergej Zankovic
- G.E.R.N. Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Adalbert Kovacs
- Limedion GmbH, Coatings and Surface Analysis, Am Schäferstock 2-4, 68163 Mannheim, Germany
| | - Moritz Benner
- Limedion GmbH, Coatings and Surface Analysis, Am Schäferstock 2-4, 68163 Mannheim, Germany
- Quadralux e.K., Am Schäferstock 2-4, 68163 Mannheim, Germany
| | - Roland Barkhoff
- Quadralux e.K., Am Schäferstock 2-4, 68163 Mannheim, Germany
| | - Michael Seidenstuecker
- G.E.R.N. Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
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Carter TH, Oliver WM, Bell KR, Graham C, Duckworth AD, White TO. Operative vs Nonoperative Management of Unstable Medial Malleolus Fractures: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2351308. [PMID: 38236603 PMCID: PMC10797457 DOI: 10.1001/jamanetworkopen.2023.51308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/21/2023] [Indexed: 01/19/2024] Open
Abstract
Importance Unstable ankle fractures are routinely managed operatively. However, because of soft tissue and implant-related complications, recent literature has reported on the nonoperative management of well-reduced medial malleolus fractures after fibular stabilization, but with limited evidence supporting the routine application. Objective To assess the superiority of internal fixation of well-reduced (displacement ≤2 mm) medial malleolus fractures compared with nonfixation after fibular stabilization. Design, Setting, and Participants This superiority, pragmatic, parallel, prospective randomized clinical trial was conducted from October 1, 2017, to August 31, 2021. A total of 154 adult participants (≥16 years) with a closed, unstable bimalleolar or trimalleolar ankle fracture requiring surgery at an academic major trauma center in the UK were assessed. Exclusion criteria included injuries with no medial-sided fracture, open fractures, neurovascular injury, and the inability to comply with follow-up. Data analysis was performed in July 2022 and confirmed in September 2023. Interventions Once the lateral (and where appropriate, posterior) malleolus had been fixed and satisfactory intraoperative reduction of the medial malleolus fracture was confirmed by the operating surgeon, participants were randomly allocated to fixation (n = 78) or nonfixation (n = 76) of the medial malleolus. Main Outcome and Measure Olerud-Molander Ankle Score (OMAS) 1 year after randomization (range, 0-100 points, with 0 indicating worst possible outcome and 100 indicating best possible outcome). Results Among 154 randomized participants (mean [SD] age, 56.5 [16.7] years; 119 [77%] female), 144 (94%) completed the trial. At 1 year, the median OMAS was 80.0 (IQR, 60.0-90.0) in the fixation group compared with 72.5 (IQR, 55.0-90.0) in the nonfixation group (P = .17). Complication rates were comparable. Significantly more patients in the nonfixation group developed a radiographic nonunion (20% vs 0%; P < .001), with 8 of 13 clinically asymptomatic; 1 patient required surgical reintervention for this. Fracture type and reduction quality appeared to influence fracture union and patient outcome. Conclusions and Relevance In this randomized clinical trial comparing internal fixation of well-reduced medial malleolus fractures with nonfixation, after fibular stabilization, fixation was not superior according to the primary outcome. However, 1 in 5 patients developed a radiographic nonunion after nonfixation, and although the reintervention rate to manage this was low, the future implications are unknown. These results support selective nonfixation of anatomically reduced medial malleolar fractures after fibular stabilization. Trial Registration ClinicalTrials.gov Identifier: NCT03362229.
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Affiliation(s)
- Thomas H. Carter
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - William M. Oliver
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Katrina R. Bell
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Catriona Graham
- Edinburgh Clinical Research Facility, Western General Hospital, Edinburgh, United Kingdom
| | - Andrew D. Duckworth
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Timothy O. White
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Muramoto Y, Fridrici V, Kapsa P, Bouvard G, Ohta M. Effects of temperature increase during surgical drilling in acrylic resin. Technol Health Care 2019; 28:369-380. [PMID: 31796714 DOI: 10.3233/thc-191870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Acrylic resin is employed for drilling bone biomodels. Since drilling causes temperature rise, the mechanical properties of thermoplastic acrylic resin can be altered, consequently affecting drilling properties. However, it is currently unclear how this temperature increase impacts drilling. OBJECTIVE This study reports the effects of temperature rise on both mechanical and drilling properties through experiments in which acrylic resin is drilled under machining conditions employed in surgical operations. METHODS Drilling tests were performed using a surgical drill on medical acrylic resin under dry conditions to observe generated cutting chips and measure drilling properties such as torque, drilling time, and temperature rise. Dynamic mechanical analysis measurements were performed to consider temperature effects. RESULTS According to the morphological classification of the cutting chips, the drilling process is divided into three phases corresponding with the generation of cylindrical helix, waved, and rounded nubby chips respectively. During drilling, the temperature of the chips can exceed the glass transition temperature (100∘C) resulting in decreased viscoelasticity, which is associated with decreased torque. CONCLUSIONS While drilling acrylic resin under surgical machining conditions, increasing temperature can decrease torque and morphologically change cutting chips due to the decrease in mechanical properties above the glass transition temperature.
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Affiliation(s)
- Y Muramoto
- Institute of Fluid Science, Tohoku University, Sendai, Miyagi, Japan.,Graduate School of Biomedical Engineering, Tohoku University, Sendai, Miyagi, Japan.,Laboratoire de Tribologie et Dynamique des Systèmes, UMR CNRS 5513, Ecole Centrale de Lyon, Université de Lyon, Ecully cedex, France
| | - V Fridrici
- Laboratoire de Tribologie et Dynamique des Systèmes, UMR CNRS 5513, Ecole Centrale de Lyon, Université de Lyon, Ecully cedex, France
| | - Ph Kapsa
- Laboratoire de Tribologie et Dynamique des Systèmes, UMR CNRS 5513, Ecole Centrale de Lyon, Université de Lyon, Ecully cedex, France
| | - G Bouvard
- Laboratoire de Tribologie et Dynamique des Systèmes, UMR CNRS 5513, Ecole Centrale de Lyon, Université de Lyon, Ecully cedex, France
| | - M Ohta
- Institute of Fluid Science, Tohoku University, Sendai, Miyagi, Japan.,ElyTMaX UMI 3757, CNRS - Université de Lyon - Tohoku University, International Joint Unit, Tohoku University, Sendai, Miyagi, Japan
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Carter TH, Oliver WM, Graham C, Duckworth AD, White TO. Medial malleolus: Operative Or Non-operative (MOON) trial protocol - a prospective randomised controlled trial of operative versus non-operative management of associated medial malleolus fractures in unstable fractures of the ankle. Trials 2019; 20:565. [PMID: 31514744 PMCID: PMC6739910 DOI: 10.1186/s13063-019-3642-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 08/09/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There are limited data reporting the outcome of patients with non-operatively managed medial malleolus fractures compared to those treated surgically in the presence of fibular stabilisation for unstable fractures of the ankle. Conservative management could result in fewer complications, reduced surgical time and lower cost. The purpose of this study is to determine if any difference exists in patient reported and surgical outcomes 1 year after surgery between operative and non-operative treatment of medial malleolar fractures in combination with stabilisation of the lateral malleolus. METHODS/DESIGN This is a single-centre, prospective, randomised controlled trial that aims to randomise 154 participants with an unstable ankle fracture to 'non-fixation' (n = 77) or 'fixation' (n = 77) of an associated well-reduced medial malleolus fracture following fibular stabilisation. The study will include patients ≥ 16 years of age with a closed bimalleolar or trimalleolar ankle fracture who are able to consent, complete questionnaires in the English language, and complete follow-up over a 1-year period. Randomisation will occur intra-operatively when the medial malleolus fracture is deemed 'well-reduced', with 2 mm or less of fluoroscopic displacement. The technique for fixation of both the medial and lateral malleoli is at the discretion of the operating surgeon. Patient-reported, observer-rated, and radiographic assessments will be collected at baseline and then at the following post-operative assessment points: 2 weeks, 6 weeks and 1 year. Postal questionnaire outcome data will be collected at 3 and 6 months. The primary outcome measure will be the Olerud Molander Ankle Score (OMAS) at 1 year following surgery. Secondary outcome measures will include the Manchester-Oxford Foot Questionnaire (MOXFQ), EuroQol-5D (EQ-5D), pain, treatment satisfaction, time to return to activity, operative tourniquet time, and complications. DISCUSSION There is only one previous randomised trial comparing non-fixation with fixation of associated medial malleolus fractures but that was limited by the lack of baseline patient-reported outcome data and an inferior sample size. This current prospective trial aims to provide high-quality evidence regarding the requirement for medial malleolar fixation in unstable ankle fractures. TRIAL REGISTRATION ClinicalTrials.gov, NCT03362229 . Registered retrospectively on 5 December 2017.
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Affiliation(s)
- Thomas H Carter
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK.
| | - William M Oliver
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Catriona Graham
- Wellcome Trust Clinical Research Facility, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Andrew D Duckworth
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Timothy O White
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
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Abstract
The medial malleolus, once believed to be the primary stabilizer of the ankle, has been the topic of conflicting clinical and biomechanical data for many decades. Despite the relevant surgical anatomy being understood for almost 40 years, the optimal treatment of medial malleolar fractures remains unclear, whether the injury occurs in isolation or as part of an unstable bi- or trimalleolar fracture configuration. Traditional teaching recommends open reduction and fixation of medial malleolar fractures that are part of an unstable injury. However, there is recent evidence to suggest that nonoperative management of well-reduced fractures may result in equivalent outcomes, but without the morbidity associated with surgery. This review gives an update on the relevant anatomy and classification systems for medial malleolar fractures and an overview of the current literature regarding their management, including surgical approaches and the choice of implants. Cite this article: Bone Joint J 2019;101-B:512-521.
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Affiliation(s)
- T H Carter
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - T O White
- Royal Infirmary of Edinburgh, Edinburgh, UK
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Uygur E, Poyanli O, Mutlu İ, Çelik T, Akpinar F. Medial malleolus fractures: A biomechanical comparison of tension band wiring fixation methods. Orthop Traumatol Surg Res 2018; 104:1259-1263. [PMID: 30107278 DOI: 10.1016/j.otsr.2018.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/14/2018] [Accepted: 06/04/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study compared the biomechanical properties of three different fixation methods of tension band wirings, used in the treatment of medial malleolus fractures. The first method used an innovative "handmade bent pin" for cerclage fixation. The second method used a U-shaped K-wire to attach the cerclage to the medial tibial cortex. These two novel fixation techniques were compared with the traditional tension band wiring technique which is fixated to the bone by a screw. HYPOTHESIS Novel fixation techniques of tension band wiring provide stable fixation. MATERIAL AND METHODS In this study 27 artificial bone models, which medial malleolus fractures were simulated on, were used. Using an electromechanical test device, the force required to pull out each implant was assessed and compared. RESULTS This study found that; while handmade bent pinning resulted averagely 840.25N (range: 647-1066±118.72) and U-shaped K-wire fixation was 381.71N (range: 176-651±150.2) pull out strength, traditional tension band wiring indicated 871.33N (range: 549-1008±137.74) pull out strength. DISCUSSION Handmade bent pinning method provide similar results with traditional tension band wiring. Therefore, in suitable cases, it may be an acceptable alternative to traditional tension band wiring techniques when treating malleolar fractures. Although the outcomes of U-shaped K-wire fixation indicated lower than other two groups, the outcomes were comparable with the literature. So while performing tension band wiring, both handmade fixation systems may be used in certain cases. For Orthopaedic surgeons, it is better to know and think about these alternative handmade pinning systems created from simple K-wires during the surgery if needed. LEVEL OF EVIDENCE IV, Biomechanical trial.
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Affiliation(s)
- Esat Uygur
- Orthopaedics and Traumatology department, İstanbul Medeniyet University Göztepe Training and Research Hospital, Kadıköy, Turkey.
| | - Oguz Poyanli
- Orthopaedics and Traumatology department, İstanbul Medeniyet University Göztepe Training and Research Hospital, Kadıköy, Turkey
| | - İbrahim Mutlu
- Technology Faculty, Biomedical Engineering, Kocaeli University, Kocaeli, Turkey
| | - Talip Çelik
- Technology Faculty, Biomedical Engineering, Kocaeli University, Kocaeli, Turkey
| | - Fuat Akpinar
- Orthopaedics and Traumatology department, İstanbul Medeniyet University Göztepe Training and Research Hospital, Kadıköy, Turkey
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Magone KM, Owen JK, Kemker BP, Bloom O, Martin S, Atkinson P. A model to evaluate Pauwels type III femoral neck fractures. Proc Inst Mech Eng H 2018; 232:310-317. [PMID: 29320924 DOI: 10.1177/0954411917752972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While many femoral neck fractures can be reliably treated with surgical intervention, Pauwels III femoral neck fractures in the young adult population continue to be a challenging injury, and there is no consensus on optimal treatment. As such, there are past and ongoing biomechanical studies to evaluate the fixation provided by different constructs for this inherently unstable fracture. While many investigations rely on cadavers to evaluate the biomechanical performance of a construct, significant inter-subject variability can confound the analysis. Biomechanical femur analogs are being used more frequently due to more consistent mechanical properties; however, they have not been stringently evaluated for morphology or suitability for instrumentation. This study sought to determine the variability among composite femoral analogs as well as consistently create a Pauwels III injury and instrument the analogs without the need for fluoroscopic guidance. In total, 24 fourth-generation composite femoral analogs were evaluated for femoral height, neck-shaft angle, anteversion, and cortical thickness. A method was developed to simulate a Pauwels III fracture and to prepare three different constructs: an inverted triangle of cannulated screws, a sliding hip screw, and a hybrid inverted triangle with cannulated screws and a sliding hip screw. Radiographs were utilized to evaluate the variation in implant position. All but one of the morphological parameters varied by <1%. The tip-to-apex distance for all sliding hip screw hardware was 18.8 ± 3.3 mm, and all relevant cannulated screw distances were within 5 mm of the adjacent cortex. All screws were parallel, on average, within 1.5° on anterior-posterior and lateral films. Fourth-generation composite femora were found to be morphologically consistent, and it is possible to consistently instrument the analogs without the use of fluoroscopy. This analog and hardware implantation model could serve as a screening model for new fracture repair constructs without the need for cadaveric tissues or radiologic technology.
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Affiliation(s)
- Kevin M Magone
- 1 Orthopaedic Surgery, McLaren Regional Medical Center, McLaren-Flint, Flint, MI, USA
| | - Jonas K Owen
- 1 Orthopaedic Surgery, McLaren Regional Medical Center, McLaren-Flint, Flint, MI, USA
| | - Bernard P Kemker
- 1 Orthopaedic Surgery, McLaren Regional Medical Center, McLaren-Flint, Flint, MI, USA
| | - Oliver Bloom
- 2 Department of Biomechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Sidney Martin
- 1 Orthopaedic Surgery, McLaren Regional Medical Center, McLaren-Flint, Flint, MI, USA
| | - Patrick Atkinson
- 1 Orthopaedic Surgery, McLaren Regional Medical Center, McLaren-Flint, Flint, MI, USA.,3 Mechanical Engineering, Kettering University, Flint, MI, USA
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Downey MW, Duncan K, Kosmopoulos V, Motley TA, Carpenter BB, Ogunyankin F, Garrett A. Comparing the Knotless Tension Band and the Traditional Stainless Steel Wire Tension Band Fixation for Medial Malleolus Fractures: A Retrospective Clinical Study. SCIENTIFICA 2016; 2016:3201678. [PMID: 27293969 PMCID: PMC4880701 DOI: 10.1155/2016/3201678] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 04/20/2016] [Indexed: 06/06/2023]
Abstract
The traditional stainless steel wire tension band (WTB) has been popularized for small avulsion fractures at the medial malleolus. Despite the tension band principle creating a stable construct, complications continue to arise utilizing the traditional stainless steel WTB with patients experiencing hardware irritation at the tension band site and subsequent hardware removal. Coupled with hardware irritation is fatigue failure with the wire. The goal of this investigation was to retrospectively compare this traditional wire technique to an innovative knotless tension band (KTB) technique in order to decrease costly complications. A total of 107 patients were reviewed with a minimum follow-up of 1 year. Outcome measures include descriptive data, fracture classification, results through economic costs, and fixation results (including hardware status, healing status, pain status, and time to healing). The KTB group had a 13% lower true cost as compared to the WTB group while the fixation results were equivocal for the measured outcomes. Our results demonstrate that the innovative KTB is comparable to the traditional WTB while offering a lower true cost, an irritation free reduction all without the frustration of returning to the operating room for additional hardware removal, which averages approximately to $8,288.
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Affiliation(s)
- Michael W. Downey
- Foot & Ankle Division, Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX 76104, USA
| | - Kyle Duncan
- Foot & Ankle Division, Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX 76104, USA
| | - Victor Kosmopoulos
- Department of Orthopaedic Surgery, Bone & Joint Institute, University of North Texas Health Science Center, Fort Worth, TX 76104, USA
- Department of Materials Science and Engineering, University of North Texas, Denton, TX 76107, USA
- Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX 76104, USA
| | - Travis A. Motley
- Foot & Ankle Division, Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX 76104, USA
- Department of Orthopaedic Surgery, Bone & Joint Institute, University of North Texas Health Science Center, Fort Worth, TX 76104, USA
| | - Brian B. Carpenter
- Foot & Ankle Division, Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX 76104, USA
- Department of Orthopaedic Surgery, Bone & Joint Institute, University of North Texas Health Science Center, Fort Worth, TX 76104, USA
| | - Fadeke Ogunyankin
- Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX 76104, USA
| | - Alan Garrett
- Foot & Ankle Division, Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX 76104, USA
- Department of Orthopaedic Surgery, Bone & Joint Institute, University of North Texas Health Science Center, Fort Worth, TX 76104, USA
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Ebraheim NA, Ludwig T, Weston JT, Carroll T, Liu J. Comparison of surgical techniques of 111 medial malleolar fractures classified by fracture geometry. Foot Ankle Int 2014; 35:471-7. [PMID: 24525543 DOI: 10.1177/1071100714524553] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Evaluation of operative techniques used for medial malleolar fractures by classifying fracture geometry has not been well documented. METHODS One hundred eleven patients with medial malleolar fractures (transverse n = 63, oblique n = 29, vertical n = 7, comminuted n = 12) were included in this study. Seventy-two patients had complicating comorbidities. All patients were treated with buttress plate, lag screw, tension band, or K-wire fixation. Treatment outcomes were evaluated on the basis of radiological outcome (union, malunion, delayed union, or nonunion), need for operative revision, presence of postoperative complications, and AOFAS Ankle-Hindfoot score. RESULTS For transverse fractures, tension band fixation showed the highest rate of union (79%), highest average AOFAS score (86), lowest revision rate (5%), and lowest complication rate (16%). For oblique fractures, lag screws showed the highest rate of union (71%), highest average AOFAS score (80), lowest revision rate (19%), and lowest complication rate (33%) of the commonly used fixation techniques. For vertical fractures, buttress plating was used in every case but 1, achieving union (whether normal or delayed) in all cases with an average AOFAS score of 84, no revisions, and a 17% complication rate. Comminuted fractures had relatively poor outcomes regardless of fixation method. CONCLUSIONS The results of this study suggest that both tension bands and lag screws result in similar rates of union for transverse fractures of the medial malleolus, but that tension band constructs are associated with less need for revision surgery and fewer complications. In addition, our data demonstrate that oblique fractures were most effectively treated with lag screws and that vertical fractures attained superior outcomes with buttress plating. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
- Nabil A Ebraheim
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, OH, USA
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Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2013. [DOI: 10.1097/bco.0b013e3182a6a18b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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