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Clavert P, Puliero B, Eichler D, Ollivier I, Bonnomet F. The distal fibular perforating axial flap for lateral malleolus coverage: an anatomical description and surgical technique. Surg Radiol Anat 2023; 45:1191-1196. [PMID: 37550484 DOI: 10.1007/s00276-023-03204-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 07/05/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE Skin closure disorders in ankle surgery are a recurrent problem not only in traumatology but also in elective surgery. The aim of the study was to describe the anatomical basis of the fasciocutaneous vascularization of the lateral malleolus region to develop a posterior cover flap for the region. METHODS We dissected ten fresh frozen specimens after arterial injection of an Indian ink preparation and individualized the perforating arteries. Their positions and diameters were collated. Then, the surgical technique was clinically applied for two different cases by transferring the fasciocutaneous flap posterior to the lateral malleolus to cover a loss of skin substance. RESULTS There were in average 5 fibular perforators over the last 100 mm of the fibula. The average diameter of the first two perforating arteries was 0.6 ± 0.12 mm and 0.9 ± 0.25 mm, respectively, and the consistency of the latter makes it possible to produce a skin flap with anterior translation. This is an axial flap. Two patients were operated on using this technique. There was no necrosis of the posterior fibular flap and healing was achieved by the third post-operative week. CONCLUSION This study showed the presence of fibular perforating arteries with a high reproducibility of their dissection. This anatomical description served as the basis for the description of a new distal fibular perforating flap.
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Affiliation(s)
- Philippe Clavert
- Institute of Normal Anatomy, Medical School, 4, rue Kirschleger, 67085, Strasbourg Cedex, France.
- Department of Orthopedic, University Hospital Hautepierre 2, Strasbourg, France.
| | - Benjamin Puliero
- Institute of Normal Anatomy, Medical School, 4, rue Kirschleger, 67085, Strasbourg Cedex, France
- Department of Orthopedic, University Hospital Hautepierre 2, Strasbourg, France
| | - David Eichler
- Department of Orthopedic, University Hospital Hautepierre 2, Strasbourg, France
| | - Irène Ollivier
- Institute of Normal Anatomy, Medical School, 4, rue Kirschleger, 67085, Strasbourg Cedex, France
| | - François Bonnomet
- Department of Orthopedic, University Hospital Hautepierre 2, Strasbourg, France
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Raipure A, Phansopkar P, Uttamchandani SR. A Unique Physical Therapy Approach in a Complex Case of Pott's Fracture: A Case Report. Cureus 2023; 15:e36847. [PMID: 37123685 PMCID: PMC10147482 DOI: 10.7759/cureus.36847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/29/2023] [Indexed: 03/31/2023] Open
Abstract
The ankle joint is a complex joint that bears the human body's weight throughout daily activities. Unimalleolar, bimalleolar, and trimalleolar fractures are the three subgroups that make up the category of ankle fractures. Determining the risk-benefit tradeoffs between non-operative and surgical therapy still requires a thorough initial examination of the fracture pattern, soft tissue condition, and patient characteristics. Ankle fractures that are stable and well-aligned respond well to conservative therapy. Open reduction and internal fixation is the current gold standard of treatment for displaced and unstable fracture patterns, with historical data revealing good to outstanding outcomes for the majority of these patients. We present a case of a 19-year-old female sustaining a Pott's fracture following a road traffic accident. The overall treatment technique used included the overload principle, task-specific training, and an impairment-based strategy. The patient's impairments with regard to the range of motion, strength, edema, discomfort, wound healing, and functional limitations were handled by the therapist using exercises, manual therapy, and compressive cryotherapy. A clinically significant rehabilitation protocol for treating Pott's fracture is established in this case report.
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Liao J, Zhang J, Ni W, Luo G. A retrospective study of deltoid ligament repair versus syndesmotic fixation in lateral malleolus fracture combined with both deltoid ligament injury and inferior tibiofibular syndesmotic disruption. Front Surg 2022; 9:912024. [PMID: 36386501 PMCID: PMC9645235 DOI: 10.3389/fsurg.2022.912024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 09/27/2022] [Indexed: 11/22/2022] Open
Abstract
Background To compare clinical outcomes of deltoid ligament repair versus syndesmotic fixation in lateral malleolus fracture combined with both deltoid ligament injury and inferior tibiofibular syndesmotic disruption. Methods Patients diagnosed with lateral malleolus fracture combined with both deltoid ligament injury and inferior tibiofibular syndesmotic disruption who received open reduction and internal fixation (ORIF) were retrospectively reviewed. Seventy-eight patients were enrolled into the study, including 40 patients treated with lateral malleolus fracture ORIF and trans-syndesmotic fixation, and 38 patients treated with lateral malleolus fracture ORIF and deltoid ligament repair. Basic information and pre- and postoperative radiological materials were reviewed. Visual analog pain scale (VAS) score, Olerud-Molander score, and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale were used for evaluating pain control and functional recovery postoperatively at different time points. Results No complication was reported in both groups. In the trans-syndesmotic fixation group, all patients received syndesmotic screw removal 6-8 weeks postoperatively. The Olerud-Molander score and AOFAS Ankle-Hindfoot Scale in the deltoid ligament repair group were higher than the trans-syndesmotic fixation group 3 months after operation. No statistical difference was found between the two groups in VAS score from 1 to 12 months postoperatively. Conclusions Lateral malleolus fracture ORIF and deltoid ligament repair is an effective method for lateral malleolus fracture combined with both deltoid ligament injury and inferior tibiofibular syndesmotic disruption. Compared with trans-syndesmotic fixation, deltoid ligament repair holds the advantage of not needing surgical removal of inferior tibiofibular screws postoperatively.
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Sun J, Li Q, Wang S, Wang G, Zhao J, Li H, Liu C, Shi Y, Li Z, Yu H. Establishment and Evaluation of a Rat Model of Medial Malleolar Fracture with Vascular Injury. Orthop Surg 2022; 14:2701-2710. [PMID: 36098492 PMCID: PMC9531110 DOI: 10.1111/os.13455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 07/12/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022] Open
Abstract
Objective A stable animal model was needed to study bone non‐union caused by insufficient blood supply, the main object of this paper is to develop a medial malleolar fracture model with controllable arterial vascular injuries in rats for revealing the biochemical mechanism of non‐union by insufficient blood supply. Methods A total of 18 rats were randomly divided into three equal groups: the Sham group, the Fracture group, and the Fracture + Vascular group. The animals were subjected to unilateral medial malleolar bone fracture and vascular injury using customized molding equipment. The fracture site was scanned by micro‐CT, and vascular injury was evaluated by laser Doppler flowmetry (LDF) 24 h after modeling. Histological examination (HE), alkaline phosphatase (ALP) and tartrate‐resistant acid phosphatase (TRAP) staining, immunohistochemistry and immunofluorescence were conducted on the medial malleolar fracture tissues of three rats randomly selected from each group 24 h after modeling. Subsequently, to further confirm the success of fracture modeling, the fracture sites of three other rats in each group underwent micro‐CT scanning again 6 weeks after surgery. Results The results of a 24 h micro‐CT showed that all rats used to create the fracture models showed controlled injury of the medial malleolus. The model was stable, and the satisfaction of the homemade equipment agreed with the expectation. LDF showed that the blood flow of rats in the Fracture + Vascular group decreased significantly 24 h after fracture injury, while collateral blood flow perfusion increased by 50% on average. The results of HE, ALP and TRAP staining in the medial malleolus showed that the number of osteoblasts (OBs) and osteoclasts (OCs) in the Fracture group increased significantly, but the number of OBs and OCs in the Fracture + Vascular group decreased sharply relative to the number in the Sham group 24 h later. Furthermore, immunohistochemistry and immunofluorescence results showed that the number of neovessels in the Fracture group was significantly increased, while the number of neovessels in the Fracture + Vascular group was significantly decreased, which was consistent with the above results. After 6 weeks of modeling, the micro‐CT results showed that the fractures in the Fracture group had healed substantially, while those in the Fracture + Vascular group had not. Conclusion This study provided a reproducible and stable experimental animal model for medial malleolar fractures with arterial injury.
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Affiliation(s)
- Jinglai Sun
- Department of Biomedical Engineering, Tianjin Key Laboratory of Biomedical Detecting Techniques and Instruments, Tianjin University, Tianjin, China.,Tianjin Joint Laboratory of Intelligent Medicine, Tianjin 4TH Centre Hospital, Tianjin University, Tianjin, China
| | - Qifeng Li
- Department of Biomedical Engineering, Tianjin Key Laboratory of Biomedical Detecting Techniques and Instruments, Tianjin University, Tianjin, China
| | - Shuo Wang
- Department of Biomedical Engineering, Tianjin Key Laboratory of Biomedical Detecting Techniques and Instruments, Tianjin University, Tianjin, China.,Academy of Medical Engineering and Translation Medicine, Tianjin University, Tianjin, China
| | - Guangpu Wang
- Department of Biomedical Engineering, Tianjin Key Laboratory of Biomedical Detecting Techniques and Instruments, Tianjin University, Tianjin, China.,Tianjin Joint Laboratory of Intelligent Medicine, Tianjin 4TH Centre Hospital, Tianjin University, Tianjin, China
| | - Jing Zhao
- Department of Biomedical Engineering, Tianjin Key Laboratory of Biomedical Detecting Techniques and Instruments, Tianjin University, Tianjin, China.,Tianjin Joint Laboratory of Intelligent Medicine, Tianjin 4TH Centre Hospital, Tianjin University, Tianjin, China
| | - Huanming Li
- Tianjin Joint Laboratory of Intelligent Medicine, Tianjin 4TH Centre Hospital, Tianjin University, Tianjin, China.,Department of Cardiovascular, Tianjin 4TH Centre Hospital, Tianjin, China
| | - Chong Liu
- Tianjin Joint Laboratory of Intelligent Medicine, Tianjin 4TH Centre Hospital, Tianjin University, Tianjin, China.,Department of Central Laboratory, Tianjin 4TH Centre Hospital, Tianjin, China.,Department of Anesthesiology, Tianjin 4TH Centre Hospital, Tianjin, China
| | - Yifan Shi
- Department of Imaging, Tianjin 4TH Centre Hospital, Tianjin, China
| | - Zhigang Li
- Tianjin Joint Laboratory of Intelligent Medicine, Tianjin 4TH Centre Hospital, Tianjin University, Tianjin, China.,Department of Emergency Medicine, Tianjin 4TH Centre Hospital, Tianjin, China
| | - Hui Yu
- Department of Biomedical Engineering, Tianjin Key Laboratory of Biomedical Detecting Techniques and Instruments, Tianjin University, Tianjin, China.,Tianjin Joint Laboratory of Intelligent Medicine, Tianjin 4TH Centre Hospital, Tianjin University, Tianjin, China.,Academy of Medical Engineering and Translation Medicine, Tianjin University, Tianjin, China
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Bilgetekin YG, Çatma MF, Öztürk A, Ünlü S, Ersan Ö. Comparison of different locking plate fixation methods in lateral malleolus fractures. Foot Ankle Surg 2019; 25:366-370. [PMID: 30321977 DOI: 10.1016/j.fas.2018.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/24/2017] [Accepted: 01/31/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Several fixation methods may be used for displaced lateral malleolar fractures. We aimed to compare clinical and radiologic outcomes associated with use of locking one third tubular plate vs. anatomical distal fibula locking plate in lateral malleolar fractures. METHODS A total of 62 orthopedic patients operated for lateral malleolus fracture were included in this retrospective study. Patients were divided into two groups regarding the plate used for fixation as locking one third tubular plate (group I; n=37) and locking anatomical distal fibula plate (group II; n=25). Data on Danis-Weber ankle fracture classification (Type A, Type B), duration of follow up, clinical outcome [ankle range of motion (ROM), American Orthopaedic Foot & Ankle Society (AOFAS) score], radiological outcomes (adequacy of reduction, loss of alignment), time to fracture healing and complications were recorded in study groups. RESULTS No significant difference was noted between groups in terms of AOFAS score [87.0 (73-100) vs. 85.0 (71-100), respectively (p=0.339)] and no patients had severe restriction in sagittal and hindfoot motion in both groups. The two groups showed similar healing time [9.0 (7-13) weeks vs. 10.0 (8-13) weeks, respectively (p=0.355)] and complication rate [0.0% vs. 4.0%, respectively (p=0.403)]. CONCLUSIONS This study revealed no significant difference between use of locking one third tubular plate and locking anatomical distal fibula plate in lateral malleolar fixation, in terms of clinical and radiological outcomes, complication rates and fracture healing time.
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Affiliation(s)
- Yenel Gürkan Bilgetekin
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Orthopaedics, Ankara, Turkey.
| | - Mehmet Faruk Çatma
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Orthopaedics, Ankara, Turkey.
| | - Alper Öztürk
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Orthopaedics, Ankara, Turkey.
| | - Serhan Ünlü
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Orthopaedics, Ankara, Turkey.
| | - Önder Ersan
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Orthopaedics, Ankara, Turkey.
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