The distal tibiofibular syndesmosis is important for ankle mortise stability, weight transmission and walking. Incorrect treatment is correlate with chronicd ankle instability, long-term pain and the development of osteoarthritis. Some controversy still exists regarding the evaluation and treatment of syndesmotic injuries with screws. The goal of this review was to collect evidence on the technical aspects for the treatment of distal tibiofibular syndesmosis injuries with screw and to formulate some recommendations for clinical practices.
Ankle Injuries ; surgery ; Bone Screws ; Fibula ; injuries ; surgery ; Fracture Fixation, Internal ; methods ; Humans ; Joint Instability ; surgery ; Tibia ; injuries ; surgery

Posterior tibial slope angle (PTSA) is a risk factor for anterior cruciate ligament (ACL) injury and has attracted a lot of attention, but its mechanism of action and diagnosis are still not systematically studied in the field of sports medicine. In this paper, we believe that PTSA should be measured by full-length lower extremity films and combined with multiple imaging data for comprehensive assessment to reduce errors. A large PTSA may increases risk of anterior cruciate ligament injury, so patients with more than 12 degrees of PTSA should be treated by preserving meniscus as much as possible during ACL reconstruction and combining with tibial osteotomy if necessary, which could effectively prevent risk of ligament re-injury. At the same time, gait analysis has an important reference value for preoperative pathogenic pattern and postoperative rehabilitation function, so the author believes that it will have a guiding significance for the development of individualized rehabilitation strategy based on PTSA, in order to achieve the best treatment effect.
Humans ; Anterior Cruciate Ligament/surgery* ; Tibia/surgery* ; Anterior Cruciate Ligament Injuries/surgery* ; Lower Extremity

Adolescent ; Child ; External Fixators ; utilization ; Female ; Fibula ; injuries ; Fractures, Open ; surgery ; Humans ; Male ; Tibia ; injuries

Adolescent ; Bone Screws ; Child ; Epiphyses ; injuries ; surgery ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Tibia ; injuries ; surgery ; Tibial Fractures ; surgery

Adolescent ; Adult ; Female ; Humans ; Male ; Middle Aged ; Tibia ; injuries ; surgery ; Tibial Fractures ; surgery ; Young Adult

OBJECTIVETo evaluate biomechanical properties in different methods of internal fixation combined with distal tibiofibular syndesmosis injury, in order to provide a theoretical basis for clinical choice.

METHODSSix lower limbs specimens were collected and divided into 5 groups, including normal group, distal tibiofibular syndesmosis injury (injury group), 3 cortexes group, 4 cortexes group and hook-plate fixation group. Neutral position, plantar flexion position (30°), dorsiflexion (20°) supination external rotation position of foot movement were simulated on universal materials tester. Strength, stiffness and stability of ankle joint in 4 kinds of motion conditions were measured.

RESULTSThere was significant differences in strength and stiffness of ankle joint between injury group and normal group in 4 different kinds of motion conditions (P<0.05). Strength and stiffness of ankle joint in 3 cortexes group, 4 cortexes group and hook-plate fixation group were improved obviously in 4 different kinds of motion conditions, and biomechanical indexes were recovered normally or better than normal group. Stiffness of the three fixation groups were better than normal group,but there was no significant differences among three groups (P > 0.05), while stiffness of hook-plate fixation group was closed to normal group.

CONCLUSIONFor distal tibiofibular syndesmosis injury, 1 screw with 3 cortexes, 4 cortexes and hook-plate had a positive impact on strength, stiffness and stability of distal tibiofibular syndesmosis injury stress,and could restore the normal stabllity of ankle joint after reconstruction. While fixing by screw fixation would limit the rototary motion of ankle joint,ankle mortise could not adapt to changes of talus bone, thus induces screw breakage and traumatic arthritis. Hook-plate fixation is more suitable than 3 cortexes or 4 cortexes fixation for bilmechanical properties,and its' stress is more balance and can reduce postoperative complcations.

Ankle Injuries ; physiopathology ; surgery ; Biomechanical Phenomena ; Fibula ; injuries ; surgery ; Fracture Fixation, Internal ; methods ; Humans ; Joint Instability ; physiopathology ; prevention & control ; Reconstructive Surgical Procedures ; methods ; Tibia ; injuries ; surgery

Intra-articular coronal fractures (Hoffas fractures) of distal femur are rare. Although bicondylar involvement in these fractures has been reported in the literature in association with high velocity traumata, the occurrence of these fractures involving extensor mechanism rupture and avulsion of ipsilateral tibial spine is extremely rare. To our acquaintance, such a fracture pattern has not yet been reported in the literature so far. In this article, we report one such case and discuss the importance of early diagnosis and prompt internal fixation in the management of such cases.We believe that these rare combinations of injuries should be treated aggressively by early open reduction and anatomic rigid internal fixation in order to achieve good recovery of function.
Femoral Fractures ; surgery ; Femur ; Fracture Fixation, Internal ; Fractures, Bone ; Humans ; Knee Injuries ; surgery ; Tibia ; Tibial Fractures ; surgery

Adult ; Bone Screws ; Collateral Ligaments ; injuries ; surgery ; Female ; Humans ; Knee Joint ; surgery ; Male ; Middle Aged ; Tibia ; surgery

OBJECTIVE: To review the studies about the tibial-graft fixation methods on anterior cruciate ligament (ACL) reconstruction, in order to provide clinical reference. METHODS: The literature about the tibial-graft fixation methods on ACL reconstruction at home and abroad was extensively reviewed, and the factors that affect the selection of fixation methods were summarized. RESULTS: The knee flexion angle, graft tension, and graft fixation device are mainly considered when the tibial-graft was fixed on ACL reconstruction. At present, the graft is mainly fixed at 0°/30° of knee flexion. The study shows that the knee joint is more stable after fixed at 30°, while the incidence of knee extension limitation decrease after fixed at 0°. In terms of graft tension, a good effectiveness can be obtained when the tension level is close to 90 N or the knee flexion is 30° to recover the affected knee over-restrained 2 mm relative to the healthy knee. In terms of the graft device, the interference screw is still the most commonly used method of tibial-graft fixation, with the development of all-inside ACL reconstruction in recent years, the cortical button fixation may become the mainstream. CONCLUSION Arthroscopic reconstruction is the main treatment of ACL rupture at present. However, there is no optimal fixation method for the tibial-graft, the advantages and disadvantages of each fixation methods need to be further studied.
Humans ; Tibia/surgery* ; Anterior Cruciate Ligament Reconstruction ; Knee Joint/surgery* ; Anterior Cruciate Ligament Injuries/surgery* ; Bone Screws

OBJECTIVETo investigate the efficacy of the application of transosseous osteosynthesis with annular external fixator for the treatment of traumatic large bone defects of the tibia.

METHODSFrom 2002 to 2011,17 cases of traumatic tibial long bone defect were treated by transosseous osteosynthesis with annular external fixator including 11 males and 6 females with an average age of (31.00+/-2.35) years old ranging from 22 to 45 years. The length of defect was from 5 to 13.1 cm with an average of (7.50+/-1.01) cm. The fixed time,bone healing time and the extend length of the affected limb were observed, and the degree of recovery of limb function after surgery were assessed ccording to the Paley's limb function evaluation.

RESULTSAll patients were followed up from 12 to 48 months with an average of (30.00+/-2.35) months, the bone defects of 17 patients achieved bone healing. The average bone healing time was (10.10+/-0.59) months (8 to 15 months); the average time of fixed time was (14.10+/-0.65) months (12 to 16 months); the average extend length of the affected limb was (7.50+/-1.01) cm. The results of Paley's functional evaluation was excellent in 9 cases,good in 6,fair in 2.

CONCLUSIONTransosseous osteosynthesis with annular external fixator is an effective method for treatment of large bone defects of the tibia. It is successful reconstruction of limb length, simple operation, less soft tissue injury,and is clinical worthy of promotion.

Adult ; External Fixators ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Tibia ; injuries ; surgery ; Wound Healing