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

A 30-year-old male was involved in a car accident. Radiographs revealed a depressed marginal fracture of the medial tibial plateau and an avulsion fracture of the fibular head. Magnetic resonance imaging showed avulsion fracture of Gerdy's tubercle, injury to the posterior cruciate ligament (PCL), posterior horn of the medial meniscus, and the attachments of the lateral collateral ligament and the biceps femoris tendon. The depressed fracture of the medial tibial plateau was elevated and stabilized using a cannulated screw and washer. The injured lateral and posterolateral corner (PLC) structures were repaired and augmented by PLC reconstruction. However, the avulsion fracture of Gerdy's tubercle was not fixed because it was minimally displaced and the torn PCL was also not repaired or reconstructed. We present a unique case of pure varus injury to the knee joint. This case contributes to our understanding of the mechanism of knee injury and provides insight regarding appropriate treatment plans for this type of injury.
Adult ; Fibula/*injuries/surgery ; Humans ; *Knee Injuries/complications/surgery ; Male ; *Multiple Trauma/complications/surgery ; *Tibial Fractures/complications/surgery

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

Fibula ; injuries ; surgery ; Fracture Healing ; Orthopedic Fixation Devices ; Tibial Fractures ; surgery ; therapy ; Time Factors

OBJECTIVETo explore the effects of early external fixation for open tibia and fibula fractures on the treatment and prognosis of severe multiple injuries.

METHODSSeventy-three patients were reviewed in the study. According to the surgical methods for tibia and fibula fractures, the patients with severe multiple injuries were divided into 2 groups: 42 patients in the treatment group, including 31 males and 11 females, with an average age of 40.2 years; 31 patients in the control group, ineluding 22 males and 9 females, with an average age of 42.6 years. The patients in treatment group were treated urgently with debridement, diaplasis and fixation with external fixator, and patients in control group were treated urgently with debridement, calcaneal traction or gypsum external fixation. The incidence rate and mortality of ARDS and MODS, wound infection rate, wound healing time, and fracture healing time between the 2 groups was compared.

RESULTSThe incidence rate and mortality of complications (ARDS) had significant differences between the 2 groups, those in the treatment group were lower than those in the control group (P < 0.05). There were significant decreases in the infection rate and wound healing time in the treatment group.

CONCLUSIONExternal fixation for severe multiple injuries with open tibia and fibula fracture has been proved to be good, which can significantly reduce the mortality and incidence rate of complications and wound infection rate, promote wound healing.

Adult ; External Fixators ; Female ; Fibula ; injuries ; surgery ; Fracture Healing ; Fractures, Open ; surgery ; Humans ; Male ; Multiple Trauma ; surgery ; Tibial Fractures ; surgery

OBJECTIVETo evaluate the clinical effect of arthroscopic excision of the os subfibulare in anterior-lateral ankle pain.

METHODSFrom December 2005 to Augest 2014, 16 patients suffering from pain associated with an os subfibulare in the anterior-lateral side of their ankles were reviewed. Among the patients,11 patients were male and 5 were female, with a mean age of (33.5 ± 15.6) years old. The mean maximum diameter of os subfibulare was (0.70 ± 0.26) cm. All the patients underwent excision of the osseous fragments, and had anatomic reconstruction of the anterior talofibular ligament if the anterior-lateral ankle was instable. The average follow-up period was (18.0 ± 4.5) months. To analyze the surgical outcome, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot pain and function scales,visual analogue scale (VAS) and Tegner activity scale were assessed preoperatively and postoperatively.

RESULTSAOFAS scales were preoperative 60.15 ± 14.52 and postoperative 92.35 ± 5.73. There was a significant difference between them (t = -8.251, P = 0.000). The mean VAS score were preoperative 7.35 ± 0.46 and postoperative 2.45 ± 0.98. Statistical significance was also notable (t = 18.105, P = 0.000). Tegner score was significantly increased from preoperative 2.87 ± 1.12 to postoperative 5.78 ± 1.06 (t= -7.548, P = 0.000).

CONCLUSIONIrrespective of the size of os subfibulare, in patients with pain or instability associated with the os subfibulare, arthroscopic excision combined with reconstruction of ther anterior talofibular ligament or not was effective in restoring ankle function and eliminating pain.

Adult ; Ankle Injuries ; surgery ; Ankle Joint ; surgery ; Arthroscopy ; methods ; Female ; Fibula ; surgery ; Humans ; Lateral Ligament, Ankle ; surgery ; Male ; Middle Aged

OBJECTIVETo explore a new method and estimate its outcome to repair deep heel tissue injuries with local tissue flap.

METHODSAt lower cnemis, a fat fascial flap combined with perineal tendofascial flap were designed and elevated between the lateral malleolars blank, the largest area is 6 cm x 13 cm, which were transplanted to cover naked calcaneal tendon and calcaneal bone, full-thickness free skin graft or middle-thickness free skin graft were grafted on flap.

RESULTS6 patients suffered from heel tissue defects had been treated from January 2004 to November 2005. The smallest area was 3.5 cm x 4.0 cm and the largest was 4 cm x 6 cm. All fascial flaps and free skin grafts were successfully survived after operations. All patients were followed up 3-23 months, the operation areas were healed, the functions and configurations were satisfied.

CONCLUSIONSPerineal tendofascial flap conjoined with adipofasical flap and free skin graft are used to repair heel deep tissue defects, which is a handy, dependable way for repairing of the small tissue defects of the lower third of leg and heel.

Achilles Tendon ; injuries ; surgery ; Adult ; Fascia ; transplantation ; Female ; Fibula ; surgery ; Heel ; injuries ; surgery ; Humans ; Male ; Middle Aged ; Skin Transplantation ; Soft Tissue Injuries ; surgery ; Surgical Flaps

A case of a 50-year-old pedestrian who was hit by a bike and suffered fractures of both bones of his right leg was presented. Complete clinical and radiographic assessment showed double segmental fractures of the tibia and multisegmental fractures of the fibula. Review of the literature revealed that this fracture pattern was unique and only a single case was reported so far. Moreover, we discussed the possible mechanisms which can lead to such an injury. We also discussed the management of segmental tibial fracture and the difficulties encountered with them. This case was managed by modern osteosynthesis technique with a pleasing outcome.
Fibula ; injuries ; Fracture Fixation, Internal ; Humans ; Leg ; Tibia ; Tibial Fractures ; surgery

OBJECTIVETo study the therapeutic effect of combined multifunctional external fixator for treatment of tibiofibular fracture.

METHODSFrom Oct 1999 to Apr 2006, 37 patients of tibiofibular fractures were treated with combined multifunctional external fixator. There were 28 males and 9 females with an average of 47.8 years (range,from 22 to 76 years). There were 7 cases with transverse fracture, 18 comminuted fracture, 8 spiral fracture and 4 oblique fracture;closed fracture was in 29 cases and open fracture was in 8.

RESULTSAll the patients were followed up 6 to 13 months (mean,9 months)and achieved union of the fractures.

CONCLUSIONCombined multifunctional external fixator for tibiofibular fracture has many advantages such as minimal invasion, convenient operation, reliable fixation and high union ratio of fracture. Moreover,the treatment has no influence on motion of knee and ankle joint, even patient can walk with external fixator without long-term bed rest.

Adult ; Aged ; External Fixators ; Female ; Fibula ; injuries ; Humans ; Male ; Middle Aged ; Tibial Fractures ; surgery

OBJECTIVETo investigate the therapeutic effect of fibular head composite flap for bone and skin defect at medial malleolus in children.

METHODSFrom Aug. 2005 to Apr. 2009, 4 children cases (2 male, 2 female, from 3 to 11 year) with bone and skin defect at medial malleolus were reconstructed with fibular head composite flaps pedicled with lateral inferior genicular vascular bundle. The skin defect was 3- 6 cm x 8-10 cm in size.

RESULTSAll the 4 composite flaps survived completely. The patients were followed up for 4 months to 4 years with good bony healing. Both esthetic and functional results were satisfactory in ankle joint.

CONCLUSIONSThe fibular head composite tissue flap has a good therapeutic effect for bone and skin defect at medial malleolus in children.

Ankle Injuries ; surgery ; Bone and Bones ; injuries ; Child ; Child, Preschool ; Female ; Fibula ; surgery ; Follow-Up Studies ; Humans ; Male ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; Treatment Outcome