Introduction. Previous studies have demonstrated the need of accurate reduction of ankle syndesmosis. Measurement of syndesmosis is difficult on plain radiographs. Recently, a difference of 2mm in anterior and posterior measurements at incisura of the inferior tibio-fibular joint on CT has been described as a measure of
Tibial plateau fractures are common injuries. Displaced fractures are treated with open reduction and internal fixation (ORIF). Goals of treatment include restoration of extremity axial alignment, joint stability and congruity, allowing for early motion and prevention of osteoarthritis. Short term results of surgical fixation of tibial plateau fractures are good, however, longer term outcomes have demonstrated a higher risk of end-stage arthritis and total knee arthroplasty. Despite the vast literature around tibial plateau fractures, to our knowledge there are no series examining post-operative reductions using axial imaging. It is our goal to define the incidence of articular
Ankle fractures are the fourth most common fracture requiring surgical management. The deltoid ligament is considered the primary stabilizer of the ankle against a valgus force. The management of the deltoid ligament in ankle fractures is currently a controversial topic no consensus exists regarding repair in the setting of ankle fractures. The purpose of this systematic review is to examine the role and indications for deltoid ligament repair in ankle fractures. A systematic database search was conducted with Medline, Pubmed and Embase for relevant studies discussing patients with ankle fractures involving deltoid ligament rupture and repair. The papers were screened independently and in duplicate by two reviewers. Study quality was evaluated using the MINORs criteria. Data extraction included post-operative outcomes, pain, range of motion (ROM), function, medial clear space (MCS), syndesmotic
Flexible fixation techniques combined with anatomic (open) syndesmosis reduction have demonstrated improved functional outcomes and rates of
The purpose of this project was to evaluate North American trauma surgeon preferences regarding patient positioning for antegrade fixation of mid shaft femoral shaft fractures. This project was a cross sectional survey taken of orthopaedic fellows and staff surgeons, belonging to three organizations across North America. An estimated sample size was calculated a priori, while various online techniques were utilized to reduce non responder and fatigue bias. The survey was distributed multiple times to optimize yield. Two hundred twelve (212) participants responded in full, 134 (56%) of whom practiced in Canada. The majority of surgeons worked in level one trauma centres (74%), while 72% treated more than one femoral shaft fracture per week. The most common patient position for mid shaft fixation amongst all surgeons was lateral positioning with manual traction (68%), however community surgeons were significantly more likely to use a fracture table. The most common difficulties faced with using a fracture table were inability to achieve fracture reduction and peroneal nerve palsies. The majority (64%) of surgeons quoted a complication rate with fracture tables of greater than 1 per 100 cases. Lateral position with use of manual traction is the preferred set up for antegrade fixation of femoral shaft fracture in this large North American cohort of trauma surgeons. However, a large subset of community and non academic surgeons still prefer use of the fracture table. Amongst all respondents, a high rate of fracture table complications, including
Traditional screw fixation of the syndesmosis can be prone to
Nearly one quarter of ankle fractures have a recognized syndesmosis injury. An intact syndesmosis ligament complex stabilizes the distal tibio-fibular joint while allowing small, physiologic amounts of relative motion. When injured,
Introduction. In this cohort study, the TightRope® fixation technique has been compared with the traditional screw fixation for ankle syndesmosis injuries, with respect to the accuracy of the syndesmotic reduction and their clinical correlation. Patients and Methods. This cohort study included consecutive patients treated for ankle syndesmotic diastases between July 2007 and June 2009. Single slice axial CT scans of both the ankles together were performed at the level of syndesmosis, 1 cm above the tibial plafond. More than 2 mm widening of syndesmosis as compared to normal contra-lateral ankle was considered as significant
Purpose. Femoral shaft fractures are routinely treated using antegrade intramedullary nailing under fluoroscopic guidance.
The outcome of 77 high energy tibial plateau fractures treated by locking or conventional plating was reviewed. The aim of the study was to determine if there was any advantage of locking plates in reducing the complication rates associated with fixation of these injuries. All patients had a high energy injury pattern (medial or bicondylar plateau fractures). There were 32 locked plates and 45 non-locking plates used. Compartment syndrome complicated 5 patients (16%) in the locked plate group and 3 (7%) in the non-locked group (p = 0.198). Superficial infection occurred in 4 (13%) patients with locked plates and 7 (16%) patients with non-locked plates. Thromboembolic complications occurred in 3 (7%) patients treated with non-locked plates. There were no thrombembolic complications in the locked plate group (p = 0.135). Overall, malunion of the plateau occurred in 10 (22%) patients treated with non-locked plates compared to 7 (22%) patients who received locked plates. This was due to residual
Intramedullary nailing is the standard fixation method for displaced diaphyseal fractures of the tibia in adults. Anecdotal clinical evidence indicates that current nail designs do not fit optimally for Asian patients. This study aimed to develop a method to quantitatively assess the fitting of two nail designs for Asian tibiae. We used 3D models of two different tibial nail designs (ETN (Expert Tibia Nail) and ETN-Proximal-Bend, Synthes), and 20 CT-based 3D cortex models of Japanese cadaver tibiae. The nail models were positioned inside the medullary cavity of the intact bone models. The anatomical fitting between nail and bone was assessed by the extent of the nail protrusion from the medullary cavity into the cortical bone, which in a real bone would lead to axial malalignments of the main fragments. The fitting was quantified in terms of the total surface area, and the maximal distance of nail protrusion. In all 20 bone models, the total area of the nail protruding from the medullary cavity was smaller for the ETN-Proximal-Bend (average 540 mm2) compared to the ETN (average 1044 mm2). Also, the maximal distance of the nail protruding from the medullary cavity was smaller for the ETN-Proximal-Bend (average 1.2 mm) compared to the ETN (average 2.7 mm). The differences were statistically significant (p < 0.05) for both the total surface area and the maximal distance measurements. For all bone models, the nail protrusion occurred on the posterior side in the middle third of the tibia. For 12 bones the protrusion was slightly lateral to the centre of the shaft, for seven bones it was centred, and for one bone it was medial to the shaft. The ETN-Proximal-Bend shows a statistical significantly better intramedullary fit with less cortical protrusion than the original ETN. The expected clinical implications of an improved anatomical nail fit are fewer complications with
In foot and ankle surgery incorrect placement of implants, or inaccuracy in fracture reduction may remain undiscovered with the use of conventional C-arm fluoroscopy. These imperfections are often only recognized on postoperative computer tomography scans. The apparition of three dimensional (3D) mobile Imaging system has allowed to provide an intraoperative control of fracture reduction and implant placement. Three dimensional computer assisted surgery (CAS) has proven to improve accuracy in spine and pelvic surgery. We hypothesized that 3D-based CAS could improve accuracy in foot and ankle surgery. The purpose of our study was to evaluate the feasibility and utility of a multi-dimensional surgical imaging platform with intra-operative three dimensional imaging and/or CAS in a broad array of foot and ankle traumatic and orthopaedic surgery. Cohort study of patients where the 3D mobile imaging system was used for intraoperative 3D imaging or 3D-based CAS in foot and ankle surgery. The imaging system used was the O-arm Surgical Imaging System and the navigation system was the Medtronic's StealthStation. Surgical procedures were performed according to standard protocols. In case of fractures, image acquisition was performed after reduction of the fracture. In cases of 3D-based CAS, image acquisition was performed at the surgical step before implants placement. At the end of the operations, an intraoperative 3D scan was made. We used the O-arm Surgical Imaging system in 11 patients: intraoperative 3D scans were performed in 3 cases of percutaneus fixation of distal tibio-fibular syndesmotic disruptions; in 2 of the cases, revision of reduction and/or implant placement were needed after the intraoperative 3D scan. Three dimensional CAS was used in 10 cases: 2 open reduction and internal fixation (ORIF) of the calcaneum, 1 subtalar fusion, 2 ankle arthrodesis, 1 retrograde drilling of an osteochondral lesion of the talus, 1 Charcot diabetic reconstruction foot and 1 intramedullary screw fixation of a fifth metatarsal fracture. The guidance was used essentially for screw placement, except in the retrograde drilling of an osteochondral lesion where the guidance was used to navigate the drill tool. Intraoperative 3D imaging showed a good accuracy in implant placement with no need to revision of implants. We report a preliminary case series with use of the O-arm Surgical Imaging System in the field of foot and ankle surgery. This system has been used either as intraoperative 3D imaging control or for 3D-based CAS. In our series, the 3D computer assisted navigation has been very useful in the placement of implants and has shown that guidance of implants is feasible in foot and ankle surgery. Intraoperative 3D imaging could confirm the accuracy of the system as no revisions were needed. Using the O-arm as intraoperative 3D imaging was also beneficial because it allowed todemonstrate intraoperative