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  • 1
    Online Resource
    Online Resource
    Does Intramedullary Nailing for Distal Fibular Fractures Restore Anatomic Parameters and Syndesmotic Relationship?
    SAGE Publications ; 2020
    In:  Foot & Ankle Orthopaedics Vol. 5, No. 2 ( 2020-04-01), p. 2473011420S0000-
    Details
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 5, No. 2 ( 2020-04-01), p. 2473011420S0000-
    Abstract: Trauma; Ankle Introduction/Purpose: Fibular nailing (FN) is a method of fixation that has proven to be useful for the treatment of distal fibular fractures (DF). FN minimizes soft tissue complications, provides similar stability compared to plating with less hardware related symptoms. Nevertheless, FN has been associated with syndesmotic malreduction and incapacity of restoring length and rotation of the fibula. We aimed to evaluate the fibular and syndesmotic reduction after fixation with FN compared to the uninjured ankle. Methods: Prospective cohort, cross-sectional study with a paired control group. Patients with DF fractures treated with FN between January 2017 and July 2019 were included. Immediate postoperative bilateral Ankle CT was obtained in all cases. Two independent radiologists performed all the measurements on both ankles (fibular rotation, length, translation, and syndesmotic diastasis. Statistical analysis was made using the Wilcoxon Test and Intraclass correlation coefficient (ICC). Considering a medium size sample effect, 95% confidence with .05 alpha error, a total sample of 26 subjects were needed to achieve a .80 of statistical power (G-Power 3.1). All analyses were performed using SPSS V20. Results: Twenty-six patients were included (14 Women). The mean age was 47 years (18-91). No statistically significant differences were identified considering fibular rotation (p:0,694), fibular length (p:0,585) and syndesmotic diastasis (p:0,078) between the injured and uninjured ankle. Fibular translation has statistical differences (p:0,043). The ICC shows an excellent concordance between radiologists except for Fibular translation (ICC 0,47) Conclusion: In this cohort, fixation of DF fractures with FN allows restoration of anatomical parameters of the ankle in terms of fibular rotation, length, and syndesmotic diastasis. However, Fibular translation had significant differences compared with the uninjured ankle.
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    URL: Article
    DOI: 10.1177/2473011420S00003
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2874570-X
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  • 2
    Online Resource
    Online Resource
    Dynamic Imaging Evaluation in Turf Toe Injuries: A Prospective Protocol in 18 Patients
    SAGE Publications ; 2020
    In:  Foot & Ankle Orthopaedics Vol. 5, No. 4 ( 2020-10-01), p. 2473011420S0020-
    Details
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 5, No. 4 ( 2020-10-01), p. 2473011420S0020-
    Abstract: Sports; Trauma Introduction/Purpose: Turf Toe remains a diagnostic challenge for the orthopedic surgeon. A high index of suspicion is needed, in addition to adequate imaging strategies to characterize the broad spectrum of injuries involving this pathology. MRI imaging provides excellent static soft-tissue details and it has become widely used to determine the anatomical structures damaged. However, defining the stability of the 1st metatarsophalangeal (MTP) plantar plate complex is difficult without proper dynamic evaluation and this is crucial to define between conservative or operative management. Since there is no current consensus regarding the optimal imaging assessment to optimize turf toe diagnosis we present the results of an imaging protocol, including dynamic fluoroscopy and ultrasound (US), to enhance the identification of unstable Turf Toe injuries. Methods: A prospective imaging protocol consisting of bilateral comparative weightbearing x-rays, US examination, and mobilization under fluoroscopy was designed. The inclusion criterion was any patient with clinical findings consistent with plantar plate injury after forced hyperextension of the hallux. All studies were informed and performed by trained musculoskeletal radiologists. Location and symmetry of the sesamoids under the metatarsal, increased distal sesamoid-to-phalanx distance and proximal migration of one or both sesamoids were suggestive findings of unstable plantar plate rupture on weightbearing x-rays. Ultrasound examination was performed to address soft tissue injuries, characterize the magnitude of the plantar plate rupture and for dynamic/comparative stability assessment. A comparative dynamic fluoroscopic evaluation was performed to evaluate the behavior of the sesamoids under maximal dorsiflexion and plantarflexion of the hallux on the lateral view. MRI was also done in all of the patients with positive findings of instability. Results: Eighteen patients (11M/7F) were evaluated under suspicion of turf toe injury from August 2016 to November 2019. The mean age was 31 years old (range:14-50). Weightbearing X-rays were positive for sesamoid complex instability in one patient. Four patients (22,2%) had positive findings for instability in fluoroscopy and US. The agreement between US and fluoroscopy was excellent (kappa coefficient 1). Assuming fluoroscopy examination as the gold standard for instability, the US was highly effective at detecting unstable injuries (Sensitivity 100%, Specificity 100%, PPV 100%, NPV 100%). Four patients positive for instability received operative treatment. Conclusion: In our series, dynamic ultrasound and fluoroscopy allowed detection of 4/18 unstable turf toe injuries compared to Weightbearing X-rays that detected only one unstable injury. US examination is highly sensitive for instability being comparable to fluoroscopic examination. Dynamic testing, with either US or fluoroscopy, in turf toe may improve the diagnosis of severe injuries, leading to higher detection of patients requiring surgical stabilization of the plantar complex.
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    URL: Article
    DOI: 10.1177/2473011420S00208
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2874570-X
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    Online Resource
  • 3
    Online Resource
    Online Resource
    Restoration of Anatomic Parameters and Syndesmotic Reduction After Intramedullary Nailing of Distal Fibular Fractures
    SAGE Publications ; 2022
    In:  Foot & Ankle Orthopaedics Vol. 7, No. 4 ( 2022-10), p. 247301142211413-
    Details
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 7, No. 4 ( 2022-10), p. 247301142211413-
    Abstract: Intramedullary nailing of the fibula (FN) is a method of fixation that has proven to be useful for treating distal fibular fractures (DFs). FN minimizes soft tissue complications and provides similar stability to plating, with fewer hardware-related symptoms. Nevertheless, FN has been associated with syndesmotic malreduction and the incapacity of restoring length and rotation of the fibula. We aimed to evaluate the fibular position and syndesmotic reduction after fixation with FN compared with the uninjured ankle in the immediate postoperative period. Methods: Prospective cohort study. Patients with DF fractures treated with IN between January 2017 and January 2020 were included. Immediate postoperative bilateral ankle CT was obtained in all cases. Fibular rotation, length, and translation as well as syndesmotic diastasis were measured on both ankles and compared by 3 independent observers. Results: Twenty-eight patients were included (16 women). The mean age was 46 years (range 16-91). Fracture type distribution according to AO/ASIF classification included 19 patients with 44.B (67.9%), 8 patients with 44.C (28.6%), and 1 patient with a 44.A fracture (3.6%). No significant differences were identified considering fibular rotation ( P = .661), syndesmotic diastasis ( P = .147), and fibular length ( P = .115) between the injured and uninjured ankle. Fibular translation had statistical differences ( P = .01) compared with the uninjured ankle. The intraclass correlation coefficient showed an excellent concordance between observers except for fibular translation on the injured ankle. Conclusion: In this cohort, fixation of DF fractures with FN allows restoration of anatomical parameters of the ankle in terms of fibular rotation, length, and syndesmotic diastasis. However, fibular translation had significant differences compared with the uninjured ankle based on bilateral CT scan evaluation. Level of Evidence: Level II, prospective cohort study.
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    URL: Article
    DOI: 10.1177/24730114221141388
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2874570-X
    Location Call Number Limitation Availability
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    Online Resource
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