Dynamische Ganganalyse bei blockiertem distalem Tibiofibulargelenk nach Syndesmosenkomplexverletzungen

Abstract

Dynamic gait analysis of blocked distal tibiofibular joint (TFJ) has not performed yet. This prospective study investigated patients treated for ankle fractures with combined syndesmotic complex lesions after surgery including tibiofibular positioning screw using CT data detecting fibular maltorsion and dynamic gait analysis. Prepublished data of 61 patients after surgical block of TFJ were analysed for torsional deformity of the distal fibula with an especially developed novel CT method. 10 of these patients were selected for dynamic pedography (emed-SF4, Novel GmbH, Munich). The measurements were accomplished one and six weeks (with blocked TFJ) and four months (with deblocked TFJ) postoperatively. The gait pattern of 10 pedographically investigated patients showed increased loads of the hindfoot as well as a load shift to the lateral midfoot. Four months postoperative significant differences of the plantar pressure pattern concerning the parameters force, pressure, impulse and contact time were not observed. The analysis of the foot progression angle (fpa) of the non operated feet demonstrated external rotation of 9,5 degrees in average. In comparison to the healthy side with tibiofibular positioning screw the operated feet were significantly internal rotated during the first two measurements. Patients with fibular torsional differences > 15 degrees showed not only with tibiofibular positioning screw but also after its removal a persistent difference of fpa in average of 5,6 degrees without external rotating retraction. The temporary blockage of TFJ results into an altered pattern of dynamic plantar pressure distribution. A constant foot progression angle in relative internal rotation is registered. After removal of the positioning screw the recovered ligamentous structures allow retraction to the anatomic position. But, concerning fibular torsional differences > 15 degrees osseous fixation leads to alterated fpa presented as diminished external rotation of the foot of the formerly fractured ankle with consecutive dysfunction of the physiologic kinematic of movement and eventual provocation of posttraumatic arthritis. Dynamic gait analysis of a blocked distal tibiofibular joint (TFJ) has not been performed yet. This prospective study investigated patients treated for ankle fractures with combined syndesmotic complex lesions after surgery including a tibiofibular positioning screw using CT data for detecting fibular maltorsion and dynamic gait analysis. Prepublished data of 61 patients after surgical block of TFJ were analysed for torsional deformity of the distal fibula with an especially developed novel CT method. Ten of these patients were selected for dynamic pedography (emed-SF4, Novel GmbH, Munich). The measurements were accomplished one and six weeks (with blocked TFJ) and four months (with deblocked TFJ) postoperatively. The gait patterns of 10 pedographically investigated patients showed increased loads of the hindfoot as well as a load shift to the lateral midfoot. Four months postoperative significant differences of the plantar pressure pattern concerning the parameters force, pressure, impulse and contact time were not observed. The analysis of the foot progression angle (fpa) of the non-operated feet demonstrated external rotation of 9,5 degrees in average. In comparison to the healthy side the operated feet with tibiofibular positioning screw were significantly internally rotated during the first two measurements. Patients with fibular torsional differences > 15 degrees showed not only with the tibiofibular positioning screw but also after its removal a persistent difference of fpa in average of 5.6 degrees without external rotating retraction. The temporary blockage of the TFJ results into an altered pattern of dynamic plantar pressure distribution. A constant foot progression angle in relative internal rotation is registered. After removal of the positioning screw the recovered ligamentous structures allow retraction to the anatomic position. But, concerning fibular torsional differences > 15 degrees osseous fixation leads to alterated fpa presented as diminished external rotation of the foot of the formerly fractured ankle with consecutive dysfunction of the physiologic kinematic of movement and eventual provocation of posttraumatic arthritis.