Coronal Plane Translation Research Articles

Comparison of a Novel Modified All-Suture Construct versus Suspensory Suture-button Fixation in a Syndesmotic Injury Model.

To biomechanically investigate a novel modified all-suture construct compared with commercially available suspensory button fixation for stabilization of the syndesmosis. Eight matched pairs of cadaver lower limbs were obtained. We used a material testing machine and Optotrak optoelectronic 3D motion measurement system for testing. Syndesmotic injuries were simulated, and specimens were fixed with either a suspensory suture button or modified all-suture construct. Repaired specimens were then cyclically loaded for 500 cycles. Spatial relationship of the tibia and fibula were continuously monitored for the intact, destabilized, and repaired states. The results were analyzed using independent samples t test. There was no significant difference in sagittal or coronal plane translation between intact and either repair. Compared with the intact state, both repair techniques demonstrated significantly more external rotation of the fibula relative to the tibia and decreased construct stiffness. Cycling of the specimens did not significantly increase coronal or sagittal plane translation; however, external rotation of the fibula relative to the tibia increased and stiffness decreased with cycling for both repair techniques. Our data suggest that sagittal and coronal plane translation is no different from the intact state for both fixation techniques. However, rotation of the fibula relative to the tibia was increased, and construct stiffness was decreased compared with the intact state for both fixation techniques. These findings suggest that an all-suture construct could offer syndesmotic fixation comparable with proprietary suspensory button fixation in a cadaver model.

Blocking Screw Technique for Maintaining Reduction during Intramedullary Screw Fixation of Oblique Metacarpal Fractures.

Intramedullary screw fixation provides a less-invasive means of surgically managing metacarpal fractures. While there are advantages to using this technique compared to CRPP and ORIF, disadvantages of intramedullary screw fixation include loss of reduction intraoperatively due to sagittal and coronal plane translation. The blocking screw technique has been previously described as a solution for this problem in intramedullary fixation of long bone fractures. We describe the blocking screw technique as applied to aid intramedullary screw fixation of metacarpals.

Correction outcomes of the postoperative malalignment salvaged by the temporary application of the hexapod external fixator in tibial diaphyseal fractures treated by monolateral external fixation

BackgroundPostoperative malalignment in fractures treated by monolateral external fixation is not uncommon in clinical practice. Accurate reduction without excessive tissue disruption caused by surgical intervention and sequentially manage the fractures using monolateral external fixation for definitive treatment is still a challenge for surgeons. The purpose of our study was to evaluate the feasibility and effectiveness of the temporary application of the hexapod external fixator (HEF) for the postoperative malalignment correction in tibial diaphyseal fractures treated by monolateral external fixation. MethodsWe carried out a retrospective analysis of 23 trauma patients with tibial diaphyseal fracture treated by the monolateral external fixation at our institution from January 2016 to May 2019. There were 21 males and 2 females with a mean age of 38 years (range 18-60 years). The hexapod external fixator was temporarily applied due to postoperative malalignment within two weeks and who unwilling to undergo a secondary surgical intervention. For patients with postoperative malalignment requiring correction, the HEF components were installed on the original existing half pins of the monolateral external fixator after removing the connecting rod. The standard anteroposterior and lateral X-rays of the injured limb combined with the temporary HEF were conducted to measure the hexapod external fixator parameters. Any residual deformities were corrected by gradual struts adjustment with the aid of computer-based software. When satisfactory alignment was achieved, the HEF was removed, and the monolateral external fixator was sequentially used as the definitive structure. ResultsAll patients acquired functional reduction, which was evaluated by radiographs. The mean correction time was 4 days (range 2 to 8 days). The mean coronal plane translation (1.3±1.0 mm), coronal plane angulation (0.9±0.7°), sagittal plane translation (1.4±1.1 mm), and sagittal plane angulation (0.7±0.7°) after correction were all less than those (7.0±4.9 mm, 4.7±2.3°, 5.6±3.6 mm, 3.2±2.5°) before correction. ConclusionsThe temporary application of the hexapod external fixator is an alternative and feasible method for the postoperative malalignment correction in tibial diaphyseal fractures treated by monolateral external fixation.

Application of elliptic registration and three-dimensional reconstruction in the postoperative measurement of Taylor spatial frame parameters

BackgroundThe Taylor spatial frame offered the ability of simultaneous correction of the multidirectional deformities without the need to change the frame, and it was widely used for limb lengthening, deformity correction, and fracture reduction in recent years. There are still some inherent limitations that can affect the accuracy of correction, especially for the measurement of the mounting and rotational parameters. The purpose of our study was to propose some more precise postoperative measurement of Taylor spatial frame (TSF) parameters by application of elliptic registration and three-dimensional reconstruction. MethodsThis retrospectively study included 28 trauma patients who suffered tibial fracture treated by the TSF at our institution from January 2016 to January 2018, including 25 males and 3 females with a mean age of 43 years (range 14-70 years). We conducted standard full-length anteroposterior and lateral X-rays of the injured extremity and the computed tomographic scans of the bilateral extremities after the operation. Elliptic registration and 3D reconstruction were used to calculate the parameters by two types of software Mimics and CorelDRAW. Correction of the deformity was conducted by adjusting the struts of the TSF according to the electronic prescription. The standard anteroposterior and lateral X-rays after correction were taken to evaluate the effectiveness. ResultsAll patients acquired functional reduction, which was evaluated by digital radiography. The mean coronal plane translation(1.9±2.2 mm), coronal plane angulation(1.2±1.0°), sagittal plane translation(2.7±2.1 mm), and sagittal plane angulation(1.2±1.0°) after correction were all less than those(5.5±4.6 mm, 4.9±3.9°, 4.7±4.0 mm, 2.7±2.3°) before correction. ConclusionsThe TSF system can correct the 6-axis deformities simultaneously with the accurate parameters. Elliptic registration and three-dimensional reconstruction are alternative methods to precisely measure the parameters needed by the TSF system, especially for the mounting and rotational parameters of unusually complex cases.

The arthroscopic syndesmotic assessment tool can differentiate between stable and unstable ankle syndesmoses.

Patients with stable isolated injuries of the ankle syndesmosis can be treated conservatively, while unstable injuries require surgical stabilisation. Although evaluating syndesmotic injuries using ankle arthroscopy is becoming more popular, differentiating between stable and unstable syndesmoses remains a topic of on-going debate in the current literature. The purpose of this study was to quantify the degree of displacement of the ankle syndesmosis using arthroscopic measurements. The hypothesis was that ankle arthroscopy by measuring multiplanar fibular motion can determine syndesmotic instability. Arthroscopic assessment of the ankle syndesmosis was performed on 22 fresh above knee cadaveric specimens, first with all syndesmotic and ankle ligaments intact and subsequently with sequential sectioning of the anterior inferior tibiofibular ligament, the interosseous ligament, the posterior inferior tibiofibular ligament, and deltoid ligaments. In all scenarios, four loading conditions were considered under 100N of direct force: (1) unstressed, (2) a lateral hook test, (3) anterior to posterior (AP) translation test, and (4) posterior to anterior (PA) translation test. Anterior and posterior coronal plane tibiofibular translation, as well as AP and PA sagittal plane translation, were arthroscopically measured. As additional ligaments of the syndesmosis were transected, all arthroscopic multiplanar translation measurements increased (p values ranging from p < 0.001 to p = 0.007). The following equation of multiplanar fibular motion relative to the tibia measured in millimeters: 0.76*AP sagittal translation + 0.82*PA sagittal translation + 1.17*anterior third coronal plane translation-0.20*posterior third coronal plane translation, referred to as the Arthroscopic Syndesmotic Assessment tool, was generated from our data. According to our results, an Arthroscopic Syndesmotic Assessment value equal or greater than 3.1mm indicated an unstable syndesmosis. This tool provides a more reliable opportunity in determining the presence of syndesmotic instability and can help providers decide whether syndesmosis injuries should be treated conservatively or operatively stabilized. The long-term usefulness of the tool will rest on whether an unstable syndesmosis correlates with acute or chronic clinical symptoms.

A Novel Technique for Correcting Radial Length and Translation in Distal Radius Fractures.

We describe a novel technique in correcting distal radius fractures deformed with significant shortening or coronal plane translation in both the acute or chronic setting. The technique involves using a modified push-pull device to assist the surgeon in correcting length and/or translation of the articular block without the use additional hardware outside of the volar plate.