Biomechanical Effects of Hindfoot Alignment in Supination External Rotation Malleolar Fractures: A Human Cadaveric Model

IF 2.4 2区医学 Q2 ORTHOPEDICS

Foot & Ankle International Pub Date : 2024-04-15 DOI:10.1177/10711007241241075

Angela Seidel, Amal Chidda, Virginie Perez, Fabian Krause, Ivan Zderic, Boyko Gueorguiev, Karl-Andre Lalonde, Brad Meulenkamp

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引用次数: 0

Abstract

Background:Pressure distribution in the ankle joint is known to be dependent on various factors, including hindfoot alignment. We seek to evaluate how hindfoot alignment affects contact pressures in the ankle joint in the setting of supination external rotation (SER) type ankle fractures.Methods:SER fractures were created in 10 human cadaver lower extremity specimens, simulating progressive stages of injury: without fracture (step 0), SER fracture and intact deltoid ligament (step 1), superficial deltoid ligament disruption (step 2), and deep deltoid ligament disruption (step 3). At each step, varus and valgus alignment was simulated by displacing the calcaneal tuberosity 7 mm medial or lateral. Each limb was axially loaded following each osteotomy at a static load of 350 N. The center of force (COF), contact area (CA), and peak contact pressure (PP) under load were measured, and radiographs of the ankle mortise were taken to analyze the medial clear space (MCS) and talar tilt (TT).Results:The COF (5.3 mm, P = .030) and the CA (−188.4 mm2, P = .015) changed in step 3 in the valgus hindfoot alignment compared to baseline parameters, indicating the importance of deep deltoid ligament integrity in maintaining normal ankle joint contact stress in the valgus hindfoot. These changes were not seen in the setting of varus alignment (COF: 2.3 mm, P = .059; CA −121 mm2, P = .133). PP were found to not change significantly in either varus or valgus (varus: −4.9 N, P = .132; valgus: −4 N, P = .464). The MCS demonstrated widening in step 3 compared to step 2 (0.7 mm, P = .020) in both varus and valgus hindfoot. The TT increased significantly in step 3 in the valgus hindfoot (2.8 degrees, P = .020) compared to step 0.Conclusion:SER-IV fractures with valgus hindfoot alignment showed significant changes in pressure distribution and radiographic parameters when compared to SER-IV fractures with varus hindfoot alignment.Clinical Relevance:Based on this cadaver modeling study, patients with SERIV fracture with varus hindfoot alignment and complete deltoid ligament lesion may not need fracture fixation, whereas those with valgus hindfoot alignment likely need fracture fixation.

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上翻外旋臼齿骨折后足对齐的生物力学影响：人体尸体模型

背景：众所周知，踝关节的压力分布取决于多种因素，包括后足的排列。我们试图评估在仰卧外旋（SER）型踝关节骨折的情况下，后足对齐如何影响踝关节内的接触压力。方法：我们在 10 个人体尸体下肢标本中创建了 SER 骨折，模拟了渐进的损伤阶段：无骨折（第 0 步）、SER 骨折和完整三角韧带（第 1 步）、浅三角韧带断裂（第 2 步）和深三角韧带断裂（第 3 步）。在每个步骤中，通过将小腿骨结节向内侧或外侧移位 7 毫米来模拟曲张和外翻对齐。在每次截骨后，对每个肢体进行轴向加载，静态载荷为 350 N。测量加载下的力中心（COF）、接触面积（CA）和峰值接触压力（PP），并拍摄踝关节臼的X光片以分析内侧净空（MCS）和距骨倾斜（TT）。结果：与基线参数相比，COF（5.3 mm，P = .030）和CA（-188.4 mm2，P = .015）在后足内翻排列的第3步中发生了变化，这表明深三角韧带的完整性对于维持后足内翻时正常的踝关节接触应力非常重要。这些变化在后足外翻时没有出现（COF：2.3 mm，P = .059；CA -121 mm2，P = .133）。PP在足外翻和足内翻的情况下均无明显变化（足外翻：-4.9 N，P = .132；足内翻：-4 N，P = .464）。在后足外翻和内翻的情况下，MCS 在第 3 步比第 2 步增宽（0.7 毫米，P = .020）。结论：与后足外翻对位的 SER-IV 骨折相比，后足内翻对位的 SER-IV 骨折在压力分布和影像学参数上有明显变化。临床意义：根据这项尸体模型研究，后足内翻且三角韧带完全损伤的SER-IV型骨折患者可能不需要进行骨折固定，而后足外翻的患者可能需要进行骨折固定。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Foot & Ankle International 医学-整形外科

CiteScore

5.60

自引率

22.20%

发文量

144

审稿时长

2 months

期刊介绍： Foot & Ankle International (FAI), in publication since 1980, is the official journal of the American Orthopaedic Foot & Ankle Society (AOFAS). This monthly medical journal emphasizes surgical and medical management as it relates to the foot and ankle with a specific focus on reconstructive, trauma, and sports-related conditions utilizing the latest technological advances. FAI offers original, clinically oriented, peer-reviewed research articles presenting new approaches to foot and ankle pathology and treatment, current case reviews, and technique tips addressing the management of complex problems. This journal is an ideal resource for highly-trained orthopaedic foot and ankle specialists and allied health care providers. The journal’s Founding Editor, Melvin H. Jahss, MD (deceased), served from 1980-1988. He was followed by Kenneth A. Johnson, MD (deceased) from 1988-1993; Lowell D. Lutter, MD (deceased) from 1993-2004; and E. Greer Richardson, MD from 2005-2007. David B. Thordarson, MD, assumed the role of Editor-in-Chief in 2008. The journal focuses on the following areas of interest: • Surgery • Wound care • Bone healing • Pain management • In-office orthotic systems • Diabetes • Sports medicine