Pub Date : 2024-06-01DOI: 10.1016/j.fuspru.2024.05.004
Recently, a better understanding of the mechanism of injury and treatment of acute syndesmotic injuries has been gained. Surgical treatment is recommended for unstable injuries. In addition to the implantation of fibulotibial positioning screws, dynamic suture button procedures and ligament bracing systems are available.
In recent years, the bony avulsions of the anterior syndesmosis on the ventral edge of the tibia (Tubercúle de Tillaux-Chaput fragment), of the ventral syndesmosis on the fibula (Wagstaffe fragment) and of the posterior syndesmosis (posterior malleolar fragment (PMF)), have become increasingly important, the refixation should be carried out generously. The treatment of additional delta ligament injuries continues to be controversial. The anatomical reconstruction of the ankle joint remains crucial for long-term results and functionality.
最近，人们对急性巩膜损伤的损伤机制和治疗方法有了更深入的了解。对于不稳定的损伤，建议采用手术治疗。除了植入腓胫定位螺钉外，还可采用动态缝合扣手术和韧带支撑系统。近年来，胫骨腹侧前联合（Tubercúle de Tillaux-Chaput片段）、腓骨腹侧联合（Wagstaffe片段）和后联合（后臼齿片段（PMF））的骨性撕脱变得越来越重要，因此应谨慎进行复位。三角韧带附加损伤的治疗仍存在争议。踝关节的解剖重建对长期效果和功能至关重要。
{"title":"Die akute ligamentäre Verletzung der Syndesmose — wie behandeln?","authors":"","doi":"10.1016/j.fuspru.2024.05.004","DOIUrl":"10.1016/j.fuspru.2024.05.004","url":null,"abstract":"<div><p>Recently, a better understanding of the mechanism of injury and treatment of acute syndesmotic injuries has been gained. Surgical treatment is recommended for unstable injuries. In addition to the implantation of fibulotibial positioning screws, dynamic suture button procedures and ligament bracing systems are available.</p><p>In recent years, the bony avulsions of the anterior syndesmosis on the ventral edge of the tibia (Tubercúle de Tillaux-Chaput fragment), of the ventral syndesmosis on the fibula (Wagstaffe fragment) and of the posterior syndesmosis (posterior malleolar fragment (PMF)), have become increasingly important, the refixation should be carried out generously. The treatment of additional delta ligament injuries continues to be controversial. The anatomical reconstruction of the ankle joint remains crucial for long-term results and functionality.</p></div>","PeriodicalId":39776,"journal":{"name":"Fuss und Sprunggelenk","volume":"22 2","pages":"Pages 83-93"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141397343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.fuspru.2024.02.005
{"title":"Minimally invasive foot and ankle surgery: A percutaneous approach","authors":"","doi":"10.1016/j.fuspru.2024.02.005","DOIUrl":"10.1016/j.fuspru.2024.02.005","url":null,"abstract":"","PeriodicalId":39776,"journal":{"name":"Fuss und Sprunggelenk","volume":"22 2","pages":"Pages 129-130"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140777534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.fuspru.2024.05.008
Stefan Rammelt , Javier Ignacio Gonzalez Salas , Christine Marx
Injuries to the distal tibiofibular syndesmosis may present as ligament ruptures or bony avulsions. Both are equally important to overall ankle stability and are considered equivalent in the wake of ankle fractures. Syndesmotic ankle fractures and avulsions occur frequently at the anterior tibial tubercle (Tillaux-Chaput fracture – anterior malleolus, AM), anterior fibular tubercle (Wagstaffe-Le Fort fracture) or the posterior tibial tubercle (Earle’s or Volkmann’s triangle – posterior malleolus, PM). Overlooked, avulsed fragments may interfere with anatomic reduction of the distal fibula into the tibial incisura which is of prognostic relevance.
With suspected injury to the anterior or posterior tibial rim, the indication to perform computed tomography (CT) imaging should be made generously. With increased understanding of the three-dimensional pathoanatomy, fragment size of the avulsed posterior (and anterior) fragments is not the sole criterion for fixation anymore. Individualized treatment recommendations are guided by CT-based classifications of PM and AM fractures. These include criteria like displacement, joint impaction, the presence of intercalary fragments and loose bodies.
Anatomic reduction and internal fixation of displaced PM and AM fractures aims at recreation of the tibial incisura thus facilitating fibular reduction and restoration of the joint surface. Direct fixation of syndesmotic avulsions allows bone-to-bone stabilization of the syndesmosis rather than indirect stabilization with a syndesmotic screw or flexible implant. Direct fixation of PM fragments reportedly allows for higher quality of reduction and a more stable fixation than indirect reduction and fixation with a-p screws which in turn translates in superior outcome. A similar effect can be assumed for displaced AM fractures and needs to be confirmed in future studies.
胫腓骨远端联合韧带的损伤可能表现为韧带断裂或骨质撕脱。这两种情况对踝关节的整体稳定性同样重要，在踝关节骨折后被认为是等同的。踝关节联合骨折和撕脱常发生在胫骨前结节（Tillaux-Chaput 骨折-踝关节前臼齿，AM）、腓骨前结节（Wagstaffe-Le Fort 骨折）或胫骨后结节（Earle's 或 Volkmann 三角区-踝关节后臼齿，PM）。被忽视的撕脱碎片可能会影响腓骨远端与胫骨切迹的解剖复位，这对预后具有重要意义。怀疑胫骨前缘或后缘受伤时，应充分考虑进行计算机断层扫描（CT）成像的指征。随着对三维病理解剖学认识的加深，撕脱的后方（和前方）碎片大小已不再是固定的唯一标准。个体化治疗建议以基于 CT 的 PM 和 AM 骨折分类为指导。对移位的 PM 和 AM 骨折进行解剖复位和内固定的目的是重建胫骨切迹，从而促进腓骨复位和关节面的恢复。巩膜撕脱的直接固定可实现巩膜骨与骨之间的稳定，而不是使用巩膜螺钉或柔性植入物进行间接稳定。据报道，与使用a-p螺钉进行间接还原和固定相比，直接固定PM碎片可实现更高质量的还原和更稳定的固定，从而获得更好的疗效。对于移位的 AM 骨折也有类似的效果，这需要在今后的研究中加以证实。
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Pub Date : 2024-06-01DOI: 10.1016/j.fuspru.2024.04.002
{"title":"Influence of joint line level on clinical outcomes and range of motion in total ankle arthroplasty","authors":"","doi":"10.1016/j.fuspru.2024.04.002","DOIUrl":"10.1016/j.fuspru.2024.04.002","url":null,"abstract":"","PeriodicalId":39776,"journal":{"name":"Fuss und Sprunggelenk","volume":"22 2","pages":"Page 126"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141276545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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