Dissertation
Dissertation > Medicine, health > Surgery > Orthopaedic Surgery ( movement system diseases,orthopedic surgery ) > Orthopedic surgery and surgery > Bone surgery

Two Kinds of Internal Fixation Methods and Clinical Research of Maisonneuve Fracture

Author NiuHao
Tutor SongLianXin
School Hebei Medical University
Course Surgery
Keywords Maisonneuve fracture syndesmosis locking plate ankle biomechanical
CLC R687.3
Type Master's thesis
Year 2013
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The Maisonneuve fracture was first described by the French surgeon in1840. The mechanism involves foot pronation with external rotation resultingin rupture of the deltoid ligament or fracture of the medial malleolus withsubsequent injury to the anterior tibiofibular ligament, interosseous membraneand a spiral fracture of the proximal third of the fibula.It is associated with5%of all ankle fracture,although the actual proportion may be higher because thediagnosis is often delayed or missed. Treatment of tibiofibular syndesmosis inMaisonneuve fracture is a special part, which is also the focus of the clinicalresearch and debate after ankle fracture. There is controversy as to whichdevice should be used for fixation of the syndesmosis, how many devicesshould be used, how many cortices the screws should engage, and whether,when, and where the screws should be removed. But a biomechanical study oftwo-hole locking palte which is fixed the syndemosis is lack. The aim of thisstudy is to determine whether a two-hole locking plate has biomechanicaladvantages over conventional screw stabilization stabilisation of thesyndesmosis in this injury pattern. And it is to evaluate the diagnosis ofMaisonneuve fracture and to assess outcomes in patients treated surgically forMaisonneuve fractures.Selected6embalmed adult cadavers specimens. The syndesmoticligaments and interosseous menbrance were sectioned, as well as the deltoidligament, to mimic the disruption that occurs in an unstable Maisonneuvefracture. The fibula was divided40mm below the proximal tibio-fibula joint.Each limb has randomly selected to receive either a3.5mm distal fibulalocking plate with two3.5mm screws, or two parallel quadricortical3.5mmscrews. Comparing the stabilisation of two fixation by biomechanical analysis.Twenty-three patients with Maisonneuve fractures were surgically treated in our hospital from January2009to January2013. The surgical proceduresinclude ORIF of the medial malleolus or repairs of the medial deltoid ligamentand screw fixation of the disrupted distal tibiofibular. The ankle function wasevaluated by Baird-Jackson criteria.This study demonstrates that in a cadaveric model simulating protectedweight bearing after syndesmosis stabilisation, a locking plate with two3.5mm screw placed across four cortices provides statistically improvedresistance to external rotation than two3.5mm screws also placed across fourcortices. Maisonneuve fracture is easy to be misdiagnosed. The lack ofknowledge of this fracture and only initially focus on the local condition arethe main reasons for the misdiagnosis. Surgical treatments include ORIF of themedial malleolus or repair of the medial deltoid ligament and screw fixation ofthe disrupted distal tibiofibular.Part.Ⅰ:A Biomechanical Study of Stabilization of the Syndesmosis in theMaisonneuve FractureObjective The aim of this study is to determine whether a two-holelocking plate has biomechanical advantages over conventional screwstabilization stabilisation of the syndesmosis in this injury pattern.Methods Selected6embalmed adult cadavers specimens, including4male,2female, aged37-52years with a mean age of45. The soft tissues of theleg and ankle, except for interosseous membrane, ankle joint capsule andligaments about the ankle were removed from each specimen. None of thespecimens had any gross structural or radiological deformities, tumors, traumaand other pathological abnormalities. The specimens were sealed with doublelayer plastic film, cryoprotected at-20°C and thaw at room temperature for6hours prior to test and sprayed intermittently with normal saline to keep thespecimens hydrated. The syndesmotic ligaments and interosseous menbrancewere sectioned, as well as the deltoid ligament, to mimic the disruption thatoccurs in an unstable Maisonneuve fracture. The fibula was divided40mmbelow the proximal tibio-fibula joint. Each limb has randomly selected toreceive either a3.5mm distal fibula locking plate with two3.5mm screws, or two parallel quadricortical3.5mm screws. The limbs were then mounted on aservo-hydraulic testing rig and axially loaded to a peak load of800N for1200cycles. Fibula diastasis were measured. Each limb was then externally rotateduntil failure occurred. Failure was defined as fracture of bone of metalwork,syndesmotic widening>2mm.Results Both constructs effectively stabilized the syndesmosis during thecyclical loading within0.1mm of movement(0.07mmVS0.06mm,P>0.05).However the locking plate group demonstrated greater resistance to torquecompared to quadricortical screw fixation(40.48NmVS20.17Nm respectively,p value<0.05).Conclution This study demonstrates that in a cadaveric model simulatingprotected weight bearing after syndesmosis stabilisation, a locking plate withtwo3.5mm screw placed across four cortices provides statistically improvedresistance to external rotation than two3.5mm screws also placed across fourcortices. No statistical difference was noted between the two groups whenanalyzing syndesmosis widening. This information suggests that a lockingplate provides improved stabilisation of the syndesmosis in the Maisonneuvefracture.Part.Ⅱ:The Clinical Observation of the Surgical Treatment ofMaisonneuve FractureObjective The aim of this study was to evaluate the diagnosis ofMaisonneuve fracture and to assess outcomes in patients treated surgically forMaisonneuve fractures.Metheds Twenty-three patients with Maisonneuve fractures weresurgically treated in our hospital from January2009to January2013. All ofthe fractures were closed, Which22cases of medial malleolus, posteriormalleolar fracture in6cases, tibiofibular syndesmosis separation of20cases;deltoid ligament tear in eight cases, posterior malleolar fracture in3cases,tibiofibular syndesmosis separation of7cases, all patients have fibularfracture which is located in the proximal one third of the fibula. The surgicalprocedures include ORIF of the medial malleolus or repairs of the medial deltoid ligament and screw fixation of the disrupted distal tibiofibular. Theankle function was evaluated by Baird-Jackson criteria.Results In all the30patients,8(26.67%) were misdiagnosed at the timeof admission or emergency. Eighteen patients were followed up and theaverage follow up time was16.5months (range,6~24months). No patientscomplained of pain, tenderness and obvious swelling of the ankle, and rangeof motion of the injuried ankle was similar to that of the contralateral side.Baird-Jackson ankle function score was from85to100. In all the30paitents,21were rated as excellent,6as good, and3as fair. The excellent and goodrate was90%(27/30).Conclusion Maisonneuve fracture is easy to be misdiagnosed. The lackof knowledge of this fracture and only initially focus on the local condition arethe main reasons for the misdiagnosis. Surgical treatments include ORIF of themedial malleolus or repair of the medial deltoid ligament and screw fixation ofthe disrupted distal tibiofibular.

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