Foot & ankle international
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Ankle fractures with syndesmotic injury treated via standard trans-syndesmotic fixation have a high percentage of syndesmotic malreduction.(10) We established a protocol involving both direct syndesmosis visualization and meticulous tibial incisura reconstruction via the posterior malleolus fracture fragment, when present, via the attached, intact PITFL, then compared this with historic controls to assess improvement after this type of syndesmosis reconstruction. ⋯ Malreductions were significantly decreased in the direct visualization group. However, our reduction sometimes remains imprecise, even with direct visualization and attention to detail. Also, posterior malleolar reconstruction was more accurate than syndesmotic screw fixation in our study.
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Comparative Study
The "Giftbox" repair of the Achilles tendon: a modification of the Krackow technique.
The Krackow locking loop technique has been used for Achilles tendon repair with documented success in allowing early range of motion with stable fixation. Previous studies documented failure at the rupture site by knot failure. We propose a modification of the traditional Krackow technique where the knots of the suture are tied away from the rupture site (aka the Giftbox technique). We compared the tensile strength of Achilles tendons repaired using the traditional Krackow technique with those repaired using the Giftbox technique. ⋯ We recommend the Giftbox modification to minimize gap formation and improve the strength of the repair of a ruptured Achilles tendon.
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Comparative Study
Suture-button versus screw fixation in a syndesmosis rupture model: a biomechanical comparison.
Flexible suture-button devices are used to stabilize the distal tibiofibular joint after syndesmotic rupture, but little is known about how they affect fibular motion during cyclic physiological loading. This study examined how much fibular motion occurs during cyclic loading of ankles repaired with suture-buttons or screws relative to one with intact ligaments. ⋯ It appears the suture-button behaves similarly to the syndesmotic screw in the syndesmotic rupture injury model tested. Clinical trials are needed to determine how the device performs in vivo.
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Stable anatomical reconstruction of the joint surface in ankle fractures is essential to successful recovery. However, the functional outcome of fractures involving the posterior tibial plafond is often poor. We describe the morbidity and functional outcome for plate fixation of the displaced posterior malleolus using a posterolateral approach. ⋯ The posterolateral approach allowed good exposure and stable fixation of a displaced posterior malleolar fragment with few local complications. The anatomical repositioning and stable fixation led to good functional and subjective outcome.