Eric W Tan1, Norachart Sirisreetreerux2, Adrian G Paez3, Brent G Parks3, Lew C Schon3, Erik A Hasenboehler4. 1. Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. 2. Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 3. Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA. 4. Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA lyn.camire@medstar.net.
Abstract
BACKGROUND: No consensus exists regarding the timing of weightbearing after surgical fixation of unstable traumatic ankle fractures. We evaluated fracture displacement and timing of displacement with simulated early weightbearing in a cadaveric model. METHODS: Twenty-four fresh-frozen lower extremities were assigned to Group 1, bimalleolar ankle fracture (n=6); Group 2, trimalleolar ankle fracture with unfixed small posterior malleolar fracture (n=9); or Group 3, trimalleolar ankle fracture with fixed large posterior malleolar fracture (n=9) and tested with axial compressive load at 3 Hz from 0 to 1000 N for 250 000 cycles to simulate 5 weeks of full weightbearing. Displacement was measured by differential variable reluctance transducer. RESULTS: The average motion at all fracture sites in all groups was significantly less than 1 mm (P < .05). Group 1 displacement of the lateral and medial malleolus fracture was 0.1±0.1 mm and 0.4±0.4 mm, respectively. Group 2 displacement of the lateral, medial, and posterior malleolar fracture was 0.6±0.4 mm, 0.5±0.4 mm, and 0.5±0.6 mm, respectively. Group 3 displacement of the lateral, medial, and posterior malleolar fracture was 0.1±0.1 mm, 0.5±0.7 mm, and 0.5±0.4 mm, respectively. The majority of displacement (64.0% to 92.3%) occurred in the first 50 000 cycles. There was no correlation between fracture displacement and bone mineral density. CONCLUSION: No significant fracture displacement, no hardware failure, and no new fractures occurred in a cadaveric model of early weightbearing in unstable ankle fracture after open reduction and internal fixation. CLINICAL RELEVANCE: This study supports further investigation of early weightbearing postoperative protocols after fixation of unstable ankle fractures.
BACKGROUND: No consensus exists regarding the timing of weightbearing after surgical fixation of unstable traumatic ankle fractures. We evaluated fracture displacement and timing of displacement with simulated early weightbearing in a cadaveric model. METHODS: Twenty-four fresh-frozen lower extremities were assigned to Group 1, bimalleolar ankle fracture (n=6); Group 2, trimalleolar ankle fracture with unfixed small posterior malleolar fracture (n=9); or Group 3, trimalleolar ankle fracture with fixed large posterior malleolar fracture (n=9) and tested with axial compressive load at 3 Hz from 0 to 1000 N for 250 000 cycles to simulate 5 weeks of full weightbearing. Displacement was measured by differential variable reluctance transducer. RESULTS: The average motion at all fracture sites in all groups was significantly less than 1 mm (P < .05). Group 1 displacement of the lateral and medial malleolus fracture was 0.1±0.1 mm and 0.4±0.4 mm, respectively. Group 2 displacement of the lateral, medial, and posterior malleolar fracture was 0.6±0.4 mm, 0.5±0.4 mm, and 0.5±0.6 mm, respectively. Group 3 displacement of the lateral, medial, and posterior malleolar fracture was 0.1±0.1 mm, 0.5±0.7 mm, and 0.5±0.4 mm, respectively. The majority of displacement (64.0% to 92.3%) occurred in the first 50 000 cycles. There was no correlation between fracture displacement and bone mineral density. CONCLUSION: No significant fracture displacement, no hardware failure, and no new fractures occurred in a cadaveric model of early weightbearing in unstable ankle fracture after open reduction and internal fixation. CLINICAL RELEVANCE: This study supports further investigation of early weightbearing postoperative protocols after fixation of unstable ankle fractures.
Authors: Diederik Pieter Johan Smeeing; Roderick Marijn Houwert; Jan Paul Briet; Rolf Hendrik Herman Groenwold; Koen Willem Wouter Lansink; Luke Petrus Hendrikus Leenen; Peer van der Zwaal; Jochem Maarten Hoogendoorn; Mark van Heijl; Egbert Jan Verleisdonk; Michiel Joseph Marie Segers; Falco Hietbrink Journal: Eur J Trauma Emerg Surg Date: 2018-09-24 Impact factor: 3.693
Authors: Dirk Wähnert; Johannes Greiner; Stefano Brianza; Christian Kaltschmidt; Thomas Vordemvenne; Barbara Kaltschmidt Journal: Biomedicines Date: 2021-06-28