Antiglide plating of vertical medial malleolus fractures provides stiffer initial fixation than bicortical or unicortical screw fixation

Wegner, Adam M.; Wolinsky, Philip R; Robbins, Michael A.; Garcia, Tanya C.; Maitra, Sukanta; Amanatullah, Derek F.

doi:10.1016/j.clinbiomech.2015.10.005

Cited by 36 publications

(37 citation statements)

References 8 publications

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“…Note that, in vertical fractures, the stiffness of the LCP was 490.3 N/mm (Fig. 2C), 3 times that of CS fixation, which very closely resembles the stiffness of the antiglide plate (463 N/ mm) in the study of Wegner et al (14). Moreover, we found that the LCP shared more stress than the CS, but the mean stress was much lower, owing to the advantage of dispersing stress across the implant.…”

Section: Discussionsupporting

confidence: 84%

“…The finite element analysis model in this study was based on previous biomechanical tests (12−14), simulating all setups in the real experiments. In this study, the stiffness of the CS fixation in the vertical fractures was 163.6 N/mm, which was consistent with that in previous articles (110 to 200 N/mm) (13,14), ensuring that the analysis was convincing and reliable.…”

Section: Validation Of the Fe Analysissupporting

confidence: 91%

“…The locking plate technique is a promising method in medial malleolar fractures, since it has been used in almost all metaphysis fractures for its advantages of biologic property, angular stability, and ability to convert shear force into compression force (16). Also, previous studies have confirmed the advantage of the stability of the plate technique in vertical fractures of the medial malleolus (13,14,24). Wegner et al (14) demonstrated that the stiffness of the construct fixed with a 4-hole antiglide plate in vertical fracture can reach as high as 463 (standard deviation 91) N/mm, which is significantly stiffer than parallel or divergent unicortical screws and bicortical screws.…”

Section: Discussionmentioning

confidence: 83%

“…Also, previous studies have confirmed the advantage of the stability of the plate technique in vertical fractures of the medial malleolus (13,14,24). Wegner et al (14) demonstrated that the stiffness of the construct fixed with a 4-hole antiglide plate in vertical fracture can reach as high as 463 (standard deviation 91) N/mm, which is significantly stiffer than parallel or divergent unicortical screws and bicortical screws. However, to date, no biomechanical study has been carried out to investigate the use of the locking plate in medial malleolar fractures.…”

Section: Discussionmentioning

confidence: 83%

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Biomechanical Comparison of Locking Plate and Cancellous Screw Techniques in Medial Malleolar Fractures: A Finite Element Analysis

Jiang

Shi

Wang

et al. 2019

The Journal of Foot and Ankle Surgery

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As the commonly used fixation strategy of medial malleolar fractures, cancellous screws (CS) have been challenged for instability, bone destruction, and metal prominence. It is still unclear whether a locking compression plate (LCP) is a better choice in such fractures. Our purpose is to compare the mechanical efficacy of LCP with traditional 4.0-mm CS for transverse, oblique, and vertical medial malleolar fractures by using finite element analysis. In this study, 3-dimensional models of the distal tibia were reconstructed from a computed tomography scan of a young healthy male adult. Conditions included 3 fracture lines at 30°, 60°, and 90°; 2 groups of fixation (LCP and CS); and 3 adduction loads of 300, 500, and 700 N applied to the medial malleolar joint surface. The proximal part of the tibia was fixed for all degrees of freedom. The fracture displacements of the LCP were smaller than those of CS (p < .05). The stiffness of the LCP constructs was much higher than that of the CS constructs, especially in the 90°fractures (490.3 versus 163.6 N/mm). The mean stress around the CS was higher than that in LCP for 60°and 90°fractures, but there was no difference for 30°. Maximal bone stress increased (19.84 to 50.86 MPa) and concentrated on cortical bone in LCP, whereas it concentrated on cancellous bone in CS. The results showed that LCP could improve stability, preventing bone destruction in oblique and vertical medial malleolar fractures. However, in transverse fractures, CS provides sufficient stability, with no need to use LCP.

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Section: Discussionsupporting

confidence: 84%

Section: Validation Of the Fe Analysissupporting

confidence: 91%

Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 83%

See 2 more Smart Citations

Biomechanical Comparison of Locking Plate and Cancellous Screw Techniques in Medial Malleolar Fractures: A Finite Element Analysis

Jiang

Shi

Wang

et al. 2019

The Journal of Foot and Ankle Surgery

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“…Although a stage 2 SA injury without a lateral malleolar fracture (i.e. deltoid ligament tear) is also demonstrated as an IMMF on radiographs, the vertical fracture line is typical for diagnosis [7,9,23,24]. Internal xation is also imperative because it is unstable.…”

Section: Discussionmentioning

confidence: 99%

Research The Representativeness of An Isolated Medial Malleolar Fracture

Wu¹,

Yeh²,

Lee³

et al. 2020

Preprint

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Background: An isolated medial malleolar fracture (IMMF) is relatively uncommon.Not only is the treatment principle undetermined well, but also is the patho-mechanism debatable. The goal of this retrospective study intended to clarify the patho-mechanism of an IMMF and develop an optimal treatment principle to upgrade a success rate.Methods: For the 10-year period, 59 consecutive adult patients (average, 38 years; range, 18-77 years) with an IMMF were treated. The causes included 42.4% of motorcycle accidents, 20.3% of working injuries, 10.2% of car accidents, 10.2% of slide injuries, and 16.9% of others. The 59 injuries were classified to 59.3% of stage 1 pronation-external rotation (PE), 20.3% of stage 2 PE, 10.2% of stage 2 pronation-abduction (PA), and 10.2% of stage 2 supination-adduction (SA) injuries. Unstable fractures which comprised stage 2 PA and stage 2 SA injuries were treated with internal fixation. Stable fractures which comprised stage 1 PE and stage 2 PE injuries were treated with either internal fixation or conservative techniques.Results: Fifty patients (84.7%, 50 / 59) were followed for at least one year (average, 1.3 years; range, 1-3.1 years). Forty-nine fractures healed with a union rate of 98%. Satisfactory ankle function was achieved in 84% of patients (42 / 50). Four out of eight patients with an unsatisfactory ankle function sustained syndesmotic diastasis. One fracture which was treated with internal fixation sustained screw breakage with nonunion. This patient also had unsatisfactory ankle function.Conclusion: Not all IMMFs can be treated conservatively. Practically, an IMMF should be classified into a stable or unstable type based on radiographs and clinical stress tests. A stable type may include 80% of IMMFs which may be treated with either surgical or conservative techniques. An unstable type may include 20% of IMMFs which had better be treated with internal fixation.

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Nonlocking Plate Functions

Eastman

2020

Essential Biomechanics for Orthopedic Trauma

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Antiglide plating of vertical medial malleolus fractures provides stiffer initial fixation than bicortical or unicortical screw fixation

Cited by 36 publications

References 8 publications

Biomechanical Comparison of Locking Plate and Cancellous Screw Techniques in Medial Malleolar Fractures: A Finite Element Analysis

Biomechanical Comparison of Locking Plate and Cancellous Screw Techniques in Medial Malleolar Fractures: A Finite Element Analysis

Research The Representativeness of An Isolated Medial Malleolar Fracture

Nonlocking Plate Functions

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