Articular Incongruity in the Lower Extremity

Beals, Tim R.; Harris, Robert M; Auston, Darryl A.

doi:10.1016/j.ocl.2017.11.005

Cited by 8 publications

(6 citation statements)

References 96 publications

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“…Amazingly, comparing residual step-offs of 1–5, 6–10, and more than 10 mm, in their series, “poor” outcomes were only associated with a step-off greater than 10 mm. Patients with a step-off of less than 10 mm achieved “good” or “excellent” outcomes in 96% of cases [ 15 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Hence, (1) an exact analysis of the fracture using computed tomography (CT)/magnetic resonance imaging (MRI) for diagnosis [ 5 , 11 ] and (2) preoperative planning of the surgical strategy accounting for the possible need for different approaches are crucial for achieving the desired anatomical reconstruction and clinical result [ 12 – 14 ]. Unfortunately, data regarding the tolerable level of articular incongruity that are needed to achieve an acceptable outcome and a low risk of posttraumatic osteoarthritis are controversial [ 15 ]. The postulated articular incongruity values range from nearly 2–10 mm in the case of tibial plateau fractures [ 7 , 9 , 15 – 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…Unfortunately, data regarding the tolerable level of articular incongruity that are needed to achieve an acceptable outcome and a low risk of posttraumatic osteoarthritis are controversial [ 15 ]. The postulated articular incongruity values range from nearly 2–10 mm in the case of tibial plateau fractures [ 7 , 9 , 15 – 18 ]. Furthermore, the detailed impact of intraarticular fracture steps, gaps, bony defects, and axial malalignment remaining postoperatively on functional outcome has poorly been investigated.…”

Section: Introductionmentioning

confidence: 99%

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Factors influencing the outcome after surgical reconstruction of OTA type B and C tibial plateau fractures: how crucial is the restoration of articular congruity?

Rosteius

Rausch

Pätzholz

et al. 2022

Arch Orthop Trauma Surg

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Introduction Only few and inconsistent data about the impact of articular congruity and tolerable residual intraarticular steps and gaps of the joint surface after tibial plateau fractures exist. Therefore, aim of this study was to investigate the correlation between OTA type B and C tibial plateau fracture outcomes and postoperative articular congruity using computed tomography (CT) data. Materials and methods Fifty-five patients with a mean age of 45.5 ± 12.5 years and treated for 27 type B and 28 C tibial plateau fractures with pre- and postsurgical CT data were included. Primary outcome measure was the correlation of postoperative intraarticular step and gap sizes, articular comminution area, the postoperative medial proximal tibial angle (MPTA), and the Lysholm and IKDC score. Receiver-operating characteristic (ROC) curves were used to determine threshold values for step and gap heights according to the following outcome scores: IKDC > 70; Lysholm > 80. Secondary outcome measures were the correlation of fracture severity, the number of complications and surgical revisions and the outcome scores, as well as the Tegner activity score before injury and at final follow-up. Results After a mean follow-up of 42.4 ± 18.9 months, the mean Lysholm score was 80.7 ± 13.3, and the mean IKDC score was 62.7 ± 17.6. The median Tegner activity score was 5 before the injury and 4 at final follow-up (p < 0.05). The intraarticular step height, gap size, comminution area and MPTA deviation were significantly negatively correlated with the IKDC and Lysholm scores. The cutoff values for step height were 2.6 and 2.9 mm. The gap size threshold was 6.6 mm. In total, an average of 0.5 ± 0.8 (range 0–3) complications occurred, and on average, 0.5 ± 1.1 (range 0–7) surgical revisions had to be performed. The number of complications and surgical revisions also had negative impacts on the outcome. Neither fracture severity nor BMI or patient’s age was significantly correlated with the IKDC or Lysholm score. Conclusions Tibial plateau fractures are severe injuries, which lead to a subsequent reduced level of patient activity. Precise reconstruction of the articular surface with regard to intraarticular step and gap size, residual comminution area and joint angle is decisive for the final outcome. Complications and surgical revisions also worsen it. Level of evidence III.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors influencing the outcome after surgical reconstruction of OTA type B and C tibial plateau fractures: how crucial is the restoration of articular congruity?

Rosteius

Rausch

Pätzholz

et al. 2022

Arch Orthop Trauma Surg

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“…Although the changes in congruity were shown to be statistically significant, changes in JLCA were minor and should be interpreted not only statistically, but also clinically. While there currently does not exist a numeric value to define an incongruent joint, 17 we do not believe mean differences of less than 5 degrees to be of clinical significance. Future studies should assess joint congruity in vivo to determine the threshold for clinical significance of incongruity.…”

Section: Discussionmentioning

confidence: 65%

“…Incongruity may alter the contact pressures of the joint, resulting in loading of forces onto anatomic locations not adapted for such loads and the eventual development of arthritis. 17,18 Despite its significance in restoring joint functionality, there are few studies that assess joint congruity, particularly in the hand. Our biomechanical study examined the impact of the PIP soft tissue structures on joint congruity following injuries to the joint, and our findings may have clinical implications on the treatment methods for such injuries.…”

Section: Discussionmentioning

confidence: 99%

Proximal Interphalangeal Joint Congruity: A Biomechanical Study

Levy

Kurtzman

Horowitz

et al. 2022

Hand (New York, N,Y.)

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Background: Surgical approaches to the proximal interphalangeal (PIP) joint often require disruption of soft tissue stabilizers. Additionally, PIP joint injuries frequently result in soft tissue disruption. This study evaluates the necessity of repairing soft tissue stabilizers by assessing their role in maintaining native joint congruity. Methods: Eight specimens were used to evaluate congruity at 0° and 30° flexion when loaded with 2 N of valgus force. This was performed in the native joint and after sequential sectioning of the surrounding ligaments in order: volar plate (VP), radial collateral ligament (CL), and ulnar CL. The skin flap was sutured with the ligaments unrepaired and the load was reapplied. Radiographs were taken after each load and used to measure the joint line convergence angle (JLCA). Results: Mean JLCA increased in both degrees of flexion after ligaments were sectioned but was only significantly different from the native joint after the VP was disrupted along with 1 CL. Joint congruity improved following repair of the skin flap in both degrees of flexion but was not significant. Joints were more congruent in 30° flexion for all subgroups, but none were significantly different compared to 0° flexion. Conclusions: Disruption of the VP is insufficient to significantly alter PIP joint congruity. While sectioning of both the VP and CLs resulted in a statistically significant change in joint congruity, mean JLCA demonstrated changes of minor clinical significance. The osseous anatomy of the phalanges imparts inherent stability that maintains a congruent joint despite loss of the soft tissue stabilizers.

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Repositionstechniken bei Osteosynthesen von artikulären Frakturen

Michelitsch

Sommer

2018

Unfallchirurg

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Articular Incongruity in the Lower Extremity

Cited by 8 publications

References 96 publications

Factors influencing the outcome after surgical reconstruction of OTA type B and C tibial plateau fractures: how crucial is the restoration of articular congruity?

Factors influencing the outcome after surgical reconstruction of OTA type B and C tibial plateau fractures: how crucial is the restoration of articular congruity?

Proximal Interphalangeal Joint Congruity: A Biomechanical Study

Repositionstechniken bei Osteosynthesen von artikulären Frakturen

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