Effect of Ankle Position and Noninvasive Distraction on Arthroscopic Accessibility of the Distal Tibial Plafond

Akoh, Craig C.; Dibbern, Kevin; Amendola, A.; Sittapairoj, Tinnart; Anderson, Donald D.; Phisitkul, Phinit

doi:10.1177/1071100717717264

Cited by 4 publications

(2 citation statements)

References 31 publications

(39 reference statements)

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“…The anteriormost fragments were accessed through either the medial or lateral malleolar approaches. Our results are consistent with Akoh et al, 3 who demonstrated the effectiveness of posterior arthroscopy in accessing the posterior 6 zones in combination with noninvasive distraction.…”

Section: Discussionsupporting

confidence: 93%

Outcomes of Posterior Arthroscopic Reduction and Internal Fixation (PARIF) for the Posterior Malleolar Fragment in Trimalleolar Ankle Fractures

2020

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Background: Posterior malleolar fractures within a trimalleolar ankle fracture pattern are challenging to manage. Posterior ankle arthroscopy provides a means to assess the intra-articular and syndesmotic reductions, while removing loose bodies. The purpose of this study was to determine the radiographic and patient reported outcomes of posterior arthroscopic reduction and internal fixation (PARIF) in trimalleolar ankle fractures. Methods: From November 2015 to March 2019, we prospectively enrolled consecutive trimalleolar ankle fractures that underwent PARIF by a single surgeon. Preoperative and postoperative computed tomography (CT) scans were interpreted by 2 blinded musculoskeletal radiologists for articular reduction, syndesmosis congruity, and presence of ossific loose bodies. Patient outcomes were assessed using the Foot and Ankle Disability Index (FADI), American Orthopaedic Foot & Ankle Society (AOFAS) ankle score, Olerud-Molander Ankle Score (OMAS), and visual analog scale (VAS). A total of 28 trimalleolar ankle fractures were treated with PARIF. Mean patient age was 36 years (range, 19-69). Results: Preoperative CT identified 18 intra-articular loose bodies (range, 0-4) in 36% of ankles and 75% (n = 21) syndesmosis incongruity. Postoperative CT scans demonstrated anatomic intra-articular reduction in all fractures, 41.7% (5/12) syndesmosis incongruity without fixation, and 0% (0/9) with suture-button fixation. At mean 2-year follow-up, the results were good to excellent with mean VAS score 1 (range, 0-4), AOFAS score 84 (range, 63-100), FADI 85 (range, 59-100), and OMAS 76 (range, 40-100). Conclusion: The PARIF technique for displaced posterior malleolar fractures was effective in achieving anatomic intra-articular reduction, syndesmosis congruity, and intra-articular loose body removal, while safely preserving the soft tissues. Level of Evidence: Level IV, prospective case series.

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Section: Discussionsupporting

confidence: 93%

Outcomes of Posterior Arthroscopic Reduction and Internal Fixation (PARIF) for the Posterior Malleolar Fragment in Trimalleolar Ankle Fractures

2020

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“…1 ). Furthermore, a 3 × 3 grid was created to divide the distal tibial plafond into nine zones (1 = anteromedial, 2 = anterocentral, 3 = anterolateral, 4 = centromedial, 5 = central, 6 = centrolateral, 7 = posteromedial, 8 posterocentral, 9 = posterolateral) as previously described by other authors [ 29 , 30 ] (Fig. 2 ).…”

Section: Methodsmentioning

confidence: 99%

Visualization of the distal tibial plafond articular surface using four established approaches and the efficacy of instrumented distraction: a cadaveric study

Kleinertz

Tessarzyk

Schoof

et al. 2022

Eur J Trauma Emerg Surg

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Purpose Direct visualization is a very effective method in accomplishing adequate articular surface reconstruction in fracture repair. This study investigates distal tibial plafond articular surface visibility using the anteromedial, anterolateral, posteromedial, and posterolateral approaches, the effect of instrumented distraction on visibility, and which zones of the articular surface are visible for each approach. Methods The anteromedial, anterolateral, posteromedial, and posterolateral approaches to the distal tibial plafond were performed on 16 cadaveric ankle specimens. The articular surface visualization for each approach was marked using an electrocautery device with manual and instrumented distraction. Articular surface visualization was photographically documented. Digital axial segmentation and quantitative analysis of the visualized distal tibial plafond articular surface were performed. Results With manual distraction, distal tibial plafond articular surface visualization, expressed in percent of overall articular surface, was limited to 9% (SD ± 9) for the anteromedial, 24% (SD ± 18) for the anterolateral, 26% (SD ± 10) for the posteromedial, and 30% (SD ± 18) for the posterolateral approaches. Using instrumented distraction significantly improved articular surface visualization in all instances (p < 0.001). The anteromedial approach visible articular surface increased to 63% (SD ± 13), the anterolateral to 72% (SD ± 22), the posteromedial to 62% (SD ± 11), and the posterolateral to 50% (± 17). Conclusion This study demonstrates the efficacy of instrumented distraction when attempting surgical visualization of the distal tibial plafond articular surface. Knowledge of approach specific articular surface visibility may assist the surgeon in choosing the appropriate approach(es) based on case-specific distal tibial plafond fracture patterns. Level of evidence IV, cadaver study.

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Osteochondral Lesions of the Tibial Plafond

Lau

Maestre

Amendola

et al. 2022

Arthroscopic Techniques and Anatomy of the Foot and Ankle

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Effect of Ankle Position and Noninvasive Distraction on Arthroscopic Accessibility of the Distal Tibial Plafond

Abstract: OLTPs are often encountered in tandem with talar lesions, and safely achieving intra-articular working space through noninvasive distraction greatly improved arthroscopic accessibility.

Cited by 4 publications

References 31 publications

Outcomes of Posterior Arthroscopic Reduction and Internal Fixation (PARIF) for the Posterior Malleolar Fragment in Trimalleolar Ankle Fractures

Outcomes of Posterior Arthroscopic Reduction and Internal Fixation (PARIF) for the Posterior Malleolar Fragment in Trimalleolar Ankle Fractures

Visualization of the distal tibial plafond articular surface using four established approaches and the efficacy of instrumented distraction: a cadaveric study

Osteochondral Lesions of the Tibial Plafond

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