ersuchungen zur biomechanik des oberen sprunggelenks bei verk�rzungen des au�enkn�chels

Martinek, H.; Egkher, E.

doi:10.1007/bf00383640

Cited by 12 publications

(5 citation statements)

References 4 publications

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“…Even a displacement of as little as 1 mm will change the mobility of the talus and fibula, and the distribution of load in the talofibular and talotibial articulations [1,5,7,8,11,12,13,15]. Recent experimental studies on cadaveric ankles showed that 30° of lateral rotation deformity decreases the tibiotalar contact area by 30 to 50% [2,12], and this may lead to abnormal stress on the cartilage and underlying bone [19].…”

Section: Discussionmentioning

confidence: 99%

Lengthening osteotomy of the fibula for post-traumatic malunion

Weber

Friederich

Müller

1998

International Orthopaedics

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Section: Discussionmentioning

confidence: 99%

Lengthening osteotomy of the fibula for post-traumatic malunion

Weber

Friederich

Müller

1998

International Orthopaedics

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“…Thus the fibula helps maintain stability during weightbearing. 8 Following an ankle fracture, the fibular fracture deformity is usually shortening and external rotation. This shortening permits lateral shift of the talus with persistent instability and valgus tilt.…”

Section: Discussionmentioning

confidence: 99%

“…Even displacement of one millimeter will change the mobility of the talus and fibula and the distribution of the load in the talofibular and talotibial articulations. 2,4–6,8–10,12,14 Objectively this shortening can be measured by comparing talocrural angles of the affected side with the normal side. The talocrural angle, as described by Sarkisian et al, 15 is the angle between a perpendicular line to the tibial plafond and a line drawn between the tips of the malleoli (Figure 4).…”

Section: Discussionmentioning

confidence: 99%

Fibular Lengthening for Malunited Ankle Fractures

Sinha¹,

Sirikonda²,

Giotakis³

et al. 2008

Foot Ankle Int.

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“…Diese Hypothese ("Leitstabtheorie") wurde durch biomechanische Untersuchungen von Martinek [16] unterstützt, der nach einer Wadenbeinverkür-zung ab 4 mm einen signifikanten Anstieg der Gelenkfehlbelastung feststellte. Yoshimine [31] bestätigte dies, konnte aber zusätzlich für eine experimentelle Außenrotationsfehlstellung der distalen Fibula von 20°keine gravierenden biomechanischen Veränderungen im OSG feststellen.…”

Section: Rotationunclassified

Beitrag der Syndesmosen und des Deltabandes zur Stabilit�t der Au�enkn�chelfraktur Typ Weber B

et al. 2003

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The purpose of the present biomechanical investigation was to check the functional importance of the syndesmosis ligaments and of the deltoid ligament for ankle fracture type B according to the AO-Weber classification. We constructed a special fixation clamp, with 12 fresh and unembalmed lower legs being tested for lateral shift (mm) and ten for tibiotalar rotation. All specimens were exposed in the same neutral position. Transverse loads (F(y)) varied between 0 and 150 N, axial loads (F(z)) between 0, 300, 600 and 1,000 N and rotational loads (F(r)) between 2.4 and 4.9 Nm. All series were repeated according to supination-eversion (SE) injury patterns of the Lauge-Hansen classification. Syndesmotic ligaments and the fibula were incrementally sectioned from anterior to posterior. Type SE I consisted of an isolated incision of the anterior syndesmosis ligament. Type SE II had an additional oblique fracture of the fibula at the height of the tibiofibular syndesmosis. In type SE III injuries, in addition to the fibular fracture, a complete rupture of the syndesmosis ligaments was present, and for type SE IV lesions the deltoid ligaments were incised. The transverse load-displacement curve was s-shaped in all uninjured joints,with the highest gradient between 10 and 20 N with no axial compression. Without axial compression in cases of F(y)=25 N transverse loads, the mean talus translation was 0.51 mm. Following type II injuries, the average talus translation was 0.68 mm (not significant) and rose to an average of 0.95 mm ( P <0.01) in type III injuries. After additional incision of the deltoid ligaments, the ankle joint subluxed permanently when more than 5-10 N transverse loads were applied. Axial loads of 300 N or more resulted in a considerable reduction in talus translations, indicating increased stability and congruency within the joint complex. In this way, the vertical loading of the ankle joints always contributed to joint stability. The average internal tibiotalar rotation reached with a torque of 2.4 Nm was 3.52 degrees and with 4.9 Nm 5.15 degrees when no axial compression was applied. External rotation measured -6.36 degrees and -8.62 degrees, respectively. Following the experimental protocol, significant increases were noted for external rotation at SE II degrees injuries ( P =0.003) and for internal rotation at SE III degrees ( P =0.03) injuries. Our data support the proposition that the deltoid ligaments and the posterior syndesmosis play a key role in the stability of ankle fractures for supination-eversion injuries. If these structures remain intact, conservative and early functional treatment are recommended in patients with minimal (<2 mm) or no fracture displacement. This concept is confirmed by the literature dealing with clinical mid- and long-term follow-up studies.

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ersuchungen zur biomechanik des oberen sprunggelenks bei verk�rzungen des au�enkn�chels

Cited by 12 publications

References 4 publications

Lengthening osteotomy of the fibula for post-traumatic malunion

Lengthening osteotomy of the fibula for post-traumatic malunion

Fibular Lengthening for Malunited Ankle Fractures

Beitrag der Syndesmosen und des Deltabandes zur Stabilit�t der Au�enkn�chelfraktur Typ Weber B

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