Medial malleolus screws: out in one view and out

Wera, Jeffrey C.; Seligson, David; Riehl, John T.

doi:10.1007/s00590-015-1673-7

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…They concluded that if an X-ray image can show the screw to be extraarticular, then it is in fact extraarticular [31]. Similar results were reported by Wera et al in 2015 in a study of sawbones where an extraarticular screw could be confirmed with a single fluoroscopic view [32].…”

Section: Anklesupporting

confidence: 58%

Periarticular screws: what’s in and what’s out of the joint?

Sridhar

Hunter

Colello

2022

BMC Musculoskelet Disord

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Periarticular hardware placement can be challenging and a source of angst for orthopaedic surgeons due to fear of penetrating the articular surface and causing undue harm to the joint. In recent years, many surgeons have turned to computed tomography (CT) and other intraoperative or postoperative modalities to determine whether hardware is truly extraarticular in areas of complex anatomy. Yet, these adjuncts are expensive, time consuming, and often unnecessary given the advancement in understanding of intraoperative fluoroscopy. We present a review article with the goal of empowering surgeons to leave the operating room, with fluoroscopy alone, assured that all hardware is beneath the articular surface that is being worked on. By understanding a simple concept, surgeons can extrapolate the information in this article to any joint and bony surface in the body. While targeted at both residents and surgeons who may not have completed a trauma fellowship, this review can benefit all orthopaedic surgeons alike.

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Section: Anklesupporting

confidence: 58%

Periarticular screws: what’s in and what’s out of the joint?

Sridhar

Hunter

Colello

2022

BMC Musculoskelet Disord

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“…Live fluoroscopic imaging in suspicious cases is another method that involves more radiation exposure during surgery. [ 12 ] Three- dimensional (3D) fluoroscopy is a novel method that may be more successful than standard fluoroscopy for perioperative detection of penetration. [ 13 ] However, this technology is not currently available in most operating rooms, and produces relatively low- quality images with high dose of radiation exposure continuing for up to 20 seconds.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the use of postoperative cut-outs, a certain subset of penetrations occur during initial screw placement. [ 12 - 14 , 17 , 18 , 20 - 22 ] The secondary screw perforation rate was 57% of cases in a recent study that included 121 patients. [ 17 ] We used a shoulder model in our study which is the most commonly discussed joint in the literature.…”

Section: Discussionmentioning

confidence: 99%

A novel method to assess intraarticular screw penetration into the joint space

Ceylan¹,

Erden

Kapıcıoğlu

et al. 2020

Jt Dis Relat Surg

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This study aims to propose a novel method to detect articular penetration of screws by relying on their electrical conductivity properties and control the validity of this method. Materials and methods: In this ex vivo study, conducted between June 2017 and August 2017, we used five fresh sheep shoulder joints. First, the shoulder joint space was filled with saline solution. An insulated cannula was placed in the joint capsule, and a conductive wire was introduced into the joint via this cannula. A single titanium screw was inserted from the tuberculum majus into the posteroinferior quadrant of the humeral head under fluoroscopic observation. Conductivity was continuously measured using a digital multimeter. When a sudden decrease in conduction resistance was detected, fluoroscopic images were obtained in the anteroposterior (AP) and lateral directions. These images were assessed for penetration by a blinded surgeon. Penetration was confirmed by dissection of the joint. Results: There was a significant decrease in electrical resistance when screw penetration occurred (p<0.001). All penetration events were confirmed using our novel method. For all five of the specimens, either AP or lateral images could not be used to confirm penetration. For two of these specimens, penetration was undetectable in both AP and lateral fluoroscopic images, but a decrease in resistance was recorded. Conclusion: The described method exhibits greater sensitivity and accuracy for metal penetration to joint, and it is effective in detecting screws in the joints. The novel method described in this paper was applied in a prototype setting, and we believe that this concept can continue to be developed.

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“…3 Screw fixation is recommended for most, although debate continues regarding screw type, length, number, and zone of insertion. [4][5][6][7][8] For fractures unsuitable for screw fixation, tension band wiring is recommended. [9][10][11] High rates of symptomatic implant(s) after these techniques have driven the development of headless screws, knotless systems, and bioresorbable implants, with encouraging results.…”

Section: Introductionmentioning

confidence: 99%

“…Conventionally, the medial malleolar component of unstable fractures has been treated through open reduction and internal fixation . Screw fixation is recommended for most, although debate continues regarding screw type, length, number, and zone of insertion . For fractures unsuitable for screw fixation, tension band wiring is recommended .…”

Section: Introductionmentioning

confidence: 99%

Operative vs Nonoperative Management of Unstable Medial Malleolus Fractures

Carter,

Oliver,

Bell

et al. 2024

JAMA Netw Open

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ImportanceUnstable ankle fractures are routinely managed operatively. However, because of soft tissue and implant-related complications, recent literature has reported on the nonoperative management of well-reduced medial malleolus fractures after fibular stabilization, but with limited evidence supporting the routine application.ObjectiveTo assess the superiority of internal fixation of well-reduced (displacement ≤2 mm) medial malleolus fractures compared with nonfixation after fibular stabilization.Design, Setting, and ParticipantsThis superiority, pragmatic, parallel, prospective randomized clinical trial was conducted from October 1, 2017, to August 31, 2021. A total of 154 adult participants (≥16 years) with a closed, unstable bimalleolar or trimalleolar ankle fracture requiring surgery at an academic major trauma center in the UK were assessed. Exclusion criteria included injuries with no medial-sided fracture, open fractures, neurovascular injury, and the inability to comply with follow-up. Data analysis was performed in July 2022 and confirmed in September 2023.InterventionsOnce the lateral (and where appropriate, posterior) malleolus had been fixed and satisfactory intraoperative reduction of the medial malleolus fracture was confirmed by the operating surgeon, participants were randomly allocated to fixation (n = 78) or nonfixation (n = 76) of the medial malleolus.Main Outcome and MeasureOlerud-Molander Ankle Score (OMAS) 1 year after randomization (range, 0-100 points, with 0 indicating worst possible outcome and 100 indicating best possible outcome).ResultsAmong 154 randomized participants (mean [SD] age, 56.5 [16.7] years; 119 [77%] female), 144 (94%) completed the trial. At 1 year, the median OMAS was 80.0 (IQR, 60.0-90.0) in the fixation group compared with 72.5 (IQR, 55.0-90.0) in the nonfixation group (P = .17). Complication rates were comparable. Significantly more patients in the nonfixation group developed a radiographic nonunion (20% vs 0%; P &lt; .001), with 8 of 13 clinically asymptomatic; 1 patient required surgical reintervention for this. Fracture type and reduction quality appeared to influence fracture union and patient outcome.Conclusions and RelevanceIn this randomized clinical trial comparing internal fixation of well-reduced medial malleolus fractures with nonfixation, after fibular stabilization, fixation was not superior according to the primary outcome. However, 1 in 5 patients developed a radiographic nonunion after nonfixation, and although the reintervention rate to manage this was low, the future implications are unknown. These results support selective nonfixation of anatomically reduced medial malleolar fractures after fibular stabilization.Trial RegistrationClinicalTrials.gov Identifier: NCT03362229

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Medial malleolus screws: out in one view and out

Cited by 5 publications

References 16 publications

Periarticular screws: what’s in and what’s out of the joint?

Periarticular screws: what’s in and what’s out of the joint?

A novel method to assess intraarticular screw penetration into the joint space

Operative vs Nonoperative Management of Unstable Medial Malleolus Fractures

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