Modeling of tibia and fibula fixation with tensioned loops in cases of injuries of the tibiofibular syndesmosis
Malleoli fractures in case of the ankle joint (AJ) injuries accompanied by injuries of ligamentous structures of the syndesmosis and subluxation of the foot. Promising method of treatment of the syndesmosis injuries is fixation with tensioned loop.
Objective: based on mathematical analysis and magnetic resonance imaging (MRI) data to justify rules of tensioned loop using in surgical treatment of suprasyndesmotic fractures of the lateral malleolus.
Objectives: 1) to determine the optimal angle between two tensioned loops in a horizontal plane for fixation of the tibiofibular syndesmosis totally damaged; 2) to substantiate the level of tensioned loops’ passage; 3) to identify anatomical landmarks for fixation of syndesmosis with tensioned loops.
Methods: as a mathematical model we used a simplified scheme of loading in «tibia – fibula – tensioned loop» system. MRI was performed in 16 patients (7 women and 9 men, age 20–38 years) with no signs of bone structures damage and AJ syndesmosis. We carried out measurements at a distance of 4 and 2 cm above the AJ gap in axial projection.
Results: it was found that the optimal angle between a tensioned loop in the horizontal plane which ensures the stability of lateral malleolus fixation in fibular notch of the tibia in sagittal and frontal planes. For syndesmosis fixation tensioned loops should be placed to the articular tibial surface as close as possible. With help of MRI there was found that the maximal possible angle between two tensioned loops in a horizontal plane at 2 cm above the AJ space an average on 10° is higher than at 4 cm above the AJ space. Passing loops not exceeding 2 cm from the AJ plane will help to achieve the maximally possible angle between them and to provide stable fixation of the lateral malleolus in fibular notch of the tibia in sagittal and frontal planes.
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