Abstract
Fractures of the lateral malleolus can occur without rupture of the deltoid ligament
or fracture of the medial malleolus. Controversy exists regarding the necessity of
surgery on supination-external rotation stage II ankle fractures. Theoretically, as
long as the medial structures are intact, the talus cannot displace enough to cause
degenerative arthritis of the ankle joint. The purpose of this study was to measure
changes in contact area between the tibial plafond and the talar dome with serial
displacement of the distal fibula in both a lateral and a superolateral direction.
Twelve cadaver lower extremities were used. Distal fibular fractures were replicated
by creating an osteotomy. Displacement was accomplished with a customized apparatus
that displaced and held the distal fibula in a malaligned position. Tibiotalar contact
area was measured with pressure sensitive film at the following intervals of fibular
displacement: 0 mm, laterally 2 mm and 4 mm, and then posteriorly and superiorly 2
mm and 4 mm. A servohydraulic testing apparatus was used to apply the same physiologic
load to all limbs while measuring contact area. Key independent variables included
the direction and amount of displacement of the distal fibula. Mean tibiotalar contact
area decreased from baseline (no displacement) 361.1 mm2 (SD ± 49.0) to 162.2 mm2 (SD ± 81.3) and 82.6 mm2 (SD ± 30.6) for 2 mm and 4 mm lateral displacement of the distal fibula respectively.
With posterior/superior displacement of 2 mm and 4 mm mean tibiotalar contact decreased
to 219.3 mm2 (SD ± 56.7) and 109.2 mm2 (SD ± 39.0), respectively. Statistical significance was found (P < .001) when comparing normal ankle alignment with displaced fractures at all levels
of displacement.
Keywords
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References
- The effects of fibular and talar displacement on joint contact areas about the ankle.Orthop Rev. 1992; 21: 741-744
- Kinematics of the axially loaded ankle.Foot Ankle Int. 1995; 16: 577-782
- The short oblique fracture of the distal fibula without medial injury.Foot Ankle Int. 1995; 16: 181-186
- Fractures of the ankle. II. Combined experimental-surgical and expalimental-roentgenologic investigation.Arch Surg. 1950; 60: 957-985
- The treatment of oblique fractures of the fibula.J Bone Joint Surg. 1961; 43A: 969-979
- On the late results in non-operative cases of malleolar fractures. I. Fractures by external rotation.Acta Chir Scand. 1944; 90: 11-116
- The effect of fibular malreductionon contact pressures in an ankle fracture malunion model.J Bone Joint Surg. 1997; 79A: 1809-1815
- Changes in tibiotalar area of contact caused by lateral talar shift.J Bone Joint Surg. 1976; 58A: 356-357
- Is surgical treatment of deltoid ligament necessary in ankle fractures?.Rev Chir Orthop Reparatrice Appar Mot. 1997; 83: 652-657
- Effects of fibular malunion on contact area and stress distribution at the ankle with six simulated loading conditions.Nippon Seikeigeka Gakkai Zasshi. 1995; 69: 460-469
- Results of operative treatment of displaced external rotation-abduction fractures of the ankle.J Bone Joint Surg. 1985; 67A: 1066-1073
- Precise evaluation of the reduction of severe ankle fractures. Technique and correlation with end results.J Bone Joint Surg. 1974; 56A: 979-993
- Is closed treatment of ankle fractures advisable?.Acta Orthop Scand. 1985; 56: 101-102
- A reproducible approach to the internal fixation of adult ankle fractures.Orthop Clin North Am. 1980; 11: 661-679
- Quantitative criteria for prediction of the results after displaced fracture of the ankle.J Bone Joint Surg. 1983; 65A: 667-677
- A prospective, randomized study of the management of severe ankle fractures.J Bone Joint Surg. 1985; 67A: 67-78
- Tibiotalar contact and fibular malunion in ankle fractures.Acta Orthop Scand. 1992; 63: 326-329
- The effect of loading on tibiotalar alignment in cadaver ankles.Foot Ankle Int. 1990; 10: 280-284
- Intraarticular contact stresses with simulated ankle malunions.J Orthop Trauma. 1994; 8: 159-166
- Tibiotalar stability in bimalleolar ankle fractures.Foot Ankle Int. 1991; 11: 222-227
- Load-bearing pattern of the ankle joint. Contact area and pressure distribution.Arch Orthop Trauma Surg. 1980; 96: 45-49
- The key role of the lateral malleolus in displaced fractures of the ankle.J Bone Joint Surg. 1977; 59A: 169-173
- Tibiotalar motion—effect of fibular displacement and deltoid ligament transaction.Foot Ankle Int. 1999; 20: 733-737
- The effect of fibular shortening and rotation on the biomechanics of the talocrural joint during various stages of stance phase.Orthop Trans. 1984; 8: 259-260
- Fractures of the fibula proximal to the distal tibiofibular syndesmosis.J Bone Joint Surg. 1978; 60A: 221-229
- Anatomical basis of variability in injuries of the medial malleolus and the deltoid ligament.Acta Ortho Scand. 1979; 50: 225-236
- Rotatory stability of the load-bearing ankle. An experimental study.J Bone Joint Surg. 1980; 62B: 460-464
- Ankle fractures.Acta Orthop Scand. 1980; 51: 695-701
- Tibiotalar joint dynamics.Foot Ankle Int. 1993; 14: 153-158
- Current concepts review fractures about the ankle.J Bone Joint Surg. 1995; 77A: 142-152
- Axially loaded members, chapter 2. In Mechanics of Materials. 3rd ed. PWS Publishing, Boston1990
- Contact characteristics of the ankle joint. Part 1: the normal joint.J Am Podiatr Med Assoc. 1994; 84: 491-498
- Tibiotalar contact area contribution of posterior malleolus and deltoid ligament.Clin Ortho Rel Res. 1995; 320: 182-187
- Articular area responses to mechanical loading.Am J Phys Anthropol. 2001; 116: 266-277
- Functional anatomy of articular cartilage under compressive loading.Osteoarthritis Cartilage. 2002; 10: 83-99
- Effect of persistent pressure on the articular cartilage.J Bone Joint Surg. 1961; 43B: 376-386
- The effect of simulated tibial deformities on the ankle joint during gait cycle.Foot Ankle. 1984; 5: 131-141
- Evaluation of ankle fractures.Clin Orthop. 1979; 138: 111-119
- Long-term results of displaced bimalleolar fractures.J Bone Joint Surg. 1966; 48A: 1065-1078
- The treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement.J Bone Joint Surg. 1965; 47B: 634-660
- Measurement of surface contact area of the ankle joint.Clin Biomech. 1998; 13: 365-370
- Intra-articular load distribution in the human ankle joint during motion.Foot Ankle Int. 2001; 22: 226-233
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© 2004 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
