Abstract
The distal tibia bone quality is of paramount importance for ankle fractures, total
ankle implants, ankle fusions, and osteotomy procedures. Despite this fact relatively
little is known regarding the overall bone quality for this section of the tibia.
Previous literature suggest that there is a statistically significant decrease in
bone mineral density within the distal 5% to 10% segment of the tibia medullary canal.
This segment of medullary bone is considerable in size and thus valuable for fixation
constructs as it is oftentimes utilized for medial malleolar fractures, distal tibia
fractures, total ankle replacements, ankle fusions, and other procedures. This study
assessed bone attenuation between the distal 5% and 10% mark of the tibia in 1% slices
via Hounsfield unit measurements on CT scans based on previously established correlation
between Hounsfield units and bone mineral density found on DEXA scans. One hundred
five distal tibia segments were assessed with an average interval in percentile slices
of 3.8 mm. As expected there was a gradual decrease in bone attenuation noted with
each proximal percentile segment. There exists a statistically significant difference
in bone attenuation among males versus females as well as those older than 60 years
versus younger than 60 years. The findings suggest fixation constructs in the tibia
medullary canal may find limited benefit proximal from 7% segment in females ≥60,
or 26.1 mm from tibial plafond. Fixation constructs in tibia medullary canal may find
limited benefit proximal from 8% segment in males <60, or 32.3 mm from tibial plafond.
Level of Clinical Evidence
Keywords
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References
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Article info
Publication history
Published online: May 23, 2022
Footnotes
Financial Disclosure: No internal or external funding to report.
Conflict of Interest: None reported.
This study has been approved through the Institutional Review Board at HealthPartners Institute Medical Research.
Identification
Copyright
© 2022 by the American College of Foot and Ankle Surgeons. All rights reserved.
