Cargando…

Medial Approaches to the Posterior Malleolus: A Comparative Cadaveric Study

CATEGORY: Ankle; Trauma INTRODUCTION/PURPOSE: Ankle fractures are the most common fractures of the lower extremity. In spite of that, there is still no consensus regarding the best way to approach posterior malleolus (PM) fractures. The aim of this study is to compare the degree of PM exposure, tens...

Descripción completa

Detalles Bibliográficos
Autores principales: Palma, Joaquin, Urrutia, Tomas, Morales, Sergio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8795048/
http://dx.doi.org/10.1177/2473011421S00386
_version_ 1784640961862696960
author Palma, Joaquin
Urrutia, Tomas
Morales, Sergio
author_facet Palma, Joaquin
Urrutia, Tomas
Morales, Sergio
author_sort Palma, Joaquin
collection PubMed
description CATEGORY: Ankle; Trauma INTRODUCTION/PURPOSE: Ankle fractures are the most common fractures of the lower extremity. In spite of that, there is still no consensus regarding the best way to approach posterior malleolus (PM) fractures. The aim of this study is to compare the degree of PM exposure, tension of the flap containing the medial neurovascular bundle (NVB) and distance between the surgical incision and the NVB using three different posteromedial ankle approaches. METHODS: Three different posteromedial approaches were compared: direct medial (DM) modified posteromedial (MPM) and posterior paramedian (PPM). Each approach was performed four times using a standardized technique. With a digital tensiometer, the minimal tension of the flap containing the NVB that allowed proper exposure of the PM was measured. In a second stage, an axial cut 1cm proximal to the tibiotalar joint was performed in nine frozen pieces and PM exposure degree and distance between the incision and the NVB was measured. RESULTS: The median minimal tension was DM: 14,78 N, MPM: 8N and PPM: 5,75N. The median distance between the incision and the NVB was DM: 17mm, MPM: 6mm and PPM: 28mm. The median degree of exposure was DM: 51%, MPM: 58% and PPM: 72%. CONCLUSION: The PPM approach achieved the highest degree of PM exposure, with the lowest tension applied to the NVB and allowing the greatest distance between the incision and the NBV. Thus, we believe it should be considered the approach of choice for large fractures compromising the posteromedial and posterolateral aspect of the PM.
format Online
Article
Text
id pubmed-8795048
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher SAGE Publications
record_format MEDLINE/PubMed
spelling pubmed-87950482022-01-28 Medial Approaches to the Posterior Malleolus: A Comparative Cadaveric Study Palma, Joaquin Urrutia, Tomas Morales, Sergio Foot Ankle Orthop Article CATEGORY: Ankle; Trauma INTRODUCTION/PURPOSE: Ankle fractures are the most common fractures of the lower extremity. In spite of that, there is still no consensus regarding the best way to approach posterior malleolus (PM) fractures. The aim of this study is to compare the degree of PM exposure, tension of the flap containing the medial neurovascular bundle (NVB) and distance between the surgical incision and the NVB using three different posteromedial ankle approaches. METHODS: Three different posteromedial approaches were compared: direct medial (DM) modified posteromedial (MPM) and posterior paramedian (PPM). Each approach was performed four times using a standardized technique. With a digital tensiometer, the minimal tension of the flap containing the NVB that allowed proper exposure of the PM was measured. In a second stage, an axial cut 1cm proximal to the tibiotalar joint was performed in nine frozen pieces and PM exposure degree and distance between the incision and the NVB was measured. RESULTS: The median minimal tension was DM: 14,78 N, MPM: 8N and PPM: 5,75N. The median distance between the incision and the NVB was DM: 17mm, MPM: 6mm and PPM: 28mm. The median degree of exposure was DM: 51%, MPM: 58% and PPM: 72%. CONCLUSION: The PPM approach achieved the highest degree of PM exposure, with the lowest tension applied to the NVB and allowing the greatest distance between the incision and the NBV. Thus, we believe it should be considered the approach of choice for large fractures compromising the posteromedial and posterolateral aspect of the PM. SAGE Publications 2022-01-21 /pmc/articles/PMC8795048/ http://dx.doi.org/10.1177/2473011421S00386 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Palma, Joaquin
Urrutia, Tomas
Morales, Sergio
Medial Approaches to the Posterior Malleolus: A Comparative Cadaveric Study
title Medial Approaches to the Posterior Malleolus: A Comparative Cadaveric Study
title_full Medial Approaches to the Posterior Malleolus: A Comparative Cadaveric Study
title_fullStr Medial Approaches to the Posterior Malleolus: A Comparative Cadaveric Study
title_full_unstemmed Medial Approaches to the Posterior Malleolus: A Comparative Cadaveric Study
title_short Medial Approaches to the Posterior Malleolus: A Comparative Cadaveric Study
title_sort medial approaches to the posterior malleolus: a comparative cadaveric study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8795048/
http://dx.doi.org/10.1177/2473011421S00386
work_keys_str_mv AT palmajoaquin medialapproachestotheposteriormalleolusacomparativecadavericstudy
AT urrutiatomas medialapproachestotheposteriormalleolusacomparativecadavericstudy
AT moralessergio medialapproachestotheposteriormalleolusacomparativecadavericstudy