Using a cervical spine cage to reconstruct malunited fibular fractures
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ORIGINAL PAPER
Using a cervical spine cage to reconstruct malunited fibular fractures Yaron S. Brin & Ezequiel Palmanovich & Sabri Massarwe & Meir Nyska & Benyamin Kish
Received: 5 November 2012 / Accepted: 30 November 2012 / Published online: 17 January 2013 # Springer-Verlag Berlin Heidelberg 2013
Abstract Purpose Anatomical reduction and fixation of unstable ankle fractures is necessary to prevent post-traumatic arthritis. Malunion of the distal fibula in unstable ankle fractures can lead to late degenerative changes of the ankle. Late reconstruction of the ankle can improve its function and postpone the need for ankle fusion or replacement. Methods We discuss three patients who presented with fibular malunion. All developed medial gutter opening, syndesmotic widening, and lateral shift and/or talar tilt. Surgery involved an anteromedial approach to clean the medial gutter, an anterolateral approach to clean the syndesmotic interval, elongation of the fibula by six to eight millimetres and stabilisation with a cervical spine cage and a locked plate. Results After one year, all patients had radiologically demonstrated reduction of the talus in the mortise. Improved function was recorded at final follow up. The cage provides several advantages over other fixation methods, including osteoconductive properties, avoiding bone graft donor site morbidity, and the range of sizes allows the surgeon to adjust the amount of elongation. Conclusions Using spinal cages to treat malunited fibula fractures has several advantages compared to bone graft and good results can be expected.
Introduction Ankle fracture is one of the most common injuries requiring open reduction and internal fixation [1]. More than age or fracture type, anatomical reduction is the most important Y. S. Brin (*) : E. Palmanovich : S. Massarwe : M. Nyska : B. Kish Department of Orthopaedic Surgery, Meir Medical Center, TelAviv University, Kfar-Saba, Israel e-mail: [email protected]
factor for the prognosis and outcome [2]. Malunion of an ankle fracture is associated with poor outcomes and may require reconstruction [3]. Successful reconstruction of a malunion requires accurate assessment, pre-operative planning and special reconstructive techniques [3, 4]. The literature contains little information about reconstruction and clinical outcomes of fibular fracture malunion. Thus, we report our experience with treating malunited fibular fractures to restore ankle joint function.
Patients and methods Three patients with fibular malunion and functional impairment of the ankle joint were referred to our institution in 2008 and 2009. Patient demographics are shown in Table 1. Protocol for clinical and radiological assessment Pre-operative evaluation included documentation of scars, the condition of the soft tissue, neurovascular status of the affected extremity, and range of motion of the ankle joint. Pain scores were documented using a visual analogue scale where 0 was no pain and 10, the worst pain imaginable. Pain scores were also documented at the final
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