Bazin I, Armendariz M, Marcheix P S, Pichon M, Fredon F, Mabit C, Mathieu P A
Centre Hospitalier Universitaire de Limoges Dupuytren, 2 Avenue Martin Luther King, 87000, Limoges, France.
Surg Radiol Anat. 2019 Jun;41(6):681-687. doi: 10.1007/s00276-019-02213-y. Epub 2019 Apr 11.
The intramedullary percutaneous pinning in fractures of the lateral malleolus is a technique of osteosynthesis that can reduce complications of ORIF. Our study describes the morphology and the morphometry of the fibula, in particular intramedullary, so as to specify the best fibular nail features.
We conducted a retrospective study on CT acquisitions of fibulae in vivo. We studied total length, and the distal malleolar angle. Regarding intramedullary morphology, six axial study levels were defined. Each level was assigned a morphometric classification (oval, triangular, quadrangular or irregular), and a measure of the diameter of the cavity. The distance between the smaller diameter and the malleolar tip was investigated.
We included 50 patients for 97 fibulae. The average age was 66.5 years. The irregular morphology type was the most frequently found. The average length was 370.5 mm (SD = 18.1; CI 95% [366.9; 374.1]), the average distal malleolar angle was 163.5° (SD = 3.7; CI 95% [162.7; 164.2]). The average minimal intramedullary diameter at malleolus level was 3.2 mm (SD = 1.2; CI 95% [3.0; 3.5]), with a minimum size reaching 95.8 mm (SD = 13.8; CI 95% [93.0; 98.5]) of the malleolar tip.
The analysis of morphological parameters of the fibula, in particular the lateral malleolus and intramedullary morphology is necessary for the design of a morpho-adapted nail. Interpersonal variability must be taken into account by the implant industry to offer nails of suited lengths and diameters.
外踝骨折的髓内经皮穿针固定术是一种可减少切开复位内固定术并发症的骨固定技术。我们的研究描述了腓骨的形态和形态测量，特别是髓内部分，以明确最佳的腓骨髓内钉特征。
我们对体内腓骨的CT图像进行了回顾性研究。我们研究了腓骨的总长度和远端踝关节角。关于髓内形态，定义了六个轴向研究层面。每个层面都被赋予一个形态测量分类（椭圆形、三角形、四边形或不规则形），并测量髓腔直径。研究了最小直径与踝关节尖端之间的距离。
我们纳入了50例患者的97根腓骨。平均年龄为66.5岁。最常发现的形态类型为不规则形。平均长度为370.5毫米（标准差=18.1；95%置信区间[366.9；374.1]），平均远端踝关节角为163.5°（标准差=3.7；95%置信区间[162.7；164.2]）。踝关节水平的平均最小髓内直径为3.2毫米（标准差=1.2；95%置信区间[3.0；3.5]），距踝关节尖端的最小尺寸为95.8毫米（标准差=13.8；95%置信区间[93.0；98.5]）。
对于设计形态适配的髓内钉而言，分析腓骨的形态参数，尤其是外踝和髓内形态是必要的。植入物行业必须考虑个体差异，以提供长度和直径合适的髓内钉。
