Mansur Nacime Salomao Barbachan, Hume Donald, Kwon John, de Carvalho Kepler Alencar Mendes, Dibbern Kevin, de Cesar Netto Cesar
Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Duke University Health System, Durham, USA.
Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, 201 E University Pkwy, Baltimore, MD, 21218, USA.
Sci Rep. 2025 Jul 1;15(1):22434. doi: 10.1038/s41598-025-04117-x.
Prior studies showed the potential of a rigid fixation, such as a trans-syndesmotic screw, to produce tibiofibular malreduction. Flexible implants, although capable of allowing forgiveness, may not provide sufficient stability for all injury patterns. To assess the malreduction forgiveness of a two-phase syndesmotic device that is designed to transition from a rigid screw construct to a flexible suture-type. Cadaveric specimens were loaded in a frame under four conditions: native (control), syndesmotic instability (injured), malreduced with engaged syndesmotic device (malreduced), and post-disengagement (disengaged). The malreduction targets were 5 mm anterior displacement, 5 mm posterior displacement, 15° of rotation, and 140 N over-compressed. Fixation was performed with a single device 20 mm proximal to the ankle, manually disengaged to allow semi-constrained motion of the syndesmosis. Weightbearing Computed Tomography (WBCT) scans were obtained, and anatomic axes of the tibia and fibula extracted to calculate tibiofibular joint position with an established orthogonal system. A total of 42 specimens were included and allocated in the four groups. Anterior and posterior malreduction demonstrated 2.50 mm (SD: ±1.37 mm) and 5.04 mm (SD: ±2.23 mm) of average malreduction. The disengaged condition resulted in average recovery of 1.79 mm (95%CI: 0.72|2.85; p = 0.0034; 72% recovery) and 1.69 mm (95%CI: 0.09|3.28; p = 0.0006; 33% recovery) toward the control position, for anterior and posterior malreduction, respectively. Rotational malreduction demonstrated 2.44° (SD: ±2.09°) of average rotational malreduction, with 1.98° (95%CI: -0.13°|4.09°; p = 0.0707; 81%) of recovery. Over-compression specimens showed average medial translation of 0.89 mm (SD: ±1.10 mm), with 0.74 mm (95%CI: 0.05|1.51; p = 0.0128; 82%) of recovery when disengaged. The two-phase syndesmotic device was able to allow partial malreduction recovery in different scenarios after transitioning to the flexible state. The use of this implant might mitigate potential surgical tibiofibular malreductions while providing the mechanical and clinical advantages of both rigid and flexible devices. Level V. Controlled laboratory study.
先前的研究表明，诸如经下胫腓联合螺钉之类的刚性固定方式有导致胫腓骨复位不良的可能性。柔性植入物虽然能够容许一定程度的偏差，但可能无法为所有损伤类型提供足够的稳定性。为了评估一种两阶段下胫腓联合装置的复位不良容许度，该装置设计为由刚性螺钉结构转变为柔性缝线类型。在四种条件下将尸体标本加载到框架中：天然状态（对照）、下胫腓联合不稳定（损伤）、使用下胫腓联合装置但复位不良（复位不良）以及解除固定后（解除固定）。复位不良的目标为向前移位5毫米、向后移位5毫米、旋转15°以及过度压缩140牛。在距踝关节近端20毫米处用单个装置进行固定，手动解除固定以允许下胫腓联合进行半约束运动。获取负重计算机断层扫描（WBCT）图像，并提取胫骨和腓骨的解剖轴，以使用既定的正交系统计算胫腓关节位置。总共纳入42个标本并分为四组。向前和向后复位不良分别显示平均复位不良2.50毫米（标准差：±1.37毫米）和5.04毫米（标准差：±2.23毫米）。解除固定状态下，向前和向后复位不良分别平均恢复至距对照位置1.79毫米（95%置信区间：0.72|2.85；p = 0.0034；恢复率72%）和1.69毫米（95%置信区间：0.09|3.28；p = 0.0006；恢复率33%）。旋转复位不良显示平均旋转复位不良2.44°（标准差：±2.09°），解除固定后恢复1.98°（95%置信区间：-0.13°|4.09°；p = 0.0707；恢复率81%）。过度压缩的标本显示平均向内移位0.89毫米（标准差：±1.10毫米），解除固定后恢复0.74毫米（95%置信区间：0.05|1.51；p = 0.0128；恢复率82%）。这种两阶段下胫腓联合装置在转变为柔性状态后，能够在不同情况下实现部分复位不良的恢复。使用这种植入物可能会减轻潜在的手术性胫腓骨复位不良，同时提供刚性和柔性装置的机械和临床优势。V级。对照实验室研究。
