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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2020; 55(01): 033-039
DOI: 10.1055/s-0039-1700820
Artigo Original
Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Uso de placa retorcida – Um método de fixação da fíbula distal[*]

Artikel in mehreren Sprachen: português | English
Sanjay Agarwala 
1   Departamento de Ortopedia, Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim (West), Mumbai, Maharashtra, Índia
,
Aditya Menon
1   Departamento de Ortopedia, Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim (West), Mumbai, Maharashtra, Índia
,
Ravi Bhadiyadra
1   Departamento de Ortopedia, Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim (West), Mumbai, Maharashtra, Índia
› Institutsangaben
Weitere Informationen

Publikationsverlauf

15. Mai 2018

06. November 2018

Publikationsdatum:
28. Februar 2020 (online)

   Lizenzen und Reprints

Resumo

Objetivo A literatura discute diversos métodos intramedulares ou extramedulares para fixação de fraturas da fíbula distal, mas não há consenso acerca do método ideal de fixação. Analisamos retrospectivamente os resultados do uso de uma placa bloqueada de compressão (LCP) de 3,5 mm retorcida e com contorno como placa de apoio posterior.

Métodos Dos 62 casos de fraturas de tornozelo tratadas em nosso instituto pelo autor sênior entre 1° de janeiro de 2012 e 31 de dezembro de 2015, 41 pacientes atenderam aos critérios de inclusão (tipos B e C de Danis-Weber).

Resultados Todas as 41 fraturas fibulares distais cicatrizaram sem intercorrências, em uma média de 10,4 semanas (8–14 semanas) (Figuras 6 a 9) e sem complicações. A pontuação American Orthopaedic Foot & Ankle Society (AOFAS) média foi de 92,6 (86–100) em um período médio de acompanhamento de 31,5 meses (14–61 meses).

Conclusões Obtivemos excelentes resultados clínicos e radiológicos com uso de LCP retorcida de 3,5 mm como apoio posterior ao combinar as vantagens da placa antideslizante posterior e a LCP lateral.

Palavras-chave

fraturas de tornozelo - fixação interna de fraturas - fraturas ósseas - fíbula - placas ósseas

* Estudo conduzido no Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim (West), Mumbai, Maharashtra, Índia.


 

  • Referências

  • 1 Court-Brown CM, McBirnie J, Wilson G. Adult ankle fractures--an increasing problem?. Acta Orthop Scand 1998; 69 (01) 43-47
    CrossrefPubMedGoogle Scholar
  • 2 Kannus P, Palvanen M, Niemi S, Parkkari J, Järvinen M. Increasing number and incidence of low-trauma ankle fractures in elderly people: Finnish statistics during 1970-2000 and projections for the future. Bone 2002; 31 (03) 430-433
    CrossrefPubMedGoogle Scholar
  • 3 Dingemans SA, Lodeizen OAP, Goslings JC, Schepers T. Reinforced fixation of distal fibula fractures in elderly patients; A meta-analysis of biomechanical studies. Clin Biomech (Bristol, Avon) 2016; 36 (01) 14-20
    CrossrefPubMedGoogle Scholar
  • 4 DeAngelis NA, Eskander MS, French BG. Does medial tenderness predict deep deltoid ligament incompetence in supination-external rotation type ankle fractures?. J Orthop Trauma 2007; 21 (04) 244-247
    CrossrefPubMedGoogle Scholar
  • 5 McConnell T, Creevy W, Tornetta 3rd P. Stress examination of supination external rotation-type fibular fractures. J Bone Joint Surg Am 2004; 86 (10) 2171-2178
    CrossrefPubMedGoogle Scholar
  • 6 Park SS, Kubiak EN, Egol KA, Kummer F, Koval KJ. Stress radiographs after ankle fracture: the effect of ankle position and deltoid ligament status on medial clear space measurements. J Orthop Trauma 2006; 20 (01) 11-18
    CrossrefPubMedGoogle Scholar
  • 7 Schock HJ, Pinzur M, Manion L, Stover M. The use of gravity or manual-stress radiographs in the assessment of supination-external rotation fractures of the ankle. J Bone Joint Surg Br 2007; 89 (08) 1055-1059
    PubMedGoogle Scholar
  • 8 Yablon IG, Heller FG, Shouse L. The key role of the lateral malleolus in displaced fractures of the ankle. J Bone Joint Surg Am 1977; 59 (02) 169-173
    CrossrefPubMedGoogle Scholar
  • 9 Hartwich K, Lorente Gomez A, Pyrc J, Gut R, Rammelt S, Grass R. Biomechanical analysis of stability of posterior antiglide plating in osteoporotic pronation abduction ankle fracture model with posterior tibial fragment. Foot Ankle Int 2017; 38 (01) 58-65
    CrossrefPubMedGoogle Scholar
  • 10 Vance DD, Vosseller JT. Double plating of distal fibula fractures. Foot Ankle Spec 2017; 10 (06) 543-546
    CrossrefPubMedGoogle Scholar
  • 11 Eckel TT, Glisson RR, Anand P, Parekh SG. Biomechanical comparison of 4 different lateral plate constructs for distal fibula fractures. Foot Ankle Int 2013; 34 (11) 1588-1595
    CrossrefPubMedGoogle Scholar
  • 12 Milner BF, Mercer D, Firoozbakhsh K, Larsen K, Decoster TA, Miller RA. Bicortical screw fixation of distal fibula fractures with a lateral plate: an anatomic and biomechanical study of a new technique. J Foot Ankle Surg 2007; 46 (05) 341-347
    CrossrefPubMedGoogle Scholar
  • 13 Klos K, Sauer S, Hoffmeier K. , et al. Biomechanical evaluation of plate osteosynthesis of distal fibula fractures with biodegradable devices. Foot Ankle Int 2009; 30 (03) 243-251
    CrossrefPubMedGoogle Scholar
  • 14 Switaj PJ, Wetzel RJ, Jain NP. , et al. Comparison of modern locked plating and antiglide plating for fixation of osteoporotic distal fibular fractures. Foot Ankle Surg 2016; 22 (03) 158-163
    CrossrefPubMedGoogle Scholar
  • 15 Zahn RK, Frey S, Jakubietz RG. , et al. A contoured locking plate for distal fibular fractures in osteoporotic bone: a biomechanical cadaver study. Injury 2012; 43 (06) 718-725
    CrossrefPubMedGoogle Scholar
  • 16 Spinner RJ, Howe BM. Leg. In: Standring S. Gray's anatomy: the anatomical basis of clinical practice. 41st ed. New York: Elsevier; 2016: 1400-1417
    Google Scholar
  • 17 Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994; 15 (07) 349-353
    CrossrefPubMedGoogle Scholar
  • 18 Ibrahim T, Beiri A, Azzabi M, Best AJ, Taylor GJ, Menon DK. Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales. J Foot Ankle Surg 2007; 46 (02) 65-74
    CrossrefPubMedGoogle Scholar
  • 19 Chiang CC, Tzeng YH, Lin CC, Huang CK, Chang MC. Minimally invasive versus open distal fibular plating for AO/OTA 44-B ankle fractures. Foot Ankle Int 2016; 37 (06) 611-619
    CrossrefPubMedGoogle Scholar
  • 20 Rehman H, McMillan T, Rehman S, Clement A, Finlayson D. Intrmedullary versus extramedullary fixation of lateral malleolus fractures. Int J Surg 2015; 22: 54-61
    CrossrefPubMedGoogle Scholar
  • 21 Huang Z, Liu L, Tu C. , et al. Comparison of three plate system for lateral malleolar fixation. BMC Musculoskelet Disord 2014; 15 (01) 1-9
    CrossrefPubMedGoogle Scholar
  • 22 Tsukada S, Otsuji M, Shiozaki A. , et al. Locking versus non-locking neutralization plates for treatment of lateral malleolar fractures: a randomized controlled trial. Int Orthop 2013; 37 (12) 2451-2456
    CrossrefPubMedGoogle Scholar
  • 23 Lamontagne J, Blachut PA, Broekhuyse HM, O'Brien PJ, Meek RN. Surgical treatment of a displaced lateral malleolus fracture: the antiglide technique versus lateral plate fixation. J Orthop Trauma 2002; 16 (07) 498-502
    CrossrefPubMedGoogle Scholar
  • 24 Ahn J, Kim S, Lee JS, Woo K, Sung KS. Incidence of peroneal tendinopathy after application of a posterior antiglide plate for repair of supination external rotation lateral malleolar fractures. J Foot Ankle Surg 2016; 55 (01) 90-93
    CrossrefPubMedGoogle Scholar
  • 25 Schaffer JJ, Manoli 2nd A. The antiglide plate for distal fibular fixation. A biomechanical comparison with fixation with a lateral plate. J Bone Joint Surg Am 1987; 69 (04) 596-604
    CrossrefPubMedGoogle Scholar
  • 26 Bariteau JT, Fantry A, Blankenhorn B, Lareau C, Paller D, Digiovanni CW. A biomechanical evaluation of locked plating for distal fibula fractures in an osteoporotic sawbone model. Foot Ankle Surg 2014; 20 (01) 44-47
    CrossrefPubMedGoogle Scholar
  • 27 Kim T, Ayturk UM, Haskell A, Miclau T, Puttlitz CM. Fixation of osteoporotic distal fibula fractures: A biomechanical comparison of locking versus conventional plates. J Foot Ankle Surg 2007; 46 (01) 2-6
    CrossrefPubMedGoogle Scholar
  • 28 Minihane KP, Lee C, Ahn C, Zhang L-Q, Merk BR. Comparison of lateral locking plate and antiglide plate for fixation of distal fibular fractures in osteoporotic bone: a biomechanical study. J Orthop Trauma 2006; 20 (08) 562-566
    CrossrefPubMedGoogle Scholar
  • 29 Ostrum RF. Posterior plating of displaced Weber B fibula fractures. J Orthop Trauma 1996; 10 (03) 199-203
    CrossrefPubMedGoogle Scholar