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Derek F Amanatullah - One of the best experts on this subject based on the ideXlab platform.
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headless compression screw fixation of vertical Medial Malleolus fractures is superior to unicortical screw fixation
American journal of orthopedics, 2018Co-Authors: Adam M Wegner, Philip R Wolinsky, Michael A Robbins, Tanya C Garcia, Sukanta Maitra, Derek F AmanatullahAbstract:: This study is the first biomechanical research of headless compression screws for fixation of vertical shear fractures of the Medial Malleolus, a promising alternative that potentially offers several advantages for fixation. Vertical shear fractures were simulated by osteotomies in 20 synthetic distal tibiae. Models were randomly assigned to fixation with either 2 parallel cancellous screws or 2 parallel Acutrak 2 headless compression screws (Acumed). Specimens were subjected to offset axial loading to simulate supination-adduction loading and tracked using high-resolution video. The headless compression screw construct was significantly stiffer (P < .0001) (360 ± 131 N/mm) than the partially threaded cancellous screws (180 ± 48 N/mm) and demonstrated a significantly increased (P < .0001) mean load to clinical failure (719 ± 91 N vs 343 ± 83 N). When specimens were displaced to 6 mm and allowed to relax, the headless compression screw constructs demonstrated an elastic recoil and were reduced to the pretesting fragment alignment, whereas the parallel cancellous screw constructs remained displaced. Along with the headless design that may decrease soft tissue irritation, the increased stiffness and elastic recoil of the headless compression screw construct offers improved fixation of Medial Malleolus vertical shear fractures over the traditional methods.
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headless compression screw for horizontal Medial Malleolus fractures
Clinical Biomechanics, 2018Co-Authors: Robin Z Cheng, Adam M Wegner, Anthony W Behn, Derek F AmanatullahAbstract:Abstract Background Horizontal Medial Malleolus fractures are caused by the application of rotational force through the ankle joint in several orientations. Multiple techniques are available for the fixation of Medial malleolar fractures. Methods Horizontal Medial Malleolus osteotomies were performed in eighteen synthetic distal tibiae and randomized into two fixation groups: 1) two parallel unicortical cancellous screws or 2) two Acutrak 2 headless compression screws. Specimens were subjected to offset axial tension loading. Frontal plane interfragmentary motion was monitored. Findings The headless compression group (1699 (SD 947) N/mm) had significantly greater proximal-distal stiffness than the unicortical group (668 (SD 298) N/mm), (P = 0.012). Similarly, the headless compression group (604 (SD 148) N/mm) had significantly greater Medial-lateral stiffness than the unicortical group (281 (SD 152) N/mm), (P Interpretation A headless compression screw construct was significantly stiffer in both the proximal-distal and Medial-lateral directions, indicating greater resistance to both axial and shear loading. Additionally, they had significantly greater load at clinical failure based on lateral displacement. The low-profile design of the headless compression screw minimizes soft tissue irritation and reduces need for implant removal.
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sled fixation for horizontal Medial Malleolus fractures
Clinical Biomechanics, 2017Co-Authors: Adam M Wegner, Robin Z Cheng, Philip R Wolinsky, Michael A Robbins, Tanya C Garcia, Derek F AmanatullahAbstract:Abstract Background Horizontal fractures of the Medial Malleolus occur through exertion of various rotational forces on the ankle, including supination-external rotation, pronation-external rotation, and pronation-abduction. Many methods of fixation are employed for these fractures, but the optimal fixation construct remains unclear. Methods Horizontal Medial Malleolus osteotomies were performed in synthetic distal tibiae and randomized into two fixation groups: 1) two parallel unicortical cancellous screws or 2) Medial malleolar sled fixation. Specimens were subjected to offset axial tension loading and tracked using high-resolution video. Clinical failure was defined as 2 mm of articular displacement. Findings There were statistically significant increases in mean stiffness (127% higher, P = 0.0007) and mean force to clinical failure (52% higher, P = 0.0002) with the Medial malleolar sled. The mean stiffness in offset tension loading was 232 (SD 83) N/mm for Medial malleolar sled and 102 (SD 20) N/mm for parallel unicortical cancellous screws. The mean force to clinical failure was 595 (SD 112) N for Medial malleolar sled and 392 (SD 34) N for unicortical screws. In addition, the Medial malleolar sled demonstrated elastic recoil to pre-testing alignment while the unicortical screws did not. Interpretation Medial malleolar sled fixation was significantly stiffer and required more force to clinical failure than parallel unicortical cancellous screws. A Medial malleolar sled requires more dissection to apply surgically, but provides significantly more initial fixation strength. Additionally, a Medial malleolar sled acts like a tension band in its ability to capture comminuted fragments while being low profile enough to minimize soft tissue irritation.
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antiglide plating of vertical Medial Malleolus fractures provides stiffer initial fixation than bicortical or unicortical screw fixation
Clinical Biomechanics, 2016Co-Authors: Adam M Wegner, Philip R Wolinsky, Michael A Robbins, Tanya C Garcia, Sukanta Maitra, Derek F AmanatullahAbstract:Abstract Background Vertical shear fractures of the Medial Malleolus (44-A2 ankle fractures) occur through a supination–adduction mechanism. There are numerous methods of internal fixation for this fracture pattern. Methods Vertical Medial Malleolus osteotomies were created in synthetic distal tibiae. The models were divided into four fixation groups: two parallel unicortical cancellous screws, two divergent unicortical cancellous screws, two parallel bicortical cortical screws, or an antiglide plate construct. Specimens were subjected to offset axial loading and tracked using high-resolution video. Findings The antiglide plate construct was stiffer ( P P P Interpretation An antiglide plate construct provides the stiffest initial fixation while withstanding higher load to failure for vertical Medial Malleolus fractures when compared to unicortical and bicortical screw fixation.
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effect of mini fragment fixation on the stabilization of Medial Malleolus fractures
Journal of Trauma-injury Infection and Critical Care, 2012Co-Authors: Derek F Amanatullah, Erik Mcdonald, Adam Shellito, Shain Lafazan, Alejandro Cortes, Shane Curtiss, Philip R WolinskyAbstract:BACKGROUND:Oblique fractures of the Medial Malleolus can arise from the application of axial force at various anatomic positions of the ankle, including supination-external rotation, pronation-external rotation, or pronation abduction. Although a variety of techniques exist to provide fixation of ho
Adam M Wegner - One of the best experts on this subject based on the ideXlab platform.
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headless compression screw fixation of vertical Medial Malleolus fractures is superior to unicortical screw fixation
American journal of orthopedics, 2018Co-Authors: Adam M Wegner, Philip R Wolinsky, Michael A Robbins, Tanya C Garcia, Sukanta Maitra, Derek F AmanatullahAbstract:: This study is the first biomechanical research of headless compression screws for fixation of vertical shear fractures of the Medial Malleolus, a promising alternative that potentially offers several advantages for fixation. Vertical shear fractures were simulated by osteotomies in 20 synthetic distal tibiae. Models were randomly assigned to fixation with either 2 parallel cancellous screws or 2 parallel Acutrak 2 headless compression screws (Acumed). Specimens were subjected to offset axial loading to simulate supination-adduction loading and tracked using high-resolution video. The headless compression screw construct was significantly stiffer (P < .0001) (360 ± 131 N/mm) than the partially threaded cancellous screws (180 ± 48 N/mm) and demonstrated a significantly increased (P < .0001) mean load to clinical failure (719 ± 91 N vs 343 ± 83 N). When specimens were displaced to 6 mm and allowed to relax, the headless compression screw constructs demonstrated an elastic recoil and were reduced to the pretesting fragment alignment, whereas the parallel cancellous screw constructs remained displaced. Along with the headless design that may decrease soft tissue irritation, the increased stiffness and elastic recoil of the headless compression screw construct offers improved fixation of Medial Malleolus vertical shear fractures over the traditional methods.
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headless compression screw for horizontal Medial Malleolus fractures
Clinical Biomechanics, 2018Co-Authors: Robin Z Cheng, Adam M Wegner, Anthony W Behn, Derek F AmanatullahAbstract:Abstract Background Horizontal Medial Malleolus fractures are caused by the application of rotational force through the ankle joint in several orientations. Multiple techniques are available for the fixation of Medial malleolar fractures. Methods Horizontal Medial Malleolus osteotomies were performed in eighteen synthetic distal tibiae and randomized into two fixation groups: 1) two parallel unicortical cancellous screws or 2) two Acutrak 2 headless compression screws. Specimens were subjected to offset axial tension loading. Frontal plane interfragmentary motion was monitored. Findings The headless compression group (1699 (SD 947) N/mm) had significantly greater proximal-distal stiffness than the unicortical group (668 (SD 298) N/mm), (P = 0.012). Similarly, the headless compression group (604 (SD 148) N/mm) had significantly greater Medial-lateral stiffness than the unicortical group (281 (SD 152) N/mm), (P Interpretation A headless compression screw construct was significantly stiffer in both the proximal-distal and Medial-lateral directions, indicating greater resistance to both axial and shear loading. Additionally, they had significantly greater load at clinical failure based on lateral displacement. The low-profile design of the headless compression screw minimizes soft tissue irritation and reduces need for implant removal.
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sled fixation for horizontal Medial Malleolus fractures
Clinical Biomechanics, 2017Co-Authors: Adam M Wegner, Robin Z Cheng, Philip R Wolinsky, Michael A Robbins, Tanya C Garcia, Derek F AmanatullahAbstract:Abstract Background Horizontal fractures of the Medial Malleolus occur through exertion of various rotational forces on the ankle, including supination-external rotation, pronation-external rotation, and pronation-abduction. Many methods of fixation are employed for these fractures, but the optimal fixation construct remains unclear. Methods Horizontal Medial Malleolus osteotomies were performed in synthetic distal tibiae and randomized into two fixation groups: 1) two parallel unicortical cancellous screws or 2) Medial malleolar sled fixation. Specimens were subjected to offset axial tension loading and tracked using high-resolution video. Clinical failure was defined as 2 mm of articular displacement. Findings There were statistically significant increases in mean stiffness (127% higher, P = 0.0007) and mean force to clinical failure (52% higher, P = 0.0002) with the Medial malleolar sled. The mean stiffness in offset tension loading was 232 (SD 83) N/mm for Medial malleolar sled and 102 (SD 20) N/mm for parallel unicortical cancellous screws. The mean force to clinical failure was 595 (SD 112) N for Medial malleolar sled and 392 (SD 34) N for unicortical screws. In addition, the Medial malleolar sled demonstrated elastic recoil to pre-testing alignment while the unicortical screws did not. Interpretation Medial malleolar sled fixation was significantly stiffer and required more force to clinical failure than parallel unicortical cancellous screws. A Medial malleolar sled requires more dissection to apply surgically, but provides significantly more initial fixation strength. Additionally, a Medial malleolar sled acts like a tension band in its ability to capture comminuted fragments while being low profile enough to minimize soft tissue irritation.
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antiglide plating of vertical Medial Malleolus fractures provides stiffer initial fixation than bicortical or unicortical screw fixation
Clinical Biomechanics, 2016Co-Authors: Adam M Wegner, Philip R Wolinsky, Michael A Robbins, Tanya C Garcia, Sukanta Maitra, Derek F AmanatullahAbstract:Abstract Background Vertical shear fractures of the Medial Malleolus (44-A2 ankle fractures) occur through a supination–adduction mechanism. There are numerous methods of internal fixation for this fracture pattern. Methods Vertical Medial Malleolus osteotomies were created in synthetic distal tibiae. The models were divided into four fixation groups: two parallel unicortical cancellous screws, two divergent unicortical cancellous screws, two parallel bicortical cortical screws, or an antiglide plate construct. Specimens were subjected to offset axial loading and tracked using high-resolution video. Findings The antiglide plate construct was stiffer ( P P P Interpretation An antiglide plate construct provides the stiffest initial fixation while withstanding higher load to failure for vertical Medial Malleolus fractures when compared to unicortical and bicortical screw fixation.
F. Stig Jacobsen - One of the best experts on this subject based on the ideXlab platform.
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Management of distal tibial Medial Malleolus type-6 physeal fractures
Journal of children's orthopaedics, 2008Co-Authors: Hamlet A. Peterson, F. Stig JacobsenAbstract:Purpose Type 6 is an open fracture in which part of the physis is missing. It is the least common physeal fracture, but has the highest rate of complications, particularly the formation of a physeal bar. Without preemptive treatment, a physeal bar always forms, producing growth retardation and angular deformity, and excision of these physeal bars has been uniformly unsuccessful. The distal Medial Malleolus is a common site for the fracture.
Philip R Wolinsky - One of the best experts on this subject based on the ideXlab platform.
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headless compression screw fixation of vertical Medial Malleolus fractures is superior to unicortical screw fixation
American journal of orthopedics, 2018Co-Authors: Adam M Wegner, Philip R Wolinsky, Michael A Robbins, Tanya C Garcia, Sukanta Maitra, Derek F AmanatullahAbstract:: This study is the first biomechanical research of headless compression screws for fixation of vertical shear fractures of the Medial Malleolus, a promising alternative that potentially offers several advantages for fixation. Vertical shear fractures were simulated by osteotomies in 20 synthetic distal tibiae. Models were randomly assigned to fixation with either 2 parallel cancellous screws or 2 parallel Acutrak 2 headless compression screws (Acumed). Specimens were subjected to offset axial loading to simulate supination-adduction loading and tracked using high-resolution video. The headless compression screw construct was significantly stiffer (P < .0001) (360 ± 131 N/mm) than the partially threaded cancellous screws (180 ± 48 N/mm) and demonstrated a significantly increased (P < .0001) mean load to clinical failure (719 ± 91 N vs 343 ± 83 N). When specimens were displaced to 6 mm and allowed to relax, the headless compression screw constructs demonstrated an elastic recoil and were reduced to the pretesting fragment alignment, whereas the parallel cancellous screw constructs remained displaced. Along with the headless design that may decrease soft tissue irritation, the increased stiffness and elastic recoil of the headless compression screw construct offers improved fixation of Medial Malleolus vertical shear fractures over the traditional methods.
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sled fixation for horizontal Medial Malleolus fractures
Clinical Biomechanics, 2017Co-Authors: Adam M Wegner, Robin Z Cheng, Philip R Wolinsky, Michael A Robbins, Tanya C Garcia, Derek F AmanatullahAbstract:Abstract Background Horizontal fractures of the Medial Malleolus occur through exertion of various rotational forces on the ankle, including supination-external rotation, pronation-external rotation, and pronation-abduction. Many methods of fixation are employed for these fractures, but the optimal fixation construct remains unclear. Methods Horizontal Medial Malleolus osteotomies were performed in synthetic distal tibiae and randomized into two fixation groups: 1) two parallel unicortical cancellous screws or 2) Medial malleolar sled fixation. Specimens were subjected to offset axial tension loading and tracked using high-resolution video. Clinical failure was defined as 2 mm of articular displacement. Findings There were statistically significant increases in mean stiffness (127% higher, P = 0.0007) and mean force to clinical failure (52% higher, P = 0.0002) with the Medial malleolar sled. The mean stiffness in offset tension loading was 232 (SD 83) N/mm for Medial malleolar sled and 102 (SD 20) N/mm for parallel unicortical cancellous screws. The mean force to clinical failure was 595 (SD 112) N for Medial malleolar sled and 392 (SD 34) N for unicortical screws. In addition, the Medial malleolar sled demonstrated elastic recoil to pre-testing alignment while the unicortical screws did not. Interpretation Medial malleolar sled fixation was significantly stiffer and required more force to clinical failure than parallel unicortical cancellous screws. A Medial malleolar sled requires more dissection to apply surgically, but provides significantly more initial fixation strength. Additionally, a Medial malleolar sled acts like a tension band in its ability to capture comminuted fragments while being low profile enough to minimize soft tissue irritation.
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antiglide plating of vertical Medial Malleolus fractures provides stiffer initial fixation than bicortical or unicortical screw fixation
Clinical Biomechanics, 2016Co-Authors: Adam M Wegner, Philip R Wolinsky, Michael A Robbins, Tanya C Garcia, Sukanta Maitra, Derek F AmanatullahAbstract:Abstract Background Vertical shear fractures of the Medial Malleolus (44-A2 ankle fractures) occur through a supination–adduction mechanism. There are numerous methods of internal fixation for this fracture pattern. Methods Vertical Medial Malleolus osteotomies were created in synthetic distal tibiae. The models were divided into four fixation groups: two parallel unicortical cancellous screws, two divergent unicortical cancellous screws, two parallel bicortical cortical screws, or an antiglide plate construct. Specimens were subjected to offset axial loading and tracked using high-resolution video. Findings The antiglide plate construct was stiffer ( P P P Interpretation An antiglide plate construct provides the stiffest initial fixation while withstanding higher load to failure for vertical Medial Malleolus fractures when compared to unicortical and bicortical screw fixation.
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effect of mini fragment fixation on the stabilization of Medial Malleolus fractures
Journal of Trauma-injury Infection and Critical Care, 2012Co-Authors: Derek F Amanatullah, Erik Mcdonald, Adam Shellito, Shain Lafazan, Alejandro Cortes, Shane Curtiss, Philip R WolinskyAbstract:BACKGROUND:Oblique fractures of the Medial Malleolus can arise from the application of axial force at various anatomic positions of the ankle, including supination-external rotation, pronation-external rotation, or pronation abduction. Although a variety of techniques exist to provide fixation of ho
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An alternative fixation technique for small Medial Malleolus fractures.
Orthopedics, 2010Co-Authors: Derek F Amanatullah, Philip R WolinskyAbstract:A contoured Medial Malleolus T-plate provides a simple alternative to tension banding and allows for fixation of small fragments that may not be accessible by more routine screw configurations.
Michael A Robbins - One of the best experts on this subject based on the ideXlab platform.
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headless compression screw fixation of vertical Medial Malleolus fractures is superior to unicortical screw fixation
American journal of orthopedics, 2018Co-Authors: Adam M Wegner, Philip R Wolinsky, Michael A Robbins, Tanya C Garcia, Sukanta Maitra, Derek F AmanatullahAbstract:: This study is the first biomechanical research of headless compression screws for fixation of vertical shear fractures of the Medial Malleolus, a promising alternative that potentially offers several advantages for fixation. Vertical shear fractures were simulated by osteotomies in 20 synthetic distal tibiae. Models were randomly assigned to fixation with either 2 parallel cancellous screws or 2 parallel Acutrak 2 headless compression screws (Acumed). Specimens were subjected to offset axial loading to simulate supination-adduction loading and tracked using high-resolution video. The headless compression screw construct was significantly stiffer (P < .0001) (360 ± 131 N/mm) than the partially threaded cancellous screws (180 ± 48 N/mm) and demonstrated a significantly increased (P < .0001) mean load to clinical failure (719 ± 91 N vs 343 ± 83 N). When specimens were displaced to 6 mm and allowed to relax, the headless compression screw constructs demonstrated an elastic recoil and were reduced to the pretesting fragment alignment, whereas the parallel cancellous screw constructs remained displaced. Along with the headless design that may decrease soft tissue irritation, the increased stiffness and elastic recoil of the headless compression screw construct offers improved fixation of Medial Malleolus vertical shear fractures over the traditional methods.
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sled fixation for horizontal Medial Malleolus fractures
Clinical Biomechanics, 2017Co-Authors: Adam M Wegner, Robin Z Cheng, Philip R Wolinsky, Michael A Robbins, Tanya C Garcia, Derek F AmanatullahAbstract:Abstract Background Horizontal fractures of the Medial Malleolus occur through exertion of various rotational forces on the ankle, including supination-external rotation, pronation-external rotation, and pronation-abduction. Many methods of fixation are employed for these fractures, but the optimal fixation construct remains unclear. Methods Horizontal Medial Malleolus osteotomies were performed in synthetic distal tibiae and randomized into two fixation groups: 1) two parallel unicortical cancellous screws or 2) Medial malleolar sled fixation. Specimens were subjected to offset axial tension loading and tracked using high-resolution video. Clinical failure was defined as 2 mm of articular displacement. Findings There were statistically significant increases in mean stiffness (127% higher, P = 0.0007) and mean force to clinical failure (52% higher, P = 0.0002) with the Medial malleolar sled. The mean stiffness in offset tension loading was 232 (SD 83) N/mm for Medial malleolar sled and 102 (SD 20) N/mm for parallel unicortical cancellous screws. The mean force to clinical failure was 595 (SD 112) N for Medial malleolar sled and 392 (SD 34) N for unicortical screws. In addition, the Medial malleolar sled demonstrated elastic recoil to pre-testing alignment while the unicortical screws did not. Interpretation Medial malleolar sled fixation was significantly stiffer and required more force to clinical failure than parallel unicortical cancellous screws. A Medial malleolar sled requires more dissection to apply surgically, but provides significantly more initial fixation strength. Additionally, a Medial malleolar sled acts like a tension band in its ability to capture comminuted fragments while being low profile enough to minimize soft tissue irritation.
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antiglide plating of vertical Medial Malleolus fractures provides stiffer initial fixation than bicortical or unicortical screw fixation
Clinical Biomechanics, 2016Co-Authors: Adam M Wegner, Philip R Wolinsky, Michael A Robbins, Tanya C Garcia, Sukanta Maitra, Derek F AmanatullahAbstract:Abstract Background Vertical shear fractures of the Medial Malleolus (44-A2 ankle fractures) occur through a supination–adduction mechanism. There are numerous methods of internal fixation for this fracture pattern. Methods Vertical Medial Malleolus osteotomies were created in synthetic distal tibiae. The models were divided into four fixation groups: two parallel unicortical cancellous screws, two divergent unicortical cancellous screws, two parallel bicortical cortical screws, or an antiglide plate construct. Specimens were subjected to offset axial loading and tracked using high-resolution video. Findings The antiglide plate construct was stiffer ( P P P Interpretation An antiglide plate construct provides the stiffest initial fixation while withstanding higher load to failure for vertical Medial Malleolus fractures when compared to unicortical and bicortical screw fixation.