Medial Malleolar Fixation: Sex Appeal Long 3.5 mm screws Bob Zura, - - PowerPoint PPT Presentation

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Medial Malleolar Fixation: Sex Appeal Long 3.5 mm screws Bob Zura, - - PowerPoint PPT Presentation

Nov 17, 2023 209 likes •421 views

Medial Malleolar Fixation: Sex Appeal Long 3.5 mm screws Bob Zura, MD LSU Health New Orleans OSET 2017 Las Vegas Acknowledge Bill Ricci Disclosures Consultant: Smith-Nephew Bioventus Cardinal Health

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SLIDE 1

Medial Malleolar Fixation: Sex Appeal – Long 3.5 mm screws

Bob Zura, MD LSU Health New Orleans OSET 2017 Las Vegas

Acknowledge Bill Ricci

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SLIDE 2

Disclosures

  • Consultant:

– Smith-Nephew – Bioventus – Cardinal Health

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SLIDE 3

TRANSVERSE FRACTURE PATTERNS

http://images.fanpop.com/images/image_uploads/Las-Vegas-united-states-of- america-697059_726_491.jpg

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SLIDE 4

Transverse Fracture Fixation

  • Typically 2

screws

  • Tension Band
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SLIDE 5

NOT VERTICAL FRACTURE PATTERNS

http://1g1uem2nc4jy1gzhn943ro0gz50.wpengine.netdna- cdn.com/wp-content/uploads/2009/11/vegas_strip.jpg

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SLIDE 6

Vertical Fracture

  • Anti-glide plate
  • Lag screws
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SLIDE 7
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SLIDE 8

Transverse Fracture Fixation

  • Typically 2

screws

  • Tension Band
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SLIDE 9

Transverse Fracture Fixation

  • Typically 2

screws

  • Tension Band
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SLIDE 10

What is Best Length?

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SLIDE 11

Or – The New Gold Standard

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SLIDE 12

Objectives

Compare medial malleolar screw fixation methods

Biomechanical Evaluation Radiographic & Clinical Evaluation

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SLIDE 13

Biomechanics

Matched pair human cadavers MM Osteotomy 3.5 mm FT Cortical 4.0 mm PT Cancellous 70 mm – 100 mm 45 mm

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SLIDE 14

Biomechanics

  • Screws inserted until

stripped

– Maximum insertion torque measured

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SLIDE 15

Biomechanics - Results

0.00 5.00 10.00 15.00 20.00 1 2 3 4 5 6

in-lbf

4.0 PT 3.5 FT

3.9 in-lpf 14.4 in-lpf >3.5 x increase P<0.0002

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SLIDE 16

Cohorts

N=25 N=64

Age Gender DM Isolated Medial Malleolus Fx’s Bimalleolar Fx’s Syndesmotic Injuries

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SLIDE 17

Results

N=25 1 (4%) N=64 12 (19%) 1 ROH Radiographic Loosening

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SLIDE 18

Results

N=25 N=64 2 Non-Union

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SLIDE 19

Study Conclusions

  • Bicortical lag screws

–Preferred method

  • Technically easy
  • Requires long screws

–Average 80 mm

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SLIDE 20

Thank You!