Deltoid bağ rüptürü olan tip 4 supinasyon dış rotasyon ayak bileği yaralanmalarında çeşitli tedavi seçeneklerinin talus üzerine etkisinin biyomekanik olarak incelenmesi: Sonlu elemanlar analizi

Abstract

Amaç: Bu çalışmanın amacı supinasyon dış rotasyon (SER) yaralanması ve deltoid yırtığı olan ayak bileğinde belirli bir yük altında talusta meydana gelen rotasyon, gerilme ve deformasyonun çeşitli fiksasyon yöntemleri ile biyomekanik olarak incelenmesidir. Yöntem: Sağlıklı bir bireyin ayak bileği sonlu elemanlar yöntemine (FEM) dayalı bir paket program yardımıyla incelendi. Ardından SER yaralanma modeli oluşturuldu. Lateral malleol plak vida ile sabitlendi ve ayak bileği uyumu için farklı onarım modelleri oluşturuldu. Analiz bölümünde literatürden elde edilen kuvvetler sağlıklı ve tamir edilmiş modellere uygulanmıştır. Yapılan analizler sonucunda yamaç talusunda oluşan mekanik değerler elde edilmiştir. Bulgular: Bu çalışma sonucunda, (sırasıyla) deltoid bağ tamiri, sütür butten sindesmoz fiksasyonu, transfiksasyon vidası ile sindesmoz fiksasyonu, sütür buton fiksasyonu + deltoid bağ tamiri ve transfiksasyon vidası + deltoid ile talusta meydana gelen mekanik değişiklikler deltoid bağ rüptürü ile SER tip 4 yaralanma modelinde bağ onarımı değerlendirildi. Sonuç: Bu çalışma, deltoid bağ rüptürü ile seyreden SER tip 4 ayak bileği yaralanmalarının tedavisinde deltoid bağ onarımı ile birlikte sindesmoz vidası uygulamasının talus üzerindeki gerileme, yer değiştirme ve talus rotasyonlarını neredeyse normale yakın yaptığını göstermiştir. Ayrıca sindesmoz tespit vidası uygulamaları, sindesmoz tespit dikiş düğmesi uygulamalarına göre daha iyi sonuç vermektedir.

Keywords

• biyomekanik
• sonlu elemanlar metodu
• talus
• sindesmoz fiksasyonu
• syndesmosis fixation

Biomechanical investigation of the effects of various treatment options on the talus in supination external rotation type 4 ankle injuries with ruptured deltoid ligament: Finite element analysis

Abstract

Purpose: The purpose of this study is the biomechanical investigation of the rotation, stress and deformation caused in the talus, under a specific load, by various fixation methods in ankle which has supination external rotation (SER) injury and deltoid rupture. Method: Ankle of a healthy individual was analyzed with the help of a package program which was based on finite elements method (FEM). Then, SER injury model was created. Lateral malleolar plate was fixed with a screw and created different repair models for ankle fit. In the analysis section, forces obtained from the literature were applied to the healthy and repaired models. As the result of the analyses, mechanical values which occured in the talus were obtained. Results: As a result of this study, mechanical changes in talus, which were caused by, (in order) deltoid ligament repair, suture button syndesmosis fixation, syndesmosis fixation with transfixation screw, suture button fixation + deltoid ligament repair and transfixation screw + deltoid ligament repair in the SER type 4 injury model with deltoid ligament rupture, were evaluated. Conlusion: This study showed that the application of syndesmosis screw together with deltoid ligament repair in the treatment of SER type 4 ankle injuries with rupture of deltoid ligament made regression, displacement and talus rotations on the talus almost normal. In addition, syndesmosis fixation screw applications give better results than syndesmosis fixation suture button applications.

Keywords

• finite element method
• syndesmosis fixation
• biomechanics
• talus

References

1. 1. Fenelon C, Galbraith JG, Fahey T, Kearns SR. The Operative Treatment of Ankle Fractures: A 10-Year Retrospective Study of 1529 Patients. J Foot Ankle Surg 2021;60(4):663-668. doi:10.1053/j.jfas.2020.03.026.
2. 2. Warner SJ, Garner MR, Hinds RM, Helfet DL, Lorich DG. Correlation Between the Lauge-Hansen Classification and Ligament Injuries in Ankle Fractures. J Orthop Trauma 2015;29(12):574-8. doi:10.1097/BOT.0000000000000393.
3. 3. Kosuge DD, Mahadevan D, Chandrasenan J, Pugh H. Managing type II and type IV Lauge-Hansen supination external rotation ankle fractures: current orthopaedic practice. Ann R Coll Surg Engl 2010;92(8):689-92. doi:10.1308/rcsann.2010.92.8.689.
4. 4. Han SM, Wu TH, Wen JX, Wang Y, Cao L, Wu WJ, Gao BL. Radiographic analysis of adult ankle fractures using combined Danis-Weber and Lauge-Hansen classification systems. Sci Rep 2020;10(1):7655. doi:10.1038/s41598-020-64479-2. 5. Martijn HA, Lambers KTA, Dahmen J, Stufkens SAS, Kerkhoffs GMMJ. High incidence of (osteo)chondral lesions in ankle fractures. Knee Surg Sports Traumatol Arthrosc 2021;29(5):1523-1534. doi:10.1007/s00167-020-06187-y.
5. 6. Boraiah S, Paul O, Parker RJ, Miller AN, Hentel KD, Lorich DG. Osteochondral lesions of talus associated with ankle fractures. Foot Ankle Int 2009 ;30(6):481-485. doi:10.3113/FAI.2009.0481.
6. 7. Gougoulias N, Sakellariou A. When is a simple fracture of the lateral malleolus not so simple? how to assess stability, which ones to fix and the role of the deltoid ligament. Bone Joint J 2017;99-B(7):851-855. doi:10.1302/0301-620X.99B7.BJJ-2016-1087.R1.
7. 8. Salameh M, Alhammoud A, Alkhatib N, Attia AK, Mekhaimar MM, D'Hooghe P, Mahmoud K. Outcome of primary deltoid ligament repair in acute ankle fractures: a meta-analysis of comparative studies. Int Orthop 2020;44(2):341-347. doi:10.1007/s00264-019-04416-9.
8. 9. Guo W, Lin W, Chen W, Pan Y, Zhuang R. Comparison of deltoid ligament repair and non-repair in acute ankle fracture: A meta-analysis of comparative studies. PLoS One 2021;16(11). doi:10.1371/journal.pone.0258785.

9. 10. van den Bekerom MP, Mutsaerts EL, van Dijk CN. Evaluation of the integrity of the deltoid ligament in supination external rotation ankle fractures: a systematic review of the literature. Arch Orthop Trauma Surg 2009;129(2):227-35. doi:10.1007/s00402-008-0768-6.
10. 11. Maynou C, Lesage P, Mestdagh H, Butruille Y.[Is surgical treatment of deltoid ligament rupture necessary in ankle fractures?. Rev Chir Orthop Reparatrice Appar Mot 1997;83(7):652-657.
11. 12. Strömsöe K, Höqevold HE, Skjeldal S, Alho A. The repair of a ruptured deltoid ligament is not necessary in ankle fractures. J Bone Joint Surg Br 1995;77(6):920-921.
12. 13. Bastias GF, Filippi J. Acute Deltoid Ligament Repair in Ankle Fractures. Foot Ankle Clin 2020;25(4):597-612. doi:10.1016/j.fcl.2020.08.009.
13. 14. Wang J, Stride D, Horner NS, Petrisor B, Johal H, Khan M, Alolabi B. The Role of Deltoid Ligament Repair in Ankle Fractures With Syndesmotic Instability: A Systematic Review. J Foot Ankle Surg 2021;60(1):132-139. doi:10.1053/j.jfas.2020.02.014.
14. 15. Güvercin Y, Abdioğlu AA, Dizdar A, Uzun Yaylacı E, Yaylacı M. Suture button fixation method used in the treatment of syndesmosis injury: A biomechanical analysis of the effect of the placement of the button on the distal tibiofibular joint in the mid-stance phase with finite elements method. Injury 2022. doi.10.1016/j.injury.2022.05.037.
15. 16. Güvercin Y, Yaylacı M, Dizdar A, Kanat A, Uzun Yaylacı E, Ay S, Abdioğlu AA, Şen A. Biomechanical analysis of odontoid and transverse atlantal ligament in humans with ponticulus posticus variation under different loading conditions: finite element study. Injury 2022;53:3879-3886. doi.10.1016/j.injury.2022.10.003.
16. 17. Güvercin Y, Yaylacı M, Ölmez H, Uzun Yaylacı E, Özdemir ME, Dizdar A. Finite element analysis of the mechanical behavior of the different angle hip femoral stem. BME 2022;6(1): 29-46. doi.10.12989/bme.2022.6.1.029.
17. 18. Mimics Innovation Suite 24.0 (Materialise, Belgium, Leuven)
18. 19. 3-Matic 16.0 ((Materialise, Belgium, Leuven)
19. 20. ANSYS 16.0, (2016). Swanson Analysis Systems Inc., Houston PA, USA.
20. 21. Ramlee MH, Kadir MR, Murali MR, Kamarul T. Finite element analysis of three commonly used external fixation devices for treating Type III pilon fractures. Med Eng Phys 2014;36(10):1322-1330. doi.org/10.1016/j.medengphy.
21. 22. Cheung JT, Zhang M, Leung AK, Fan YB. Three-dimensional finite element analysis of the foot during standing a material sensitivity study. J Biomech 2005;38(5):1045-1054. doi.org/10.1016/j.jbiomech.
22. 23. St Pierre RK, Rosen J, Whitesides TE, Szczukowski M, Fleming LL, Hutton WC. The tensile strength of the anterior talofibular ligament. Foot Ankle 1983;4(2):83-85. doi:10.1177/107110078300400208.
23. 24. Attarian DE, McCrackin HJ, DeVito DP, McElhaney JH, Garrett WE. Biomechanical characteristics of human ankle ligaments. Foot Ankle 1985;6(2):54-58. doi:10.1177/107110078500600202.
24. 25. Siegler S, Block J, Schneck CD. The mechanical characteristics of the collateral ligaments of the human ankle joint. Foot Ankle 1988;8(5):234-42. doi:10.1177/107110078800800502.
25. 26. Colville MR, Marder RA, Boyle JJ, Zarins B. Strain measurement in lateral ankle ligaments. Am J Sports Med 1990;18(2):196-200. doi:10.1177/036354659001800214.
26. 27. Terzi M, Güvercin Y, Ateş SM, Sekban DM, Yaylacı M. Effect of different abutment materials on stress distrıbution in peripheral bone and dental implant system. Sigma J Eng Nat Sci 2020;38(3):1495-1507.
27. 28. Tu YK, Liu YÇ, Yang WJ, Chen LW, Hong YY, Chen YC, et al. Temperature Rise Simulation During a Kirschner Pin Drilling in Bone, 2009 3rd Int. Con on Bioinformatics and Biomedical Eng 2009;1-4, doi:10.1109/ICBBE.2009.5163563.
28. 29. Guan M, Zhao J, Kuang Y, Li G, Tan J. Finite element analysis of the effect of sagittal angle on ankle joint stability in posterior malleolus fracture: A cohort study. Int J Surg 2019;70:53-59. doi:10.1016/j.ijsu.2019.08.022.
29. 30. Atmaca H, Özkan A. Assessment of changes in the loading of menisci femur structural deformities. Sakarya Medical Journal doi:10.5505/sakaryamj.2013.52523.
30. 31. Alastuey-López D, Seral B, Pérez MÁ. Biomechanical evaluation of syndesmotic fixation techniques via finite element analysis: Screw vs. suture button. Comput Methods Programs Biomed 2021. doi:10.1016/j.cmpb.2021.106272.
31. 32. Haraguchi N, Armiger RS, Myerson MS, Campbell JT, Chao EY. Prediction of three-dimensional contact stress and ligament tension in the ankle during stance determined from computational modeling. Foot Ankle Int 2009;30(2):177-185. doi:10.3113/FAI-2009-0177.
32. 33. Liu Q, Zhao G, Yu B, Ma J, Li Z, Zhang K. Effects of inferior tibiofibular syndesmosis injury and screw stabilization on motion of the ankle: a finite element study. Knee Surg Sports Traumatol Arthrosc 2016;24(4):1228-1235. doi:10.1007/s00167-014-3320-y.
33. 34. Whitlock KG, LaRose M, Barber H, Fletcher A, Cunningham D, Menken L, Yoon RS, Gage MJ. Deltoid ligament repair versus trans-syndesmotic fixation for bimalleolar equivalent ankle fractures. Injury 2022;53(6):2292-2296. doi:10.1016/j.injury.2022.03.063.
34. 35. Goetz JE, Davidson NP, Rudert MJ, Szabo N, Karam MD, Phisitkul P. Biomechanical comparison of syndesmotic repair techniques during external rotation stress. Foot Ankle Int 2018;39(11):1345-1354. doi:10.1177/1071100718786500.
35. 36. Butler BA, Hempen EC, Barbosa M, Muriuki M, Havey RM, Nicolay RW, Kadakia AR. Deltoid ligament repair reduces and stabilizes the talus in unstable ankle fractures. J Orthop 2019;17:87-90. doi:10.1016/j.jor.2019.06.005.
36. 37. Özcan S, Koçkara N, Camurcu Y, Yurten H. Magnetic resonance ımaging and outcomes of osteochondral lesions of the talus associated with ankle fractures. Foot Ankle Int 2020;41(10):1219-1225. doi:10.1177/1071100720937243.