Fibula

Impingement by the distal fascicle of the anterior inferior tibiofibular ligament (AITFL) is a relatively new entity among the known causes of anterolateral impingement syndromes of the ankle. This study investigated the anatomy of the anterior inferior tibiofibular ligament and its possible role in talar impingement in 47 ankles of 27 cadavers. The length, width, insertion point to the fibula and the interactions with talus were noted, as was the relationship of the fascicle and talus during different ankle movements before and after incision of the lateral ligaments. A distal fascicle of the AITFL was found in 39 of the 47 ankles (83%) and appeared as a single-complete ligament in the remaining 8 ankles (17%). The fascicle averaged 16.1±2.94 mm in length (range 10–21) and 4.2±1.00 mm in width (range, 3–7). The insertion point of the fascicle on the fibula averaged 10.3±2.27 mm (5–13) distal to the joint level. Contact between the ligament and the lateral dome of the talus was observed in 42 specimens (89.3%). Bending of the fascicle was observed in 8 of these 42 ankles with forced dorsiflexion. These 8 specimens were significantly wider and longer than the specimens without bending of the fascicle. Incision of the anterior talofibular ligament led to bending in dorsiflexion in additional 11 ankles. The total 19 fascicles with bending after incision of the anterior talofibular ligament were significantly longer and inserted more distally than the remaining 20 fascisles without bending. Manual traction simulating distraction during arthroscopic procedures relieved the contact. These findings show that the presence of the distal fascicle of the AITFL and its contact with the talus is a normal finding. However, it may become pathological due to anatomical variations and/or instability of the ankle resulting from torn lateral ligaments. When observed during an ankle arthroscopy, the surgeon should look for the criteria described in the present study to decide whether it is pathological and needs to be resected.

Bones adapt to prevalent loading, which comprises mainly forces caused by muscle contractions. Therefore, we hypothesized that similar associations would be observed between neuromuscular performance and rigidity of bones located in the same body segment. These associations were assessed among 221 premenopausal women representing athletes in high-impact, odd-impact, high-magnitude, repetitive low-impact, and repetitive nonimpact sports and physically active referents aged 17–40 years. The whole group mean age and body mass were 23 (5) and 63 (9) kg, respectively. Bone cross sections at the tibial and fibular mid-diaphysis were assessed with peripheral quantitative computed tomography (pQCT). Density-weighted polar section modulus (SSI) and minimal and maximal cross-sectional moments of inertia (Imin, Imax) were analyzed. Bone morphology was described as the Imax/Imin ratio. Neuromuscular performance was assessed by maximal power during countermovement jump (CMJ). Tibial SSI was 31% higher in the high-impact, 19% in the odd-impact, and 30% in the repetitive low-impact groups compared with the reference group (P < 0.005). Only the high-impact group differed from the referents in fibular SSI (17%, P < 0.005). Tibial morphology differed between groups (P = 0.001), but fibular morphology did not (P = 0.247). The bone-by-group interaction was highly significant (P < 0.001). After controlling for height, weight, and age, the CMJ peak power correlated moderately with tibial SSI (r = 0.31, P < 0.001) but not with fibular SSI (r = 0.069, P = 0.313). In conclusion, observed differences in the association between neuromuscular performance and tibial and fibular traits suggest that the tibia and fibula experience different loading environments despite their anatomical vicinity.

The lateral ligaments of talocrural articulation, namely anterior talofibular liga- ment, posterior talofibular ligament and cal- caneofibular ligament, are important in an- atomic reconstruction. If reconstructed improperly, they are known to limit the movements of talocrural articulation and sub- talar articulation (talocalcaneal articulation) Studies on anatomy of anterior talofibular lig- ament, posterior talofibular ligament and cal- caneofibular ligament known as the lateral ligaments have some discrepancies. Knowing

Osteoporotic bone with poor mechanical capacity provides limited stability after fixation of ankle fractures. Stabilization with an implant providing increased fixation strength in osteoporotic bone could reduce failure rates of fixation and allow a more functional treatment. The purpose of this study was to evaluate a locking contoured plate for fixation of distal fibular fractures in comparison with a conventional contoured plate in an osteoporotic bone model. Eighty cylinders of osteoporotic bone surrogates were fixed with the two plates. We performed torque-to-failure and cyclic testing experiments using screws of different length with a Zwick/Roell testing machine. The locking system showed higher torque-to-failure and maximum torque levels as compared with the conventional plate in torque-to-failure experiments and torsional cyclic testing. The locking contoured plate provides improved fixation strength in the osteoporotic bone model. The locking system may be appropriate for ...

&amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp;Straps and Trains m the Viking Age: Birka&#39;s Female Costume in a New Light Since 1938, when Agnes Geijer presented her theories on female costume in the Viking town of Birka (1), scholars and illustrators have generally worked on the basis of the same elements. The Finnish-Baltic hurstut dress was the model for the reconstruction attempts, and compared with the female figures from the Gotlandic picture-stones and small bronze and silver figures, two main forms of costume reconstruction have resulted (fig. 1). In 1974, Inga Hägg published her doctoral thesis, Kvinnodräkten i Birka, which is a new study of the Birka material seen from the viewpoint of costume history, With this thesis the Birka textiles have in an exemplary manner been made accessible to others for evaluation and possibly new interpretations (2). Fig. 2 shows an attempt at a visual presentation of Inga Hägg&#39;s theory, in which the strapped dress, in relation to earlier reconstructions, is completely closed, and two new garments, the tunic and the kaftan, have been added. A common feature of all the reconstructions is the idea of the shift as a long train-like garment. Most scholars, including I. Hägg, (3) have found support of this idea in their interpretation of the contemporary illustrations. Fig. 3 reproduces the best known, and, in this connection, most significant figurative representations. Clearly, all the figures, except for f, bear a train, but the train seems to be formed of different garments. The figures d and g show unbroken lines from the front of the woman and to the back in a train. Only a little triangle of the undergarment remains visible in front. On top of these two garments, a sort of shirt is worn. In fig. e, the lines leading to the back are interrupted in the train with a hanging length of cloth in front. In fig. f, h, and i, the train hangs down from the shoulder area and not from the front of the woman, as for the figures mentioned earlier. The silver figure f clearly shows a shoulder train, in front of which hangs a length of cloth, and an undergarment may be discerned. In fig. h and i, there is a train which, especially in i, is clearly worn on top of another garment with ornamental borders (see fig. 4). In both cases, and seemingly also in c, a garment hangs down in front, but is not as long as the train. Finally, on the front of the gold game-piece, fig. j, there is a hanging garment (4). These examples show that the normal interpretation, with the long trailing shift, can at the most find support in fig. d and e, which are dated to the 8th century. Not one of the figures provides proof for the type of reconstruction showing a strapped gown with an opening in one side. Fig. f clearly shows a rear part which extends higher up the back than a strapped gown would do; the front and the train of fig. h and i vary in length, which invalidates the idea that the two pieces belong together as one garment. It is also worth­while remarking that there seem to be two different types of trains: first, d, e, and g, which are fastened at same place on the woman&#39;s breast, and which open in front at the bottom when she walks; second, f,h, and i, which hang freely from the shoulders. These differences from the usual reconstructions provided the impetus to seek other possible reconstructions of the Viking Age strapped gown (5). Inga Hägg&#39;s treatise forms the basis for the analysis in connection with a new theory, and certain published finds, from Vernes, Norway, Barshalder, Sweden, and Kjuloholm, Finland, have also been taken into consideration. THE STRAPS The tortoise-shaped fibulae m the women&#39;s graves of Birka contain well-preserved fragments of the straps which held up the gown or gowns. As apparent in fig. 5 a-b, the lower straps come from the garments at the wearer&#39;s front. In cases where the cloth from the upper edge of the gown has been preserved, it is usually placed within the edge of the fibula. The fragments of straps at the top of the tortoise-shape fibulae usually extend all the way to the edge of the fibula and probably fastened one or more garments at the woman&#39;s back. The straps were primarily intended to hold up the garments, but certain straps, which at the bottom extend all the way to the edge of the fibula, or which are of a different material, may be interpreted as bands from which scissors, knives, and keys were hung. Formerly, only two strap combinations were considered, namely: one strap below and above; and two straps below and above. Inga Hägg, who also considers only these two combinations, attributes the uneven number of straps to poor conditions of preservation. Study of all the data from the graves with tortoiseshaped fibulae resulted in the identification of four strap combinations, as shown by fig. 5 b and the diagrams in fig. 6 (6). With this categorization, we can greatly reduce the number of cases of missing straps in…

In a series of 126 consecutive pilon fractures, we have described anatomically explicable fragments. Fracture lines describing these fragments have revealed ten types of pilon fracture which belong to two families, sagittal and coronal. The type of fracture is dictated by the energy of injury, the direction of the force of injury and the age of the patient.

Treatment of the loss of the distal part of the radius, including the physis and epiphysis, in a skeletally immature patient requires both replacement of the osseous defect and restoration of longitudinal growth. Autologous vascularized epiphyseal transfer is the only possible procedure that can meet both requirements. Between 1993 and 2002, six patients with a mean age of 8.4 years (range, six to eleven years) who had a malignant bone tumor in the distal part of the radius underwent microsurgical reconstruction of the distal part of the radius with a vascularized proximal fibular transfer, including the physis and a variable length of the diaphysis. All of the grafts were supplied by the anterior tibial vascular network. The rate of survival and bone union of the graft, the growth rate per year, the ratio between the lengths of the ulna and the reconstructed radius, and the range of motion of the wrist were evaluated for five of the six patients who had been followed for three year...

We present a novel technique of intramedullary fixation of the fibula using a humeral guide wire as an adjunct to tibial fixation, in the setting of tibial shaft fracture. Not only does this technique aid in determining length, alignment, and rotation of the tibial fracture, but it may also help the support of the lower extremity as whole by stabilizing the lateral column. In addition, this technique can be used to help maintain reduction of the fibula when there is concern for the soft tissues of the lower extremity secondary to swelling or injury. Our clinical case series demonstrates this safe, effective, and cost-sensitive technique to be used in the treatment of select concurrent fractures of the tibia and fibula.

BACKGROUND Distal radius reconstruction after en bloc tumor resection remains a surgical challenge. Although several surgical techniques, either reconstructing the wrist or achieving a stable arthrodesis, have been described, it is unclear to what degree these restore function. DESCRIPTION OF TECHNIQUE: We describe an updated technique making use of a tibia cortical strut autograft (TCSA) to perform a functional arthrodesis from the remaining radius to the first carpal row. This, in theory, could lead to less donor site morbidity while resulting in a stable but functional and pain-free arthrodesis of the wrist. METHODS: Between 1987 and 2010 we reconstructed the wrists of 17 patients using a TCSA arthrodesis (six primary and three revisions), seven with an osteoarticular allograft, three using an ulnar translocation, and one with a fibula autograft. Median age at diagnosis was 24 years (range, 9-58 years) and minimum followup was 2.7 years (median, 13.8 years; range, 2.7-24.5 years)...

The aim of the present study was to compare the biomechanical effects of different lengths of implants in an immediate loading condition in mandibular and fibular bone. Three-dimensional (3D) nonlinear finite element analysis (FEA) was used to examine the complex irregular structures. The variables of this research were the two different bone types (mandible and fibula) and three different implant lengths. Simplified half models were constructed for 3D FEA. Three different implant lengths (6 mm, 10 mm, and 15 mm) were inserted into the mandibular and fibular bone models, which were made to simulate immediate implant loading conditions. A load of 125 N was applied to the center of the suprastructure at a 45-degree angle relative to the long axis of the implant, and the resultant maximum von Mises equivalent (EQV) stresses, stress distribution, strain energy, and micromotion were measured. In the mandible, the maximum EQV stresses were 115.636 MPa, 155.943 MPa, and 157.105 MPa with th...

Syndesmosis sprains can contribute to chronic pain and instability, which are often indications for surgical intervention. The literature lacks sufficient objective data detailing the complex anatomy and localized osseous landmarks essential for current surgical techniques. To qualitatively and quantitatively analyze the anatomy of the 3 syndesmotic ligaments with respect to surgically identifiable bony landmarks. Descriptive laboratory study. Sixteen ankle specimens were dissected to identify the anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), interosseous tibiofibular ligament (ITFL), and bony anatomy. Ligament lengths, footprints, and orientations were measured in reference to bony landmarks by use of an anatomically based coordinate system and a 3-dimensional coordinate measuring device. The syndesmotic ligaments were identified in all specimens. The pyramidal-shaped ITFL was the broadest, originating from the distal interosseou...