Academic literature on the topic 'Distal tibiofibular joint'

Objective: To determine percentages of types A (flat) and B (concave) of the distal tibiofibular joint in patients with ankle fractures or chronic ligament instabilities, with syndesmosis lesions; check the shape of the fixation and position of the fibula in this joint; to identify poor fibular reduction and its frequency in types A and B; patients according to the AOFAS criteria. Methods: 104 patients surgically treated with syndesmosis fixation underwent clinical evaluation using AOFAS functional criteria and tomographic exams to classify the distal tibiofibular joint in types A or B and evaluated the poor position of the fibula in this joint. Results: Distal tibiofibular joint type A was present in 27 ankles and type B in 77. Non-anatomical reduction of the fibula (17 ankles) was more frequent in type A than in type B and more frequent in fractures than in instabilities. The AOFAS score was 91.79 points in the 87 patients with good reduction and 86.76 points in the 17 patients with poor fibula reduction. Conclusion: Distal tibiofibular joint type B was more frequent than type A (p=0.00001); there was poor reduction of the fibula in this joint in 17 ankles (16.34%). Poor fibula reduction was more frequent in fractures than in instabilities (p=0.006). The poor reduction was more constant in type A than in type B, without statistical significance (p=0.34). The AOFAS score was 91.79 points in patients with good reduction and 86.76 points in patients with poor fibula reduction in the distal tibiofibular joint. Level of Evidence IV; Therapeutic Studies; Case Series.

Background Rupture of the distal tibiofibular syndesmosis commonly occurs with extreme external rotation. Most studies of syndesmosis injuries have concentrated only on external rotation instability of the ankle joint and have not examined other defects. Hypothesis Syndesmosis injuries cause multidirectional ankle instability. Study Design Controlled laboratory study. Methods Ankle instability caused by distal tibiofibular syndesmosis injuries was examined using 7 normal fresh-frozen cadaveric legs. The anterior tibiofibular ligament, interosseous membrane, and posterior tibiofibular ligament, which compose the distal tibiofibular syndesmosis, were sequentially cut. Anterior, posterior, medial, and lateral traction forces, as well as internal and external rotation torque, were applied to the tibia; the diastasis between the tibia and fibula and the angular motion among the tibia, fibula, and talus were measured using a magnetic tracking system. Results A medial traction force with a cut anterior tibiofibular ligament significantly increased the diastasis from 1.1 to 2.0 mm ( P = .001) and talar tilt angles from 9.6° to 15.2° ( P < .001). External rotation torque significantly increased the diastasis from 0.5 to 1.8 mm ( P= .009) with a complete cut; external rotation torque also significantly increased rotational angles from 7.1° to 9.4° ( P = .05) with an anterior tibiofibular ligament cut. Conclusion Syndesmosis injuries caused ankle instability with medial traction force and external rotation torque to the tibia. Clinical Relevance Both physicians and athletes should be aware of inversion instability of the ankle joint caused by tibiofibular syndesmosis injuries.

Occult malunion of the ankle is a condition in which the talus appears to be situated in its normal position on standard radiographs. The lateral malleolus, however, is incompletely reduced. This causes a subluxation of the distal tibiofibular joint and some degree of talar instability. The malunion of the lateral malleolus is best visualized on lateral radiographs or tomograms. This condition can be corrected by osteotomizing the lateral malleolus and restoring the integrity of the distal tibiofibular joint by pulling the lateral malleolus distally and internally rotating it.

Osteochondroma is one of the most common benign bone tumor; however, the surgical treatment still remains a challenge for those that occur at the distal tibiofibular interosseous location. Previously, the transfibular approach has been successfully described, but the potential damage of the syndesmosis would give rise to the instability of the ankle joint and thus may result in the unfavorable long-term outcome. Here, a revised strategy which can protect the syndesmotic complex is introduced. From 2010 to 2017, eleven patients with the distal tibiofibular interosseous osteochondroma who underwent the revised surgery were collected. The distal fibular osteotomy and posterior tibial osteotomy were performed to keep the inferior syndesmosis intact for better stability of the ankle joint. Both the anterior tibiofibular ligaments (AITFL) and posterior tibiofibular ligaments (PITFL) have been preserved successfully, and thus, the stability of the ankle joint has been maintained due to our strategy. The VAS and AOFAS scores were utilized to assess the clinical outcome and function. Postoperatively, all the patients were pain-free and were able to wear the appropriate shoes at the last follow-up. Preoperative and postoperative AOFAS scores were 93.63±6.91 and 47.27±5.27 (P<0.05), respectively. Moreover, the average VAS score was 1.73±0.27 (compared with preoperative as 7.45±2.15, P<0.05), demonstrating obvious improvement after the operation. To our best knowledge, this is the first time to perform the resection of the distal tibial interosseous osteochondroma involving the fibula without interrupting the inferior syndesmotic complex especially the AITFL and PITFL. We believe that this strategy may pave a new way for optimized clinical outcome for these patients with distal tibiofibular interosseous osteochondroma. This clinical trial study is registered with number ChiCTR1900024690.

Hindfoot and distal leg neuropathic fracture collapse secondary to normal pressure hydrocephalus is a very rare clinical pathology. The authors present a case of a 69-year-old woman who sustained a distal tibiofibular fracture that resulted in a recurvatum deformity with idiopathic neuropathy and gait instability on initial presentation. A subtalar and ankle joint arthrodesis was performed achieving rectus alignment of the lower extremity with no postoperative complications. Her neuropathic etiology was negative for common causative factors, including diabetes, infection, nutritional deficiencies, congenital neuropathy, and trauma. Approximately 6 months postoperatively, the patient had persistent bilateral lower extremity weakness with the sensation of her “feet sticking to the floor” on ambulation. A referral to neurology revealed a normal pressure hydrocephalus as a possible etiology for her gait abnormalities and neuropathy. She required a ventriculoperitoneal shunt, with resolved gait disturbance and associated weakness approximately 1.5 years postoperatively. Levels of Evidence: Therapeutic, Level IV: Case report

BACKGROUND: The rupture of syndesmotic ligaments is treated with a screw fixation as the gold standard. An alternative is the stabilization with a TightRope®. A couple of studies investigated the different clinical outcome and some even looked at the stability in the joint, but none of them examined the occurring pressure after fixation. OBJECTIVE: Is there a difference in pressure inside the distal tibiofibular joint between a screw fixation and a TightRope®? Does the contact area differ in these two treatment options? METHODS: This biomechanical study aimed to investigate the differences in fixation of the injured syndesmotic ligaments by using a fixation with one quadricortical screw versus singular TightRope® both implanted 1 cm above the joint. By using 12 adult lower leg cadaveric specimens and pressure recording sensor, we recorded the pressure across the distal tibiofibular joint. Additionally we measured the contact surface area across the joint. RESULTS: The mean of the pressure across the distal tibiofibular joint from the start of the insertion of the fixation device to the complete fixation was 0.05 Pascal for the TightRope® and 0.1 for the screw (P= 0.016). The mean of the maximum pressure across the joint (after completion of fixation and releasing the reduction clamp) was 1.750 mega Pascal with the screw fixation and 0.540 mega Pascal with TightRope® (P= 0.008). The mean of the measured contact area of the distal tibiofibular joint after fixation was 250 mm2 in the TightRope® group and of 355 mm2 in the screw fixation (P= 0.123). CONCLUSIONS: The screw fixation is stronger and provides a larger surface contact area, which leads us to the conclusion that it provides a better stability in the joint. While previous clinical studies did not show significant clinical difference between the two methods of fixation, the biomechanical construct varied. Long term clinical studies are required to establish whether this biomechanical distinction will contribute to various clinical outcomes.

RESUMO: A entorse do tornozelo é uma das lesões músculo-esqueléticas mais comuns. A limitação da amplitude de dorsiflexão tem sido demonstrada como uma das consequências desta lesão, bem como um dos factores contribuintes para a recorrência. Vários estudos têm demonstrado que o membro lesado de indivíduos com história de entorse, apresenta uma falha posicional anterior do peróneo. Um estudo realizado em cadáveres revelou que um deslizamento póstero-superior ao nível da articulação tibioperoneal inferior pode contribuir para aumentar a amplitude de dorsiflexão. Está descrita uma técnica de terapia manual que realiza o deslizamento póstero-superior do maléolo lateral associada ao movimento activo de flexão dorsal (MWM). No entanto, não existe, até à data, nenhum estudo que investigue a efectividade desta MWM em indivíduos com limitação da FD e história de entorse unilateral do tornozelo. Desenho de estudo: Ensaio clínico aleatorizado e controlado por placebo, duplamente cego. Objectivos: Avaliar os efeitos imediatos da MWM na articulação tibio-peroneal inferior na amplitude de flexão dorsal e no deslizamento posterior do astrágalo em indivíduos com história de entorse unilateral do tornozelo e limitação da flexão dorsal. O protocolo experimental foi aplicado uma única vez e os seus efeitos comparados com uma intervenção placebo. Metodologia: Uma amostra de 30 indivíduos com história de entorse unilateral e limitação da amplitude de flexão dorsal foi aleatoriamente distribuído por dois grupos: grupo MWM e grupo placebo. Foram avaliados o deslizamento posterior do astrágalo e a avaliação da amplitude de flexão dorsal em carga. As avaliações foram realizadas imediatamente antes e após a intervenção. Resultados: Não foram encontradas diferenças significativas entre os grupos na avaliação inicial (baseline). A realização da one-way ANCOVA revelou que, imediatamente após a intervenção, se verificou um aumento na amplitude de flexão dorsal no grupo MWM (aumento de 1.37 cm (DP, 0.97) significativamente superior ao grupo placebo (diminuição de 0.15cm (DP, 0.63) (P<.001). O deslizamento posterior do astrágalo aumentou 1.51º (DP, 1.77) no grupo MWM, no entanto este aumento não foi significativamente superior ao aumento de 0.76º (DP, 1.26) do grupo placebo (P=.113). Conclusão: Os resultados sugerem que a MWM na articulação tibioperoneal inferior produziram um efeito significativo na amplitude de flexão dorsal embora o mesmo não se tenha verificado no deslizamento posterior do astrágalo. Estes resultados fornecem evidência preliminar para a efectividade da MWM como intervenção em indivíduos com história de entorse unilateral e limitação da amplitude de flexão dorsal.---------------ABSTRACT:Background: Ankle sprains are one of the most common musculo-skeletal injuries. Impaired dorsiflexion range of motion has been shown to be one of the consequences of this injury, as well as one of the contributing factors to recurrence. Several studies have shown the presence of an anterior positional fault of the fibula in injuried ankles. A cadaveric study revealed that a posterosuperior glide of the distal tibiofibular may contribute to improve dorsiflexion. There is a manual therapy technique which provides a posterosuperior glide of the lateral malleolus combined with dorsiflexion active movement (MWM). However, there was no study, until now, that investigated the effectiveness of this MWM in individuals with impaired dorsiflexion and history of unilateral ankle sprain. Design: Double-blind randomized placebo controlled trial. Objectives: To determine the immediate effects of a distal tibiofibular MWM in ankle dorsiflexion and talar posterior glide in patients with history of unilateral ankle sprain and limitation of dorsiflexion. The treatment technique was used as a single treatment against a placebo group. Methods: A sample of 30 subjects with a history of unilateral ankle sprain and limitation of dorsiflexion were randomized into two groups: distal tibiofibular MWM or a placebo group. The outcome measures used in this study were the posterior talar glide and weight-bearing (WB) ankle dorsiflexion range of motion. The measures were taken before and immediately after the intervention. Results: No significant differences were found in baseline measures between groups. A one-way ANCOVA revealed that, immediately after the intervention, there was an improvement in ankle dorsiflexion in the MWM group (increase of 1.37 cm (SD, 0.97) significantly superior to the placebo group (decrease of 0.15cm (SD, 0.63) (P<.001). Posterior talar glide increased by 1.51º (SD, 1.77) for the MWM group, which was more than 0.76º (SD, 1.25) for the placebo intervention although there wasn’t a significant difference between groups (P=.113). Conclusion: This investigation’s findings suggest that an inferior tibio-fibular MWM produced a significant effect on WB dorsiflexion range of motion and posterior talar glide. These results provide preliminary evidence for the efficacy of mobilisations with movement in the management of individuals with history of unilateral ankle sprain and limitation of dorsiflexion.

Tese de Mestrado em Fisioterapia
Introdução: A entorse do tornozelo é uma das lesões músculo-esqueléticas mais comuns. A limitação da amplitude de dorsiflexão tem sido demonstrada como uma das consequências desta lesão, bem como um dos factores contribuintes para a recorrência. Vários estudos têm demonstrado que o membro lesado de indivíduos com história de entorse, apresenta uma falha posicional anterior do peróneo. Um estudo realizado em cadáveres revelou que um deslizamento póstero-superior ao nível da articulação tibioperoneal inferior pode contribuir para aumentar a amplitude de dorsiflexão. Está descrita uma técnica de terapia manual que realiza o deslizamento póstero-superior do maléolo lateral associada ao movimento activo de flexão dorsal (MWM). No entanto, não existe, até à data, nenhum estudo que investigue a efectividade desta MWM em indivíduos com limitação da FD e história de entorse unilateral do tornozelo. Desenho de estudo: Ensaio clínico aleatorizado e controlado por placebo, duplamente cego. Objectivos: Avaliar os efeitos imediatos da MWM na articulação tibio-peroneal inferior na amplitude de flexão dorsal e no deslizamento posterior do astrágalo em indivíduos com história de entorse unilateral do tornozelo e limitação da flexão dorsal. O protocolo experimental foi aplicado uma única vez e os seus efeitos comparados com uma intervenção placebo. Metodologia: Uma amostra de 30 indivíduos com história de entorse unilateral e limitação da amplitude de flexão dorsal foi aleatoriamente distribuído por dois grupos: grupo MWM e grupo placebo. Foram avaliados o deslizamento posterior do astrágalo e a avaliação da amplitude de flexão dorsal em carga. As avaliações foram realizadas imediatamente antes e após a intervenção. Resultados: Não foram encontradas diferenças significativas entre os grupos na avaliação inicial (baseline). A realização da one-way ANCOVA revelou que, imediatamente após a intervenção, se verificou um aumento na amplitude de flexão dorsal no grupo MWM (aumento de 1.37 cm (DP, 0.97) significativamente superior ao grupo placebo (diminuição de 0.15cm (DP, 0.63) (P<.001). O deslizamento posterior do astrágalo aumentou 1.51º (DP, 1.77) no grupo MWM, no entanto este aumento não foi significativamente superior ao aumento de 0.76º (DP, 1.26) do grupo placebo (P=.113). Conclusão: Os resultados sugerem que a MWM na articulação tibioperoneal inferior produziram um efeito significativo na amplitude de flexão dorsal embora o mesmo não se tenha verificado no deslizamento posterior do astrágalo. Estes resultados fornecem evidência preliminar para a efectividade da MWM como intervenção em indivíduos com história de entorse unilateral e limitação da amplitude de flexão dorsal.
Abstract: Background: Ankle sprains are one of the most common musculo-skeletal injuries. Impaired dorsiflexion range of motion has been shown to be one of the consequences of this injury, as well as one of the contributing factors to recurrence. Several studies have shown the presence of an anterior positional fault of the fibula in injuried ankles. A cadaveric study revealed that a posterosuperior glide of the distal tibiofibular may contribute to improve dorsiflexion. There is a manual therapy technique which provides a posterosuperior glide of the lateral malleolus combined with dorsiflexion active movement (MWM). However, there was no study, until now, that investigated the effectiveness of this MWM in individuals with impaired dorsiflexion and history of unilateral ankle sprain. Design: Double-blind randomized placebo controlled trial. Objectives: To determine the immediate effects of a distal tibiofibular MWM in ankle dorsiflexion and talar posterior glide in patients with history of unilateral ankle sprain and limitation of dorsiflexion. The treatment technique was used as a single treatment against a placebo group. Methods: A sample of 30 subjects with a history of unilateral ankle sprain and limitation of dorsiflexion were randomized into two groups: distal tibiofibular MWM or a placebo group. The outcome measures used in this study were the posterior talar glide and weight-bearing (WB) ankle dorsiflexion range of motion. The measures were taken before and immediately after the intervention. Results: No significant differences were found in baseline measures between groups. A one-way ANCOVA revealed that, immediately after the intervention, there was an improvement in ankle dorsiflexion in the MWM group (increase of 1.37 cm (SD, 0.97) significantly superior to the placebo group (decrease of 0.15cm (SD, 0.63) (P<.001). Posterior talar glide increased by 1.51º (SD, 1.77) for the MWM group, which was more than 0.76º (SD, 1.25) for the placebo intervention although there wasn't a significant difference between groups (P=.113). Conclusion: This investigation's findings suggest that an inferior tibio-fibular MWM produced a significant effect on WB dorsiflexion range of motion and posterior talar glide. These results provide preliminary evidence for the efficacy of mobilisations with movement in the management of individuals with history of unilateral ankle sprain and limitation of dorsiflexion.

Approximately 82 percent of all amputations performed in the United States are transtibial amputations, in which the leg is removed below the hiee. Because the knee joint is left intact the use of prosthetics is one of the most preferred methods for returning mobility to amputees. The improvement of prosthetics for transtibial amputees is currently an area of intense research. This paper summarizes the state of the art of prosthetics for transtibial amputees by focusing on the four major components associated with standard transtibial prosthetic. The socket transfers the forces between the residual limb and the prosthetic. A suspension system ensures that solid contact is maintained between the leg and the artificial limb. The prosthetic foot is attached to the socket by a pylon, which also accounts for length of limb lost during amputation. Prosthetic feet come in many forms ranging from little more than wooden blocks to carbon fiber sprinting feet. Two recent advances in transtibial prosthetics include the procedures of direct skeletal attachment, and distal tibiofibular bone bridging which increases the weight bearing capability of the residual limb.