APPLICATION OF COMPUTER-ASSISTED SURGICAL PLANNING IN SURGICAL TREATMENT OF ANKLE FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 XIAShengli , WANGXiuhui , FUBeigang , LUYaogang , WANGMinghui

Department of Orthopaedics, Zhoupu Hospital of Pudong, Shanghai, 201318, P. R. China;

Corresponding author：

XIAShengli, Email: victorxia@126.com

Keywords：

Ankle fracture; Computer-aided software; Preoperartive planning; Internal fixation

DOI：

10.7507/1002-1892.20150315

Video：

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Objective To explore the clinical value of computer-assisted surgical planning in the treatment of ankle fractures. Methods Between January 2012 and January 2014, open reduction and internal fixation were performed on 42 patients with ankle fractures. There were 22 males and 20 females with an average age of 52 years (range, 19-72 years). The causes were spraining injury (20 cases), traffic accident injury (14 cases), and falling from height injury (8 cases). The time from injury to operation was 5 hours to 12 days (mean, 2.5 days). All fractures were closed trimalleolar fractures. According to Lauge-Hansen classification, 25 cases were rated as supination extorsion type IV, 13 as pronation extorsion type IV, and 4 as pronation abduction type Ⅲ. The preoperative planning was made by virtual reduction and internal fixation using Superimage software. Results The mean operation time was 93.7 minutes (range, 76-120 minutes). Delayed wound healing occurred in 1 case, and secondary healing was obtained after treatment; primary healing of incision was achieved in the other patients. Postoperative X-ray films and CT images showed anatomic reduction of fracture and good position of internal fixation. All patients were followed up 14.6 months on average (range, 9-27 months). The range of motion of the affected ankle was close to the normal side at 6-8 weeks. The mean fracture healing time was 13.1 weeks (range, 11-17 weeks). Degenerative change of the ankle joint was observed in 3 cases (7.1%) with manifestation of mild narrowing of joint space on the X-ray films at last follow-up. According to Baird-Jackson score system, the results were excellent in 24 cases, good in 13 cases, and fair in 5 cases, with an excellent and good rate of 88%. Conclusion Computer-assisted surgical planning for ankle fractures can help surgeons identify type of ankle fractures and improve surgical scheme for guiding fracture reduction and selecting and placing implants, so good effectiveness can be obtained.

Citation： XIAShengli, WANGXiuhui, FUBeigang, LUYaogang, WANGMinghui. APPLICATION OF COMPUTER-ASSISTED SURGICAL PLANNING IN SURGICAL TREATMENT OF ANKLE FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(12): 1469-1473. doi: 10.7507/1002-1892.20150315 Copy

1.	Mandi DM. Ankle fractures. Clin Podiatr Med Surg, 2012, 29(2):155-186.
2.	Westerman RW, Porter K. Ankle fractures in adults:an overview. Trauma, 2007, 9(4):267-272.
3.	Thomas TP, Anderson DD, Willis AR, et al. ASB Clinical Biomechanics Award Paper 2010:Virtual pre-operative reconstruction planning for comminuted articular fractures. Clin Biomech (Bristol, Avon), 2011, 26(2):109-115.
4.	Mardini S, Alsubaie S, Cayci C, et al. Three-dimensional preoperative virtual planning and template use for surgical correction of craniosynostosis. J Plast Reconstr Aesthet Surg, 2014, 67(3):336-343.
5.	Thomas TP, Anderson DD, Willis AR, et al. A computational/experimental platform for investigating three-dimensional puzzle solving of comminuted articular fractures. Comput Methods Biomech Biomed Engin, 2011, 14(3):263-270.
6.	Gardner MJ, Demetrakopoulos D, Briggs SM, et al. Malreduction of the tibiofibular syndesmosis in ankle fractures. Foot Ankle Int, 2006, 27(10):788-792.
7.	Haraguchi N, Haruyama H, Toga H, et al. Pathoanatomy of posterior malleolar fractures of the ankle. J Bone Joint Surg (Am), 2006, 88(5):1085-1092.
8.	Baird RA, Jackson ST. Fractures of the distal part of the fibula with associated disruption of the deltoid ligament. Treatment without repair of the deltoid ligament. J Bone Joint Surg (Am), 1987, 69(9):1346-1352.
9.	Ovaska MT, Mäkinen TJ, Madanat R, et al. A comprehensive analysis of patients with malreduced ankle fractures undergoing reoperation. Int Orthop, 2014, 38(1):83-88.
10.	Mehta SS, Rees K, Cutler L, et al. Understanding risks and complications in the management of ankle fractures. Indian J Orthop, 2014, 48(5):445-452.
11.	张殿英, 付中国, 徐海林, 等. 影响不稳定性踝关节骨折手术疗效的相关因素分析. 中华创伤骨科杂志, 2010, 12(8):727-731.
12.	Dubois-Ferrière V, Assal M. Benefit of computer assisted surgery in foot and ankle surgery. Rev Med Suisse, 2014, 10(420):562-564.
13.	杨云峰, 杨炯, 王人彦, 等. 临床病例讨论——踝关节骨折术后功能不良的原因分析. 中华创伤骨科杂志, 2010, 12(8):798-800.
14.	Zhao L, Patel PK, Cohen M. Application of virtual surgical planning with computer assisted design and manufacturing technology to cranio-maxillofacial surgery. Arch Plast Surg, 2012, 39(4):309-316.
15.	Chen Y, Zhang K, Qiang M, et al. Computer-assisted preoperative planning for proximal humeral fractures by minimally invasive plate osteosynthesis. Chin Med J (Engl), 2014, 127(18):3278-3285.
16.	Porter DA, Jaggers RR, Barnes AF, et al. Optimal management of ankle syndesmosis injuries. Open Access J Sports Med, 2014, 5:173-182.
17.	Warner SJ, Schottel PC, Hinds RM, et al. Fracture-dislocations demonstrate poorer postoperative functional outcomes among pronation external rotation IV ankle fractures. Foot Ankle Int, 2015, 36(6):641-647.

1. Mandi DM. Ankle fractures. Clin Podiatr Med Surg, 2012, 29(2):155-186.
2. Westerman RW, Porter K. Ankle fractures in adults:an overview. Trauma, 2007, 9(4):267-272.
3. Thomas TP, Anderson DD, Willis AR, et al. ASB Clinical Biomechanics Award Paper 2010:Virtual pre-operative reconstruction planning for comminuted articular fractures. Clin Biomech (Bristol, Avon), 2011, 26(2):109-115.
4. Mardini S, Alsubaie S, Cayci C, et al. Three-dimensional preoperative virtual planning and template use for surgical correction of craniosynostosis. J Plast Reconstr Aesthet Surg, 2014, 67(3):336-343.
5. Thomas TP, Anderson DD, Willis AR, et al. A computational/experimental platform for investigating three-dimensional puzzle solving of comminuted articular fractures. Comput Methods Biomech Biomed Engin, 2011, 14(3):263-270.
6. Gardner MJ, Demetrakopoulos D, Briggs SM, et al. Malreduction of the tibiofibular syndesmosis in ankle fractures. Foot Ankle Int, 2006, 27(10):788-792.
7. Haraguchi N, Haruyama H, Toga H, et al. Pathoanatomy of posterior malleolar fractures of the ankle. J Bone Joint Surg (Am), 2006, 88(5):1085-1092.
8. Baird RA, Jackson ST. Fractures of the distal part of the fibula with associated disruption of the deltoid ligament. Treatment without repair of the deltoid ligament. J Bone Joint Surg (Am), 1987, 69(9):1346-1352.
9. Ovaska MT, Mäkinen TJ, Madanat R, et al. A comprehensive analysis of patients with malreduced ankle fractures undergoing reoperation. Int Orthop, 2014, 38(1):83-88.
10. Mehta SS, Rees K, Cutler L, et al. Understanding risks and complications in the management of ankle fractures. Indian J Orthop, 2014, 48(5):445-452.
11. 张殿英, 付中国, 徐海林, 等. 影响不稳定性踝关节骨折手术疗效的相关因素分析. 中华创伤骨科杂志, 2010, 12(8):727-731.
12. Dubois-Ferrière V, Assal M. Benefit of computer assisted surgery in foot and ankle surgery. Rev Med Suisse, 2014, 10(420):562-564.
13. 杨云峰, 杨炯, 王人彦, 等. 临床病例讨论——踝关节骨折术后功能不良的原因分析. 中华创伤骨科杂志, 2010, 12(8):798-800.
14. Zhao L, Patel PK, Cohen M. Application of virtual surgical planning with computer assisted design and manufacturing technology to cranio-maxillofacial surgery. Arch Plast Surg, 2012, 39(4):309-316.
15. Chen Y, Zhang K, Qiang M, et al. Computer-assisted preoperative planning for proximal humeral fractures by minimally invasive plate osteosynthesis. Chin Med J (Engl), 2014, 127(18):3278-3285.
16. Porter DA, Jaggers RR, Barnes AF, et al. Optimal management of ankle syndesmosis injuries. Open Access J Sports Med, 2014, 5:173-182.
17. Warner SJ, Schottel PC, Hinds RM, et al. Fracture-dislocations demonstrate poorer postoperative functional outcomes among pronation external rotation IV ankle fractures. Foot Ankle Int, 2015, 36(6):641-647.

Chinese Journal of Reparative and Reconstructive Surgery

APPLICATION OF COMPUTER-ASSISTED SURGICAL PLANNING IN SURGICAL TREATMENT OF ANKLE FRACTURES

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