Browsing by Author "Wong, Murray T"

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    Four-Dimensional Computed Tomography to Determine Normal Syndesmotic Motion and to Compare Motion after Rigid and Flexible Fixation of Syndesmotic Injuries
    (2020-11-27) Wong, Murray T; Schneider, Prism S; Edwards, W Brent; Wiens, Charmaine AS; Manske, Sarah L; LaMothe, Jeremy M
    Syndesmotic injuries occur in up to one-quarter of all ankle fractures. Despite mitigating efforts, malreduction of the syndesmosis is common after both rigid and flexible fixation methods, causing inferior patient function. Conventional assessments of syndesmotic reduction do not account for normal syndesmotic motion with ankle range-of-motion (ROM). The aims of this thesis were to use four-dimensional computed tomography (4DCT) to determine normal syndesmotic motion and to investigate the impact of rigid and flexible fixation on postoperative syndesmotic kinematics. Fifty-eight uninjured ankles were imaged to quantify normal syndesmotic kinematics. Thirteen patients after rigid or flexible fixation underwent bilateral ankle 4DCT to evaluate postoperative syndesmotic kinematics. Measures of syndesmotic width including anterior, middle, and posterior syndesmosis distances as well as tibiofibular clear space and tibiofibular overlap were automatically extracted from 4DCT data. Sagittal translation and fibular rotation were also recorded. Linear mixed effects models were used to determine the position of the syndesmosis at neutral dorsiflexion as well as syndesmotic motion, defined as the change in syndesmotic measurements with ankle ROM.In uninjured ankles, various measures of syndesmotic width decreased by 0.7-1.1 mm as ankles moved from dorsiflexion to plantarflexion (p < 0.001). The fibula externally rotated by 1.2° with plantarflexion (p < 0.001). There was no significant motion in the sagittal plane (p = 0.43). Rigid fixation increased syndesmotic width compared to uninjured ankles when measured by middle syndesmotic distance and tibiofibular clear space only (p = 0.039 and 0.032 respectively). Rigid fixation demonstrated reduced motion compared to uninjured ankles in middle and posterior syndesmotic distance, tibiofibular clear space, and tibiofibular overlap (p < 0.01). There were no differences in syndesmotic position or motion between flexible fixation and uninjured ankles.Ankle plantarflexion leads to decreased syndesmotic width and fibular external rotation in uninjured ankles, indicating ankle position must be accounted for when performing syndesmotic imaging and fixation. Flexible fixation better restores syndesmotic position and motion compared to rigid fixation. These findings may be used to decrease the rate of syndesmotic malreduction and, consequently, improve post-surgical outcomes.
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    Understanding the role of total knee arthroplasty for primary treatment of tibial plateau fracture: a systematic review of the literature
    (2020-05-25) Wong, Murray T; Bourget-Murray, Jonathan; Johnston, Kelly; Desy, Nicholas M
    Abstract Background Surgical fixation of tibial plateau fracture in elderly patients with open reduction and internal fixation (ORIF) provides inferior outcomes compared with younger patients. Primary total knee arthroplasty (TKA) may be of benefit in elderly patients with a combination of osteoporotic bone and metaphyseal comminution. However, there continues to be conflicting evidence on the use of TKA for primary treatment of tibial plateau fracture. This systematic review was performed to quantify the outcomes and perioperative complication rates of TKA for primary treatment of tibial plateau fracture. Materials and methods A comprehensive search of MEDLINE, Embase, and PubMed databases from inception through March 2018 was performed in accordance with PRISMA guidelines. Two reviewers independently screened papers for inclusion and identified studies featuring perioperative complications and outcomes of primary TKA for tibial plateau fracture. Weighted means and standard deviations are presented for each outcome. Results Seven articles (105 patients) were eligible for inclusion. All-cause mortality was 4.75 ± 4.85%. The total complication rate was 15.2 ± 17.3%. Regarding outcomes, Knee Society scores were most commonly reported. The average Knee Society Knee Score was 85.6 ± 5.5, while the average Knee Society Function Score was 64.6 ± 13.7. Average range of motion at final follow-up was 107.5 ± 10.0°. Conclusions Primary TKA for select tibial plateau fractures has acceptable clinical outcomes but does not appear to be superior to ORIF. It may be appropriate to treat certain geriatric patients with TKA to allow for early mobilization and reduce the need for reoperation. Other factors may need to be considered in deciding the optimal treatment. Level of evidence Level III.