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    Biomechanical comparison of different fixation methods for tibiofibular syndesmosis injuries: a finite element analysis study
    (Bmc, 2026) Karaca, Halil; Esenyel, Cem Zeki; Ugur, Levent; Aytekin, Kursad; Kurt, Emre; Demir, Tugcan
    Background Syndesmosis injuries require effective fixation to restore ankle stability and function.Therefore, the aim of this study was to use the finite element method to evaluate and compare the biomechanical efficiency of three different fixation techniques used to treat syndesmosis injuries: ANK nails, cortical screws, and suture buttons. Methods A three-dimensional model of the ankle complex of a healthy individual was created from computed tomography (CT) images for finite element analysis (FEA). In the model, the tibia, fibula, talus, calcaneus, and navicular bones and ligament structures were modeled according to anatomical data. Sikka stage-4 syndesmosis injury was simulated by removing the anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), transverse tibiofibular ligament (TTFL), interosseous ligament (IOL), and deltoid ligament. Eight different implant configurations were modeled for fixation, which included ANK nails, cortical screws, and suture buttons. During loading, compressive and tangential forces were applied to the tibial plateau by simulating the midstance phase of gait. Lateral and posterior fibular translation, external rotation, and the joint reaction force (JRF) were evaluated. Results Compared with the intact model, the lateral translation and external fibular rotation were more restricted by the use of two screws, whereas posterior fibular translation was more restricted by the use of the ANK nail.The screw and ANK nails provided rigid fixation, whereas the suture button allowed flexible fixation.The rigid fixation methods resulted in a more pronounced increase in JRFs. Anatomical suture-button (ANSB) fixation achieved the closest biomechanical parameters to those of the intact ankle model. Discussion In the treatment of syndesmosis injuries, ANSB fixation stands out as a method that balances stability with natural joint motion. While rigid fixation methods lead to high joint reaction forces, the ANSB model provides advantages in terms of long-term joint health by providing better preservation of physiological mobility.
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    The minimally invasive approach for lateral malleolus fractures plating demonstrating less pain, shorter operative time and earlier discharge compared to open approach: a prospective randomized controlled trial
    (Bmc, 2026) Kurt, Emre; Demir, Tugcan; Teksan, Emre; Karaca, Halil; Aytekin, Kursad
    Background Open reduction and internal fixation (ORIF) has been a long-established and accepted technique for the treatment of lateral malleolar fractures. However, minimally invasive percutaneous plate osteosynthesis (MIPPO) may be preferred in cases with compromised soft tissue conditions or in the presence of comorbidities. MIPPO is increasingly being used in the treatment of long bone fractures. The aim of this study was to compare the clinical, functional and radiological outcomes of the MIPPO technique for lateral malleolus fractures with those of ORIF. Methods This prospective randomized controlled study analysed patients who underwent surgery for lateral malleolus fractures treated with ORIF or MIPPO between the years 2022 and 2024. The study included patients with lateral malleolus fractures of Danis-Weber types B and C requiring surgical intervention. Postoperative pain, the American Orthopaedic Foot and Ankle Society (AOFAS) score, hospital stay, surgical time, fluoroscopy time, and radiological measurements were compared. Results The study included 68 patients (ORIF n = 34, MIPPO n = 34). The minimum follow-up for all the patients was 12 months and maximum was 24 months with a mean of 18,20 months postoperatively. The postoperative pain scores at 8 h (p = 0.001), 24 h (p < 0.001) and 2 weeks (p = 0.003) were lower in the MIPPO group. Pain scores were similar between the preoperative measurement and those observed at 4 weeks, 6 weeks, 3 months, 6 months and 1 year postoperatively. AOFAS scores were similar between both groups at 3 months, 6 months and 1 year postoperatively. Surgical time and the postoperative hospitalisation period were shorter in the MIPPO group (p < 0.001, p = 0.005). A higher level of fluoroscopy exposure was observed in the MIPPO group (p = 0.001). Similar results were obtained in radiological measurements between groups. Conclusion The MIPPO technique leads to lower pain scores in the short term, shorter surgery times, and earlier discharge. In the long term, it provides similar clinical, functional, and radiological results to those obtained with ORIF.