Evaluation of the horizontal approach to the medial malleolar facet in sagittal talar fractures through dorsiflexion and plantarflexion positions
Data files
Jan 23, 2024 version files 17.19 KB
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Minimum_data_set.xlsx
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README.md
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Abstract
Background
Talar fractures often require osteotomy during surgery to achieve reduction and screw fixation of the fractured fragments due to limited visualization and operating space of the talar articular surface. The objective of this study was to evaluate the horizontal approach to the medial malleolus facet by maximizing exposure through dorsiflexion and plantarflexion positions.
Methods
In dorsiflexion, plantarflexion, and functional foot positions, we respectively obtained the anterior and posterior edge lines of the projection of the medial malleolus on the medial malleolar facet. The talar model from Mimics was imported into Geomagic software for image refinement. Then Solidworks software was used to segment the medial surface of the talus and extend the edge lines from the three positions to project them onto the "semicircular" base for 2D projection. The exposed area in different positions, the percentage of total area it represents, and the anatomic location of the insertion point at the groove between the anteroposternal protrusions of the medial malleolus were calculated.
Results
The mean total area of the "semicircular" region on the medial malleolus surface of the talus was 542.10 ± 80.05 mm2. In the functional position, the exposed mean area of the medial malleolar facet around the medial malleolus both anteriorly and posteriorly was 141.22 ± 24.34 mm2, 167.58 ± 22.36mm2, respectively. In dorsiflexion, the mean area of the posterior aspect of the medial malleolar facet was 366.28 ± 48.12 mm2. In plantarflexion, the mean of the anterior aspect of the medial malleolar facet was 222.70 ± 35.32 mm2. The mean overlap area of unexposed area in both dorsiflexion and plantarflexion was 23.32 ± 5.94 mm2. The mean percentage of the increased exposure area in dorsiflexion and plantarflexion were 36.71 ± 3.25 % and 15.13 ± 2.83 %. The mean distance from the insertion point to the top of the talar dome was 10.69 ± 1.24 mm, to the medial malleolus facet border of the talar trochlea was 5.61 ± 0.96 mm, and to the tuberosity of the posterior tibiotalar portion of the deltoid ligament complex was 4.53 ± 0.64 mm.
Conclusions
Within the 3D model, we measured the exposed area of the medial malleolus facet in different positions and the anatomic location of the insertion point at the medial malleolus groove. When the foot is in plantarflexion or dorsiflexion, a sufficiently large area and operating space can be exposed during surgery. The data regarding the exposed visualization area and virtual screws need to be combined with clinical experience for safer reduction and fixation of fracture fragments. Further validation of its intraoperative feasibility will require additional clinical research.
README: Evaluation of the horizontal approach to the medial malleolar facet in sagittal talar fractures through dorsiflexion and plantarflexion positions
https://doi.org/10.5061/dryad.r7sqv9skk
In the positions of foot dorsiflexion, plantarflexion, and functional, we respectively obtained the anterior and posterior edge lines of the projection of the medial malleolus on the medial malleolar facet. The talar model from Mimics was imported into Geomagic software for image refinement. Then Solidworks software was used to segment the medial surface of the talus and extend the edge lines from the three positions to project them onto the "semicircular" base for 2D projection. The exposed area in different positions, the percentage of total area it represents, and the anatomic location of the insertion point at the groove between the anteroposternal protrusions of the medial malleolus were calculated. The mean total area of the "semicircular" region on the medial malleolus surface of the talus was 542.10 ± 80.05 mm2. In the functional position, the exposed mean area of the medial malleolar facet around the medial malleolus both anteriorly and posteriorly was 141.22 ± 24.34 mm2, 167.58 ± 22.36mm2, respectively. In dorsiflexion, the mean area of the posterior aspect of the medial malleolar facet was 366.28 ± 48.12 mm2. In plantarflexion, the mean of the anterior aspect of the medial malleolar facet was 222.70 ± 35.32 mm2. The mean overlap area of unexposed area in both dorsiflexion and plantarflexion was 23.32 ± 5.94 mm2. The mean percentage of the increased exposure area in dorsiflexion (36.71 ± 3.25 %) and plantarflexion were 36.71 ± 3.25 % and 15.13 ± 2.83 %. The mean distance from the insertion point to the top of the talar dome was 10.69 ± 1.24 mm, to the medial malleolus facet border of the talar trochlea was 5.61 ± 0.96 mm, and to the tuberosity of the posterior tibiotalar portion of the deltoid ligament complex was 4.53 ± 0.64 mm.
Description of data and file structure
DICOM-formatted CT-scan images of each patient were imported into Mimics software (21.0; Materialise, Leuven, Belgium). We removed the soft tissue and affected bones by the function of image segmentation, region growth and multiple slice editing of Mimics software, respectively. A total of 273 virtual foot-and-ankle models were created. In the positions of foot dorsiflexion, plantarflexion, and functional, we respectively obtained the anterior and posterior edge lines of the projection of the medial malleolus on the medial malleolar facet (Fig. 1). At the same time, we found that the medial malleolar facet had a shape resembling a “semicircle”, and regardless of whether the foot was in the functional position, dorsiflexed, or plantarflexed, the movement of the medial malleolus occurred within this "semicircular" region (Fig. 2A). Tracing the outline of the foot in the three positions on the talus, it is not difficult to observe that plantarflexion and dorsiflexion expand the exposure area on the anterior and posterior aspects of the talus (Fig. 2B). The talar model from Mimics was imported into Geomagic software (2019, 3D Systems, North Carolina, USA) for image refinement. Then Solidworks software(2021, Dassault Systemes, USA) was used to segment the medial surface of the talus and extend the edge lines from the three positions to project them onto the "semicircular" base for 2D projection. This data can be used to describe the medial malleolar area of the talus.
Abbreviations
TA(mm2): Total area of the "semicircular" region on the medial malleolar facet.
FAA(mm2): In functional position, the exposed area of the anterior aspect of the Medial malleolus.
FAP(mm2): In functional position, the exposed area of the posterior aspect of the Medial malleolus.
DA(mm2): In dorsiflexion, the exposed area of the posterior aspect of the medial malleolar facet.
PA(mm2): In plantarflexion, the exposed area of the anterior aspect of the medial malleolar facet.
UA(mm2): Unexposed area in both dorsiflexion and plantarflexion.
L1(mm):The distance of the insertion point to the top of the talar dome.
L2(mm):The distance of the medial malleolus facet border of the talar trochlea.
L3(mm):The distance from the insertion point to the tuberosity of the posterior tibiotalar portion of the deltoid ligament complex.
Code/Software
Mimics software (21.0; Materialise, Leuven, Belgium); Geomagic software (2019, 3D Systems, North Carolina, USA); Solidworks software (2021, Dassault Systemes, USA)
Methods
DICOM-formatted CT-scan images of each patient were imported into Mimics software (21.0 ; Materialise, Leuven, Belgium). We removed the soft tissue and affected bones by the function of image segmentation, region growth and multiple slice editing of Mimics software, respectively. A total of 273 virtual foot and ankle models were created. In dorsiflexion, plantarflexion, and functional foot positions, we respectively obtained the anterior and posterior edge lines of the projection of the medial malleolus on the medial malleolar facet (Fig. 1). At the same time, we found that the medial malleolar facet had a shape resembling a “semicircle”, and regardless of whether the foot was in the functional position, dorsiflexed, or plantarflexed, the movement of the medial malleolus occurred within this "semicircular" region (Fig. 2A). Tracing the outline of the foot in the three positions on the talus, it is not difficult to observe that plantarflexion and dorsiflexion expand the exposure area on the anterior and posterior aspects of the talus (Fig. 2B). The talar model from Mimics was imported into Geomagic software (2019, 3D Systems, North Carolina, USA) for image refinement. Then Solidworks software (2021, Dassault Systemes, USA) was used to segment the medial surface of the talus and extend the edge lines from the three positions to project them onto the "semicircular" base for 2D projection. The following areas were measured: Total area (TA) of the "semicircular" region on the medial malleolar facet; In the functional position, the exposed area of the medial malleolar facet around the medial malleolus both anteriorly (FAA) and posteriorly (FAP); In dorsiflexion, the exposed area of the posterior aspect of the medial malleolar facet (DA); In plantarflexion, the exposed area of the anterior aspect of the medial malleolar facet (PA); Unexposed overlap area in both dorsiflexion and plantarflexion (UA). The percentage of the increased exposure area in dorsiflexion and plantarflexion positions were calculated.