title: Influence of hooks and a lag screw on internal fixation plates for lateral malleolar fracture: a biomechanical and ergonomic study.
abstract: BACKGROUND
  For internal fixation of AO classification Type B lateral malleolar fracture, insertion of lag screws into the fracture plane and fixation with a one-third tubular plate as a neutralization plate are the standard treatment procedures. The one-third tubular plate is processed to a hook shape and hung on the distal end of the fibula. In this study, to compare the function of the hook and lag screws of a one-third tubular plate and LCP for osteosynthesis of lateral malleolar fracture, mechanical indices of internal fixation were compared among the one-third tubular plates with lag screws with and without the hook and a locking compression plate.
  
  
  METHODS
  As mechanical tests, a compression test was performed in which compression in the bone axis direction produced by supporting the body weight was simulated, and a torsion test was performed in which external rotation of the bone axis caused by plantar flexion of the ankle joint was simulated. Muscle strength during walking and the force and torque acting on the ankle and knee joints were determined using inverse dynamic analysis. Finite element analysis was performed to analyze the function of hooks and lag screws. The joint reaction force determined by inverse dynamic analysis was adopted as the loading condition of finite element analysis.
  
  
  RESULTS
  A stiffness equivalent to that of healthy bone could be achieved by all three internal fixations. It was clarified that the presence of the hook does not make a difference in stiffness. Displacement of the one-third tubular plate was small regardless of the presence or absence of the hook compared with those of locking compression plates.
  
  
  CONCLUSIONS
  The presence of the hook did not make any difference in stiffness, suggesting that active preparation of the hook is unnecessary. We also clarified that lag screws inhibit displacement.
authors.affiliation: Department of Medical Engineering and Technology, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan. rinax@kitasato-u.ac.jp.|Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan. rinax@kitasato-u.ac.jp.
authors.forename: Rina
authors.initials: R
authors.lastname: Sakai
authors.affiliation: Department of Orthopedic Surgery, Kitasato University Medical Center, 6-100 Arai, Kitamoto, Saitama, 364-8501, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Uchino
authors.affiliation: Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.
authors.forename: Terumasa
authors.initials: T
authors.lastname: Yoneo
authors.affiliation: Faculty of Engineering, Kanagawa Institute of Technology, 1030 Shimo-Ogino, Atsugi, Kanagawa, 243-0292, Japan.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Ohtaki
authors.affiliation: Department of Orthopedic Surgery, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Minehara
authors.affiliation: Department of Orthopedic Surgery, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.
authors.forename: Terumasa
authors.initials: T
authors.lastname: Matsuura
authors.affiliation: Department of Medical Engineering and Technology, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.|Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Gomi
authors.affiliation: Department of Medical Engineering and Technology, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.|Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Ujihira
mesh_terms: D064386:Ankle Fractures / Q000503:physiopathology / Q000601:surgery*; D000843:Ankle Joint / Q000503:physiopathology; D001696:Biomechanical Phenomena; D001860:Bone Plates; D001863:Bone Screws; D019245:Compressive Strength; D006804:Ergonomics / Q000379:methods; D020342:Finite Element Analysis; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008422:Materials Testing / Q000379:methods; D053580:Muscle Strength / Q000502:physiology
keywords: Internal fixation; Lateral malleolar fractures; Locking compression plate; One-third tubular plate; Osteosynthesis