Thierry C BEGUE

Abstract: There are many studies describing the perforating branches of the peroneal artery but none of them identifies their locations relative to fibula. The aim of this study was to demonstrate the locations of the perforators relative to the fibula and to present a case, treated with an adipofascial flap, based on one of these small arteries. In this study, nine fresh male cadavers' legs injected with colored latex were dissected for demonstration of the longitudinal axis of these perforators. A large incision was made on the lateral part of the leg from the head of the fibula to the ankle. The peroneal perforating vessels were displayed. The posterior margin of the fibula was marked with needles from proximal to distal just above every perforator. The distance between the needle and the perforator was recorded. Their diameters were measured at the level of fascial emergence. There were four to seven perforating vessels; the larger vessels were near the proximal end of the fibula with an average of 1.1 mm and a minimum of 0.8 mm. We found that these branches were not parallel to fibula, but aligned in an oblique projection from posterior to anterior and from distal to proximal because of the course of the intermuscular septum between the soleus and peroneus longus muscles. The lowermost vessel was 1.7 cm away from the posterior margin of the fibula while the uppermost vessel was 0.25 cm away from the posterior ridge of the fibula. Adipofascial or fasciocutaneous flaps, which have important advantages in covering small to medium sized defects, can be based on the perforators of the peroneal artery. But for the centralization of the flap pedicle, the locations of the perforators, which are aligned from the lateral malleolus to the fibular head in oblique direction and from the posterior to the anterior must be taken into consideration. This knowledge is crucial for the flap design and the centralization of the vessels.

Abstract: I. INTRODUCTION Locked plates are new implants useful for fracture treatment and some orthopaedic surgical procedures as osteotomies. New concepts are associated with biological fixation of fractures, additional internal fixators, et mini invasive surgery which leads to lesser amount of mor-bidity at the operative site.. II. METHODS AND RESULTS Biomechanics of locked plates concern the junction between the locked screw in the plate. Studies were done on diaphyseal models with a 4 points bending stress, and on metaphyso-epiphyseal areas with bending stress on models with bone defects. In any circumstance, the locked plate specimen gives better results, due mainly to the non parallel posi-tion of the epiphyso-metaphyseal screws. Clinical applications were tested in all situations where failed usual internal fixation was seen, as well as osteotomy for axial correction in th lower limb. Locked plates for diaphyseal fractures are linked to exten-sive osteosynthesis with screws well inserted all along the plate to restore elasticity and allow dynamic splinting of the bone. Additional ancillary devices allow percutaneous insertion of such plates. Stabiliza-tion is effective when no more than 3 bicortical screws is inserted in each major fragment from proximal to distal. In metaphyseal area, locked plates allow an unilateral approach and no need for bone grafting as elastic fixation with a single-beam construct leads to bone union even if bone defect. Monoaxial locked screws give possibilities for partial weight-bearing soon after surgery. Polyaxial locked screws are better for comminutive fractures as they can fix a larger number of fragments, but are insufficient for weight-bearing. In epiphyseal fractures, locked plates are still under evaluation. In periprosthetic epiphyseal fractures, locked plates and screws are valu-able as the non-parallel distribution of the screws gives a better anchor-age in the porotic bone and resists loosening of the implant from the bone. III. CONCLUSIONS Locked plates are an innovative and original concept that needs to be well understood with some learning curve, as use of such implants is different from classical plates. Locked plates are based upon dynamic fixation devices and need extended fixation for a better constraint figure. Locked plates are a new armantarium in biological bone healing with an enchondral phenomenon. Precontoured anatomical plates must be used as internal fixators. Specific screw positioning is of interest in a specific osteoporotic bone. Using locked plates allows surgeons to do mini-invasive surgery with subcutaneous or submuscular insertion of the implant. REFERENCES 1. Bedi A, Karunakar MA. 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