{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T05:28:33Z","timestamp":1777613313320,"version":"3.51.4"},"reference-count":18,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2013,1,14]],"date-time":"2013-01-14T00:00:00Z","timestamp":1358121600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot Ankle Int."],"published-print":{"date-parts":[[2013,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Displaced medial malleolus fractures require surgical repair because of the critical role the structure plays in normal joint function. Various approaches exist, but options are limited for small fragment fractures. This study compared repair with the Medial Malleolar Sled fixation system (Trimed, Inc, Valencia, CA) to lag screws in 2 modes of biomechanical loading in a cadaveric model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A M\u00fcller type B medial malleolus fracture was simulated on matched pairs of cadaveric lower extremities and repaired with the sled or 2 cancellous lag screws. Tibial distraction (tension, n = 10) or internal rotation (torsion, n = 11) was applied. Fragment movement was measured in the sagittal (tension and torsion) and transverse (torsion-only) planes. Fragment movement at 1 mm and 2 mm (clinical malunion) of gapping during tension and at 2, 4, 6, and 8 N-m during torsion was analyzed via paired t tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>In tension, the load at the 2-mm gap was statistically lower for screws ( P = .026). Opening angle was statistically larger for the sled at the 1-mm ( P = .0004) and 2-mm ( P = .008) gap. In torsion, gapping was statistically lower for the sled (ranging from P = .0013 at 4 N-m to P = .0187 at 8 N-m). No differences were detected for opening angle or transverse plane movement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The sled appeared stronger in tension and as effective as lag screws in torsion. The sled may be a viable option for fractures too small for 4.0- or 3.5-mm lag screws.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>The sled may be suitable in applications where a tension band would normally be considered and may provide stronger fixation in osteoporotic bone compared with lag screw fixation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1071100712466231","type":"journal-article","created":{"date-parts":[[2013,1,14]],"date-time":"2013-01-14T23:55:11Z","timestamp":1358207711000},"page":"426-433","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["Biomechanical Performance of a New Device for Medial Malleolar Fractures"],"prefix":"10.1177","volume":"34","author":[{"given":"Tejas","family":"Patel","sequence":"first","affiliation":[{"name":"Virginia Commonwealth University, Richmond, VA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John R.","family":"Owen","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University, Richmond, VA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William A.","family":"Byrd","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University, Richmond, VA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan B.","family":"Graves","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University, Richmond, VA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruchi D.","family":"Chande","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University, Richmond, VA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Varatharaj","family":"Mounasamy","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University, Richmond, VA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert S.","family":"Adelaar","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University, Richmond, VA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer S.","family":"Wayne","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University, Richmond, VA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2013,1,14]]},"reference":[{"key":"bibr1-1071100712466231","doi-asserted-by":"crossref","unstructured":"Brown OL, Dirshl DR, Obremskey WT. Incidence of hardware-related pain and its effect on functional outcomes after open reduction and internal fixation of ankle fractures. J Orthop Trauma. 2001;15:271-274. http:\/\/dx.doi.org\/10.1097\/00005131-200105000-00006","DOI":"10.1097\/00005131-200105000-00006"},{"key":"bibr2-1071100712466231","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199403000-00001"},{"key":"bibr3-1071100712466231","doi-asserted-by":"crossref","unstructured":"Chapman JR, Harrington RM, Lee KM, Factors affecting the pullout strength of cancellous bone screws. J Biomech Eng. 1996;118:391-398. http:\/\/dx.doi.org\/10.1115\/1.2796022","DOI":"10.1115\/1.2796022"},{"key":"bibr4-1071100712466231","first-page":"1975","volume-title":"Rockwood and Green\u2019s Fractures in Adults","volume":"2010","author":"Davidovitch RI","edition":"7"},{"key":"bibr5-1071100712466231","doi-asserted-by":"crossref","unstructured":"Femino JE, Gruber BF, Karunakar MA. Safe zone for the placement of medial malleolar screws. J Bone Joint Surg Am. 2007;89:133-138. http:\/\/dx.doi.org\/10.2106\/JBJS.F.00689","DOI":"10.2106\/JBJS.F.00689"},{"key":"bibr6-1071100712466231","doi-asserted-by":"crossref","unstructured":"Fowler TT, Pugh KJ, Litsky AS, Taylor BC, French BG. Medial malleolar fractures: a biomechanical study of fixation techniques. Orthopedics. 2011;34:e349-e355. http:\/\/dx.doi.org\/10.3928\/01477447-20110627-09","DOI":"10.3928\/01477447-20110627-09"},{"key":"bibr7-1071100712466231","doi-asserted-by":"publisher","DOI":"10.1177\/107110079501600202"},{"key":"bibr8-1071100712466231","first-page":"870","volume-title":"AO Principles of Fracture Management","volume":"2007","author":"Hahn DM","edition":"2"},{"key":"bibr9-1071100712466231","doi-asserted-by":"publisher","DOI":"10.1177\/107110079401500402"},{"key":"bibr10-1071100712466231","doi-asserted-by":"crossref","unstructured":"Johnson BA, Fallat LM. Comparison of tension band wire and cancellous bone screw fixation for medial malleolar fractures. J Foot Ankle Surg. 1997;36:284-289. http:\/\/dx.doi.org\/10.1016\/S1067-2516(97)80074-9","DOI":"10.1016\/S1067-2516(97)80074-9"},{"key":"bibr11-1071100712466231","doi-asserted-by":"crossref","unstructured":"King CM, Cobb M, Collman DR, Lagaay PM, Pollard JD. Bicortical fixation of medial malleolar fractures: a review of 23 cases at risk for complicated bone healing. 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