Determination of the most appropriate surgical treatment in syndesmotic injury of ankle joint: Application of Taguchi method

Background: Ankle injuries are more frequently observed in youth and athletes, and may lead to permanent disabilities if not treated properly. Approximately 10% of ankle injuries are associated with syndesmotic ligament injuries and fixation with screw is frequently applied as surgical treatment. The present study we aimed to determine the most proper model and model parameters by evaluating the minimum equivalent von Mises stress value developed in syndesmotic fixation of the ankle. Methods: By modeling the normal lower extremity in a healthy subject via the finite element analysis (FEA) method, we compared stress developed in a normal standing position in the models of syndesmotic injuries approached by frequently used cortical screws of various lengths and diameters, and by considering the number of screws and localization of fixation. Tibia, fibula, talus, and calcaneus were modeled as a three dimensional (3D) solid model via images of computerized tomography (CT), using the MIMICS program (version 10.01). The obtained 3D model was saved in the MIMICS program in STL (steriolithography) format, and transferred to the Geomagic Studio (version 10) program. Essential corrections were applied to the bones with the aid of the Geomagic program. The model of lower extremity designed was transferred to the Solidworks (version 2014) program in IGES (Initial Graphics Exchange Specification) format, and thus the meniscus and cartilage were modeled. Tensions that developed in the ankle were calculated after forming a mesh pattern via the ANSYS Workbench (version 15.0) software. Results: Sixteen different models obtained were analyzed by the Taguchi method, and the most appropriate models and model parameters were indicated by determining the minimum equivalent von Mises stress value. Conclusion: Screw diameter was determined to be the most important parameter. When 16 different models were considered, a screw diameter of 4.5 mm and threecortex fixation with two screws parallel to the tibial joint surface were found to produce the most convenient model.