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Medicina (Kaunas, Lithuania) Jul 2023: Patients experience severe pain after surgical correction of ankle fractures. Although their exact mechanism is unknown, dexamethasone and epinephrine increase the... (Randomized Controlled Trial)
Randomized Controlled Trial
: Patients experience severe pain after surgical correction of ankle fractures. Although their exact mechanism is unknown, dexamethasone and epinephrine increase the analgesic effect of anesthetics in peripheral nerve blocks. This study aimed to compare the postoperative pain control efficacy of peripheral nerve blocks with ropivacaine combined with dexamethasone/epinephrine and peripheral nerve blocks with only ropivacaine and added patient-controlled analgesia in patients with ankle fractures. : This randomized, controlled prospective study included patients aged 18-70 years surgically treated for ankle fractures between December 2021 and September 2022. The patients were divided into group A ( = 30), wherein pain was controlled using patient-controlled analgesia after lower extremity peripheral nerve block, and group B ( = 30), wherein dexamethasone/epinephrine was combined with the anesthetic solution during peripheral nerve block. In both groups, ropivacaine was used as the anesthetic solution for peripheral nerve block, and this peripheral nerve block was performed just before ankle surgery for the purpose of anesthesia for surgery. Pain (visual analog scale), patient satisfaction, and side effects were assessed and compared between the two groups. : The patients' demographic data were similar between groups. Pain scores were significantly lower in group B than in group A postoperatively. Satisfaction scores were significantly higher in group B ( = 0.003). There were no anesthesia-related complications in either group. : Dexamethasone and epinephrine as adjuvant anesthetic solutions can effectively control pain when performing surgery using peripheral nerve blocks for patients with ankle fractures.
Topics: Humans; Ropivacaine; Anesthetics, Local; Prospective Studies; Ankle Fractures; Pain, Postoperative; Nerve Block; Peripheral Nerves; Epinephrine; Dexamethasone
PubMed: 37512113
DOI: 10.3390/medicina59071302 -
Chinese Journal of Traumatology =... Nov 2023Bosworth fracture and dislocation is relatively rare, accounting for about 1% of ankle fractures. It is characterized by the proximal fibula fracture embedded in the... (Review)
Review
Bosworth fracture and dislocation is relatively rare, accounting for about 1% of ankle fractures. It is characterized by the proximal fibula fracture embedded in the posterolateral distal tibia. Due to an insufficient understanding of this fracture, it is easy to cause missed diagnosis and misdiagnosis in clinical practice. Due to the insertion of the fracture, it is challenging to perform closed reduction, and improper treatment is easy to cause complications. Surgical treatment is recommended for this type of fracture. In order to improve the understanding of orthopedic surgeons about Bosworth fracture and dislocation, this paper reports the diagnosis and treatment of 2 cases of Bosworth fracture and dislocation, and reviews the literature on Bosworth fracture's mechanism, diagnosis, classification, complications, and treatment options in recent years.
Topics: Humans; Ankle Fractures; Joint Dislocations; Fracture Fixation, Internal; Fibula; Tibia
PubMed: 37925272
DOI: 10.1016/j.cjtee.2023.07.003 -
Journal of Children's Orthopaedics Aug 2023Ankle fracture is one of the most frequent pediatric lower-limb fractures and may result in serious complications.
BACKGROUND
Ankle fracture is one of the most frequent pediatric lower-limb fractures and may result in serious complications.
OBJECTIVE
This study aimed to determine the epidemiology of ankle fractures, defining fracture types, treatments, and complications in a pediatric population below 16 years old.
METHODS
Medical records of all the ankle fracture patients treated in our hospital during 2004-2020 were retrospectively reviewed. Data regarding age, sex, mechanism of injury, fracture type, treatment modalities, and complications were collected.
RESULTS
We examined records involving 328 children with 331 ankle fractures, with a ratio of 1:2 male per female. Mean annual prevalence was 24.3 per 100,000 children. Mean patient age was 11.2 ± 4.2 years, with 75.3% of them aged over 10 years. Sports activities accounted for the largest percentage of fractures (162 cases; 49.4%), followed by falls (67; 20.4%) and road traffic accidents (37; 11.3%). Physeal fractures were the most frequent type of lesion (223 cases). Most ankle fractures (60%) were managed using closed reduction and casting; for the remaining 40% of cases, fracture fixation was performed after closed or open reduction to correct the articular step-off and ensure the anatomical restoration of the physis. The main ankle fracture complication was premature growth arrest (12.1% of all physeal fractures).
CONCLUSION
Pediatric ankle fractures primarily affect children older than 10 years. Most of these fractures were caused by sports injuries or low-energy trauma. The majority of these fractures are physeal, and the distal tibial physis is affected 10 times more frequently than the distal fibular physis.
LEVEL OF EVIDENCE
Level III.
PubMed: 37565007
DOI: 10.1177/18632521231182424 -
Injury Oct 2023Ankle fractures comprise 9% of all fractures and are among the most common fractures requiring operative management. Open reduction and internal fixation (ORIF) with...
INTRODUCTION
Ankle fractures comprise 9% of all fractures and are among the most common fractures requiring operative management. Open reduction and internal fixation (ORIF) with plates and screws is the gold standard for the treatment of unstable, displaced ankle fractures. While performing ORIF, orthopaedic surgeons may choose from several fixation methods including locking versus nonlocking plating and whether to use screws or suture buttons for syndesmotic injuries. Nearly all orthopaedic surgeons treat ankle fractures but most are unfamiliar with implant costs. No study to date has correlated the cost of ankle fracture fixation with health status as perceived by patients through patient reported outcomes (PROs). The purpose of this study was to determine whether there is a relationship between increasing implant cost and PROs after a rotational ankle fracture.
METHODS
All ankle fractures treated with open reduction internal fixation (ORIF) at a level I academic trauma center from January 2018 to December 2022 were identified. Inclusion criteria included all rotational ankle fractures with a minimum 6-month follow-up and completed 6-month PRO. Patients were excluded for age <18, polytrauma and open fracture. Variables assessed included demographics, fracture classifications, Foot and Ankle Ability Measure-Activities of Daily Living (FAAM-ADL) score, implant type, and implant cost.
RESULTS
There was a statistically significant difference in cost between fracture types (p < 0.0001) with trimalleolar fractures being the most expensive. The mean FAAM-ADL score was lowest for trimalleolar fractures at 78.9, 95% CI [75.5, 82.3]. A diagnosis of osteoporosis/osteopenia was associated with a decrease in cost of $233.3, 95% CI [-411.8, -54.8]. There was no relationship between syndesmotic fixation and implant cost, $102.6, 95% CI [-74.9, 280.0]. There was no correlation between implant cost and FAAM-ADL score at 6 months (p = 0.48).
CONCLUSIONS
The utilization of higher cost ankle fixation does not correlate with better FAAM-ADL scores. Orthopaedic surgeons may choose less expensive implants to improve the value of ankle fixation without impacting patient reported outcomes.
Topics: Humans; Ankle Fractures; Activities of Daily Living; Retrospective Studies; Fracture Fixation, Internal; Ankle Injuries; Treatment Outcome
PubMed: 37542790
DOI: 10.1016/j.injury.2023.110963 -
Foot & Ankle International Sep 2023The first stage of fracture healing consists of hematoma formation with recruitment of proinflammatory cytokines and matrix metalloproteinases. Unfortunately, when there...
Exposure of Tissue-Engineered Cartilage Analogs to Synovial Fluid Hematoma After Ankle Fracture Is Associated With Chondrocyte Death and Altered Cartilage Maintenance Gene Expression.
BACKGROUND
The first stage of fracture healing consists of hematoma formation with recruitment of proinflammatory cytokines and matrix metalloproteinases. Unfortunately, when there is an intra-articular fracture, these inflammatory mediators are not retained at the fracture site, but instead, envelop the healthy cartilage of the entire joint via the synovial fluid fracture hematoma (SFFH). These inflammatory cytokines and matrix metalloproteinases are known factors in the progression of osteoarthritis and rheumatoid arthritis. Despite the known inflammatory contents of the SFFH, little research has been done on the effects of the SFFH on healthy cartilage with regard to cell death and alteration in gene expression that could lead to posttraumatic osteoarthritis (PTOA).
METHODS
SFFH was collected from 12 patients with intraarticular ankle fracture at the time of surgery. Separately, C20A4 immortalized human chondrocytes were 3-dimensionally cultured to create scaffold-free cartilage tissue analogs (CTAs) to simulate healthy cartilage. Experimental CTAs (n = 12) were exposed to 100% SFFH for 3 days, washed, and transferred to complete media for 3 days. Control CTAs (n = 12) were simultaneously cultured in complete medium without exposure to SFFH. Subsequently, CTAs were harvested and underwent biochemical, histological, and gene expression analysis.
RESULTS
Exposure of CTAs to ankle SFFH for 3 days significantly decreased chondrocyte viability by 34% ( = .027). Gene expression of both and were significantly decreased after exposure to SFFH ( = .012 and = .0013 respectively), while there was no difference in , , and gene expression. Quantitative analysis of Picrosirius red staining demonstrated increased collagen I deposition with poor ultrastructural organization in SFFH-exposed CTAs.
CONCLUSION
Exposure of an organoid model of healthy cartilage tissue to SFFH after intraarticular ankle fracture resulted in decreased chondrocyte viability, decreased expression of genes regulating normal chondrocyte phenotype, and altered matrix ultrastructure indicating differentiation toward an osteoarthritis phenotype.
CLINICAL RELEVANCE
The majority of ankle fracture open reduction and internal fixation does not occur immediately after fracture. In fact, typically these fractures are treated several days to weeks later in order to let the swelling subside. This means that the healthy innocent bystander cartilage not involved in the fracture is exposed to SFFH during this time. In this study, the SFFH caused decreased chondrocyte viability and specific altered gene expression that might have the potential to induce osteoarthritis. These data suggest that early intervention after intraarticular ankle fracture could possibly mitigate progression toward PTOA.
Topics: Humans; Synovial Fluid; Ankle Fractures; Chondrocytes; Cytokines; Osteoarthritis; Intra-Articular Fractures; Cartilage, Articular; Matrix Metalloproteinases; Gene Expression
PubMed: 37329280
DOI: 10.1177/10711007231178829 -
Journal of Orthopaedic Surgery and... Aug 2023In this study, we try to investigate the risk factors of postoperative surgical site infection (SSI) in closed pilon fractures and establish a nomogram prediction model. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
In this study, we try to investigate the risk factors of postoperative surgical site infection (SSI) in closed pilon fractures and establish a nomogram prediction model.
METHODS
From January 2012 to June 2021, 516 closed pilon fracture patients were included in this study. Of these, 387 patients were randomly assigned to the training group and 129 patients were assigned to the validation group (3:1). By univariate and multivariate Cox analysis, we identified independent risk factors for postoperative SSI after Pilon fracture. We established a nomogram model and used receiver operating characteristic (ROC) and calibration chart to evaluate its discriminant and calibration.
RESULTS
SSI occurred in 71 patients in the training group and 23 patients in the validation group. Ultimately, age, preoperative blood sugar, operative time, Tscherne classification and fracture classification were identified as independent risk factors for SSI. The AUC values for SSI of the training and validation group were 0.898 and 0.880, and the P value of the Hosmer-Lemeshow test was 0.125. We established a nomogram prediction model based on age, preoperative blood sugar, operative time, Tscherne classification and fracture classification.
CONCLUSION
Our nomogram model had good discrimination and calibration power, so it could be used to predict SSI risk in patients with pilon fracture.
Topics: Humans; Nomograms; Surgical Wound Infection; Blood Glucose; Retrospective Studies; Risk Factors; Ankle Fractures; Tibial Fractures
PubMed: 37553679
DOI: 10.1186/s13018-023-04058-z -
Chinese Journal of Traumatology =... Nov 2023Electric scooters (e-scooters) have become an increasingly popular mode of public transportation in recent years. As the incidence of related injuries rises, it is...
PURPOSE
Electric scooters (e-scooters) have become an increasingly popular mode of public transportation in recent years. As the incidence of related injuries rises, it is important to understand specific fracture patterns unique to e-scooters and electric bikes (e-bikes) to help guide management. The purpose of this study was to review the prevalence and describe specific fracture patterns of e-scooter and e-bike related injuries at the busiest level 1 trauma center in the borough of Manhattan.
METHODS
Chart review to determine mechanism of injury was performed on all patients for whom an orthopedic consult was requested from 1/1/2021 to 12/31/2021. All patients whose injuries were sustained due to an e-scooter or e-bike were further reviewed for demographics, injury characteristics including fracture pattern, and definitive injury management. Any patients who had an orthopedic consult placed for a reason other than an acute injury were excluded. Descriptive statistics are reported as frequency (percentage) for categorical variables and means for continuous variables.
RESULTS
Of the 1815 orthopedic consults requested, 1357 (74.8%) were for acute injury management. Of those with acute injuries, 119 (8.8%) sustained 136 e-scooter or e-bike related injuries. There were 92 (77.3%) males at an average age of (33.8 ± 15.7) years. Approximately one-fifth of all patients presented in June 2021 (26, 21.8%). There was a 9.2% rate of open fractures. The 136 injuries were evenly split between the upper and lower extremities, with 57 (47.9%) upper extremity, 57 (47.9%) lower extremity injuries, and 5 (4.2%) concomitant upper and lower extremity injuries. The most common fracture patterns were ankle fractures (16, 11.7%), followed by tibial shaft (14, 10.2%), tibial plateau (13, 9.5%), and radial head fractures (11, 8.0%). There was a 33.3% incidence of associated posterior malleolar fractures in the spiral tibial shaft fractures, 31.0% of posterior malleolar involvement and 18.8% of isolated vertical medial malleolar fractures in the ankle fractures, and 61.5% of posterior comminution in the tibial plateau fractures.
CONCLUSION
E-scooter and e-bike related injuries have a high incidence of tibial shaft fractures, ankle fractures, tibial plateau fractures, and radial head fractures. There should be a high index of suspicion for posterior and medial involvement in lower extremity fractures sustained due to e-scooter or e-bikes. Identifying specific fracture patterns seen in e-scooter and e-bike related mechanisms will help guide management of these injuries.
Topics: Male; Humans; Adolescent; Young Adult; Adult; Middle Aged; Female; Ankle Fractures; Trauma Centers; Incidence; Radial Head and Neck Fractures; Tibial Plateau Fractures; Retrospective Studies; Tibial Fractures; Radius Fractures
PubMed: 36922264
DOI: 10.1016/j.cjtee.2023.02.003 -
World Journal of Orthopedics Jul 2023Open fractures of the ankle are complex injuries requiring multidisciplinary input and are associated with significant morbidity and mortality. However, data on the...
BACKGROUND
Open fractures of the ankle are complex injuries requiring multidisciplinary input and are associated with significant morbidity and mortality. However, data on the clinical outcomes of open ankle fracture management in patients older than 70 is minimal.
AIM
To evaluate the clinical outcomes following open ankle fracture management in patients older than 70. Our secondary aim is to look at predictors of poor outcomes.
METHODS
Following local research and audit department registration, 22 years of prospectively collated data from an electronic database in a district general hospital were assessed. All patients older than 70 years of age with an open ankle fracture requiring surgical intervention were identified. Demographic information, the nature, and the number of surgical interventions were collated. Complications, including surgical site infection (SSI), venous thromboembolic events (VTEs) during hospital stay, and mortality rate, were reviewed.
RESULTS
A total of 37 patients were identified (median age: 84 years, range: 70-98); = 30 females median age: 84 years, range: 70-97); = 7 males median age: 74 years, range: 71-98)) who underwent surgical intervention after an open ankle fracture. Sixteen patients developed SSIs (43%). Superficial SSIs ( = 8) were managed without surgical intervention and treated with antibiotics and regular dressing changes. Deep SSIs ( = 8; 20%) required a median of 3 (range: 2-9) surgical interventions, with four patients requiring multiple washouts and one patient having metalwork removed. VTE incidence was 5% during the hospital stay. Eight patients died within 30 d, and mortality at one year was 19%. The 10-year mortality rate was 57%. The presence of a history of stroke, cancer, or prolonged inpatient stay was found to be predictive of lower survivorship in this population (log-rank test: cancer = 0.008, stroke = 0.001, length of stay > 33 d = 0.015). The presence of a cardiac history was predictive of wound complications (logistic regression, = 0.045). Age, number of operations, and diabetic history were found to be predictive of an increase in the length of stay (general linear model; age < 0.001, number of operations < 0.001, diabetes = 0.041).
CONCLUSION
An open ankle fracture in a patient older than 70 years has at least a 20% chance of requiring repeated surgical intervention due to deep SSIs. The presence of a cardiac history appears to be the main predictor for wound complications.
PubMed: 37485433
DOI: 10.5312/wjo.v14.i7.554 -
Journal of Functional Morphology and... Aug 2023Ankle arthrodesis is a commonly used salvage procedure in the management of post-traumatic ankle fractures, which often result in severe disability and may require the...
Ankle arthrodesis is a commonly used salvage procedure in the management of post-traumatic ankle fractures, which often result in severe disability and may require the amputation of the distal third of the leg. Successful ankle arthrodesis relies on a thorough assessment of local and systemic risk factors to ensure optimal results. Failure to accurately assess these factors may lead to unsatisfactory results. High-energy trauma causing bone defects and soft tissue necrosis often results in osteomyelitis, a condition that poses a significant threat to the success of the arthrodesis procedure. It is important to apply a standardised surgical protocol to minimise the possibility of superficial and deep infection and limit damage to the neighbouring soft tissues. Therefore, it is critical to undertake surgical lavage and debridement and administer systemic and local antibiotic therapy, along with the use of a spacer, to eradicate infection prior to performing arthrodesis. In this study, we present our experience in the recovery of limbs with post-traumatic complications via tibio-astragalic or tibio-calcaneal arthrodesis using a retrograde intramedullary nail technique. The approach involves a multi-step procedure using a previous antibiotic spacer implant and an autologous bone graft (RIA). This study spanned a period from January 2014 to December 2021 and included 35 patients (12 women and 23 men) with a mean age of 47.8 ± 20.08 years (range: 22-85 years). Among the patients, 18 had osteomyelitis following AO 43 C3 fractures, and 9 of them had previous exposure and bone loss at the time of injury. The remaining cases included 10 patients with AO 44 C fracture outcomes and 7 patients with AO 44 B fracture outcomes. Our results emphasise the importance of the meticulous management of local and systemic risk factors in ankle arthrodesis procedures. The successful eradication of infection and subsequent arthrodesis can be achieved via the implementation of surgical lavage, debridement, and systemic and local antibiotic therapy using spacers. This surgical protocol implemented by us has yielded excellent results, saving affected limbs from post-traumatic complications and avoiding the need for amputation. Our study contributes to the existing knowledge supporting the use of retrograde arthrodesis with intramedullary nails in severe cases where limb salvage is the primary goal. However, further research and long-term follow-up studies are needed to validate these results and evaluate the effectiveness of this technique in a larger patient population.
PubMed: 37606418
DOI: 10.3390/jfmk8030122 -
Journal of Clinical Medicine Sep 2023(1) Background: Ankle fractures are common injuries that typically require surgical treatment. Complications may arise, leading to reinterventions with poor recovery and...
(1) Background: Ankle fractures are common injuries that typically require surgical treatment. Complications may arise, leading to reinterventions with poor recovery and reduced quality of life for patients. The aim of this study was to determine the number of patients who underwent surgical reintervention for ankle fractures, characteristics, and associated factors. (2) Methods: A cross-sectional study was conducted to analyze the number of patients requiring surgical intervention for ankle fractures at General Hospital Zone No1 IMSS in Colima over a period of two years. The age, gender, comorbidities, laterality, cause of surgical reintervention, Weber classification, and elapsed time to reintervention were analyzed. (3) Results: A total of 33 patients were included in this study, of whom 63.3% were male, ranging in age from 18 to 51 years old. The predominant Danis-Weber classification for both sexes was suprasyndesmotic fracture (Type C). No established relationship was found between comorbidities and surgical reintervention; however, a significant relationship was observed between home accidents and the need for reintervention. (4) Conclusions: Reintervention in patients previously operated on for ankle fractures is more frequent in male patients and those who sustained the injury at home.
PubMed: 37762784
DOI: 10.3390/jcm12185843