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Ugeskrift For Laeger Feb 2024Beak fractures represent a rare subtype of calcaneal fractures with potential risk of soft tissue complications due to compromised local perfusion. Early diagnosis and...
Beak fractures represent a rare subtype of calcaneal fractures with potential risk of soft tissue complications due to compromised local perfusion. Early diagnosis and timely intervention are crucial to prevent necrosis, infection, and soft tissue defects. This case report describes a 71-year-old male with a beak fracture and delayed intervention with reoccurring soft tissue defects. Given the rarity of the condition, atypical presentation and need for urgent intervention, this emphasizes the importance of awareness of beak fractures of the calcaneus.
Topics: Animals; Male; Humans; Aged; Calcaneus; Beak; Lower Extremity; Ankle Injuries; Knee Injuries; Fractures, Bone
PubMed: 38445338
DOI: 10.61409/V10230635 -
Injury Oct 2023Ankle fracture surgery comes with a risk of fracture-related infection (FRI). Identifying risk factors are important in preoperative planning, in management of patients,...
INTRODUCTION
Ankle fracture surgery comes with a risk of fracture-related infection (FRI). Identifying risk factors are important in preoperative planning, in management of patients, and for information to the individual patient about their risk of complications. In addition, modifiable factors can be addressed prior to surgery. The aim of the current paper was to identify risk factors for FRI in patients operated for ankle fractures.
METHODS
A cohort of 1004 patients surgically treated for ankle fractures at Haukeland University Hospital in the period of 2015-2019 was studied retrospectively. Patient charts and radiographs were assessed for the diagnosis of FRI. Binary logistic regression was used in analyses of risk factors. Regression coefficients were used to calculate the probability for FRI based on the patients' age and presence of one or more risk factors.
RESULTS
FRI was confirmed in 87 (9%) of 1004 patients. Higher age at operation (p < .001), congestive heart failure (CHF), p = 0.006), peripheral artery disease (PAD, p = 0.001), and current smoking (p = .006) were identified as risk factors for FRI. PAD and CHF were the risk factors displaying the strongest association with FRI with an adjusted odds ratio of 4.2 (95% CI 1.8-10.1) and 4.7 (95% CI 1.6-14.1) respectively.
CONCLUSION
The prevalence of FRI was 9% after surgical treatment of ankle fractures. The combination of risk factors found in this study demonstrate the need for a thorough, multidisciplinary, and careful approach when faced with an elderly or frail patient with an ankle fracture. The results of this study help the treating surgeons to inform their patients of the risk of FRI prior to ankle fracture surgery.
LEVEL OF EVIDENCE
Level III retrospective case-control study.
Topics: Aged; Humans; Ankle Fractures; Retrospective Studies; Case-Control Studies; Risk Factors; Smoking; Heart Failure
PubMed: 37688812
DOI: 10.1016/j.injury.2023.111011 -
Clinics in Podiatric Medicine and... Jul 2024Ankle fractures are one of the more common musculoskeletal injuries that are treated by foot and ankle specialists. A thorough understanding of managing these injuries... (Review)
Review
Ankle fractures are one of the more common musculoskeletal injuries that are treated by foot and ankle specialists. A thorough understanding of managing these injuries requires the ability to differentiate between stable and unstable fractures. The current literature supports the nonoperative management of stable Weber B ankle fractures, whereas unstable fractures have much better outcomes with surgical intervention. Specifically, we review the fixation strategies for the lateral, medial, and posterior malleolar fractures respectively. Finally, we discuss the current trends in postoperative management of some of the more common fracture patterns, and the safety in early weight-bearing protocols.
Topics: Female; Humans; Male; Ankle Fractures; Fracture Fixation; Fracture Fixation, Internal; Weight-Bearing; Practice Guidelines as Topic
PubMed: 38789168
DOI: 10.1016/j.cpm.2024.01.008 -
EFORT Open Reviews Jun 2024Bosworth fracture (BF) is a special type of locked ankle fracture-dislocation, characterized by displacement of a fragment of the fractured fibula from the fibular notch... (Review)
Review
Bosworth fracture (BF) is a special type of locked ankle fracture-dislocation, characterized by displacement of a fragment of the fractured fibula from the fibular notch behind the posterior surface of the distal tibia. BF is a complex injury affecting multiple structures of the ankle joint, which is still frequently misjudged even today, potentially leading to severe complications. CT examination, including 3D reconstructions, should be the diagnostic standard in BF, as it provides a complete picture of the fracture pathoanatomy, most prominently the morphology of the frequently associated posterior malleolar fracture. BF requires early reduction of the displaced fibular fragment without repeated attempts on closed reduction. Non-operative treatment of BF almost always fails. The standard treatment procedure is early open reduction internal fixation. Due to the relative severity and paucity of the injury, BF seems to be particularly prone to soft tissue complications, including compartment syndrome. The results of operative treatment are mixed. Many studies report persistent pain even after a short time interval, with limitations of the range of motion or even stiffness of the ankle joint, and development of degenerative changes. Larger studies with long-term results are still missing.
PubMed: 38828971
DOI: 10.1530/EOR-23-0050 -
Instructional Course Lectures 2024Multiple fracture patterns can occur around the proximal interphalangeal joint and require surgeons to have a thorough understanding of the anatomy, clinical and...
Multiple fracture patterns can occur around the proximal interphalangeal joint and require surgeons to have a thorough understanding of the anatomy, clinical and radiographic examination, common fracture patterns, surgical and nonsurgical treatment options, and potential complications. Proximal phalangeal condylar fractures are typically managed surgically, because even nondisplaced fractures have a propensity for displacement. Middle phalangeal base fractures most commonly present as a volar lip fracture with or without dorsal subluxation or dislocation. Treatment options include extension block splinting or pinning, transarticular pinning, open reduction and internal fixation, external fixation, volar plate arthroplasty, and hemihamate arthroplasty. Less common fractures include dorsal lip fractures with or without volar subluxation or dislocation (the central slip fracture), lateral plateau impaction or avulsion injuries, and pilon fractures. The main goals in the management of middle phalangeal base fractures are to restore articular congruency and initial early range of motion, which are more important than obtaining an anatomic reduction.
Topics: Humans; Finger Joint; Fractures, Bone; Finger Injuries; Joint Dislocations; Fracture Fixation, Internal; Ankle Fractures; Range of Motion, Articular
PubMed: 38090907
DOI: No ID Found -
Foot & Ankle International Oct 2023Midfoot fractures and dislocations are infrequent and functional outcomes following Lisfranc injuries have not been well described. The purpose of this project was to...
BACKGROUND
Midfoot fractures and dislocations are infrequent and functional outcomes following Lisfranc injuries have not been well described. The purpose of this project was to explore functional outcomes following operative treatment of high-energy Lisfranc injury.
METHODS
A retrospective cohort of 46 adults with tarsometatarsal fractures and dislocations treated at a single Level 1 trauma center were reviewed. Demographic, medical, social, and injury features of these patients and their injuries were recorded. Foot Function Index (FFI) and Short Musculoskeletal Function Assessment (SMFA) surveys were collected after mean 8.7 years' follow-up. Multiple linear regression was performed to identify independent predictors of outcome.
RESULTS
Forty-six patients with mean age 39.7 years completed functional outcome surveys. Mean SMFA scores were 29.3 (dysfunction) and 32.6 (bothersome). Mean FFI scores were 43.1 (pain), 43.0 (disability), and 21.7 (activity), with a mean total score of 35.9. FFI pain scores were worse than published values for fractures of the plafond (33, = .04), distal tibia (33, = .04), and talus (25.3, = .001). Lisfranc injury patients reported worse disability (43.0 vs 29, = .008) and total FFI scores (35.9 vs 26, = .02) compared with distal tibia fractures. Tobacco smoking was an independent predictor of worse FFI ( < .05) and SMFA emotion and bothersome scores ( < .04). Chronic renal disease was a predictor of worse FFI disability ( = .04) and SMFA subcategory scores ( < .04). Male sex was associated with better scores in all SMFA categories ( < .04). Age, obesity, or open injury did not affect functional outcomes.
CONCLUSION
Patients reported worse pain by FFI after Lisfranc injury compared to other injuries about the foot and ankle. Tobacco smoking, female sex, and preexisting chronic renal disease are predictive of worse functional outcome scores, warranting further study in a larger sample, as well as counseling of long-term consequences of this injury.
LEVEL OF EVIDENCE
Level IV, retrospective, prognostic.
Topics: Adult; Humans; Male; Female; Retrospective Studies; Fracture Fixation, Internal; Fractures, Bone; Ankle Fractures; Joint Dislocations; Foot Injuries; Pain; Renal Insufficiency, Chronic; Treatment Outcome
PubMed: 37341124
DOI: 10.1177/10711007231181121 -
Journal of Orthopaedic Case Reports Nov 2023A dislocated knee is a potential limb-threatening injury. Simultaneous dislocation of knee and ankle joint in an ipsilateral limb is a very rare pattern of injury. A few...
INTRODUCTION
A dislocated knee is a potential limb-threatening injury. Simultaneous dislocation of knee and ankle joint in an ipsilateral limb is a very rare pattern of injury. A few cases of ipsilateral hip and knee dislocation were described in literature. Rare injury such as posterior dislocation knee with ipsilateral ankle fracture dislocation cases was also presented. However, lateral dislocation of knee along with the same side ankle fracture dislocation is a rare scenario. To the best of our knowledge, these two simultaneous lesions do not seem to have been reported previously. Immediate management of such injury is to reduce both joint and stabilization with external fixator and definitive surgery in the second stage when soft-tissue condition allows.
CASE REPORT
We describe a rare case of a 37-year-old farmer having injury to his right leg with tiller machine. Lateral right knee dislocation and right ankle fracture dislocation reduced in the emergency department. In emergency OT, external fixator applied for knee and ankle stabilization. When swelling subsides in ankle, fracture fixation is done with plates and screws. Knee fixator is kept for 6 weeks then knee physiotherapy started.
CONCLUSION
Dislocation of any joint is treated as an orthopedic emergency. Simultaneous dislocation of knee and ankle joints in an ipsilateral limb is a challenging situation for even the experienced surgeon. The outcome of such patients varies with associated injuries and time took for relocation and meticulous physical examination, with a high index of clinical suspicion is needed in diagnosing and management of such cases.
PubMed: 38025347
DOI: 10.13107/jocr.2023.v13.i11.4026 -
Clinics in Podiatric Medicine and... Jan 2024Successful outcomes in the surgical treatment of the fractured ankle require methods that respect the soft tissue envelope and establish a stable mortise for functional... (Review)
Review
Successful outcomes in the surgical treatment of the fractured ankle require methods that respect the soft tissue envelope and establish a stable mortise for functional rehabilitation. Ankle fractures in patients with osteopenia and in diabetic patients with deranged bone remodeling constitute high-risk injuries that may result in catastrophic complications. These patients present unique care challenges and should not be approached in the same manner as their healthy counterparts. We present the principles of treatment in high-risk ankle fractures, operative treatment philosophy illustrating techniques frequently used at our institution, and a review of current literature.
Topics: Humans; Ankle Fractures; Fracture Fixation, Internal; Ankle Injuries; Ankle; Ankle Joint; Treatment Outcome; Retrospective Studies
PubMed: 37951680
DOI: 10.1016/j.cpm.2023.06.003 -
Injury Nov 2023The use of nitinol continuous compression staples has shown clinical utility in the management of various orthopaedic injuries. While literature is most robust in the... (Review)
Review
INTRODUCTION
The use of nitinol continuous compression staples has shown clinical utility in the management of various orthopaedic injuries. While literature is most robust in the realm of foot/ankle and spine surgery, the use of nitinol staples has been documented in fixation of wrist, olecranon, patella, and pelvis fractures.
METHODOLOGY
A narrative review was conducted by searching three online databases - PubMed, Web of Science, and Cochrane using the terms "Nitinol" and "Staple" published between 2003 and 2023. A total of 42 articles met inclusion/exclusion criteria and were included in this review.
REVIEW
Literature outside of foot/ankle and spine surgery is largely limited to biomechanical studies, case reports, and finite element analyses. The literature is summarized within this review by anatomic location including foot/ankle, lower extremity, hand, upper extremity, spine, and pelvis.
CONCLUSION
Existing literature demonstrates a diverse array of applications for nitinol continuous compression staples in both axial and appendicular orthopaedic care. Advantages of these implants include ease of application, ability to capture small bony fragments, continuous compression across a fracture or arthrodesis, and full coaptation which maximizes the surface area for healing and/or fusion.
Topics: Humans; Orthopedics; Alloys; Fractures, Bone; Arthrodesis
PubMed: 37769424
DOI: 10.1016/j.injury.2023.111036