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Developmental Medicine and Child... May 2024To examine patients with cerebral palsy (CP) undergoing open reduction and internal fixation (ORIF) for ankle fractures.
AIM
To examine patients with cerebral palsy (CP) undergoing open reduction and internal fixation (ORIF) for ankle fractures.
METHOD
This was a retrospective study of adult patients undergoing ankle fracture ORIF for closed, isolated ankle fractures identified in between 2010 and 2021 in the Q1 PearlDiver M151 database. Patients with CP were identified with International Classification of Diseases (ICD)-9 and ICD-10 codes, and were matched to those without 1:10 on age, sex, and Elixhauser comorbidity index (ECI). Ninety-day adverse events were assessed with multivariable logistic regression.
RESULTS
A total of 148 993 patients with isolated ankle fracture ORIF were identified, of whom 407 (0.27%) had CP. After matching, 3863 without CP were compared to 389 with CP. Patients with CP were at increased odds of: 90-day urinary tract infection (odds ratios [OR] 6.26), pneumonia (OR 3.50), minor adverse events (OR 3.46), sepsis (OR 3.30), any adverse events (OR 3.04), emergency department visits (OR 2.28), serious adverse events (OR 1.77), and prolonged length of stay more than 4 days (OR 22.44) (p < 0.001 for all).
INTERPRETATION
Patients with CP undergoing ORIF for isolated, closed ankle fractures are at increased odds of several 90-day adverse events and prolonged length of stay compared to matched patients without CP.
PubMed: 38773804
DOI: 10.1111/dmcn.15958 -
The Journal of Bone and Joint Surgery.... Apr 2024Ankle fracture is a common injury and often requires operative treatment. This study investigated short-term (≤4 months) and long-term (>4 months) complications after...
BACKGROUND
Ankle fracture is a common injury and often requires operative treatment. This study investigated short-term (≤4 months) and long-term (>4 months) complications after ankle fracture surgery in a 23-year period with use of data from a comprehensive, nationwide, individual-level register.
METHODS
Data regarding patients who underwent operative treatment for ankle fracture were collected from the Finnish Care Register for Health Care and analyzed with use of logistic and Cox regression.
RESULTS
A total of 83,666 ankle fractures were operatively treated between 1998 and 2020. Of these, 36% were lateral malleolar fractures, 7% were medial malleolar fractures, 52% were bimalleolar or trimalleolar fractures, and 5% were other types of fractures. Fifty-one percent of the fractures were in female patients. The overall rate of short-term complications was 7.2%. Specifically, infection occurred in 4.4% of cases; thromboembolic complications,1.6% of cases; mechanical complications, 0.4% of cases; and other complications, 0.9% of cases. An age of >75 years was associated with a higher rate of short-term complications than an age of 51 to 75 years, with an odds ratio of 1.53 in the multivariable analysis (95% confidence interval, 1.39 to 1.67; p < 0.001). Short-term complications were also more prevalent in patients with diabetes (with or without associated complications); chronic pulmonary, kidney, or liver disease; or peripheral vascular disease. Mortality during the first 4 months after the ankle fracture operation was 0.6%. The most common reason for reoperation in the long term (>4 months after the index procedure) was fixation device removal, with a cumulative incidence of 17% within the first 3 years postoperatively. The risk of implant removal increased in younger patients and patients with bimalleolar or trimalleolar fractures. The cumulative incidence of ankle arthrodesis and arthroplasty was low.
CONCLUSIONS
Although postoperative complications are relatively rare, their treatment can lead to considerable morbidity. The findings of this study allow us to identify patients who are prone to complications or reoperations after undergoing operative treatment for ankle fracture.
LEVEL OF EVIDENCE
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
PubMed: 38683891
DOI: 10.2106/JBJS.23.00745 -
Foot & Ankle International Sep 2023The importance of the deltoid ligament in the congruency and coupling of the tibiotalar joint is well known. The current trend is to repair it in cases of acute injuries...
BACKGROUND
The importance of the deltoid ligament in the congruency and coupling of the tibiotalar joint is well known. The current trend is to repair it in cases of acute injuries in the context of ankle fractures; however, there is limited information on how it should be reconstructed. The objective of this study was to compare different deltoid ligament repair types in an ankle fracture cadaveric model.
METHODS
Sixteen cadaveric foot-ankle-distal tibia specimens were used. All samples were prepared as a supination external rotation ankle fracture model. Axial load and cyclic axial rotations were applied on every specimen using a specifically designed frame. This test was performed without deltoid injury, with deltoid injury, and after repair. The reconstruction was performed in 4 different ways (anterior, posterior, middle, and combined). Medial clear space (MCS) was measured for each condition on simulated weightbearing (WB) and gravity stress (GS) radiographs. Reflective markers were used in tibia and talus, registering the kinematics through a motion analysis system to record the tibiotalar uncoupling.
RESULTS
After deltoid damage, in all cases the MCS increased significantly on GS radiographs, but there was no increase in the MCS on WB radiographs. After repair, in all cases, the MCS was normalized. Kinematically, after deltoid damage, the tibiotalar uncoupling increased significantly. All isolated repairs achieved a similar tibiotalar uncoupling value as its baseline condition. The combined repair resulted in a significant decrease in tibiotalar uncoupling.
CONCLUSION
Our results show that deltoid repair recovers the tibiotalar coupling mechanism in an ankle fracture model. Isolated deltoid repairs recovered baseline MCS and tibiotalar uncoupling values. Combined repairs may lead to overconstraint, which could lead to postoperative stiffness. Clinical studies are needed to prove these results and show clinically improved outcomes.
CLINICAL RELEVANCE
This study helps in finding the optimum deltoid repair to use in an acute trauma setting.
Topics: Humans; Ankle Fractures; Ligaments, Articular; Ankle; Ankle Joint; Cadaver
PubMed: 37489020
DOI: 10.1177/10711007231184844 -
FP Essentials Dec 2023The ankle is the cause of many musculoskeletal injuries. Knowledge of ankle anatomy and physiology can provide an initial framework to help clinicians formulate a...
The ankle is the cause of many musculoskeletal injuries. Knowledge of ankle anatomy and physiology can provide an initial framework to help clinicians formulate a differential diagnosis. A thorough history should be obtained, with a focus on mechanism of injury and symptom duration to hone the differential diagnosis and physical examination. Specific diagnostic maneuvers allow for evaluation of individual structures and assessment of ankle stability. The Ottawa Ankle Rules can assess the need for x-rays and help rule out underlying fracture. Lateral and medial ankle sprains and Achilles tendinopathy are among the most common ankle conditions in the primary care setting. These sprains are managed with ankle protection with a splint, brace, or other device; the rest, ice, compression, and elevation (RICE) protocol; and a short course of nonsteroidal anti-inflammatory drugs (NSAIDs). Management of Achilles tendon conditions typically consists of the RICE protocol, activity reduction, physical therapy or clinician-directed exercises, NSAIDs, and, in severe cases, short-term immobilization. For patients with stable ankle fractures, various orthoses can be used for immobilization. Orthopedic consultation should be sought for patients with unstable ankle fractures.
Topics: Humans; Ankle; Achilles Tendon; Ankle Fractures; Tendinopathy; Anti-Inflammatory Agents, Non-Steroidal; Musculoskeletal Diseases
PubMed: 38109047
DOI: No ID Found -
BMC Musculoskeletal Disorders Nov 2023Ankle fracture-dislocations are among the most severe injuries, and the use of an external fixator as a recommended fixation method has some disadvantages. The aim of...
PURPOSE
Ankle fracture-dislocations are among the most severe injuries, and the use of an external fixator as a recommended fixation method has some disadvantages. The aim of this study was to compare the clinical outcomes and complication rates of external and K-wire fixations in the treatment of ankle fracture dislocations.
METHODS
A total of 67 patients with ankle fracture-dislocations requiring temporary external or percutaneous K-wire fixation were included. The exclusion criteria were pilon fractures, open fractures, and those who required acute open reduction internal fixation (ORIF). The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, a 10-point visual analog scale (VAS) score (range 0-10), and complications before and after the definitive surgery were recorded.
RESULTS
A significant difference between the two groups was not observed for age, sex, affected side, fracture type, smoking status, or diabetes. The average AOFAS scores were 83.2 and 83.3, the median VAS scores were 3 and 3, and the complication rates were 32.4% and 6.7% in the external and K-wire fixation groups, respectively (p = 0.010). However, skin necrosis, re-dislocation of the ankle, surgical wound infection, and posttraumatic ankle osteoarthritis frequency were not significantly different between the groups, except for pin-sites infection (p = 0.036).
CONCLUSION
Ankle fracture-dislocations using percutaneous k-wire fixation showed a low rate of complications and favorable clinical outcomes. This method could be a good alternative treatment option for ankle fracture-dislocations.
Topics: Humans; Ankle Fractures; Ankle; Treatment Outcome; Fracture Fixation; External Fixators; Fracture Dislocation; Fracture Fixation, Internal; Retrospective Studies
PubMed: 37951888
DOI: 10.1186/s12891-023-07020-6 -
Patient Education and Counseling Nov 2023The aim of this study was to employ a user-driven participatory design (PD) approach to develop an mHealth solution that addresses patients' information needs after...
OBJECTIVE
The aim of this study was to employ a user-driven participatory design (PD) approach to develop an mHealth solution that addresses patients' information needs after surgical or non-surgical treatment for an ankle fracture.
METHODS
Patients with an ankle fracture and health care professionals along the treatment pathway in both the hospital and municipality participated in four workshops (WS).
RESULTS
We found that patients with an ankle fracture need information on topics such as "a typical course," "bandages and assistive devices," "what can I feel," "what may I do," "what to usually worry about," "medicine," "tips and tricks," and "contact information." Moreover, patients requested diverse modes of dissemination, preferably a combination of text, timelines, pictures, animations, and videos. Alpha and beta testing of the digital platform was conducted, and content-related improvements were made. A readability analysis showed reading ease of 40.1 of 100, meaning that it should be easily understood by 15-16 year-olds.
CONCLUSION
Involving representatives of future users in creating this mHealth solution using PD demonstrates the benefits of creating a solution that aligns with users' needs.
PRACTICE IMPLICATIONS
The mHealth solution is now ready for implementation and large-scale evaluation in phase three of the overall PD study. An mHealth usability questionnaire will be employed to assess usability by future patients with surgically or non-surgically treated ankle fractures.
Topics: Humans; Ankle Fractures; Health Personnel; Telemedicine; Surveys and Questionnaires; Mobile Applications
PubMed: 37591014
DOI: 10.1016/j.pec.2023.107891 -
Journal of Orthopaedic Case Reports Jul 2023Talus fractures are relatively rare injuries. These injuries are very serious because they can compromise the motion of foot and ankle and result in severe disability....
INTRODUCTION
Talus fractures are relatively rare injuries. These injuries are very serious because they can compromise the motion of foot and ankle and result in severe disability. Fractures of talar neck and body constitutes about 40% of all talus fractures. These occur secondary to high energy trauma most commonly motor vehicle collisions or fall from height. Fractures involving the lateral process results due to ankle inversion and dorsiflexion. Majority of talar surface is covered by articular cartilage and its role in force transmission between leg and foot makes successful treatment of such injuries a mandatory prerequisite to regain function. We present an atypical case of talus fracture in which fracture plane extends from posterior aspect of lateral talar process involving the body in coronal plane. Not much of literature has been published in this regard.
CASE REPORT
A 28 year old male presented with pain in the left ankle following fall from a tree. Following the radiological investigations, in coronal plane fracture line extends from posterior aspect of lateral talar process into the body medially and anteriorly. Internal fixation of the fracture was done by an open approach and a strict rehabilitation protocol was followed. At three months the patient had satisfactory healing of fracture without any irregularity of the articular surface and ambulant pain free with full range of ankle movements.
CONCLUSION
There are several choices to treat talar fractures. The ideal treatment should be customized as per the fracture morphology. Open reduction and internal fixation is one of the best options to restore the tibiotalar and subtalar joint congruency and to prevent post traumatic arthritis. Appropriate diagnosis and perioperative treatment is the key to success in talar fracture management.
PubMed: 37521380
DOI: 10.13107/jocr.2023.v13.i07.3770 -
Orthopadie (Heidelberg, Germany) Mar 2024Lateral ligament injuries are the most common injuries of the ankle joint and are usually treated with early weight bearing after a short period of immobilization. If...
Lateral ligament injuries are the most common injuries of the ankle joint and are usually treated with early weight bearing after a short period of immobilization. If the clinical presentation is suspicious, additional injuries to the deltoid ligament complex and the syndesmosis should be considered. The indications for additional diagnostics should be generously applied. Injuries to the deltoid ligament usually occur as part of a complex ankle injury and should also be addressed in the surgical treatment of accompanying injuries. Chronic instability in this area necessitates complex bony and soft tissue procedures. Syndesmotic injuries with insufficiency of the capsule-ligament apparatus are frequent in ankle fractures and are stabilized during fracture treatment. Isolated syndesmotic instability should also be surgically treated as chronic injuries are usually associated with poor clinical results and early osteoarthritis.
Topics: Humans; Ankle Joint; Ankle; Joint Instability; Collateral Ligaments; Ankle Injuries
PubMed: 38324018
DOI: 10.1007/s00132-023-04462-7 -
Clinics in Podiatric Medicine and... Jul 2024Intra-articular calcaneal fractures are debilitating injuries that can result in a dramatic effect on quality of life post-injury. Surgical intervention is generally... (Review)
Review
Intra-articular calcaneal fractures are debilitating injuries that can result in a dramatic effect on quality of life post-injury. Surgical intervention is generally advised when significant displacement or comminution is present but can present a host of complications secondary to the limited blood supply and fragility to the soft tissues following injury. Surgical approaches to calcaneal fractures generally include the lateral extensile approach, minimal incision (sinus tarsi approach), or percutaneous approach. Each approach presents risks and benefits; therefore, determining the optimal incisional approach should be based on patient comorbidities, fracture pathoanatomy, soft tissue envelope concerns, and patient pre-injury functional status.
Topics: Humans; Calcaneus; Intra-Articular Fractures; Fracture Fixation, Internal; Male; Fractures, Bone
PubMed: 38789165
DOI: 10.1016/j.cpm.2024.01.006 -
The Journal of Foot and Ankle Surgery :... 2023Patients with diabetes mellitus (DM) are at increased risk of complications following ankle fracture surgery. Previous research suggests that patients of low...
Patients with diabetes mellitus (DM) are at increased risk of complications following ankle fracture surgery. Previous research suggests that patients of low socioeconomic status are at increased risk of amputation following orthopedic complications. The purpose of this research was to determine if low socioeconomic status increases risk of below-knee amputation (BKA) following ankle fractures among patients with DM. The National Inpatient Sample (NIS) was queried from 2010 to 2014 to identify 125 diabetic patients who underwent ankle fracture surgical fixation followed by BKA. Two cohorts (BKA vs no BKA) and a multivariate logistic regression model were created to compare the effects of independent variables, including age, sex, race, primary payer, median household income by ZIP code, hospital location/teaching status, and comorbidities. The most predictive variables for BKA were concomitant peripheral vascular disease (odds ratio [OR] 5.35, 95% confidence interval [CI] 3.51-8.15), history of chronic diabetes-related medical complications (OR 3.29, CI 2.16-5.01), age in the youngest quartile (OR 2.54, CI 1.38-4.67), and male sex (OR 2.28, CI 1.54-3.36). Patient race and median household income were not significantly associated with BKA; however, risk of BKA was greater among patients with Medicaid (OR 2.23, CI 1.09-4.53) or Medicare (OR 1.85, CI 1.03-3.32) compared to privately insured patients. Diabetic inpatients with Medicaid insurance are at over twice the odds of BKA compared to privately insured patients following ankle fracture. Furthermore, peripheral vascular diseases, uncontrolled diabetes, younger age, and male sex each independently increase risk of BKA.
Topics: Humans; Male; Aged; United States; Ankle Fractures; Treatment Outcome; Risk Factors; Medicare; Amputation, Surgical; Peripheral Vascular Diseases; Diabetes Mellitus; Retrospective Studies
PubMed: 37086905
DOI: 10.1053/j.jfas.2023.04.002