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Injury Oct 2023The aim of the study was to propose a classification system of posterior malleolar fractures by fracture lines with the use of CT scans, including 3D CT reconstruction,...
OBJECTIVES
The aim of the study was to propose a classification system of posterior malleolar fractures by fracture lines with the use of CT scans, including 3D CT reconstruction, which can better understand morphological characteristics, analyze the mechanism and guide the surgeon to choose the optimal approach and fixation.
METHODS
Patients with OTA/AO type 44 fractures involving the posterior malleolus and preoperative CT scans were included. We retrospectively analyzed 128 consecutive patients with posterior malleolar fractures from January 2013 to December 2019 at our institution. CT data were loaded into Mimics software (V20.0, Materialize), in which 3D CT reconstruction, morphological analysis and data measurements were made.
RESULTS
Based on the number of fracture lines in 128 consecutive patients, posterior malleolar fractures were classified into three types: type 1 with a single fracture line, type 2 with double fracture lines and type 3 with multiple fracture lines. According to the distribution of the fracture line, type 1 was divided into types 1A, 1B and 1C, and type 2 was divided into types 2A, 2B and 2C. The fracture line from the fibular notch to the posterior rim of the distal tibia was defined as type 1A, and the fracture line to the medial malleolus was defined as type 1B. Type 1C was a small fragment in the posterior rim of the distal tibia. Type 2A was regarded as type 1A with type 1C. It was considered type 2B because another fracture line started from the fracture line of type 1A and extended to the medial malleolus. In type 2C, we could see that the double fracture lines were all from the fibular notch to the posterior rim of the distal tibia and did not cross. Type 3 fractures were comminuted fractures with multiple fracture lines.
CONCLUSION
The morphology of posterior malleolar fractures, involvement of the fibular notch, or the medial malleolus can be obviously assessed by our classification system. We found the relation of the injury mechanism between type 1 and type 2 by comparing the area of the fragment. We have indicated that each type of fracture corresponds to its associated injury mechanism and which surgical approach and fixation can be chosen.
Topics: Humans; Fractures, Multiple; Retrospective Studies; Ankle Fractures; Fractures, Comminuted; Tomography, X-Ray Computed
PubMed: 37643538
DOI: 10.1016/j.injury.2023.111006 -
European Review For Medical and... Nov 2023To investigate the effect of Diclofenac sodium sustained-release capsules combined with function training on functional recovery and Visual Analog Scale (VAS) score... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To investigate the effect of Diclofenac sodium sustained-release capsules combined with function training on functional recovery and Visual Analog Scale (VAS) score after surgery for ankle fractures.
PATIENTS AND METHODS
The study included 88 patients with ankle fractures who were surgically treated at our institution between October 2019 and October 2021. The individuals were randomized into experimental and control groups, with 44 patients in each group. Following their hospitalization, all patients had surgical therapy. After surgery, patients in the control group received conventional analgesics together with function training, whereas those in the experimental group received Diclofenac sodium sustained-release capsules along with function training. The efficacy of the post-surgical treatment in the two groups was then evaluated using functional recovery and VAS scores.
RESULTS
There was no significant difference in the VAS score between the two groups before intervention (p>0.05). After treatment, both groups experienced pain relief, with the VAS score of the experimental group being significantly lower than the control group (p<0.05). The number of patients in the experimental group who fully and partially complied with the study was 19 and 24, respectively, significantly higher than that of 15 and 20 in the control group. Only 1 patient in the experimental group was non-compliant, compared to 9 in the control group. The total compliance rate in the experimental group was 97.73%, much higher than that of 79.55% in the control group (p<0.05). Before the intervention, there was no significant difference in the range of active ankle motion between the two groups (p>0.05). After treatment, there was an improvement in the range of active motion of the ankle in patients from both groups.
CONCLUSIONS
After ankle fracture surgery, using Diclofenac sodium sustained-release capsules in conjunction with function training successfully lowers postoperative pain. It also maintains emotional stability and ensures sleep, factors which are helpful in improving patient compliance to treatment and promoting functional recovery of the ankle. The clinical value of this treatment regimen is certain, and it deserves more widespread application.
Topics: Humans; Diclofenac; Ankle Fractures; Delayed-Action Preparations; Pain, Postoperative; Analgesics; Treatment Outcome
PubMed: 38039014
DOI: 10.26355/eurrev_202311_34452 -
Foot & Ankle Orthopaedics Oct 2023The aim of this study was to translate and cross-culturally adapt the Olerud-Molander Ankle Score (OMAS) into Spanish and to assess its reliability and validity.
BACKGROUND
The aim of this study was to translate and cross-culturally adapt the Olerud-Molander Ankle Score (OMAS) into Spanish and to assess its reliability and validity.
METHODS
The translation and adaptation to develop the Spanish version of the OMAS (OMAS-Sp) was performed according to current international guidelines. The OMAS-Sp was administered to 98 patients with a surgically treated ankle fracture, and it was repeated 7-14 days later to assess construct reliability of each question's score and the total score. Test-retest reliability and the internal consistency were calculated, and concurrent validity was assessed by comparing the OMAS-Sp with the Foot and Ankle Outcome Score (FAOS). The presence of floor and ceiling effects was also analyzed.
RESULTS
Adequate internal consistency was found with a Cronbach α of 0.821. Excellent test-retest reliability was demonstrated with an interclass correlation coefficient for the total score of 0.970 (95% CI 0.956-0.980; < .001). Spearman correlation coefficients ('s) between the OMAS-Sp total score and the 5 FAOS subscales ranged from 0.944 to 0.951 ( < .001). No floor or ceiling effects were found.
CONCLUSION
The OMAS-Sp demonstrated adequate psychometric properties and is a valid and reliable tool for assessing outcomes in Spanish-speaking patients with surgically treated ankle fractures.
LEVEL OF EVIDENCE
Level II, prospective cohort study.
PubMed: 38058977
DOI: 10.1177/24730114231213594 -
Zhongguo Gu Shang = China Journal of... Aug 2023To explore curative effect of conservative treatment of supination-lateral rotation (SER) with type Ⅲ and Ⅳ ankle fracture by bone setting technique.
OBJECTIVE
To explore curative effect of conservative treatment of supination-lateral rotation (SER) with type Ⅲ and Ⅳ ankle fracture by bone setting technique.
METHODS
From January 2017 to December 2019, 64 patients diagnosed with SER with type Ⅲ and Ⅳ ankle fracture were treated with manipulative reduction and conservative treatment (manipulation group) and surgical treatment with open reduction and internal fixation (operation group), 32 patients in each group. In manipulation group, there were 17 males and 15 females, aged from 15 to 79 years old with an average of (51.42±13.68) years old;according to Lauge-Hansen classification, there were 8 patients with supination external rotation type Ⅲ and 24 patients with type Ⅳ. In operation group, there were 13 males and 19 females, aged from 18 to 76 years old with an average of (47.36±15.02) years old;7 patients with type Ⅲ and 25 patients with type Ⅳ. Displacement of ankle fracture was measured by Digimizer software, and compared before treatment, 3 and 12 months after treatment between two groups. Lateral medial malleolus displacement, lateral medial malleolus displacement, lateral malleolus displacement, lateral malleolus displacement, lateral malleolus contraction displacement and posterior malleolus displacement were measured and compared between two groups. Mazur score was used to evaluate ankle joint function.
RESULTS
All patients were followed up from 12 to 36 months with an average of (17.16±9.36) months. There were statistical differences in lateral medial malleolus displacement, lateral medial malleolus displacement, lateral malleolus displacement, lateral malleolus displacement, lateral malleolus contraction displacement and posterior malleolus displacement in manipulation group before and after reduction(<0.05). Compared with operation group, there were no statistically significant differences in lateral malleolus shift, lateral malleolus shift, lateral malleolus contraction shift(>0.05), while there were statistically significant differences in lateral malleolus shift, posterior malleolus shift up and down (<0.05). Mazur scores of ankle joint at 3 months after treatment in manipulation group and operation group were 68.84±13.08 and 82.53±7.31, respectively, and had statistical differences(<0.05), while there was no difference in evaluation of clnical effect(>0.05). There were no differences in Mazur score and evaluation of clnical effect between two groups at 12 months after treatment (>0.05).
CONCLUSION
Bone setting technique could effectively correct lateral displacement of medial malleolus, lateral displacement of medial malleolus, lateral displacement of lateral malleolus and lateral contraction displacement of lateral malleolus in supination lateral rotation type Ⅲ and Ⅳ ankle fracture, and has good long-term clinical effect, which could avoid operation for some patients and restore ankle function after fracture.
Topics: Female; Male; Humans; Adolescent; Young Adult; Adult; Middle Aged; Aged; Conservative Treatment; Ankle Fractures; Supination; Fibula; Ankle Joint
PubMed: 37605912
DOI: 10.12200/j.issn.1003-0034.2023.08.008 -
Archives of Orthopaedic and Trauma... Jun 2024Unstable fractures often necessitate open reduction and internal fixation (ORIF), which generally yield favourable outcomes. However, the impact of surgical trainee... (Comparative Study)
Comparative Study
BACKGROUND
Unstable fractures often necessitate open reduction and internal fixation (ORIF), which generally yield favourable outcomes. However, the impact of surgical trainee autonomy on healthcare quality in these procedures remains uncertain. We hypothesized that surgery performed solely by residents, without supervision or participation of an attending surgeon, can provide similar outcomes to surgery performed by trauma or foot and ankle fellowship-trained orthopaedic surgeons.
METHODS
A single-center cohort of an academic level-1 trauma center was retrospectively reviewed for all ankle ORIF between 2015 and 2019. Data were compared between surgery performed solely by post-graduate-year 4 to 6 residents, and surgery performed by trauma or foot and ankle fellowship-trained surgeons. Demographics, surgical parameters, preoperative and postoperative radiographs, and primary (mortality, complications, and revision surgery) and secondary outcome variables were collected and analyzed. Univariate analysis was performed to evaluate outcomes.
RESULTS
A total of 460 ankle fractures were included in the study. Nonoperative cases and cases operated by senior orthopaedic surgeons who are not trauma or foot and ankle fellowship-trained orthopaedic surgeons were excluded. The average follow-up time was 58.4 months (SD ± 12.5). Univariate analysis of outcomes demonstrated no significant difference between residents and attendings in complications and reoperations rate (p = 0.690, p = 0.388). Sub-analysis by fracture pattern (Lauge-Hansen classification) and the number of malleoli involved and fixated demonstrated similar outcomes. surgery time was significantly longer in the resident group (p < 0.001).
CONCLUSION
The current study demonstrates that ankle fracture surgery can be performed by trained orthopaedic surgery residents, with similar results and complication rates as surgery performed by fellowship-trained attendings. These findings provide valuable insights into surgical autonomy in residency and its role in modern clinical training and surgical education.
LEVEL OF EVIDENCE
Level III - retrospective cohort study.
Topics: Humans; Internship and Residency; Ankle Fractures; Retrospective Studies; Female; Male; Fellowships and Scholarships; Middle Aged; Adult; Orthopedic Surgeons; Fracture Fixation, Internal; Clinical Competence; Treatment Outcome; Orthopedics; Aged
PubMed: 38703214
DOI: 10.1007/s00402-024-05259-9 -
International Journal of Molecular... May 2024Post-traumatic osteoarthritis of the ankle (PTOA) is frequently observed following a debilitating consequence of intra-articular ankle fractures. Numerous risk factors... (Review)
Review
Post-traumatic osteoarthritis of the ankle (PTOA) is frequently observed following a debilitating consequence of intra-articular ankle fractures. Numerous risk factors contribute to the pathogenesis of PTOA, including articular incongruity, joint malalignment, and concomitant soft tissue damage. Despite attempts to restore joint anatomy and manage soft tissues to avoid long-term complications after intra-articular ankle fractures, the incidence of PTOA remains markedly elevated. Inflammatory processes triggered by intra-articular ankle fractures have emerged as potential instigators that expedite the progression of PTOA. Injury to the articular cartilage and subchondral bone may lead to the release of inflammatory mediators, which can contribute to cartilage degradation and bone resorption. This study provides a narrative review on the current knowledge concerning the association between inflammation and the development of PTOA following intra-articular ankle fractures. We also discuss novel therapeutic agents that target inflammatory pathways to impede the progression of post-traumatic osteoarthritis after intra-articular ankle fractures. These medication and interventions were summarized within this review article.
Topics: Humans; Osteoarthritis; Inflammation; Animals; Cartilage, Articular; Ankle Joint; Ankle Fractures; Ankle Injuries
PubMed: 38892089
DOI: 10.3390/ijms25115903 -
Foot & Ankle Specialist Oct 2023The incidence of ankle fractures is increasing, and risk factors for prolonged opioid use after ankle fracture fixation are unknown. Accordingly, the purpose of this...
BACKGROUND
The incidence of ankle fractures is increasing, and risk factors for prolonged opioid use after ankle fracture fixation are unknown. Accordingly, the purpose of this study was to investigate risk factors that lead to prolonged opioid use after surgery.
METHODS
The Truven MarketScan database was used to identify patients who underwent ankle fracture surgery from January 2009 to December 2018 based on CPT codes. Patient characteristics were collected, and patients separated into 3 cohorts based on postoperative opioid use (no refills, refills within 6 months postoperative, and refills within 1 year postoperatively). The χ test and multivariate analysis were performed to assess the association between risk factors and prolonged use.
RESULTS
In total, 34 691 patients were analyzed. Comorbidities most highly associated with prolonged opioid use include 2+ preoperative opioid prescriptions (odds ratio [OR] = 11.92; < .001), tobacco use (OR = 2.03; < .001), low back pain (OR = 1.81; < .001), depression (OR = 1.48; < .001), diabetes (OR = 1.34; < .001), and alcohol abuse (OR = 1.32; < .001).
CONCLUSION
Opioid use after ankle fracture surgery is common and may be necessary; however, prolonged opioid use and development of dependence carries significant risk. Identifying those patients at an increased risk for prolonged opioid use can aid providers in tailoring their postoperative pain regimen.
LEVELS OF EVIDENCE
Prognostic, Level III.
Topics: Humans; Analgesics, Opioid; Ankle Fractures; Retrospective Studies; Opioid-Related Disorders; Risk Factors; Pain, Postoperative
PubMed: 34369179
DOI: 10.1177/19386400211029123 -
Foot (Edinburgh, Scotland) Sep 2023Over the past 30 years, several studies have compared early weight-bearing versus late weight-bearing following open reduction and internal fixation of ankle fractures;... (Review)
Review
BACKGROUND
Over the past 30 years, several studies have compared early weight-bearing versus late weight-bearing following open reduction and internal fixation of ankle fractures; however, no review strictly including patients with ankle fractures and complete syndesmotic disruption has been performed.
OBJECTIVE
The objective of this systematic review was to compare early versus late weight-bearing following surgery for ankle fracture with syndesmotic injury regarding clinical and patient-reported outcomes.
METHODS
A comprehensive search strategy was applied to the Cochrane Library, MEDLINE, Embase, CINAHL and PubMed databases from their inception to the 17th of January 2022. The articles were screened independently by two blinded reviewers. Data were extracted by one author, then cross-checked and approved by the other.
RESULTS
No comparative studies were found; therefore, studies describing either early or late weight-bearing were included. It was thus not possible to perform a meta-analysis. 11 studies and 751 patients were included. An early partial weight-bearing protocol was used in three studies (253 patients) and late in eight studies (498 patients). Functional outcomes suggested that there were no clear differences between early partial weight-bearing and late weight-bearing. The reoperation rate was 9-31% in the early group and 0-11% in the late. Similar results were seen for loss of syndesmotic reduction, malreduction, infection, and fixation failure.
CONCLUSION
Pros and cons were reported for early partial weight-bearing and late weight-bearing, but the evidence was very limited as our results were based on noncomparative studies. In the future, high-quality comparative studies focusing on functional outcomes within 6 months postoperatively are needed.
LEVEL OF CLINICAL EVIDENCE
1.
Topics: Humans; Ankle Fractures; Treatment Outcome; Bone Screws; Ankle Injuries; Fracture Fixation, Internal; Weight-Bearing; Rupture
PubMed: 37352790
DOI: 10.1016/j.foot.2023.101967 -
Acta Ortopedica Brasileira 2023Ankle injuries are the most common musculoskeletal injuries in emergency rooms and are associated with a great social and economic impact. The need to request additional...
UNLABELLED
Ankle injuries are the most common musculoskeletal injuries in emergency rooms and are associated with a great social and economic impact. The need to request additional tests for ankle sprains is based on suspicion of fracture. The Ottawa Ankle Rules (OAR) establish criteria for ordering radiographs to avoid performing unnecessary examinations.
OBJECTIVE
To evaluate the implementation of the Ottawa Rules as a protocol for treating ankle sprains in the emergency department of a university hospital.
METHODS
This is a retrospective observational study, conducted over a period of three months before and three months after implementation of the protocol.
RESULTS
In the first phase, all patients complaining of ankle sprain underwent radiographs. In the second phase, after the application of the OAR, out of 85 patients evaluated, only 58 underwent complementary exams, showing a reduction of 31.8% in the request for imaging exams. There was no significant difference in fracture detection between the two groups (p=0.476).
CONCLUSION
The OAR can be used as a tool in diagnosing ankle sprains, and their implementation reduced the request for imaging exams. .
PubMed: 37876862
DOI: 10.1590/1413-785220233105e266034 -
Pakistan Journal of Medical Sciences 2023To explore the clinical effectiveness of suture anchor (SA) repair combined with open reduction and internal fixation (ORIF) in the treatment of deltoid ligament rupture...
OBJECTIVE
To explore the clinical effectiveness of suture anchor (SA) repair combined with open reduction and internal fixation (ORIF) in the treatment of deltoid ligament rupture (DLR) in ankle fractures.
METHODS
This is a retrospective analysis of 210 patients with DLR in ankle fracture who were treated in Beijing Chaoyang Hospital from January 2020 to June 2022. According to the surgical records, 125 patients received SA repair combined with ORIF (Repair group) and 85 patients received ORIF only (Non-repair group). The curative effect, recovery of ankle joint function, pain, and bone metabolism of the two groups were observed.
RESULTS
The clinical effectiveness (overall good) was higher in the Repair group (<0.05). The American Orthopedic Foot and Ankle Society (AOFAS) score was higher three and six months post-operation in the Repair group, and the Visual Analogue Scale (VAS) score was lower than that of the Non-repair group (<0.05). The Repair group had higher levels of bone-specific alkaline phosphatase (BALP) and bone gla protein (BGP) than the Non-repair group six months post-operation (<0.05).
CONCLUSIONS
SA combined with ORIF has a good effect in the treatment of DLR in ankle fracture patients, which can promote the recovery of ankle function, relieve postoperative pain and improve bone metabolism.
PubMed: 37936789
DOI: 10.12669/pjms.39.6.8070