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The Journal of the American Academy of... Jul 2019The last stage of a supination-external rotation ankle fracture involves either transverse fracture of the medial malleolus or rupture of the deltoid ligament. When the... (Review)
Review
The last stage of a supination-external rotation ankle fracture involves either transverse fracture of the medial malleolus or rupture of the deltoid ligament. When the deltoid ligament ruptures, a "bimalleolar equivalent" ankle fracture occurs, and the surgeon is presented with several diagnostic and therapeutic challenges. In the native ankle, the deltoid ligament provides restraint to eversion and external rotation of the talus on the tibia. In bimalleolar equivalent ankle fractures, there is often gross medial instability even after fibular reduction. Retraction of the deltoid with subsequent healing in a nonanatomic position theoretically may cause instability, persistent medial gutter pain, and loss of function with risk of early arthritis. In mild cases, deltoid injury may not be obvious, and potential diagnostic techniques include preoperative and intraoperative stress radiography, MRI, and ultrasonography. The most common injury pattern is avulsion from the medial malleolus, and most current repair techniques involve direct repair of the capsular and deltoid injuries involving suture anchors in the medial malleolus and imbrication of the superficial and deep deltoid fibers. To date, there is limited evidence of superior clinical outcomes with the addition of deltoid repair compared with open reduction and internal fixation of the fibula alone.
Topics: Ankle Fractures; Ankle Injuries; Biomechanical Phenomena; Diagnostic Imaging; Female; Fracture Fixation, Internal; Humans; Ligaments, Articular; Male; Open Fracture Reduction; Orthopedic Procedures; Rupture; Treatment Outcome
PubMed: 30475279
DOI: 10.5435/JAAOS-D-18-00198 -
Rozhledy V Chirurgii : Mesicnik... 2023Maisonneuve fracture (MF) is defined as an ankle fracture-dislocation associated always with a fracture of the proximal quarter of the fibula and rupture of the anterior...
Maisonneuve fracture (MF) is defined as an ankle fracture-dislocation associated always with a fracture of the proximal quarter of the fibula and rupture of the anterior and interosseous tibiofibular ligaments. Other injuries are variable. Recent CT studies have demonstrated that MF is a far more complex injury than initially supposed. Therefore it is necessary to change substantially the current concepts related to this issue. MF is combined in about 80% of cases with a fracture of the posterior malleolus and also with malposition of the distal fibula in the fibular notch. An exact assessment of these injuries requires post-injury CT examination which should be used as a standard in MFs. The main goal of treatment is anatomical reduction of the distal fibula into the fibular notch. In case of avulsion of a larger fragment of the posterior malleolus, it is necessary to perform as the first step its reduction and fixation from the posterolateral approach and thus restore integrity of the notch. Closed reduction of the distal fibula is associated with malposition in up to 50% of cases and therefore open reduction from a short anterolateral approach is preferred. Accuracy of reduction should be always checked by postoperative CT scan.
Topics: Humans; Ankle Fractures; Fracture Fixation, Internal; Ankle Joint; Fibula; Tibia; Fibula Fractures; Joint Dislocations
PubMed: 37185026
DOI: 10.33699/PIS.2023.102.2.48-59 -
BMJ (Clinical Research Ed.) Jul 2021To assess function, quality of life, resource use, and complications in adults treated with plaster cast immobilisation versus a removable brace for ankle fracture. (Comparative Study)
Comparative Study Randomized Controlled Trial
OBJECTIVES
To assess function, quality of life, resource use, and complications in adults treated with plaster cast immobilisation versus a removable brace for ankle fracture.
DESIGN
Multicentre randomised controlled trial.
SETTING
20 trauma units in the UK National Health Service.
PARTICIPANTS
669 adults aged 18 years and older with an acute ankle fracture suitable for cast immobilisation: 334 were randomised to a plaster cast and 335 to a removable brace.
INTERVENTIONS
A below the knee cast was applied and ankle range of movement exercises started on cast removal. The removable brace was fitted, and ankle range of movement exercises were started immediately.
MAIN OUTCOME MEASURES
Primary outcome was the Olerud Molander ankle score at 16 weeks, analysed by intention to treat. Secondary outcomes were Manchester-Oxford foot questionnaire, disability rating index, quality of life, and complications at 6, 10, and 16 weeks.
RESULTS
The mean age of participants was 46 years (SD 17 years) and 381 (57%) were women. 502 (75%) participants completed the study. No statistically significant difference was found in the Olerud Molander ankle score between the cast and removable brace groups at 16 weeks (favours brace: 1.8, 95% confidence interval -2.0 to 5.6). No clinically significant differences were found in the Olerud Molander ankle scores at other time points, in the secondary unadjusted, imputed, or per protocol analyses.
CONCLUSIONS
Traditional plaster casting was not found to be superior to functional bracing in adults with an ankle fracture. No statistically difference was found in the Olerud Molander ankle score between the trial arms at 16 weeks.
TRIAL REGISTRATION
ISRCTN registry ISRCTN15537280.
Topics: Adult; Ankle Fractures; Braces; Casts, Surgical; Exercise Therapy; Female; Humans; Male; Middle Aged; Quality of Life; Range of Motion, Articular; Recovery of Function; Time Factors; Treatment Outcome; United Kingdom
PubMed: 34226192
DOI: 10.1136/bmj.n1506 -
The Orthopedic Clinics of North America Apr 2021This article explores different nontraditional methods that could be adopted in clinical settings as alternatives to the traditional fibular fixation. Less invasive... (Review)
Review
This article explores different nontraditional methods that could be adopted in clinical settings as alternatives to the traditional fibular fixation. Less invasive methods, such as intramedullary nail and screw fixation, might be viable alternatives for managing ankle fractures. These methods might especially benefit patients with poor soft tissue envelopes, low immunity, and poor bone quality. There is minimal soft tissue coverage for most orthopedic implants around the ankle. Various authors have highlighted the importance of minimally invasive surgery as an effective modality for ensuring superior prognosis for ankle fracture surgery or those fractures involving both the distal tibia and fibula.
Topics: Ankle Fractures; Fibula; Fracture Fixation, Internal; Humans; Internal Fixators
PubMed: 33752833
DOI: 10.1016/j.ocl.2021.01.001 -
Clinics in Podiatric Medicine and... Jul 2023Using ankle arthroscopy in conjunction to open reduction internal fixation of traumatic ankle injuries can play an important role in the management of these injuries by... (Review)
Review
Using ankle arthroscopy in conjunction to open reduction internal fixation of traumatic ankle injuries can play an important role in the management of these injuries by way of treating intra-articular pathologies, leading to improved patient outcomes. While a majority of these injuries are not treated with concurrent arthroscopy, its addition may lead to more prognostic information to dictate the patient's course. This article has illustrated its use in managing malleolar fractures, syndesmotic injuries, pilon fractures and pediatric ankle fractures. While additional studies may be needed to further support AORIF, it may prove to play a vital role in the future.
Topics: Humans; Child; Ankle; Arthroscopy; Ankle Injuries; Ankle Fractures; Ankle Joint; Fracture Fixation, Internal; Treatment Outcome; Retrospective Studies
PubMed: 37236689
DOI: 10.1016/j.cpm.2022.12.003 -
Foot and Ankle Clinics Sep 2022The management of ankle fractures in the diabetic population requires special attention as the risks of injury or treatment-related complications are high. Thorough... (Review)
Review
The management of ankle fractures in the diabetic population requires special attention as the risks of injury or treatment-related complications are high. Thorough review of clinical history and detailed assessment provide the treating surgeons with key information to guide treatment pathway. Vigilance is required when opting for nonoperative treatment in undisplaced stable ankle fractures in patients with peripheral neuropathy. The presence of critical ischemia in injured limb demands vascular consultation and ultimately, an intervention before surgical fixation of ankle fracture. An extended period of immobilization is one of the key principles in the management of ankle fracture patients with diabetes.
Topics: Ankle; Ankle Fractures; Ankle Injuries; Ankle Joint; Diabetes Mellitus; Humans
PubMed: 36096556
DOI: 10.1016/j.fcl.2022.02.002 -
Foot and Ankle Clinics Jun 2020Malunion of ankle and pilon fractures has significant detrimental effect on function and development of post-trauma osteoarthritis. Unfortunately, the incidence of... (Review)
Review
Malunion of ankle and pilon fractures has significant detrimental effect on function and development of post-trauma osteoarthritis. Unfortunately, the incidence of malunion has been reported to be increasing. It is important to assess the ankle for congruency, because this determines the level where correction will occur. A plethora of techniques are available, with low-level evidence supporting each, and therefore it is important that the treating surgeon is fully prepared and comfortable in the techniques they are to use. Supplementary procedures are common and should be expected. This article provides a review of current methods of treatment and their outcomes.
Topics: Ankle Fractures; Bone Malalignment; Fracture Fixation, Internal; Fractures, Malunited; Humans; Osteotomy
PubMed: 32381311
DOI: 10.1016/j.fcl.2020.02.007 -
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: Humans; Ankle Fractures; Fracture Fixation, Internal; Male; Female; Fracture Fixation; Weight-Bearing
PubMed: 38789168
DOI: 10.1016/j.cpm.2024.01.008 -
Injury Dec 2020Ankle fractures remain the third most common musculoskeletal injury in the elderly population. The presence of osteoporosis, significant multiple comorbidities and... (Review)
Review
Ankle fractures remain the third most common musculoskeletal injury in the elderly population. The presence of osteoporosis, significant multiple comorbidities and limited functional independence makes treatment of such injuries challenging. Early studies highlighted high rates of post-operative complications and poor outcomes after surgical intervention. With advances in surgical techniques and a greater understanding of multi-disciplinary team (MDT)-driven peri-operative care and rehabilitation, evidence now appears to suggest improved outcomes for operative management. Approaches must be adapted according to co-morbidities, baseline function and patient wishes. This review article aims to discuss contemporary treatment strategies and the complex challenges associated with the management of the elderly ankle fracture.
Topics: Aged; Ankle; Ankle Fractures; Ankle Injuries; Ankle Joint; Fracture Fixation, Internal; Humans; Osteoporosis; Retrospective Studies; Treatment Outcome
PubMed: 33153712
DOI: 10.1016/j.injury.2020.10.093