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Pain Research & Management 2022The enhanced recovery after surgery (ERAS) program is aimed to shorten patients' recovery process and improve clinical outcomes. This study aimed to compare the outcomes...
BACKGROUND
The enhanced recovery after surgery (ERAS) program is aimed to shorten patients' recovery process and improve clinical outcomes. This study aimed to compare the outcomes between the ERAS program and the traditional pathway among patients with ankle fracture and distal radius fracture.
METHODS
This is a multicenter prospective clinical controlled study consisting of 323 consecutive adults with ankle fracture from 12 centers and 323 consecutive adults with distal radial fracture from 13 centers scheduled for open reduction and internal fixation between January 2017 and December 2018. According to the perioperative protocol, patients were divided into two groups: the ERAS group and the traditional group. The primary outcome was the patients' satisfaction of the whole treatment on discharge and at 6 months postoperatively. The secondary outcomes include delapsed time between admission and surgery, length of hospital stay, postoperative complications, functional score, and the MOS item short form health survey-36.
RESULTS
Data describing 772 patients with ankle fracture and 658 patients with distal radius fracture were collected, of which 323 patients with ankle fracture and 323 patients with distal radial fracture were included for analysis. The patients in the ERAS group showed higher satisfaction levels on discharge and at 6 months postoperatively than in the traditional group ( < 0.001). In the subgroup analysis, patients with distal radial fracture in the ERAS group were more satisfied with the treatment (=0.001). Furthermore, patients with ankle fracture had less time in bed ( < 0.001) and shorter hospital stay ( < 0.001) and patients with distal radial fracture received surgery quickly after being admitted into the ward in the ERAS group than in the traditional group (=0.001).
CONCLUSIONS
Perioperative protocol based on the ERAS program was associated with high satisfaction levels, less time in bed, and short hospital stay without increased complication rate and decreased functional outcomes.
Topics: Adult; Ankle Fractures; Enhanced Recovery After Surgery; Humans; Length of Stay; Prospective Studies; Radius Fractures; Treatment Outcome
PubMed: 35711611
DOI: 10.1155/2022/3458056 -
Foot & Ankle International Dec 2022Although chronic kidney disease (CKD) has been associated with poor outcomes following traumatic fractures, there is a scarcity of literature describing the effect on...
BACKGROUND
Although chronic kidney disease (CKD) has been associated with poor outcomes following traumatic fractures, there is a scarcity of literature describing the effect on outcomes of ankle fractures. We will examine the impact of CKD on clinical outcomes following torsional ankle fracture, including complications and unplanned surgical procedures.
METHODS
A retrospective review of 1981 adult patients with torsional ankle fractures treated at a level 1 trauma center was performed to identify patients with CKD based on glomerular filtration rate. Demographic, injury, and treatment-related characteristics were collected. Outcomes included any unplanned procedure: implant removal, debridement, revision, arthrodesis, and amputation; in addition to complications of superficial infection, deep infection, and implant irritation. Patients with CKD were matched with patients without CKD by propensity score matching. Univariate comparisons between groups were conducted using chi-square and Mann-Whitney tests.
RESULTS
136 patients (68 with CKD and 68 without CKD) were analyzed. Of the 68 patients with CKD, the mean stage of disease was 3.7 with 24% on dialysis for a mean length of 4.1 years. Patients without CKD were more likely to undergo primary ORIF (100% vs 54%, < .001). Thirty-five percent of patients with CKD had surgical complications vs 19% in the cohort without ( = .07). Patients with open fractures, dislocation, and chronic kidney disease were, respectively, 5.19, 3.77, and 3.91 times more likely to have any complication ( = .02, = .05, = .05). Patients with CKD were more likely to undergo unplanned arthrodesis ( = .01). Only dislocation was an independent predictor for unplanned procedure (odds ratio = 5.08, = .026).
CONCLUSION
Following torsional ankle fracture, CKD is associated with increased likelihood of having a complication or an unplanned arthrodesis. Open fractures and dislocation at time of injury are also associated with complications. Our findings encourage caution about surgical treatment of ankle fractures in patients with CKD.
LEVEL OF EVIDENCE
Level III, retrospective, comparative, prognostic.
Topics: Adult; Humans; Ankle Fractures; Retrospective Studies; Fracture Fixation, Internal; Fractures, Open; Renal Insufficiency, Chronic; Treatment Outcome
PubMed: 36254721
DOI: 10.1177/10711007221127026 -
Clinics in Sports Medicine Oct 2020Despite the fact that ankle fractures are common injuries, not all patients obtain satisfactory results. Historically, the deltoid ligament injury and intra-articular... (Review)
Review
Despite the fact that ankle fractures are common injuries, not all patients obtain satisfactory results. Historically, the deltoid ligament injury and intra-articular pathology have not often been treated at the time of fracture stabilization. Recent literature has suggested that repair of the deltoid ligament may lead to better stability of the ankle mortise. Additionally, the use of arthroscopy in conjunction with fracture fixation may allow for better identification and treatment of intra-articular lesions and improve detection and reduction of subtle instability.
Topics: Ankle Fractures; Ankle Injuries; Arthroscopy; Fracture Fixation, Internal; Humans; Ligaments, Articular; Treatment Outcome
PubMed: 32892964
DOI: 10.1016/j.csm.2020.06.003 -
Injury Mar 2020Supination adduction (SAD) fractures are rotational ankle fractures with a characteristic vertical medial malleolus fracture and tension failure fibula fracture. While...
BACKGROUND
Supination adduction (SAD) fractures are rotational ankle fractures with a characteristic vertical medial malleolus fracture and tension failure fibula fracture. While these fractures are considered rotational injuries, they can have joint impaction that could lead to early joint degeneration. The purpose of this study was to characterize SAD ankle fractures and compare these injuries with partial articular pilon fractures.
METHODS
Following IRB approval, we retrospectively reviewed ankle and pilon fractures (OTA 43 & 44) treated at two academic level-1 trauma centers from 2008-2016. Our primary outcome was failure defined as either ankle arthrodesis or arthroplasty. Infection and significant arthrosis were also compared. We performed multivariate Cox regression to compare failure between SAD ankles and pilon fractures.
RESULTS
Seventy-nine SAD ankle and 91 pilon fractures met inclusion criteria. Patient demographics including age and open injury did not differ between groups. For SAD ankle fractures, impaction occurred in 66% (44/79) of injuries. Impaction failed to be significant risk factor for arthrosis after adjustment for malreduction (p = 0.13). Failure was significantly more common in pilon fractures (11/91, 12%) than SAD fractures (5/79, 6%) (HR=0.25, 95% CI:[0.07,0.92], p = 0.036). Infection and arthrosis rates failed to show a difference between the groups (p = 0.19, 0.63, respectively). Malreduction was significantly associated with joint arthrosis (OR=7.05, 95% CI: [1.63,36.12], p = 0.01).
CONCLUSION
Rotational ankle fractures have low rates (<2%) of ankle arthrodesis or arthroplasty. The present study demonstrates that SAD ankles have failure (6%) that remains somewhere between rotational ankle fractures and pilon fractures (12%) on the ankle injury spectrum.
LEVEL OF EVIDENCE
Level 3, Prognostic.
Topics: Adult; Ankle Fractures; Ankle Joint; Equipment Failure; External Fixators; Female; Fracture Fixation, Internal; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Proportional Hazards Models; Radiography; Range of Motion, Articular; Retrospective Studies; Supination; Tibial Fractures; Treatment Outcome
PubMed: 31932039
DOI: 10.1016/j.injury.2020.01.008 -
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 -
Foot (Edinburgh, Scotland) Dec 2022Patient reported outcome measures (PROMs) are increasingly used by orthopaedic surgeons in order to measure their results. The Chertsey Outcome Score for Trauma (COST)...
BACKGROUND
Patient reported outcome measures (PROMs) are increasingly used by orthopaedic surgeons in order to measure their results. The Chertsey Outcome Score for Trauma (COST) is a recently validated PROM, which treats trauma as pathology, is not site or pathology specific. It measures the rehabilitation of the patients after an injury, using the pre-injury status as the default state of the patients. The aim of the present study was to focus on a narrow group of patients with similar ankle fracture injuries, investigate if there is any floor or ceiling effect of the scale and examine its use during the ankle fracture at the immediate post-injury rehabilitation period.
MATERIALS AND METHODS
All patients who had isolated ankle fractures treated either operatively or conservatively between March 2018 and December 2019, were included in the study. A COST and a FADI questionnaire was completed prior to their follow-up at 2, 6 and 12 weeks post injury/operation. Demographic data were also collected.
RESULTS
A total of 527 COST questionnaires from 314 different patients (aged 51.4 ± 18.4 years) were included in the study. The average COST score was 40.28 ± 18 and the average FADI score was 60.1 ± 21.8. The VAS score reached 3.57 ± 2.2. There was no significant floor and ceiling effect for the COST score. The COST score had good correlation with the FADI score (Spearman's Rho=0.69) and good internal consistency (Cronbach's Alpha=0.85).
CONCLUSION
No significant floor or ceiling effect was identified for the COST score, during the short and medium term follow up period following an ankle fracture, treated with either conservative or operative management. The scale was found to be valid and with good internal consistency.
Topics: Humans; Ankle Fractures; Reproducibility of Results; Ankle Injuries; Patient Reported Outcome Measures; Surveys and Questionnaires
PubMed: 36037776
DOI: 10.1016/j.foot.2022.101936 -
Irish Journal of Medical Science Oct 2022Virtual fracture clinics (VFC) have been widely adopted worldwide as part of the changes in healthcare delivery during the COVID-19 pandemic. They have been shown to be...
BACKGROUND
Virtual fracture clinics (VFC) have been widely adopted worldwide as part of the changes in healthcare delivery during the COVID-19 pandemic. They have been shown to be a safe and effective method of delivering trauma care for injuries which do not require immediate intervention or specialist management, whilst maintaining high levels of patient satisfaction.
AIMS
Our aim was to evaluate whether VFCs reduce the volume of X-rays performed for common fractures of the wrist and ankle.
METHODS
A retrospective cohort review was performed. The pre-VFC group consisted of 168 wrist and 108 ankle referrals from March to September 2019. The VFC group included 75 wrist and 68 ankle referrals, during the period March to September 2020. The total number of X-ray images, carried out within a 3-month period for each fracture was summated, with statistical analysis performed following fracture pattern classification.
FINDINGS
A statistically significant decrease in mean X-rays was observed for isolated stable fracture patterns, such as non-displaced distal radius, - 0.976 (p = 0.00025), and Weber A ankle fractures, - 0.907 (p = 0.000013). A reduction was also observed for more complex fracture patterns such as dorsally displaced distal radius, - 0.701 (p = 0.129) and Weber B ankle fractures, - 0.786 (p = 0.235), though not achieving statistical significance.
CONCLUSIONS
Virtual fracture clinics can reduce X-ray frequency for common stable wrist and ankle fractures, with resultant benefits for both patients and healthcare systems. These benefits may be sustained in patient care beyond the current COVID-19 pandemic.
Topics: Ankle Fractures; COVID-19; Humans; Pandemics; Retrospective Studies; Wrist; X-Rays
PubMed: 34655402
DOI: 10.1007/s11845-021-02812-y -
The Bone & Joint Journal May 2021The morphology of medial malleolar fracture is highly variable and difficult to characterize without 3D reconstruction. There is also no universally accepeted...
AIMS
The morphology of medial malleolar fracture is highly variable and difficult to characterize without 3D reconstruction. There is also no universally accepeted classification system. Thus, we aimed to characterize fracture patterns of the medial malleolus and propose a classification scheme based on 3D CT reconstruction.
METHODS
We retrospectively reviewed 537 consecutive cases of ankle fractures involving the medial malleolus treated in our institution. 3D fracture maps were produced by superimposing all the fracture lines onto a standard template. We sliced fracture fragments and the standard template based on selected sagittal and coronal planes to create 2D fracture maps, where angles α and β were measured. Angles α and β were defined as the acute angles formed by the fracture line and the horizontal line on the selected planes.
RESULTS
A total of 121 ankle fractures were included. We revealed several important fracture features, such as a high correlation between posterior collicular fractures and posteromedial fragments. Moreover, we generalized the fracture geometry into three recurrent patterns on the coronal view of 3D maps (transverse, vertical, and irregular) and five recurrent patterns on the lateral view (transverse, oblique, vertical, Y-shaped, and irregular). According to the fracture geometry on the coronal and lateral view of 3D maps, we subsequently categorized medial malleolar fractures into six types based on the recurrent patterns: anterior collicular fracture (27 type I, 22.3%), posterior collicular fracture (12 type II, 9.9%), concurrent fracture of anterior and posterior colliculus (16 type III, 13.2%), and supra-intercollicular groove fracture (66 type IV, 54.5%). Therewere three variants of type IV fractures: transverse (type IVa), vertical (type IVb), and comminuted fracture (type IVc). The angles α and β varied accordingly.
CONCLUSION
Our findings yield insight into the characteristics and recurrent patterns of medial malleolar fractures. The proposed classification system is helpful in understanding injury mechanisms and guiding diagnosis, as well as surgical strategies. Cite this article: 2021;103-B(5):931-938.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ankle Fractures; Female; Humans; Imaging, Three-Dimensional; Male; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 33934640
DOI: 10.1302/0301-620X.103B5.BJJ-2020-1859.R2 -
The Journal of Foot and Ankle Surgery :... 2020Current nationwide epidemiological data regarding ankle fractures are scarce. Such information is important towards better quantifying the mortality associated with...
Current nationwide epidemiological data regarding ankle fractures are scarce. Such information is important towards better quantifying the mortality associated with such injuries, financial impact, as well as the implementation of preventative measures. This study evaluated the epidemiology of ankle fractures that occurred during a 5-year period. Specifically, we evaluated demographics, mechanism of injury, and disposition. The National Electronic Injury Surveillance System was queried to identify all patients with ankle fractures that presented to US hospital emergency departments between 2012 and 2016. Census data were used to determine the incidence rates of ankle fractures in terms of age, sex, and race. There was an estimated total of 673,214 ankle fractures that occurred during this period, with an incidence rate of 4.22/10,000 person-years. The mean age of patients with an ankle fracture was 37 ± 22.86 (SD) years; 23.5% of ankle fractures occurred in patients aged 10 to 19 years (7.56/10,000 person-years). In addition, 44% of ankle fractures occurred in men (3.81/10,000 person-years), whereas 56% occurred in women (4.63/10,000 person-years). Data on race/ethnicity were available for 71% of the subjects, with incidence rates of 2.85/10,000 person-years for whites, 3.01/10,000 person-years for blacks, and 4.08/10,000 person-years for others. The most common mechanism of injury was falls (54.83%), followed by sports (20.76%), exercise (16.84%), jumping (4.42%), trauma (2.84%), and other (0.30%). For disposition, 81.84% of patients were treated and released, 1.43% were transferred, 16.01% were admitted, 0.59% were held for observation, and 0.13% left against medical advice. The highest incidence of ankle fractures in men occurred in the 10-to-19-years age group, but women were more commonly affected in all other age groups.
Topics: Accidental Falls; Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Ankle Fractures; Athletic Injuries; Child; Child, Preschool; Emergency Service, Hospital; Female; Humans; Incidence; Male; Middle Aged; Risk Factors; Sex Distribution; United States; Young Adult
PubMed: 32354504
DOI: 10.1053/j.jfas.2019.09.016 -
Foot and Ankle Clinics Dec 2020There is no consensus on whether the deltoid ligament must be repaired in ankle fractures. Recent studies have shown better early radiologic results when the deltoid... (Review)
Review
There is no consensus on whether the deltoid ligament must be repaired in ankle fractures. Recent studies have shown better early radiologic results when the deltoid ligament is repaired, but no differences in long term functional outcomes. However, there is evidence suggesting that patients with high fibular fractures or injuries with concomitant syndesmotic instability may benefit from repair. The authors recommend repairing the deltoid ligament complex in bimalleolar equivalent fractures associated with syndesmotic or gross multiligamentous instability as well as in heavier patients with greater mechanical requirements.
Topics: Ankle Fractures; Ankle Joint; Fracture Fixation, Internal; Humans; Ligaments; Ligaments, Articular; Treatment Outcome
PubMed: 33543718
DOI: 10.1016/j.fcl.2020.08.009