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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 -
Journal of Korean Medical Science Oct 2022Although ankle fractures are among the most common fractures, nationwide population-based data on the epidemiology of patients with ankle fractures are scarce. This...
BACKGROUND
Although ankle fractures are among the most common fractures, nationwide population-based data on the epidemiology of patients with ankle fractures are scarce. This study aimed to perform an epidemiological analysis of all ankle fractures in Korea from 2010 through 2018.
METHODS
We used national registries from the Korean Health Insurance Review and Assessment Service from 2009 to 2018. The annual incidence of the ankle fracture was calculated. The incidence was also calculated according to gender and age. Trends of fracture subtypes were also analyzed. Then, the incidence of ankle fractures by seasonal variation was investigated.
RESULTS
A total of 735,073 ankle fractures were identified in 461,497,758 people for 10 years. The annual incidence of ankle fracture was 171.37/100,000 persons in 2018, with a male to female ratio of 0.78. Interesting differences in the ankle fracture trends were observed between gender. Male shows the highest incidence in adolescence, and the even distribution has lasted for the rest of their lives. In females, the incidence of ankle fracture showed an increasing tendency as their age increased. There was a clear difference in the incidence rate of each season according to age. Ankle fractures occurred more in spring and autumn in children and adolescents and most in winter in the elderly.
CONCLUSION
Ankle fracture risk was different between sex and exhibited seasonal variations. Our findings can be used for epidemiological awareness and prevention campaigns for ankle fractures.
Topics: Adolescent; Aged; Ankle Fractures; Child; Female; Humans; Incidence; Male; Registries; Republic of Korea; Seasons
PubMed: 36193640
DOI: 10.3346/jkms.2022.37.e288 -
International Orthopaedics Mar 2021The purpose of this retrospective study was to evaluate the usefulness of ankle arthroscopy at the time of ORIF or after six months in patients with residual symptoms....
BACKGROUND
The purpose of this retrospective study was to evaluate the usefulness of ankle arthroscopy at the time of ORIF or after six months in patients with residual symptoms. The hypothesis was that in patients treated arthroscopically at the time of ORIF, there were faster and better clinical results than those treated after or untreated with arthroscopy.
METHODS
In this retrospective study, we compared three homogeneous groups of selected patients with specific inclusion criteria (144 in total, mean age 38.2 years). They have been surgically treated for an ankle fracture (bimalleolar or trimalleolar without frank syndesmotic injuries) with open technique (ORIF) or arthroscopic ORIF (AORIF), between 2013 and 2017. The AO classification system was used for each patient. The clinical assessment was based on the Foot and Ankle Outcome Score (FAOS).
RESULTS
At the final follow-up (mean 38 months), both patients treated with ankle arthroscopic debridement at the time of ORIF and patients treated with arthroscopic debridement after ORIF showed a significant improvement of the FAOS, which reported 84 and 85 respectively at final follow-up.
CONCLUSION
Through minimally invasive visualization of intra-articular structures, ankle arthroscopy can offer an essential option for selected patients both in acute and in sequelae after an ankle fracture. More studies are needed to understand the real effectiveness of the procedure, especially in acute at the same time of osteosynthesis.
Topics: Adult; Ankle; Ankle Fractures; Ankle Joint; Arthroscopy; Debridement; Fracture Fixation, Internal; Humans; Retrospective Studies; Treatment Outcome
PubMed: 33416908
DOI: 10.1007/s00264-020-04882-6 -
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 -
The Journal of Foot and Ankle Surgery :... Sep 2019Ankle fractures are common fractures of the lower extremities that have an incidence rate of 101 fractures per 100.000 person-years. It is not clear which rehabilitation... (Comparative Study)
Comparative Study
Ankle fractures are common fractures of the lower extremities that have an incidence rate of 101 fractures per 100.000 person-years. It is not clear which rehabilitation intervention should be performed after an ankle fracture. The aims of this study are to compare the effectiveness of a supervised exercise program with that of a home exercise program and to determine and compare the costs of these programs. A supervised exercise program and a home exercise program were performed for 8 weeks. The supervised exercise group consisted of 35 patients (mean age 39.23 years), and the home exercise group consisted of 73 patients (mean age 41.78 years). The average follow-up was 27.86 ± 9.88 months. Demographic information, injury details, type and classification of fracture, pain severity, and ankle range of motion were recorded. The clinical outcomes were determined by using the Pain Disability Index, the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score, and the Short-Form 36 Health Survey. Surgical and rehabilitation satisfaction was evaluated with the use of a numeric scale. American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scores were statistically significantly higher in the home exercise group (p = .036), and rehabilitation satisfaction of the supervised exercise group was statistically significantly better (p = .047). The total rehabilitation crude cost of a patient in the supervised exercise group is 1113.63 Turkish lira (310.25 U.S. dollars) versus 182.31 Turkish lira (50.79 U.S. dollars) in the home exercise group. Considering that the crude cost of the home exercise program is very low and clinical outcomes are satisfactory, we recommend that patients with surgically treated isolated ankle fractures be followed up with a postoperative home exercise program.
Topics: Adult; Aged; Ankle Fractures; Exercise Therapy; Female; Fracture Fixation; Health Care Costs; Home Care Services; Humans; Male; Middle Aged; Quality of Life; Range of Motion, Articular; Recovery of Function; Treatment Outcome; Young Adult
PubMed: 31474396
DOI: 10.1053/j.jfas.2018.11.021 -
Foot and Ankle Surgery : Official... Jun 2023This systematic literature review compared weight bearing (WB) vs. partial- / non-weight bearing (NWB) and mobilization (MB) vs. immobilization (IMB) for surgically... (Review)
Review
BACKGROUND
This systematic literature review compared weight bearing (WB) vs. partial- / non-weight bearing (NWB) and mobilization (MB) vs. immobilization (IMB) for surgically treated ankle fractures.
METHODS
Five databases were searched. Eligible were (quasi-)randomized controlled trials comparing at least two different postoperative treatment protocols. The risk of bias was assessed using the RoB-2 toolkit. The primary outcome was complication rate, secondary outcome Olerud and Molander Ankle Score (OMAS), range of motion (ROM), and return to work (RTW).
RESULTS
Out of 10,345 studies, 24 papers were eligible. Thirteen studies (n = 853) compared WB/NWB, 13 studies (n = 706) MB/IMB with a moderate study quality. WB did not increase the risk for complications but resulted in superior short-term outcomes for OMAS, ROM, RTW. 12 studies found no inferior results for MB compared to IMB.
CONCLUSION
Early and immediate WB and MB do not increase the complication rates but result in superior short term outcome scores.
LEVEL OF EVIDENCE
Level I Systematic Review.
Topics: Humans; Ankle Fractures; Range of Motion, Articular; Weight-Bearing; Treatment Outcome
PubMed: 37076381
DOI: 10.1016/j.fas.2023.04.006 -
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 -
Foot & Ankle International Sep 2023This study aims to evaluate the results and the safety of a novel fixation method we developed for syndesmosis injuries that we call the "embrace" technique.
BACKGROUND
This study aims to evaluate the results and the safety of a novel fixation method we developed for syndesmosis injuries that we call the "embrace" technique.
METHODS
Between March 2018 and October 2020, a total of 67 patients with ankle fractures and syndesmotic injuries underwent syndesmosis fixation with the embrace technique at our institute. Plain radiographs and computed tomographic (CT) scans were obtained preoperatively. Postoperative radiographic assessment included anteroposterior (AP) and lateral radiographs and CT scans of both ankles. Additionally, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score, Olerud-Molander Ankle Score, and visual analog scale (VAS) score were used for postoperative assessment.
RESULTS
The mean age was 27.6 ± 10.9 (range, 14-56) years. The mean follow-up time was 30.3 ± 6.2 (range, 24-48) months. There were no malreductions indicated by any CT parameter except fibular rotation in a postoperative comparison between 2 sides. We found significant preoperative-postoperative changes in anterior difference, posterior difference, and fibular rotation but no significant preoperative-postoperative difference in fibular translation. There was no significant postoperative difference between the affected-side and normal-side measurements of any parameter. Complications included delayed wound healing, lateral pain because of wire knot irritation (11.9%), and medial fiber wire irritation (7.5%). The mean AOFAS, Olerud-Molander, and VAS scores at the last follow-up were 94.4 ± 6.8 (range, 84-100), 95.4 ± 6.1 (range, 80-100), and 0.68 ± 1.0 (range, 0-3) points, respectively.
CONCLUSION
In our cohort, this novel technique proved to be an effective method for syndesmosis fixation in patients with ankle fractures associated with very good radiologic and patient-reported outcomes.
LEVEL OF EVIDENCE
Level IV, case series.
Topics: Humans; Adolescent; Young Adult; Adult; Ankle Fractures; Fracture Fixation, Internal; Bone Screws; Ankle Injuries; Ankle; Ankle Joint; Treatment Outcome; Retrospective Studies
PubMed: 37329236
DOI: 10.1177/10711007231177044 -
The Orthopedic Clinics of North America Oct 2021Syndesmotic injuries in the setting of ankle fracture are critically important to diagnosis and treat to restore an anatomic tibiotalar relationship. Physical... (Review)
Review
Syndesmotic injuries in the setting of ankle fracture are critically important to diagnosis and treat to restore an anatomic tibiotalar relationship. Physical examination and clinical suspicion remain critically important for diagnosis. Ultrasound examination and weight-bearing computed tomography scans are evolving to help diagnosis more subtle injuries. Although flexible syndesmotic fixation may decrease malreduction rates, the benefits over rigid fixation is the subject of ongoing study. Anatomic reduction remains critical regardless of fixation choice. Routine removal of rigid syndesmotic hardware does not seem to offer substantial clinical improvement in pain or range of motion; however, broken hardware may cause irritation.
Topics: Ankle Fractures; Ankle Injuries; Ankle Joint; Humans; Joint Instability; Ligaments, Articular
PubMed: 34538352
DOI: 10.1016/j.ocl.2021.05.011 -
Foot and Ankle Surgery : Official... Jan 2022The use of smartphones and multimedia messaging service (MMS) continues to increase in day to day orthopaedic clinical practice. However, there is limited evidence to...
BACKGROUND
The use of smartphones and multimedia messaging service (MMS) continues to increase in day to day orthopaedic clinical practice. However, there is limited evidence to support the safe utilisation of MMS.
OBJECTIVES
The aim of this study was to correlate the performance of MMS imaging to picture archiving and communication systems (PACS) imaging within the setting of diagnosis and management of ankle fractures.
METHODS
The ankle fracture radiograph series of 82 consecutive patients were evaluated by five orthopaedic consultant specialists. A questionnaire regarding diagnosis and preferred management was completed separately for each patient using smartphone and PACS images. Statistical analysis was performed using Intraclass Correlation Coefficient (ICC).
RESULTS
Ankle fracture diagnosis showed strong to excellent correlation both inter- and intraobserver MMS vs PACS when using the Weber (0.815, 0.988), Anatomical (0.858, 0.988), and AO classification systems (0.855, 0.985). MMS was less reliable than PACS in determining many management options.
CONCLUSION
The reliability of ankle fracture classification using MMS image viewing was not significantly different to interpretation on PACS workstations. Smartphone use in ankle fracture classification is supported by this study. Smartphone use was less accurate than PACS in devising management plans and future use should be limited to making only initial plans that must be corroberated with PACS and intraoperative findings prior to definitive fixation.
Topics: Ankle Fractures; Humans; Multimedia; Radiography; Reproducibility of Results; Smartphone
PubMed: 33500217
DOI: 10.1016/j.fas.2021.01.004