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The Journal of Foot and Ankle Surgery :... 2022A systematic literature search was performed using the PubMed, MEDLINE, and the Cochrane Library databases according to the Preferred Reporting Items for Systematic... (Review)
Review
A systematic literature search was performed using the PubMed, MEDLINE, and the Cochrane Library databases according to the Preferred Reporting Items for Systematic review and Meta-Analyses guidelines on May 20, 2019. The keywords used were: ankle, distal tibia, distal fibula, fracture, arthroscopic, cartilage, and chondral. The objective of this study is to systematically review the characterization of intra-articular chondral injuries of the talus, tibial plafond, medial malleolus, and lateral malleolus in patients who undergo ankle arthroscopy following ankle fracture. Studies evaluating the incidence of chondral lesions at the time of arthroscopy for ankle fractures within any timeframe were included. The incidence of intra-articular chondral lesions was recorded, the location within the ankle, ankle fracture type, time of arthroscopy, characterization of chondral injury, complications, and outcome if available. Fifteen studies with 1355 ankle fractures were included. About 738 demonstrated evidence of chondral or osteochondral lesion (54.5%). Statistical analyses were carried out with statistical software package SPSS 24.0 (SPSS, Chicago, IL). We compared incidence rates of chondral injury based on Weber classification, malleolar fracture type, and Lauge-Hansen classification, using Pearson chi-square test. For all analyses, p < .05 was considered statistically significant. We found a high incidence of intra-articular chondral lesion in the setting of ankle fractures as demonstrated by arthroscopy.
Topics: Ankle; Ankle Fractures; Ankle Joint; Arthroscopy; Cartilage Diseases; Humans; Incidence; Intra-Articular Fractures
PubMed: 35033444
DOI: 10.1053/j.jfas.2021.12.013 -
Clinics in Podiatric Medicine and... Jul 2020Optimal healing for fractures requires anatomic reduction and stable fixation. This optimizes not only bone healing, but optimal function within the limb including joint... (Review)
Review
Optimal healing for fractures requires anatomic reduction and stable fixation. This optimizes not only bone healing, but optimal function within the limb including joint functioning. Proper ligamentous healing is also crucial for optimal functioning. In patients with injuries around the ankle involving distal tibiofibular syndesmotic injuries of the ankle, malreduction of the syndesmosis is a potential consequence that can lead to chronic pain and functional limitations. This article discusses proper ways of evaluating reduction of the syndesmosis and surgical revision for the chronic injury.
Topics: Adult; Ankle Fractures; Ankle Injuries; Arthralgia; Chronic Pain; Humans; Joint Instability; Male; Reoperation
PubMed: 32471620
DOI: 10.1016/j.cpm.2020.03.011 -
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 -
Risk factors for venous thromboembolism following fractures isolated to the foot and ankle fracture.PloS One 2022Venous thromboembolism (VTE) is an uncommon, but potentially morbid, complication following foot and ankle fractures. Current standard is to not administer...
OBJECTIVE
Venous thromboembolism (VTE) is an uncommon, but potentially morbid, complication following foot and ankle fractures. Current standard is to not administer thromboprophylaxis to patients with such injuries. Nonetheless, patient and fracture factors might affect this risk/benefit consideration. The goal of this study was to determine what patients are most at risk.
METHODS
The M53Ortho Pearldiver database was used to identify patients with fractures isolated to the foot and ankle that were treated non-operatively or operatively. Patients with pilon, other appendicular fractures remote from the foot and ankle, and other traumatic injuries were excluded. The 90-day occurrence of VTE was identified based on codes for deep vein thrombosis or pulmonary embolism. Characteristics of those patients who did and did not have VTEs were compared using chi-square analyses. Multivariate logistical regression was then performed to determined factors independently associated with VTE. Finally, timing of VTE relative to fracture was analyzed.
RESULTS
A total of 298,886 patients with isolated foot or ankle fractures were identified, of which 1,661 (0.56%) had VTE in the 90 days following fracture. In terms of timing, 27.3% occurred in the first week, and 49.8% occurred in the first three weeks. Independent risk factors for VTE included (in decreasing order):prior VTE (odd ratio [OR] = 25.44), factor V Leiden (OR = 24.34), active cancer (OR = 1.84), specific fracture relative to metatarsal fracture (multiple fractures [OR: 1.51], ankle fracture [OR = 1.51], and calcaneus fracture [OR = 1.24]), surgical treatment (OR = 1.41), male sex (OR = 1.19), greater Elixhauser index (OR = 1.05), and increasing age (OR:1.05 per decade) (p<0.05 for each).
CONCLUSIONS
The present study found that, although only 0.56% of isolated foot and ankle fractures had a VTE within ninety days. Defined risk factors, such as Factor V Leiden, prior VTE, surgical treatment, active cancer, specific fracture patterns, and surgical treatment significantly affected the odds of their occurrence.
Topics: Humans; Male; Venous Thromboembolism; Ankle Fractures; Anticoagulants; Pulmonary Embolism; Risk Factors; Ankle Injuries; Foot Injuries; Retrospective Studies
PubMed: 36264985
DOI: 10.1371/journal.pone.0276548 -
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 -
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 & Ankle Specialist Apr 2023This study reviews the current evidence on the indications and outcomes of the posterolateral approach in the treatment of posterior malleolar fractures. PubMed and... (Review)
Review
This study reviews the current evidence on the indications and outcomes of the posterolateral approach in the treatment of posterior malleolar fractures. PubMed and Google Scholar search engines were used to construct a review of the literature for all studies detailing the posterolateral approach for posterior malleolar fracture fixation. A total of 11 studies met our inclusion criteria. In total, 332 fractures were identified. Overall superficial infection occurred in 4.5%, skin necrosis in 4.5%, and nerve injury in 4.5%. Hardware irritation that required removal occurred in 13.6%. None of the hardware removals involved posterior malleolus fixation. A total of 51 (15.4%) cases of arthritis were reported, follow-up ranged from a mean of 5.3 months to a mean 7.9 years. Regardless the majority of patient reported outcomes were excellent/good at final follow-up. Thresholds for joint reduction were not uniformly described or even quantified at all in some of the included studies. Variable indications for fixation were reported without reference to posterior malleolus fracture morphology. The posterolateral approach provides a satisfactory approach for fracture reduction with similar complication rates to that reported for other ankle fracture approaches. Further research is required on posterior malleolus fracture morphology, optimal fracture fixation and longer term functional and radiological outcomes. Level III: Systematic review of retrospective cohort studies.
Topics: Humans; Ankle Fractures; Fracture Fixation; Fracture Fixation, Internal; Retrospective Studies; Tibia; Treatment Outcome
PubMed: 34353143
DOI: 10.1177/19386400211009366 -
Injury Jun 2022The incidence of ankle fractures is increasing and the clinical outcome is highly variable.
BACKGROUND
The incidence of ankle fractures is increasing and the clinical outcome is highly variable.
QUESTION
What person and fracture characteristics are associated with patient reported outcomes after surgically or conservatively managed ankle fractures in adults?
DATA SOURCES
Medline, EMBASE, and Allied and Complimentary Health Medical Database (AMED) databases were searched from the earliest available date until 16th July 2020.
STUDY SELECTION
Prognostic factors studies recruiting adults of age 18 years or older with a radiologically confirmed ankle fracture, and evaluating function, symptoms and quality of life by patient reported outcome measures, were included.
STUDY APPRAISAL/SYNTHESIS METHODS
Risk of bias of individual studies was assessed by the Quality in Prognostic Factors Studies tool. Correlation coefficients were calculated and data were analysed using narrative synthesis.
RESULTS
Fifty-one phase 1 explanatory studies with 6177 participants met the inclusion criteria. Thirty-one studies were rated as high risk of bias using the Quality in Prognostic Factors Studies tool. There was low quality evidence that age, body mass index, American Society of Anesthesiologists classification and pre-injury mobility were associated with function, and low to moderate quality evidence that age, smoking and American Society of Anesthesiologists classification were associated with quality of life. No person characteristics were associated with symptoms and no fracture characteristics were associated with any outcomes.
CONCLUSION
There was low to moderate quality evidence that person characteristics may be associated with patient reported function and quality of life following ankle fracture.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO registration number CRD42020184830.
Topics: Adolescent; Adult; Ankle Fractures; Ankle Joint; Humans; Patient Reported Outcome Measures; Quality of Life
PubMed: 35197205
DOI: 10.1016/j.injury.2022.02.016 -
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