-
Journal of Orthopaedic Trauma Jan 2018The diagnosis and treatment of syndesmotic ankle fractures is controversial. This systematic review was performed to clarify the current understanding addressing several... (Review)
Review
OBJECTIVES
The diagnosis and treatment of syndesmotic ankle fractures is controversial. This systematic review was performed to clarify the current understanding addressing several clinical questions that arise in the treatment of such injuries.
DATA SOURCES
The English language literature was searched using PubMed, EMBASE, and Web of Science. The search terms were "syndesmosis" or "syndesmotic" in combination with the terms "ankle fracture" or "fracture." The included dates were between 1967 and July 2015.
STUDY SELECTION
Inclusion criteria were number of patients >20, patient age ≥18 years, follow-up ≥1 year, ankle fracture classification was reported, criteria for surgery was reported, technique of surgery was reported, and a validated outcome measure was used. Studies limited to biomechanical or imaging investigations were excluded.
DATA EXTRACTION
Information was abstracted using a standardized template, which encompassed the inclusion criteria together with the study type, postoperative regimen, and complications. Study quality was evaluated using the modified CONSORT statement and Coleman criteria. Study bias was assessed, and methodological quality was rated. Any difference in ratings was resolved by consensus.
DATA SYNTHESIS
None.
CONCLUSIONS
The overall quality of the studies was poor. The number or placement of syndesmotic screws or the breakage of trans-syndesmotic screws postoperatively had no adverse effect on outcomes (both with moderate strength of evidence). The use of alternative fixation devices (bioabsorbable and endobutton) had poor strength of evidence, as did the opinion that nondisplaced, unstable by stress test, syndesmotic injuries required fixation. There are insufficient data that link subtle rotational syndesmotic malreduction to clinical outcomes.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Topics: Ankle Fractures; Humans
PubMed: 28708780
DOI: 10.1097/BOT.0000000000000937 -
Journal of Sport Rehabilitation May 2018Ankle fractures (AFs) are the most common fractures of the lower limbs found in emergency services. Approximately 53% of these fractures are unstable and treated... (Review)
Review
CONTEXT
Ankle fractures (AFs) are the most common fractures of the lower limbs found in emergency services. Approximately 53% of these fractures are unstable and treated surgically.
OBJECTIVE
To conduct a systematic review evaluating functional outcomes and quality of life of patients with AFs surgically treated.
EVIDENCE ACQUISITION
A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. Five electronic databases were searched, without any limit on publication dates. Only patients with an unstable AF that was surgically treated were included; functional outcomes and the quality of life were controlled by the 36-Item Short-Form Health Survey instrument.
EVIDENCE SYNTHESIS
Five studies were included in the analysis, including 267 patients. The values of the Physiotherapy Evidence Database scale ranged between a minimum of 5 and a maximum of 7 points. Patients with surgically treated AF reported less functionality and physical capacity compared with the nonfractured population. Some patients experienced vitality, emotional, and mental health limitations for a long period. Most surgically treated patients reported no pain and a good health and social status.
CONCLUSION
Limitations in functionality and physical capacity represent the main threats to health-related quality of life in patients with surgically treated AFs.
Topics: Activities of Daily Living; Ankle Fractures; Health Status; Humans; Mental Health; Pain; Quality of Life
PubMed: 28338395
DOI: 10.1123/jsr.2016-0199 -
Diagnostics (Basel, Switzerland) Jan 2022(1) Background: Ankle fracture results in pain, swelling, stiffness and strength reduction, leading to an altered biomechanical behavior of the joint during the gait... (Review)
Review
(1) Background: Ankle fracture results in pain, swelling, stiffness and strength reduction, leading to an altered biomechanical behavior of the joint during the gait cycle. Nevertheless, a common pattern of kinematic alterations has still not been defined. To this end, we analyzed the literature on instrumental gait assessment after ankle fracture, and its correlation with evaluator-based and patient-reported outcome measures. (2) Methods: We conducted a systematic search, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, of articles published from January 2000 to June 2021 in PubMed, Embase and PEDro on instrumental gait assessment after ankle fracture. (3) Results: Several changes in gait occur after ankle fracture, including a reduction in step length, swing time, single support time, stride length, cadence, speed and an earlier foot-off time in the affected side. Additionally, trunk movement symmetry (especially vertical) is significantly reduced after ankle fracture. The instrumental assessments correlate with different clinical outcome measures. (4) Conclusions: Instrumental gait assessment can provide an objective characterization of the gait alterations after ankle fracture. Such assessment is important not only in clinical practice to assess patients' performance but also in clinical research as a reference point to evaluate existing or new rehabilitative interventions.
PubMed: 35054366
DOI: 10.3390/diagnostics12010199 -
Journal of Bodywork and Movement... Oct 2020Orthopedic injuries in conjunction with extensive damage to tissues, bones and blood vessels, usually require a long recovery. Associated consequences are pain, movement... (Review)
Review
BACKGROUND
Orthopedic injuries in conjunction with extensive damage to tissues, bones and blood vessels, usually require a long recovery. Associated consequences are pain, movement limitations, decreased function and occasionally, prolonged edema, which can delay or interfere with the healing process. Lymphatic and compression therapy have become increasingly common, intending to reduce edema and pain, thus, promoting the recovery process.
AIMS
To examine the efficacy of methods commonly used to reduce edema after orthopedic injury or surgery, i.e. decongestive therapy, manual lymphatic drainage, and compression bandaging.
METHODS
English literature search was undertaken in January 2019, in the following databases: Cochrane Library, MEDLINE, PEDro.
INCLUSION CRITERIA
randomized controlled or quasi-controlled trials in adults who have edema or pain after recent limb trauma or surgery. Two independent assessors rated study quality and risk of bias using the PRISMA recommendations and PEDro score.
RESULTS
We evaluated 71 papers. After excluding duplicated and irrelevant papers, 15 met the eligibility criteria (6 on lymphatic treatment and 9 on compression). Quality of papers ranged from 3 to 7 on PEDro score; of them, 13 were 1b Level of Evidence and two were 1c.
CONCLUSION
After elective surgeries, when the significant edema appears or persists beyond recovery time, complex decongestive therapy and manual edema mobilization should be recommended in addition to conventional physical therapy. In acute injuries such as ankle or distal radius fractures, lymphatic treatments and compression bandaging should be considered as part of the therapeutic protocol. Nine studies evaluated different compression modalities found that only multilayer and long stretch compression significantly reduce edema.
Topics: Adult; Edema; Humans; Massage; Orthopedic Procedures; Orthopedics; Physical Therapy Modalities
PubMed: 33218497
DOI: 10.1016/j.jbmt.2020.06.034 -
European Journal of Trauma and... Aug 2017The main purpose of this systematic review was to investigate the effect of compression treatment on the perioperative course of ankle fractures and describe its effect... (Review)
Review
PURPOSE
The main purpose of this systematic review was to investigate the effect of compression treatment on the perioperative course of ankle fractures and describe its effect on edema, pain, ankle joint mobility, wound healing complication, length of stay (LOS) and time to surgery (TTS). The aim was to suggest a recommendation to clinicians considering implementing compression therapy in the standard care of the ankle fracture patient, based on the existing literature.
METHODS
We conducted a systematic search of literature including studies concerning adult patients with unstable ankle fractures undergoing surgery, testing either intermittent pneumatic compression, compression bandage and/or compression stocking and reporting its effect on edema, pain, ankle joint mobility, wound healing complication, LOS and TTS. To conclude on data a narrative synthesis was performed.
RESULTS
The review included eight studies (451 patients). Seven studies found a significant effect on edema, two studies described a significant reduction in pain, one a positive effect on ankle movement, two a positive effect on wound healing, one a reduction in LOS and finally two studies reported reduction in TTS. A systematic bias assessment showed that the included studies had methodological limitations influencing the confidence in the effect estimate.
CONCLUSIONS
Compression therapy has a beneficial effect on edema reduction and probably a positive effect on pain and ankle joint mobility, but with the methodological limitations in the included studies it is not possible to make a solid conclusion on the effect on wound healing, LOS and TTS.
Topics: Ankle Fractures; Compression Bandages; Edema; Humans; Intermittent Pneumatic Compression Devices; Length of Stay; Pain Measurement; Postoperative Complications; Wound Healing
PubMed: 28624992
DOI: 10.1007/s00068-017-0801-y -
Osteoporosis and Sarcopenia Sep 2020Ankle fractures are common in the elderly. However, their association with osteoporosis remains controversial. This systematic review aims to determine the relationship...
OBJECTIVES
Ankle fractures are common in the elderly. However, their association with osteoporosis remains controversial. This systematic review aims to determine the relationship between ankle fracture and bone mineral density (BMD), and to investigate the risk of subsequent fractures after ankle fracture.
METHODS
MEDLINE and Scopus publications were searched from inception to March and April 2019, respectively. Articles were selected by 2 independent reviewers for cross-sectional, cohort, or case-control studies comparing BMD or subsequent fracture risk in low-energy ankle fractures patients with that of the normal population. Data extraction was performed by 2 investigators. Discrepancies were resolved with the third reviewer. Quality assessment was conducted using the modified Newcastle-Ottawa Scale.
RESULTS
Overall, 19 articles were included. The quality assessment showed a generally low-to-moderate risk of bias among studies, mainly due to potential confounders and inadequate follow-up. Of 13 studies exploring BMD in ankle fractured-patients, lower central and peripheral BMD was found in 3 and 2 studies, respectively. The risk of subsequent fracture was examined in 11 studies with relative risks ranging from 0.7 to 4.59. An increased risk of any subsequent fractures in women, both genders, and men was found in 5, 2, and 1 articles, respectively.
CONCLUSIONS
Despite the lack of clear association with BMD, the contribution of ankle fracture to increased subsequent fracture risk and its associated microarchitectural changes cannot be overlooked. Moreover, its potential role as an early predictor of future fracture may promote secondary prevention. Further studies with longer follow-up and stricter confounder control are recommended.
PubMed: 33102810
DOI: 10.1016/j.afos.2020.08.003 -
Annals of Palliative Medicine Aug 2021This study aimed to apply meta-analysis to study the efficacy of surgical repair treatment on ankle fractures. (Meta-Analysis)
Meta-Analysis
BACKGROUND
This study aimed to apply meta-analysis to study the efficacy of surgical repair treatment on ankle fractures.
METHODS
The Boolean logic search method was adopted to retrieve relevant randomized control trials (RCTs), with "Fracture", "Ankles", "Fractured Foot", "Fractures Merge", and "Surgical Treatment" as search terms. The databases PubMed, Medline, HowNet, and others were searched from the time of their establishment. The software Review Manager (Rev Man 5.3) was used for meta-analysis.
RESULTS
A total of 10 references were included in the study, and most of them had low-risk bias (medium-high quality). The results of meta-analysis showed that after surgical repair treatment, gait was good, while the gait score of the non-surgical group was poor. The result was Chi2 (Chi-squared Test) =57.91, df (degree of freedom) =5, I2=91%, P<0.1, mean difference (MD) =-9.21, 95% CI: -10.25 to -8.17, Z=17.36, P<0.05. The non-surgical group showed a higher degree of pain and poorer ankle and hindfoot functions vs. the surgical group. Also, the pain degree of the non-surgical repair combined with surrounding tissue group was higher, and the ankle and hindfoot functions were poorer vs. the surgical repair treatment group. The Pain intensity results of the surgical and non-surgical groups were Chi2 =12.89, df =2, I2=84%, P<0.1, MD =-9.51, 95% CI: -10.47 to -8.55, Z=19.39, P<0.05; the AOFAS scores of surgical repair treatment and non-surgical repair treatment were Chi2 =27.07, df =6, I2=78%, P<0.1, MD =8.89, 95% CI: 8.26 to 9.71, Z=24.30, P<0.05. It was revealed that surgical repair treatment can significantly reduce the postoperative pain of patients with ankle joint fractures, while the non-surgical repair treatment group had a higher degree of postoperative pain. The result was (MD =2.32, 95% CI: 2.16 to 2.48, I2=100%, Z=28.33, P<0.05).
DISCUSSION
Surgical repair treatment of ankle fracture demonstrated significant curative effects, with fewer adverse reactions, and the stability of the ankle joint was well restored.
Topics: Ankle Fractures; Ankle Joint; Humans
PubMed: 34488374
DOI: 10.21037/apm-21-1618 -
Foot and Ankle Surgery : Official... Dec 2022Total ankle arthroplasty (TAA) is increasingly used as a treatment for end-stage ankle arthropathy. However, TAA may be more sensitive to complications, failure and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Total ankle arthroplasty (TAA) is increasingly used as a treatment for end-stage ankle arthropathy. However, TAA may be more sensitive to complications, failure and subsequent re-operations compared to ankle arthrodesis. The aim of this systematic review and meta-analysis is to generate an overview of complications of TAA surgery.
METHODS
PubMed, EMBASE and the Cochrane library were searched between 2000 and 2020 to identify all papers reporting on complications in TAA surgery. Meta-analysis was conducted based on type of complication in TAA surgery. Pooled estimates of complications were calculated using a random effects model. Risk of bias and quality was assessed using the Cochrane risk of bias and ROBINS-I tools. The confidence in estimates was rated and described according to the recommendations of the GRADE working group.
RESULTS
One hundred twenty-seven studies were included in this systematic review. All combined, they reported on 16.964 TAAs with an average follow-up of 47.99 ± 29.18 months. Complications with highest reported pooled incidence were intra-operative fracture 0.06 (95 %CI 0.04-0.08) (GRADE Very low) and impingement 0.06 (95 %CI 0.04-0.08) (GRADE low) respectively.
CONCLUSION
Reported complication incidence of TAA surgery is still high and remains a significant clinical problem that can be severely hampering long-term clinical survival of the prosthesis. The results of this systematic review and meta-analysis can help guide surgeons in informing their patient about complication risks. Implementation of more stringent patient selection criteria might contribute to diminishing TAA complication rates.
Topics: Humans; Retrospective Studies; Arthroplasty, Replacement, Ankle; Arthrodesis; Ankle Joint; Reoperation; Treatment Outcome
PubMed: 35872118
DOI: 10.1016/j.fas.2022.07.004 -
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