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The Journal of Foot and Ankle Surgery :... 2023The standard surgical treatment for unstable ankle fractures involves open reduction and internal fixation (ORIF) with plates. However, ORIF has been associated with... (Meta-Analysis)
Meta-Analysis Review
The standard surgical treatment for unstable ankle fractures involves open reduction and internal fixation (ORIF) with plates. However, ORIF has been associated with several complications, such as soft tissue irritation, wound infection, and nerve injury. Previous studies have shown that closed reduction and internal fixation with locked intramedullary nails (LIMNs) yields satisfactory efficacy in the treatment of ankle fractures and is associated with low complication rates. Therefore, a systematic review and meta-analysis of randomized controlled trials is imperative to provide evidence on whether or not LIMN fixation is comparable to or superior than traditional ORIF. We conducted a comprehensive literature search in the PubMed, Cochrane Library and EMBASE databases. A total of 4 randomized controlled trials involving 359 participants who suffered ankle fractures were included in this systematic review and meta-analysis. The results showed that the LIMN fixation group was statistically significant in terms of functional outcomes at the 3-month follow-up and wound-related complications. There was no statistical advantage for patients in the LIMN fixation group in terms of nonwound-related complications, total complications, or mid-term follow-up functional outcomes. There was no statistical difference between the LIMN and ORIF groups regarding operation time and quality of reduction. We believe LIMN fixation is a viable option for the treatment of unstable ankle fractures in both young and elderly individuals.
Topics: Humans; Aged; Ankle Fractures; Fibula; Treatment Outcome; Fracture Fixation, Internal; Fracture Fixation, Intramedullary; Bone Plates
PubMed: 36333182
DOI: 10.1053/j.jfas.2022.10.003 -
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 -
Quality of Life Research : An... Jan 2023Ankle fractures are commonly occurring fractures, especially in the aging population, where they often present as fragility fractures. The disease burden and economic... (Review)
Review
PURPOSE
Ankle fractures are commonly occurring fractures, especially in the aging population, where they often present as fragility fractures. The disease burden and economic costs to the patient and society are considerable. Choosing accurate outcome measures for the evaluation of the management of ankle fractures in clinical trials facilitates better decision-making. This systematic review assesses the evidence for the measurement properties of patient-reported outcome measures (PROMs) used in the evaluation of adult patients with ankle fractures.
METHODS
Searches were performed in CINAHL, EMBASE, Medline and Google Scholar from the date of inception to July 2021. Studies that assessed the measurement properties of a PROM in an adult ankle fracture population were included. The included studies were assessed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology for systematic reviews of PROMs.
RESULTS
In total, 13 different PROMs were identified in the 23 included articles. Only the Ankle Fracture Outcome of Rehabilitation Measure (A-FORM) presented some evidence on content validity. The Olerud-Molander Ankle Score (OMAS) and Self-reported Foot and Ankle Score (SEFAS) displayed good evidence of construct validity and internal consistency. The measurement properties of the OMAS, LEFS and SEFAS were most studied.
CONCLUSION
The absence of validation studies covering all measurement properties of PROMs used in the adult ankle fracture population precludes the recommendation of a specific PROM to be used in the evaluation of this population. Further research should focus on validation of the content validity of the instruments used in patients with ankle fractures.
Topics: Adult; Aged; Humans; Ankle; Ankle Fractures; Patient Reported Outcome Measures; Quality of Life
PubMed: 35716224
DOI: 10.1007/s11136-022-03166-3 -
International Orthopaedics Mar 2013Information about the influence of delayed surgery on infectious wound complications is ambiguous. A clinical audit was performed to test the hypothesis that early... (Review)
Review
PURPOSE
Information about the influence of delayed surgery on infectious wound complications is ambiguous. A clinical audit was performed to test the hypothesis that early surgery lowers the rate of infectious wound complications. Secondly we looked at the influence of surgical delay and complications on patient reported functional outcome.
METHODS
All consecutive, closed distal fibular fractures treated surgically with a plate were included and retrospectively analysed for the delay in operation and wound complications. In a second cohort of patients with a AO-Weber B-type ankle fracture outcome was measured using the Olerud-Molander ankle score (OMAS), the American Orthopaedic Foot and Ankle Society score (AOFAS) and a visual analog score (VAS) for overall satisfaction.
RESULTS
Patients treated within one day experienced no wound complications (zero out of 60), whereas in the delayed group 11% (16/145) did (p = 0.004). A similar significant difference was found for the patients treated within one week (2/98) versus after one week (14/107). A systematic review of the literature showed a difference in wound complications of 3.6% (early) versus 12.9% (late) (p < 0.0001). After 43 months, the median AOFAS was 11.5 points lower in the complication group, the OMAS 10 points, and the VAS 0.5 points, with all differences being statistically significant.
CONCLUSIONS
Every effort should be made to operate on closed ankle fractures as soon as reasonably possible. A delay in surgery is associated with a significant rise in infectious wound complications, which significantly lowers outcome and patient satisfaction. These fractures should preferably be treated within the first day.
Topics: Adult; Ankle Injuries; Bone Plates; Female; Fibula; Fracture Fixation, Internal; Fractures, Bone; Humans; Male; Middle Aged; Recovery of Function; Retrospective Studies; Surgical Wound Infection; Time Factors; Treatment Outcome; Young Adult
PubMed: 23288046
DOI: 10.1007/s00264-012-1753-9 -
Injury Oct 2017Ankle dislocation without fracture is rare. We used electronic hospital records to determine the incidence of pure ankle dislocation and performed a systematic review of... (Review)
Review
BACKGROUND
Ankle dislocation without fracture is rare. We used electronic hospital records to determine the incidence of pure ankle dislocation and performed a systematic review of the literature to investigate the occurrence, treatment and outcome of this injury to better inform treating clinicians.
METHODS
A review of electronic medical records at a tertiary referral centre was conducted to estimate in incidence of pure ankle dislocation. Systematic review of the literature was undertaken according to PRISMA guidelines for the reporting of individual patient data. This identified 64 English language articles that included 18 case series, 45 case reports and 1 biomechanical cadaveric study. Data was extracted by standard form independently by 2 of the authors and descriptive statistics were used to describe results.
RESULTS
The estimated incidence of pure ankle dislocation is 0.065% (13/20,000) of presentations with an ankle injury or 0.46% (23/5000) of presentations with an ankle dislocation. Systematic review of English literature identified 154 cases and demonstrated that sporting accidents (31%) and motor vehicle accidents (30%) are the most common cause. 73% (112/154) of the cases occurred in males and 50% (77/154) were open. In 46% (71/154) of patients the direction of dislocation was posteromedial. 46% of patients had nonoperative treatment; ligamentous repair was described in 26% (37 patients). The mean period of immobilisation was just over 6 weeks (range 2-16 weeks). In most patients, good functional outcomes were described. The most common long-term complaint was decreased ankle range of motion (18%) (27/154). Ankle instability was rare (2.6%) (4/154) and not influenced by acute ligament repair (P=0.98).
CONCLUSION
Pure ankle dislocation is a rare injury. The literature reports that most injuries occur in sports and motor vehicle accidents. The majority of injuries treated with early reduction followed by a short period of immobilisation and functional rehabilitation have good clinical outcomes.
Topics: Ankle Injuries; Humans; Immobilization; Incidence; Joint Dislocations; Physical Therapy Modalities; Radiography; Range of Motion, Articular
PubMed: 28826653
DOI: 10.1016/j.injury.2017.08.011 -
Journal of Clinical Orthopaedics and... May 2021This systematic review evaluated the surgical outcomes of various ankle fracture treatment modalities in patients with Diabetes Mellitus as well as the methodological...
AIM
This systematic review evaluated the surgical outcomes of various ankle fracture treatment modalities in patients with Diabetes Mellitus as well as the methodological quality of the studies.
METHODS
For our review, four online databases were searched: PubMed, MEDLINE (Clarivate Analytics), CINAHL (Cumulative Index to Nursing and Allied Health) and Web of Science (Clarivate Analytics). The overall methodological quality of the studies was assessed with the Coleman Methodology Score. Data regarding diabetic ankle fractures were pooled into three outcomes groups for comparison: (1) the standard fixation cohort with management of diabetic ankle fractures using ORIF with small or mini fragment internal fixation techniques following AO principles, (2) the minimally invasive cohort with diabetic ankle fracture management utilizing percutaneous cannulated screws or intramedullary fixation, and (3) the combined construct cohort treated with a combination of ORIF and another construct (transarticular or external fixation).
RESULTS
The search strategy identified 2228 potential studies from the four databases and 11 were included in the final review. Compared to the standard fixation cohort, the minimally invasive cohort had increased risk of hardware breakage or migration and the combined constructs cohort had increased risk of hardware breakage or migration, surgical site infection and nonunion. Limb salvage rates were similar for the standard fixation and minimally invasive cohorts; however, the combined constructs cohort had a significantly lower limb salvage rate compared to that of the standard fixation cohort. The mean Coleman Methodology Score indicated the quality of the studies in the review was poor and consistent with its limitations.
DISCUSSION
The overall quality of published studies on operative treatment of diabetic ankle fractures is low. Treating diabetic ankle fractures operatively results in a high number of complications regardless of fixation method. However, limb salvage rates remain high overall at 97.9% at a mean follow-up of 21.7 months. To achieve improved limb salvage rates and decrease complications, it is critical is to follow basic AO principles, respect the soft tissue envelope or utilize minimally invasive techniques, and be wary that certain combined constructs may be associated with higher complication rates.
LEVEL OF EVIDENCE
2.
PubMed: 33717936
DOI: 10.1016/j.jcot.2020.12.013 -
Scandinavian Journal of Medicine &... Dec 2013Studies regarding ankle and foot overuse injuries are quite diverse in research methodology, data reporting, and outcomes. The aims of this systematic review were to... (Review)
Review
Studies regarding ankle and foot overuse injuries are quite diverse in research methodology, data reporting, and outcomes. The aims of this systematic review were to analyze the methodology of published studies regarding ankle and foot overuse injuries in different sports disciplines and to summarize epidemiological data of ankle and foot overuse injuries. Four electronic databases, PubMed (MEDLINE), EMBASE, CINAHL, and SPORTDiscus(®) were systematically searched up to June 2011. A total of 89 articles on 23 sports disciplines were included in this review. Soccer, running, and gymnastics were the most frequently studied sports. Achilles tendinopathy, plantar fasciitis, and stress fracture were the most frequently studied injuries. Study design and reporting methods were heterogeneous. Most studies suffered from a weak methodology and poor reporting. The most common weaknesses were lack of a clear case definition, describing assessment procedures and reporting sample characteristics. Due to methodological heterogeneity of studies, inter-sports and intra-sports comparisons and meta-analysis were not possible. Methodology of most studies on incidence and prevalence of ankle and foot overuse injuries is insufficient. Based on the results, we recommend authors to clearly define cases, describe assessment procedures and report sample characteristics adequately.
Topics: Achilles Tendon; Ankle Injuries; Athletic Injuries; Cumulative Trauma Disorders; Fasciitis, Plantar; Foot Bones; Foot Injuries; Fractures, Stress; Gymnastics; Humans; Running; Soccer; Tendinopathy
PubMed: 22846101
DOI: 10.1111/j.1600-0838.2012.01509.x -
The Journal of Orthopaedic and Sports... Nov 2014Systematic review and meta-analysis of longitudinal studies. (Meta-Analysis)
Meta-Analysis Review
STUDY DESIGN
Systematic review and meta-analysis of longitudinal studies.
OBJECTIVES
To quantify the prognosis of physical function following ankle fracture.
BACKGROUND
Information about the course of recovery of physical function after ankle fracture is essential for patient care and health care policy. The existing data have not previously been included in a meta-analysis.
METHODS
Studies were identified using searches of electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, PEDro, AMED, SPORTDiscus) and gray literature to September 2012. Studies of people with traumatic ankle fracture were included. Two reviewers independently screened references for inclusion, then extracted data and evaluated risk of bias. The outcome of interest was physical function (physical activity and activity limitation). Outcomes were converted to a common 100-point scale, on which higher scores indicated better outcomes. Meta-regression was conducted using generalized estimating equations.
RESULTS
Thirty-one studies (37 articles) were included. Adults with ankle fracture, present with significant activity limitation in the short term (mean at 1 month, 31.9; 95% confidence interval [CI]: 18.8, 45.1), recovered markedly but incompletely in the short to medium term (mean at 6 months, 78.3; 95% CI: 70.1, 85.1), and showed little further improvement in the long term (mean at 24 months, 86.6; 95% CI: 78.2, 95.0). Studies with older participants and predominantly male participants tended to report worse functional outcomes.
CONCLUSION
Adults typically experience a rapid initial recovery of physical function after ankle fracture (approximately 80% function at 6 months), but, on average, recovery remains incomplete 24 months after injury. PROSPERO registration number: 42012002979.
LEVEL OF EVIDENCE
Prognosis, level 2a.
Topics: Activities of Daily Living; Ankle Fractures; Humans; Longitudinal Studies; Male; Prognosis; Recovery of Function
PubMed: 25269609
DOI: 10.2519/jospt.2014.5199 -
The Journal of Orthopaedic and Sports... Sep 2014Systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis Review
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVES
To compare early ankle movement versus ankle immobilization after surgery for ankle fracture on clinical and patient-reported outcomes.
BACKGROUND
A significant proportion of patients undergoing surgery for ankle fracture experience postoperative complications and delayed return to function. The risks and benefits of movement of the ankle in the first 6 weeks after surgery are not known, and clinical practice varies widely.
METHODS
We searched bibliographic databases and reference lists to identify eligible trials. Two independent reviewers conducted data extraction and risk-of-bias assessments.
RESULTS
Fourteen trials (705 participants) were included in the review, 11 of which were included in the meta-analysis. The quality of the trials was universally poor. The pooled effect of early ankle movement on function at 9 to 12 weeks after surgery compared to immobilization was inconclusive (standardized mean difference, 0.46; 95% confidence interval: -0.02, 0.93; P = .06; I(2) = 72%), and no differences were observed between groups at 1 year. The odds of venous thromboembolism were significantly lower with early ankle movement compared to immobilization (Peto odds ratio = 0.12; 95% confidence interval: 0.02, 0.71; P = .02; I(2) = 0%). Deep surgical site infection (Peto odds ratio = 7.08; 95% confidence interval: 1.39, 35.99; P = .02; I(2) = 0%), superficial surgical site infection, fixation failure, and reoperation to remove metalwork were more common after early ankle movement compared to immobilization.
CONCLUSION
The quality of evidence is poor. The effects of early movement after ankle surgery on short-term functional outcomes are unclear, but there is no observable difference in the longer term. There is a small reduction in risk of postoperative thromboembolism with early ankle movement. Current evidence suggests that deep and superficial surgical site infections, fixation failure, and the need to remove metalwork are more common after early ankle movement. Level of Evidence Therapy, level 1a-.
Topics: Ankle; Ankle Fractures; Casts, Surgical; Early Ambulation; Fracture Fixation; Humans; Postoperative Care; Postoperative Complications; Recovery of Function; Risk Factors
PubMed: 25098197
DOI: 10.2519/jospt.2014.5294 -
The Journal of Foot and Ankle Surgery :... 2022Unstable ankle fractures are traditionally treated with open reduction and internal fixation. An alternative surgical option is primary tibio-talar-calcaneal fusion. Our... (Review)
Review
Unstable ankle fractures are traditionally treated with open reduction and internal fixation. An alternative surgical option is primary tibio-talar-calcaneal fusion. Our aims were to determine the indication, complication rates, and functional outcomes, of tibio-talar-calcaneal nailing when used as the primary treatment of ankle fractures. A multidatabase literature search was performed on December 14, 2019 according to PRISMA guidelines. All studies in the English language reporting complications and outcomes involving tibio-talar-calcaneal nailing for primary treatment of ankle fractures were included. Ten studies with 252 ankle fractures were included. Mean age of patients was 75.5 (32-101) years. Mean follow-up duration was 79 weeks (36-104 weeks). Surgical site infection occurred in 11.2% (95% confidence interval [CI] 6.3%-19%) of patients, implant failure occurred in 8.1% (95% CI 5%-12.8%) of patients, and unplanned return to operating room occurred in 10.1% (95% CI 6.1%-16.2%) of patients. There were no cases of wound dehiscence. All-cause mortality rate at the end of follow-up was 26.6% (95% CI 19.7%-34.9%). Average reduction in Olerud-Molander Ankle Score after surgery was 7.9 points (5.0-11.8). Eighty-one point five percent (95% CI: 67.4%-90.4%) of patients were able to return to similar preoperative mobility aid after surgery. Tibio-talar-calcaneal nailing is an alternative procedure for patients who have sustained fractures unsuitable for nonoperative management, but have low functional demands and at increased risks of complications after open reduction and internal fixation. About 81.5% (95% CI 67.4%-90.4%) of patients were able to return to a similar preinjury mobility status after tibio-talar-calcaneal nailing.
PubMed: 34802910
DOI: 10.1053/j.jfas.2021.10.006