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The Journal of the American Academy of... Jul 2019The last stage of a supination-external rotation ankle fracture involves either transverse fracture of the medial malleolus or rupture of the deltoid ligament. When the... (Review)
Review
The last stage of a supination-external rotation ankle fracture involves either transverse fracture of the medial malleolus or rupture of the deltoid ligament. When the deltoid ligament ruptures, a "bimalleolar equivalent" ankle fracture occurs, and the surgeon is presented with several diagnostic and therapeutic challenges. In the native ankle, the deltoid ligament provides restraint to eversion and external rotation of the talus on the tibia. In bimalleolar equivalent ankle fractures, there is often gross medial instability even after fibular reduction. Retraction of the deltoid with subsequent healing in a nonanatomic position theoretically may cause instability, persistent medial gutter pain, and loss of function with risk of early arthritis. In mild cases, deltoid injury may not be obvious, and potential diagnostic techniques include preoperative and intraoperative stress radiography, MRI, and ultrasonography. The most common injury pattern is avulsion from the medial malleolus, and most current repair techniques involve direct repair of the capsular and deltoid injuries involving suture anchors in the medial malleolus and imbrication of the superficial and deep deltoid fibers. To date, there is limited evidence of superior clinical outcomes with the addition of deltoid repair compared with open reduction and internal fixation of the fibula alone.
Topics: Ankle Fractures; Ankle Injuries; Biomechanical Phenomena; Diagnostic Imaging; Female; Fracture Fixation, Internal; Humans; Ligaments, Articular; Male; Open Fracture Reduction; Orthopedic Procedures; Rupture; Treatment Outcome
PubMed: 30475279
DOI: 10.5435/JAAOS-D-18-00198 -
The Journal of Foot and Ankle Surgery :... May 2019A good classification system is important for clinical handoffs, research, and clinical treatment guidelines. A reliable classification system shows good interobserver...
A good classification system is important for clinical handoffs, research, and clinical treatment guidelines. A reliable classification system shows good interobserver and intraobserver agreement. This study analyzed the interobserver and intraobserver agreement of a descriptive system for ankle fractures and the Lauge-Hansen classification. Three groups of observers (experts, semiexperts, and novices) scored a total of 20 ankle radiographs. All ankle radiographs were classified according to the Lauge-Hansen and Danis-Weber classifications. The ankle fractures were subsequently reviewed in a descriptive manner for the following features: number of affected malleoli, type of fracture of the lateral and medial malleolus, and congruence of the ankle joint. After 2 weeks, the same set of radiographs were reviewed. For interobserver and intraobserver variability, the separate groups were used for analysis, and the Fleiss (multirater) κ values were calculated. The interobserver agreement for the Lauge-Hansen classification was moderate for the experts, fair for semiexperts, and slight for novices (κ = 0.45, κ = 0.37, and κ = 0.16). All factors of the descriptive system had better interobserver agreement than the Lauge-Hansen classification, except for the agreement on the type of fracture of the lateral malleolus. The intraobserver agreement of the Lauge-Hansen classification was substantial for the experts, moderate for the semiexperts, and fair for the novice observers (κ = 0.70, κ = 0.49, and κ = 0.26). The intraobserver agreement was better for all factors of the descriptive system compared with the Lauge-Hansen classification. The descriptive system presented in this study shows less variability between observers than the Lauge-Hansen classification. This system has clinical implications and is easy to use for clinicians with mixed levels of experience. It has the potential to improve clinical and research handoffs and overcome the limitations of current classification systems.
Topics: Ankle Fractures; Clinical Competence; Humans; Observer Variation; Radiography; Reproducibility of Results
PubMed: 30795890
DOI: 10.1053/j.jfas.2018.09.028 -
Foot and Ankle Clinics Sep 2022The management of ankle fractures in the diabetic population requires special attention as the risks of injury or treatment-related complications are high. Thorough... (Review)
Review
The management of ankle fractures in the diabetic population requires special attention as the risks of injury or treatment-related complications are high. Thorough review of clinical history and detailed assessment provide the treating surgeons with key information to guide treatment pathway. Vigilance is required when opting for nonoperative treatment in undisplaced stable ankle fractures in patients with peripheral neuropathy. The presence of critical ischemia in injured limb demands vascular consultation and ultimately, an intervention before surgical fixation of ankle fracture. An extended period of immobilization is one of the key principles in the management of ankle fracture patients with diabetes.
Topics: Ankle; Ankle Fractures; Ankle Injuries; Ankle Joint; Diabetes Mellitus; Humans
PubMed: 36096556
DOI: 10.1016/j.fcl.2022.02.002 -
Rozhledy V Chirurgii : Mesicnik... 2023Maisonneuve fracture (MF) is defined as an ankle fracture-dislocation associated always with a fracture of the proximal quarter of the fibula and rupture of the anterior...
Maisonneuve fracture (MF) is defined as an ankle fracture-dislocation associated always with a fracture of the proximal quarter of the fibula and rupture of the anterior and interosseous tibiofibular ligaments. Other injuries are variable. Recent CT studies have demonstrated that MF is a far more complex injury than initially supposed. Therefore it is necessary to change substantially the current concepts related to this issue. MF is combined in about 80% of cases with a fracture of the posterior malleolus and also with malposition of the distal fibula in the fibular notch. An exact assessment of these injuries requires post-injury CT examination which should be used as a standard in MFs. The main goal of treatment is anatomical reduction of the distal fibula into the fibular notch. In case of avulsion of a larger fragment of the posterior malleolus, it is necessary to perform as the first step its reduction and fixation from the posterolateral approach and thus restore integrity of the notch. Closed reduction of the distal fibula is associated with malposition in up to 50% of cases and therefore open reduction from a short anterolateral approach is preferred. Accuracy of reduction should be always checked by postoperative CT scan.
Topics: Humans; Ankle Fractures; Fracture Fixation, Internal; Ankle Joint; Fibula; Tibia; Fibula Fractures; Joint Dislocations
PubMed: 37185026
DOI: 10.33699/PIS.2023.102.2.48-59 -
Journal of the American Podiatric... 2023Tillaux fractures in adults are rare and, if unrecognized, can lead to ankle fracture healing complications, early progression of arthritis, and limited ankle movement... (Review)
Review
Tillaux fractures in adults are rare and, if unrecognized, can lead to ankle fracture healing complications, early progression of arthritis, and limited ankle movement caused by pain and degenerative changes. The Tillaux fracture was first described by Paul Tillaux as an external rotation injury of the ankle, involving an avulsion fracture of the distal anterolateral tibia. This fracture can be easily overlooked on plain radiographs in the adult. A high index of suspicion for this type of fracture pattern along with the use of computed tomographic scanning can help confirm the suspected diagnosis, rule out other tibial injuries, and provide more information on the best course of action. Historically, Tillaux fractures have been more common in adolescents because of the open tibial epiphyseal plate. Once the epiphyseal plate fully closes, skeletal maturity is achieved, thus making it extremely unusual for the anterior tibiofibular ligament to cause an avulsion fragment of the distal anterolateral tibia. Because of how uncommon this type of fracture is in adults, it has rarely been reported in our literature. We reviewed the literature and present a case report of this rare fracture injury.
Topics: Adolescent; Humans; Adult; Ankle Fractures; Fracture Fixation, Internal; Ankle Injuries; Tibial Fractures; Ligaments, Articular
PubMed: 37467261
DOI: 10.7547/22-076 -
Foot and Ankle Clinics Jun 2020Malunion of ankle and pilon fractures has significant detrimental effect on function and development of post-trauma osteoarthritis. Unfortunately, the incidence of... (Review)
Review
Malunion of ankle and pilon fractures has significant detrimental effect on function and development of post-trauma osteoarthritis. Unfortunately, the incidence of malunion has been reported to be increasing. It is important to assess the ankle for congruency, because this determines the level where correction will occur. A plethora of techniques are available, with low-level evidence supporting each, and therefore it is important that the treating surgeon is fully prepared and comfortable in the techniques they are to use. Supplementary procedures are common and should be expected. This article provides a review of current methods of treatment and their outcomes.
Topics: Ankle Fractures; Bone Malalignment; Fracture Fixation, Internal; Fractures, Malunited; Humans; Osteotomy
PubMed: 32381311
DOI: 10.1016/j.fcl.2020.02.007 -
The Orthopedic Clinics of North America Apr 2019As the geriatric population and associated ankle fractures continues to increase, fracture surgeons should be prepared to surgically manage osteoporotic ankle fractures.... (Comparative Study)
Comparative Study Review
As the geriatric population and associated ankle fractures continues to increase, fracture surgeons should be prepared to surgically manage osteoporotic ankle fractures. There are abundant challenges in management, soft tissue care, and fixation of ankle fractures with poor bone quality especially in elderly patients who have difficulty limiting weight bearing. This article summarizes several different surgical techniques that can be used to optimize outcomes of these fractures.
Topics: Aged; Ankle; Ankle Fractures; Ankle Joint; Bone Plates; Bone Screws; Female; Fracture Fixation, Internal; Humans; Incidence; Male; Osteoporosis; Osteoporotic Fractures; Treatment Outcome
PubMed: 30850082
DOI: 10.1016/j.ocl.2018.10.007 -
The Bone & Joint Journal Nov 2023Triplane ankle fractures are complex injuries typically occurring in children aged between 12 and 15 years. Classic teaching that closure of the physis dictates the...
AIMS
Triplane ankle fractures are complex injuries typically occurring in children aged between 12 and 15 years. Classic teaching that closure of the physis dictates the overall fracture pattern, based on studies in the 1960s, has not been challenged. The aim of this paper is to analyze whether these injuries correlate with the advancing closure of the physis with age.
METHODS
A fracture mapping study was performed in 83 paediatric patients with a triplane ankle fracture treated in three trauma centres between January 2010 and June 2020. Patients aged younger than 18 years who had CT scans available were included. An independent Paediatric Orthopaedic Trauma Surgeon assessed all CT scans and classified the injuries as n-part triplane fractures. Qualitative analysis of the fracture pattern was performed using the modified Cole fracture mapping technique. The maps were assessed for both patterns and correlation with the closing of the physis until consensus was reached by a panel of six surgeons.
RESULTS
Fracture map grouped by age demonstrates that, regardless of age (even at the extremes of the spectrum), the fracture lines consolidate in a characteristic Y-pattern, and no shift with closure of the physis was observed. A second fracture map with two years added to female age also did not show a shift. The fracture map, grouped by both age and sex, shows a Y-pattern in all different groups. The fracture lines appear to occur between the anterior and posterior inferior tibiofibular ligaments, and the medially fused physis or deltoid ligament.
CONCLUSION
This fracture mapping study reveals that triplane ankle fractures have a characteristic Y-pattern, and acknowledges the weakness created by the physis, however it also challenges classic teaching that the specific fracture pattern at the level of the joint of these injuries relies on advancing closure of the physis with age. Instead, this study observes the importance of ligament attachment in the fracture patterns of these injuries.
Topics: Humans; Child; Female; Adolescent; Ankle Fractures; Tomography, X-Ray Computed; Growth Plate; Fracture Fixation, Internal; Ankle Injuries
PubMed: 37909160
DOI: 10.1302/0301-620X.105B11.BJJ-2023-0204.R1 -
Clinics in Podiatric Medicine and... Jul 2024Ankle fractures are one of the more common musculoskeletal injuries that are treated by foot and ankle specialists. A thorough understanding of managing these injuries... (Review)
Review
Ankle fractures are one of the more common musculoskeletal injuries that are treated by foot and ankle specialists. A thorough understanding of managing these injuries requires the ability to differentiate between stable and unstable fractures. The current literature supports the nonoperative management of stable Weber B ankle fractures, whereas unstable fractures have much better outcomes with surgical intervention. Specifically, we review the fixation strategies for the lateral, medial, and posterior malleolar fractures respectively. Finally, we discuss the current trends in postoperative management of some of the more common fracture patterns, and the safety in early weight-bearing protocols.
Topics: Humans; Ankle Fractures; Fracture Fixation, Internal; Male; Female; Fracture Fixation; Weight-Bearing
PubMed: 38789168
DOI: 10.1016/j.cpm.2024.01.008 -
Foot and Ankle Clinics Jun 2022Although surgical fixation can take many forms depending on ankle fracture morphology, the goals of open reduction internal fixation are to restore fracture alignment,... (Review)
Review
Although surgical fixation can take many forms depending on ankle fracture morphology, the goals of open reduction internal fixation are to restore fracture alignment, re-establish ankle stability, and achieve an anatomic mortise. A subset of patients may present postoperatively with evidence of suboptimal open reduction internal fixation. Increased contact pressures across the tibiotalar joint, increased talar shift, and pathologic joint loading leading to the development of post-traumatic arthritis are common sequela of the malaligned mortise. Treatment necessitates a comprehensive approach. This article describes our preferred systematic approach for diagnosis and treatment of the aseptic, malaligned, surgically treated ankle fracture.
Topics: Ankle Fractures; Ankle Joint; Fracture Fixation, Internal; Humans; Open Fracture Reduction; Treatment Outcome
PubMed: 35680293
DOI: 10.1016/j.fcl.2021.11.022