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The Journal of Foot and Ankle Surgery :... 2021Recent literature suggests the majority of osteochondral lesions occur in the ankle joint. Previous studies have suggested that varying incidences of talar osteochondral...
Recent literature suggests the majority of osteochondral lesions occur in the ankle joint. Previous studies have suggested that varying incidences of talar osteochondral lesions (OCLT) are associated with ankle fractures. The primary aim of our study was to investigate the incidence of osteochondral lesions associated with acute ankle fractures as observed on computed tomographic (CT) imaging. We also compared the rates of talar osteochondral lesions in patients who had ankle fractures with dislocation and closed manual reduction (CMR) prior to open reduction with internal fixation, to those who did not suffer from ankle joint dislocation. Additionally, a correlation between the location of talar dome lesions with type of ankle fracture as classified by Lauge-Hansen was investigated. Preoperative CT imaging was retrospectively reviewed in 108 patients with acute ankle fractures. A CT-modified version of Berndt Hardy's classification of osteochondral lesions, as previously described by Loomer et al, was used for diagnosis of lesions in our study. The incidence of lesions was calculated across all subjects, and retrospective comparison was performed in those who did and did not undergo closed manual reduction. Supplementary data on location of lesion and its association with ankle fracture type was also recorded. We found an overall incidence of 50.9% OCLT in patients with acute ankle fractures. This number did not significantly differ from those who underwent closed manual reduction (49%). Although a majority of lesions did occur posteriorly, we saw no statistically significant information was seen between either type of fractures or OCLT locations. Careful consideration and thorough evaluation of preoperative CT imaging should be assessed by the performing surgeon, as this could guide both diagnostic and therapeutic treatments for patients with possible osteochondral lesions of the talus undergoing surgical repair of a fractured ankle.
Topics: Ankle Fractures; Ankle Joint; Humans; Incidence; Intra-Articular Fractures; Retrospective Studies; Talus
PubMed: 34092459
DOI: 10.1053/j.jfas.2021.05.001 -
Foot & Ankle Specialist Oct 2015Vitamin D is a generic name for a group of essential vitamins, or secosteroids, important in calcium homeostasis and bone metabolism. Specifically, efficacy of vitamin D... (Review)
Review
UNLABELLED
Vitamin D is a generic name for a group of essential vitamins, or secosteroids, important in calcium homeostasis and bone metabolism. Specifically, efficacy of vitamin D with regard to bone healing is in question. A literature review was performed, finding mostly large studies involving vitamin D effects on prevention of fractures and randomized animal model studies consisting of controlled fractures with vitamin D interventions. The prevention articles generally focus on at-risk populations, including menopausal women and osteoporotic patients, and also most often include calcium in the treatment group. Few studies look at vitamin D specifically. The animal model studies often focus more on vitamin D supplementation; however the results are still largely inconclusive. While recent case reports appear promising, the ambiguity of results on the topic of fracture healing suggests a need for more, higher level research. A novel study design is proposed to help determine the efficacy on vitamin D in fracture healing.
LEVELS OF EVIDENCE
Therapeutic, Level IV: Systematic Review.
Topics: Aged; Ankle Fractures; Dietary Supplements; Female; Foot Injuries; Fracture Fixation, Internal; Fracture Healing; Humans; Injury Severity Score; Male; Middle Aged; Postoperative Care; Prognosis; Radiography; Randomized Controlled Trials as Topic; Research Design; Vitamin D
PubMed: 25964289
DOI: 10.1177/1938640015585958 -
Acta Orthopaedica. Supplementum Feb 2015
Topics: Ankle Fractures; Ankle Injuries; Fracture Fixation, Internal; Humans; Reoperation; Surgical Flaps; Surgical Wound Infection
PubMed: 25586467
DOI: 10.3109/17453674.2014.100227 -
The Iowa Orthopaedic Journal 2021Inaccuracy of ankle syndesmotic repair via reduction and trans-syndesmotic fixation can occur during ankle fracture repair. The goal of this study was to determine...
BACKGROUND
Inaccuracy of ankle syndesmotic repair via reduction and trans-syndesmotic fixation can occur during ankle fracture repair. The goal of this study was to determine whether reduction and fixation of the posterior malleolar fracture (PM) fragment in rotational ankle fractures reduces the need for independent syndesmotic screw fixation.
METHODS
A retrospective study was conducted using a consecutive series of patients treated operatively for a rotationally unstable ankle fracture with a PM fragment between 2011-2017. All ankle fractures underwent open reduction and internal fixation and divided into two groups: PM fixed or not fixed. An intraoperative stress evaluation of the ankle following bony fixation was performed in all cases to evaluate syndesmotic instability. Patient and fracture characteristics, and intraoperative instability and trans-syndesmotic fixation were compared between both groups.
RESULTS
Eighty-five unstable ankle fractures that had a PM fragment were identified. Forty-three fractures underwent PM fixation and 42 did not. There were no differences between the PM fixation groups with regard to age, gender, body mass index or fracture pattern (p>0.183 for all). On average, PM fragments in the fixed group were larger than those not fixed (p<0.001). There were significantly lower odds of needing syndesmotic fixation if the PM fragment was reduced and fixed (p<0.001). Only 2 out of 43 ankles with a fixed PM fragment underwent syndesmotic fixation compared with 34 out of 42 non-fixed PM fragments.
CONCLUSION
Posterior malleolar fixation imparts syndesmotic stability and may obviate the need for trans-syndesmotic fixation for restoring dynamic ankle mortise congruence..
Topics: Ankle Fractures; Ankle Joint; Bone Screws; Fracture Fixation, Internal; Humans; Incidence; Retrospective Studies; Treatment Outcome
PubMed: 34552413
DOI: No ID Found -
BMC Musculoskeletal Disorders Dec 2022The epidemiology and payer costs for ankle fractures are not well documented. This study evaluated: (1) the incidence of ankle fracture and ankle surgery following...
BACKGROUND
The epidemiology and payer costs for ankle fractures are not well documented. This study evaluated: (1) the incidence of ankle fracture and ankle surgery following fracture in the US population; and (2) the clinical presentation of patients presenting with ankle fractures requiring surgery, their complication rates, and payer costs.
METHODS
Patients in the IBM® MarketScan® Commercial and Medicare Supplemental databases with an inpatient/outpatient diagnosis of ankle fracture from 2016 to 2019 were stratified by age group and gender, and rates of fracture per 10,000 enrollees were estimated. Surgically-treated patients between January 2016 - October 2021 were further analyzed. One-year post-surgical outcomes evaluated complication rates (e.g., infection, residual pain), reoperations, and 1-year payments. Standard descriptive statistics were calculated for all variables and outcomes. Generalized linear models were designed to estimate payments for surgical care and incremental payments associated with postoperative complications.
RESULTS
Fracture cases affected 0.14% of the population; 23.4% of fractures required surgery. Pediatric and elderly patients were at increased risk. From 3 weeks to 12 months following index ankle surgery, 5.5% (5.3% - 5.7%) of commercially insured and 5.9% (5.1% - 6.8%) of Medicare patients required a new surgery. Infection was observed in 4.4% (4.2% - 4.6%) commercially insured and 9.8% (8.8% - 10.9%) Medicare patients, and residual pain 3 months post-surgery was observed in 29.5% (28.7% - 30.3%) commercially-insured and 39.3% (36.0% - 42.6%) Medicare patients. Commercial payments for index surgery ranged from $9,821 (95% CI: $9,697 - $9,945) in the ambulatory surgical center to $28,169 (95% CI: $27,780 - $28,559) in the hospital inpatient setting, and from $16,775 (95% CI: $16,668 - $16,882) in patients with closed fractures, to $41,206 (95% CI: $38,795 - $43,617) in patients with Gustilo III fractures. Incremental commercial payments for pain and infection averaged $5,200 (95% CI: $4,261 - $6,139) and $27,510 (95% CI: $21,759 - $33,261), respectively.
CONCLUSION
Ankle fracture has a high incidence and complication rate. Residual pain affects more than one-third of all patients. Ankle fracture thus presents a significant societal impact in terms of patient outcomes and payer burden.
Topics: Humans; Aged; United States; Child; Ankle Fractures; Medicare; Incidence; Pain; Postoperative Complications; Retrospective Studies
PubMed: 36567314
DOI: 10.1186/s12891-022-06095-x -
European Journal of Trauma and... Dec 2015Despite an increasing awareness of injuries to PM in ankle fracture-dislocations, there are still many open questions. The mere presence of a posterior fragment leads to... (Review)
Review
Despite an increasing awareness of injuries to PM in ankle fracture-dislocations, there are still many open questions. The mere presence of a posterior fragment leads to significantly poorer outcomes. Adequate diagnosis, classification and treatment require preoperative CT examination, preferably with 3D reconstructions. The indication for surgical treatment is made individually on the basis of comprehensive assessment of the three-dimensional outline of the PM fracture and all associated injuries to the ankle including syndesmotic instability. Anatomic fixation of the avulsed posterior tibiofibular ligament will contribute to syndesmotic stability and restore the integrity of the incisura tibiae thus facilitating anatomic reduction of the distal fibula. A necessary prerequisite is mastering of posterolateral and posteromedial approaches and the technique of direct reduction and internal fixation. Further clinical studies with higher numbers of patients treated by similar methods and evaluation of pre- and postoperative CT scans will be necessary to determine reliable prognostic factors associated with certain types of PM fractures and associated injuries to the ankle.
Topics: Ankle Fractures; Biomechanical Phenomena; Bone Screws; Bone Wires; Fracture Fixation, Internal; Humans; Imaging, Three-Dimensional; Joint Dislocations; Joint Instability; Ligaments, Articular; Postoperative Complications; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 26253884
DOI: 10.1007/s00068-015-0560-6 -
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 -
Foot and Ankle Clinics Dec 2015Current clinical concepts are reviewed regarding the epidemiology, anatomy, evaluation, and treatment of pediatric ankle fractures. Correct diagnosis and management... (Review)
Review
Current clinical concepts are reviewed regarding the epidemiology, anatomy, evaluation, and treatment of pediatric ankle fractures. Correct diagnosis and management relies on appropriate examination, imaging, and knowledge of fracture patterns specific to children. Treatment is guided by patient history, physical examination, plain film radiographs and, in some instances, computed tomography. Treatment goals are to restore acceptable limb alignment, physeal anatomy, and joint congruency. For high-risk physeal fractures, patients should be monitored for growth disturbance as needed until skeletal maturity.
Topics: Ankle; Ankle Fractures; Child; Humans
PubMed: 26589088
DOI: 10.1016/j.fcl.2015.07.004 -
JBJS Case Connector Jul 2023We describe the case of a 63-year-old man with anterior ankle dislocation and fracture confirmed by x-ray. Postreduction x-ray and computed tomography (CT) revealed...
CASE
We describe the case of a 63-year-old man with anterior ankle dislocation and fracture confirmed by x-ray. Postreduction x-ray and computed tomography (CT) revealed Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) type 44C3 and Lauge-Hansen pronation-external rotation-type ankle fractures.
CONCLUSION
This was a rare case of ankle fracture dislocation because of entrapment of the tibialis posterior and flexor digitorum longus tendons in the interosseous membrane. Tendon entrapment should be suspected in cases of high-energy injuries, Weber type C fractures, Lauge-Hansen pronation-external rotation fractures, syndesmosis widening, and irreducible fractures using manual closed reduction. Fractures and soft tissues should be evaluated by changing the CT settings.
Topics: Male; Humans; Middle Aged; Ankle Fractures; Ankle; Interosseous Membrane; Tendons; Joint Dislocations; Fracture Dislocation; Tendon Entrapment
PubMed: 37478312
DOI: 10.2106/JBJS.CC.23.00117