-
BioMed Research International 2016The indications and clinical necessity for routine hardware removal after treating ankle or distal tibia fracture with open reduction and internal fixation are disputed...
The indications and clinical necessity for routine hardware removal after treating ankle or distal tibia fracture with open reduction and internal fixation are disputed even when hardware-related pain is insignificant. Thus, we determined the clinical effects of routine hardware removal irrespective of the degree of hardware-related pain, especially in the perspective of patients' daily activities. This study was conducted on 80 consecutive cases (78 patients) treated by surgery and hardware removal after bony union. There were 56 ankle and 24 distal tibia fractures. The hardware-related pain, ankle joint stiffness, discomfort on ambulation, and patient satisfaction were evaluated before and at least 6 months after hardware removal. Pain score before hardware removal was 3.4 (range 0 to 6) and decreased to 1.3 (range 0 to 6) after removal. 58 (72.5%) patients experienced improved ankle stiffness and 65 (81.3%) less discomfort while walking on uneven ground and 63 (80.8%) patients were satisfied with hardware removal. These results suggest that routine hardware removal after ankle or distal tibia fracture could ameliorate hardware-related pain and improves daily activities and patient satisfaction even when the hardware-related pain is minimal.
Topics: Adolescent; Adult; Ankle Fractures; Bone Screws; Female; Follow-Up Studies; Humans; Male; Middle Aged; Tibia; Walking
PubMed: 27819005
DOI: 10.1155/2016/5250672 -
Injury Feb 2022Venous thromboembolic events (VTE) are well-known and serious complications following a trauma to the lower extremities. There is an ongoing debate on the benefit of...
BACKGROUND
Venous thromboembolic events (VTE) are well-known and serious complications following a trauma to the lower extremities. There is an ongoing debate on the benefit of low-molecular-weight heparin (LMWH) as prophylaxis following ankle fracture treatment. We examined the association between the incidence of VTE and the use of LMWH-prophylaxis following an ankle fracture, as well as factors affecting the risk of VTE.
METHODS
In this retrospective cohort study, data on ankle fractures and fracture treatment from the Swedish Fracture Register was linked to data from the Swedish National Patient Register and the Swedish Prescribed Drug Register. Patients with VTE and patients who received LMWH prophylaxis were identified. The treating orthopedic departments were sent a questionnaire about their guidelines regarding the use of LMWH prophylaxis.
RESULTS
222 cases of diagnosed VTE were identified among 14,954 ankle fractures. Orthopedic departments with higher-than-average use of LMWH prophylaxis among non-operatively treated ankle fractures had a lower incidence of VTE (OR 0.60, CI 0.39-0.92). Among operatively treated patients, departments with a guideline for the routine use of LMWH prophylaxis also had lower incidence of VTE (OR 0.56, CI 0.37-0.86). A later onset of VTE was seen among patients prescribed LMWH prophylaxis, with a mean of 56 days to onset (CI 44-67), compared to 39 days (CI 33-45) in patients without prescribed prophylaxis. During the first two weeks following injury, there was only one case of VTE in patients with prescribed LMWH, compared to 39 cases of VTE among patients without prescribed prophylaxis.
CONCLUSIONS
Routine use of LMWH in patients with operatively treated ankle fractures was associated with a lower incidence of VTE. A more frequent use of LMWH among patients with non-operatively treated ankle fractures were associated with a lower incidence of VTE. The onset occurred later among patients with LMWH-prophylaxis who still suffered a VTE.
Topics: Ankle Fractures; Anticoagulants; Heparin, Low-Molecular-Weight; Humans; Incidence; Retrospective Studies; Venous Thromboembolism
PubMed: 34865819
DOI: 10.1016/j.injury.2021.11.028 -
Journal of Biological Regulators and... 2020Necrotizing fasciitis is a dreadful complication of the soft tissue. This pathology could be triggered by many factors, such as a fracture. We present a case of case of...
Necrotizing fasciitis is a dreadful complication of the soft tissue. This pathology could be triggered by many factors, such as a fracture. We present a case of case of a necrotizing fasciitis in ankle fracture.
Topics: Ankle Fractures; Fasciitis, Necrotizing; Humans
PubMed: 32856443
DOI: No ID Found -
Journal of Orthopaedic Trauma Dec 2019To compare posterior malleolar fracture morphology in ankle fractures compared with those with tibial shaft fractures.
OBJECTIVE
To compare posterior malleolar fracture morphology in ankle fractures compared with those with tibial shaft fractures.
SETTING
Level 1 trauma center.
DESIGN
Retrospective cohort study.
PATIENTS/PARTICIPANTS
Fifty-four patients with tibial shaft fractures and 61 patients with ankle fractures.
MAIN OUTCOME MEASUREMENTS
Posterior malleolar fractures in ankle fractures versus tibial shaft fractures were classified by type and pathomorphology analyzed.
RESULTS
Posterior malleolar fractures were significantly larger when associated with tibial shaft fractures (32% cross-sectional area) as compared to ankle fractures (15% cross-sectional area) (P < 0.001). The distribution of posterior malleolar fracture type differed between tibial shaft fractures and ankle fractures. In addition, 47% of the type II posterior malleolar fractures in tibial shaft fractures had an additional fracture line oriented in the sagittal plane, a fracture pattern unique to these injuries that were not observed in the ankle fracture cohort.
CONCLUSIONS
Posterior malleolar fracture morphology varied significantly between tibial shaft fractures and rotational ankle fractures. Posterior malleolar fractures in tibial shaft fractures were over twice the size of posterior malleolar fractures that occur with rotational ankle fractures and more likely to involved the medial malleolus. This information emphasizes the importance of recognizing that large posterior malleolar fractures are associated with tibial shaft fractures.
LEVEL OF EVIDENCE
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ankle Fractures; Ankle Injuries; Female; Humans; Male; Middle Aged; Range of Motion, Articular; Retrospective Studies; Sensitivity and Specificity; Tibial Fractures; Tomography, X-Ray Computed; Young Adult
PubMed: 31738279
DOI: 10.1097/BOT.0000000000001601 -
Fa Yi Xue Za Zhi Oct 2018To explore the injury mechanism of ankle fracture inferred by the Lauge-Hansen classification with the application of medical imageology and its application value in...
OBJECTIVES
To explore the injury mechanism of ankle fracture inferred by the Lauge-Hansen classification with the application of medical imageology and its application value in forensic medicine.
METHODS
A total of 32 ankle fracture cases with known injury mechanism were collected from January 2013 to May 2018, which were identified in Yongkang Public Security Bureau, Zhejiang Province. The Lauge-Hansen classification of ankle fracture was performed by three forensic experts based on the data of X-ray and CT image. Fisher's exact test and Kappa consistency analysis were performed by SPSS 20.0 statistical software to compare the results of the Lauge-Hansen classification with the injury mechanism of ankle fracture obtained through the criminal evidence.
RESULTS
In 32 cases, 84.4% (27/32) ankle fractures were classified according to the Lauge-Hansen classification based on medical imaging. The mechanism of ankle fracture identified by the Lauge-Hansen classification was consistent with that obtained through the criminal evidence.
CONCLUSIONS
Based on medical imaging, the Lauge-Hansen classification can be well applied to infer the injury mechanism of ankle fracture in part cases, and provide objective evidence for the crime scene reconstruction of criminal cases.
Topics: Ankle Fractures; Ankle Injuries; Forensic Medicine; Fractures, Bone; Humans; Radiography
PubMed: 30468054
DOI: 10.12116/j.issn.1004-5619.2018.05.015 -
BMC Musculoskeletal Disorders Nov 2023Ankle fracture-dislocations are among the most severe injuries, and the use of an external fixator as a recommended fixation method has some disadvantages. The aim of...
PURPOSE
Ankle fracture-dislocations are among the most severe injuries, and the use of an external fixator as a recommended fixation method has some disadvantages. The aim of this study was to compare the clinical outcomes and complication rates of external and K-wire fixations in the treatment of ankle fracture dislocations.
METHODS
A total of 67 patients with ankle fracture-dislocations requiring temporary external or percutaneous K-wire fixation were included. The exclusion criteria were pilon fractures, open fractures, and those who required acute open reduction internal fixation (ORIF). The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, a 10-point visual analog scale (VAS) score (range 0-10), and complications before and after the definitive surgery were recorded.
RESULTS
A significant difference between the two groups was not observed for age, sex, affected side, fracture type, smoking status, or diabetes. The average AOFAS scores were 83.2 and 83.3, the median VAS scores were 3 and 3, and the complication rates were 32.4% and 6.7% in the external and K-wire fixation groups, respectively (p = 0.010). However, skin necrosis, re-dislocation of the ankle, surgical wound infection, and posttraumatic ankle osteoarthritis frequency were not significantly different between the groups, except for pin-sites infection (p = 0.036).
CONCLUSION
Ankle fracture-dislocations using percutaneous k-wire fixation showed a low rate of complications and favorable clinical outcomes. This method could be a good alternative treatment option for ankle fracture-dislocations.
Topics: Humans; Ankle Fractures; Ankle; Treatment Outcome; Fracture Fixation; External Fixators; Fracture Dislocation; Fracture Fixation, Internal; Retrospective Studies
PubMed: 37951888
DOI: 10.1186/s12891-023-07020-6 -
Archives of Orthopaedic and Trauma... Oct 2023Trimalleolar fractures are difficult to treat and malreduction can lead to functional impairment. Involvement of the posterior malleolus has a poor predictive value....
INTRODUCTION
Trimalleolar fractures are difficult to treat and malreduction can lead to functional impairment. Involvement of the posterior malleolus has a poor predictive value. Current computed-tomography (CT)-based fracture classifications led to an increase in fixation of the posterior malleolus. The aim of this study was to describe the functional outcome after a two-stage stabilisation with direct fixation of the posterior fragment in trimalleolar dislocation fractures.
MATERIALS AND METHODS
In a retrospective study, all patients presenting with a trimalleolar dislocation fracture, an available CT scan, and a two-stage operative stabilisation including the posterior malleolus by a posterior approach were included. All fractures were treated with initial external fixator and delayed definitive stabilisation including fixation of the posterior malleolus. Next to clinical and radiological follow-up, outcome measures (Foot and Ankle Outcome Score (FAOS), Numeric Rating Scale (NRS), Activity of Daily Living (ADL), Hulsmans implant removal score) and complications were analysed.
RESULTS
Between 2008 and 2019, of 320 trimalleolar dislocation fractures, 39 patients were included. Mean follow-up was 49 months (standard deviation (SD) 29.7, range 16-148). Mean age was 60 years (SD 15.3, 17-84) with 69% female patients. The mean FAOS was 93/100 (SD 9.7, 57-100), NRS 2 (interquartile range (IQR) 0-3) and ADL 2 (IQR 1-2). Four patients showed a postoperative infection, three re-operations had to be performed and implants were removed in 24 individuals.
CONCLUSION
A two-stage procedure of trimalleolar dislocation fractures with in-direct reduction and fixation of the posterior tibial fragment through a posterior approach leads to good functional outcome scores with a low rate of complications.
Topics: Humans; Female; Middle Aged; Male; Ankle Fractures; Ankle; Retrospective Studies; Treatment Outcome; Fracture Fixation, Internal; Ankle Joint; Fracture Dislocation; Joint Dislocations; Tomography, X-Ray Computed
PubMed: 37335355
DOI: 10.1007/s00402-023-04949-0 -
Foot and Ankle Surgery : Official... Feb 2022To compare the efficacy, functional outcome, and complication frequency of splinting and external fixation in the initial treatment of ankle fracture-dislocations.
BACKGROUND
To compare the efficacy, functional outcome, and complication frequency of splinting and external fixation in the initial treatment of ankle fracture-dislocations.
METHOD
Ankles with poor soft tissue conditions who underwent temporary stabilization due to using a splint or external fixator due to an ankle fracture-dislocation between 2012 and 2019 were retrospectively evaluated. Ankles were divided into two groups as the splint (n=69) and external fixator (n=48). The time between the injury to definitive surgery, reduction loss, operation time, functional outcome, pain, and soft-tissue complication frequency before and after definitive surgery were compared.
RESULTS
The frequency of reduction loss (25% vs. 4%, p=0.019) and skin necrosis (22% vs. 6%, p=0.028) were significantly higher in the splint group. Posterior malleolar fracture fragment ratio was calculated by dividing the fracture fragment axial length by the total axial length of the articular surface on computed tomography. Posterior malleolar fracture fragment ratio was found to be significantly higher in ankles with reduction loss in both the splint (25% vs 75%, p=0.032) and fixator groups (4% vs 96%, p=0.021). The mean time period between injury and definitive surgery was significantly shorter in the external fixator group (11±5 vs 7±4 days, p=0.033). Before definitive treatment, pin tract infection was observed in two ankles in the fixator group.
CONCLUSION
Splint immobilization of ankle fracture-dislocations may predispose to reduction loss, soft tissue complications, and a longer time period between injury and definitive fixation. The risk of these potential complications can be reduced with the use of an external fixator.
Topics: Ankle; Ankle Fractures; External Fixators; Fracture Fixation; Fracture Fixation, Internal; Humans; Retrospective Studies; Treatment Outcome
PubMed: 33814287
DOI: 10.1016/j.fas.2021.03.018 -
Journal of Orthopaedic Trauma Aug 2017The incidence of ankle fractures is rapidly increasing in geriatric populations. Of the 4 fracture patterns described by the Lauge-Hansen classification system,...
PURPOSE
The incidence of ankle fractures is rapidly increasing in geriatric populations. Of the 4 fracture patterns described by the Lauge-Hansen classification system, supination-external rotation (SER) accounts for most ankle fractures. This video demonstrates surgical repair of a SER type 4 ankle fracture in a geriatric patient.
METHODS
SER type 4 ankle fractures are considered unstable and are generally treated with surgical fixation. After placement of plate and screws, intraoperative stress tests can be used to assess for syndesmotic widening. If necessary, the syndesmosis can be reduced open, with screw fixation placed parallel to the joint. Patients are kept non-weight-bearing for 6 weeks after surgery.
RESULTS
This video, shot on an iPhone 6S, shows the case of a 66-year-old female status after a fall with twisting mechanism resulting in an unstable SER type 4 fracture requiring operative repair. Intraoperative stress test revealed medial clear space widening requiring syndesmotic reduction.
CONCLUSIONS
SER type 4 ankle fractures are a common injury that must be properly managed to return patients to baseline functional status. The surgical technique described in this video provides for good stabilization and allows for early range of motion with advancement to weight-bearing as tolerated at 6 weeks postoperatively.
Topics: Accidental Falls; Aged; Ankle Fractures; Bone Plates; Bone Screws; Female; Follow-Up Studies; Fracture Fixation, Internal; Fracture Healing; Humans; Injury Severity Score; Patient Positioning; Postoperative Care; Range of Motion, Articular; Time Factors; Treatment Outcome; Video Recording; Weight-Bearing
PubMed: 28697074
DOI: 10.1097/BOT.0000000000000893 -
Ankle fracture - Correlation of Lauge-Hansen classification and patient reported fracture mechanism.Forensic Science International Jan 2018The genetic Lauge-Hansen classification is used for reconstruction of the mechanism of ankle injury. In this study, we addressed the question of agreement between the...
INTRODUCTION
The genetic Lauge-Hansen classification is used for reconstruction of the mechanism of ankle injury. In this study, we addressed the question of agreement between the mechanism of the fracture as postulated by the Lauge-Hansen classification and mechanism reported by the patient in rotational ankle fractures.
MATERIAL AND METHODS
Radiographs of 78 patients with acute malleolar fractures were analyzed and compared with fracture mechanisms reported by these patients.
RESULTS
The patient reported mechanisms were in concordance with the mechanism deducted from the X-rays in 49% of cases. Only 17% of patients who recalled a pronation trauma actually had radiographs classified as pronation fractures while 76% of patients who recalled a supination trauma were also radiographically classified as having sustained supination type fractures.
CONCLUSION
The Lauge-Hansen classification should be used with caution for determining the actual mechanism of injury as it was able to predict the patient reported fracture mechanism in less than 50% of cases. A substantial percentage of fractures appearing radiographically as supination type injuries may have been actually produced by a pronation fracture mechanism.
Topics: Adult; Aged; Aged, 80 and over; Ankle Fractures; Female; Humans; Male; Middle Aged; Pronation; Supination; Young Adult
PubMed: 29182957
DOI: 10.1016/j.forsciint.2017.11.023