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The Journal of Foot and Ankle Surgery :... 2015Irreducible ankle fracture-dislocations are rare. Several cases of irreducible ankle fracture-dislocation have been reported in published studies secondary to the...
Irreducible ankle fracture-dislocations are rare. Several cases of irreducible ankle fracture-dislocation have been reported in published studies secondary to the tibialis posterior tendon, deltoid ligament, or extensor digitorum longus tendon blocking the reduction. We report a case of irreducible ankle fracture-dislocation resulting from posteromedial subluxation of the tibialis anterior tendon around a medial malleolar fracture fragment. Ultimately, the ankle required open reduction of the incarcerated tendon to reduce the joint and proceed with internal fixation of the associated fracture. The patient's postoperative course was uncomplicated, and the tibialis anterior tendon was functioning at 10 months postoperatively, after which he did not return for follow-up examinations. To our knowledge, this is the first reported case of the tibialis anterior tendon blocking closed reduction of an ankle fracture-dislocation.
Topics: Adult; Ankle Fractures; Fracture Fixation, Internal; Humans; Joint Dislocations; Male; Tendon Injuries
PubMed: 25618805
DOI: 10.1053/j.jfas.2014.11.012 -
Forensic Science International Oct 2018The genetic Lauge-Hansen classification has been traditionally used for reconstruction of the mechanism of ankle injury. The ability of the Lauge-Hansen classification...
INTRODUCTION
The genetic Lauge-Hansen classification has been traditionally used for reconstruction of the mechanism of ankle injury. The ability of the Lauge-Hansen classification to predict actual mechanism of the injury has been questioned in recent studies, leaving a void in medicolegal reasoning. The aim of this study is to identify morphologic features of malleolar fractures on plain X-rays that may be used to reveal the fracture mechanism.
MATERIAL AND METHODS
Radiographs of 78 patients with acute malleolar fractures were analyzed and compared with fracture mechanisms reported by these patients.
RESULTS
A modified Pankovich classification of medial malleolus fractures and the presence of a posterior malleolus fracture were able to significantly predict the mechanism of fracture reported by the patient (p<0.05). Lateral fracture morphology was not useful for predicting the fracture mechanism except for infrasyndesmotic fractures pointing to a supination mechanism.
CONCLUSION
A supination mechanism of the fracture can be predicted by observing pure ligamentous or chip-avulsion deltoid injury. The presence of an anterior colliculus fracture of the medial malleolus is correlated with a pronation mechanism. A fracture of the posterior malleolus correlates with pronation while an intact posterior malleolus correlateds with supination as a fracture mechanism. Absolute determination of fracture mechanism from the X-ray morphology of the fracture is impossible in the majority of cases.
Topics: Accidental Falls; Adult; Aged; Aged, 80 and over; Ankle Fractures; Athletic Injuries; Bicycling; Female; Forensic Medicine; Humans; Male; Middle Aged; Pronation; Radiography; Supination; Young Adult
PubMed: 30216844
DOI: 10.1016/j.forsciint.2018.08.042 -
Foot & Ankle Specialist Feb 2023Previous literature has demonstrated an association between acute opioid exposure and the risk of long-term opioid use. Here, the investigators assess immediate...
INTRODUCTION
Previous literature has demonstrated an association between acute opioid exposure and the risk of long-term opioid use. Here, the investigators assess immediate postoperative opioid consumption patterns as well as the incidence of prolonged opioid use among opioid-naïve patients following ankle fracture surgery.
METHODS
Included patients underwent outpatient open reduction and internal fixation of an ankle or tibial plafond fracture over a 1-year period. At patients' first postoperative visit, opioid pills were counted and standardized to the equivalent number of 5-mg oxycodone pills. Prolonged use was defined as filling a prescription for a controlled substance more than 90 days after the index procedure, tracked by the New Jersey Prescription Drug Monitoring Program up to 1 year postoperatively.
RESULTS
At the first postoperative visit, 173 patients consumed a median of 24 out of 40 pills prescribed. The initial utilization rate was 60%, and 2736 pills were left unused. In all, 32 (18.7%) patients required a narcotic prescription 90 days after the index procedure. Patients with a self-reported history of depression (P = .11) or diabetes (P = .07) demonstrated marginal correlation with prolonged narcotic use.
CONCLUSION
Our study demonstrated that, on average, patients utilize significantly fewer opioid pills than prescribed and that many patient demographics are not significant predictors of continued long-term use following outpatient ankle fracture surgery. Large variations in consumption rates make it difficult for physicians to accurately prescribe and predict prolonged narcotic use.
LEVEL OF EVIDENCE
Level III.
Topics: Humans; Analgesics, Opioid; Ankle Fractures; Pain, Postoperative; Opioid-Related Disorders; Narcotics; Practice Patterns, Physicians'
PubMed: 33576251
DOI: 10.1177/1938640021992922 -
The American Journal of Case Reports Mar 2018BACKGROUND Fractures of the talus are uncommon injuries that usually involve the talar neck, rather than the talar body. This report is of a rare case of combined left...
BACKGROUND Fractures of the talus are uncommon injuries that usually involve the talar neck, rather than the talar body. This report is of a rare case of combined left talar neck fracture and adjacent joint dislocation with an ipsilateral bimalleolar ankle fracture. CASE REPORT A 37-year-old man presented with an injury to his left foot following a motor vehicle accident. When he presented to the hospital emergency department, his left foot and ankle were swollen, the overlying skin was intact but badly contused, and there was no neurovascular deficit. Radiographs of the left ankle showed a fracture of the talar neck and bimalleolar fracture. An initial closed reduction under anesthesia failed. Therefore, open reduction and rigid stabilization of all fractures were achieved surgically, followed by the application of an external fixator spanning the ankle and the subtalar joints. The external fixator was removed at six weeks, range of motion (ROM) exercises were commenced, and a non-weight-bearing mobilization protocol was continued for 12 weeks. At four-year follow-up, radiographs confirmed solid union of all fractures, and although avascular necrosis (AVN) of the talus and secondary ankle arthritis developed, the functional outcome was satisfactory. CONCLUSIONS The immediate management of talar neck fracture with dislocation combined with a bimalleolar fracture is important to prevent soft tissue complications and to improve the functional ROM of the ankle. However, AVN and post-traumatic osteoarthritis at both the ankle and the subtalar joints are still common sequelae of talus fracture.
Topics: Adult; Ankle Fractures; External Fixators; Fracture Dislocation; Fracture Fixation; Humans; Male; Radiography; Talus
PubMed: 29555896
DOI: 10.12659/ajcr.907157 -
Injury Feb 2022
Unstable weber B Ankle fracture with a deltoid ligament rupture - ORIF of the fibula with no repair of the deltoid ligament versus ORIF of the fibula but operative repair of the deltoid ligament.
Topics: Ankle Fractures; Ankle Injuries; Ankle Joint; Fibula; Fracture Fixation, Internal; Humans; Ligaments; Ligaments, Articular; Rupture
PubMed: 34991864
DOI: 10.1016/j.injury.2021.12.037 -
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 -
European Journal of Orthopaedic Surgery... Feb 2024Patients with surgically treated ankle fractures are traditionally kept non-weightbearing for at least six weeks post-operatively; however, recent literature suggests...
PURPOSE
Patients with surgically treated ankle fractures are traditionally kept non-weightbearing for at least six weeks post-operatively; however, recent literature suggests numerous benefits of early weightbearing (EWB) before six weeks without significantly impacting long-term outcomes. This study aims to review the safety of early vs late weightbearing following ankle fracture fixation by assessing the complication rate.
METHODS
This was a single-centre retrospective study. Between 2020 and 2023, all ankle fixations that commenced weightbearing at two weeks were added to the EWB group. An equal number of similar patients with six-week non-weightbearing were added to the late weightbearing (LWB) group. Baseline characteristics, risk factors, types of fractures and any complications in the six-month post-operative period were evaluated from these cohorts.
RESULTS
In total, 459 ankle fixations were identified of which 87 patients met the criteria for the EWB group, with a further 87 added to the LWB group. There was no significant difference in age between the two groups (51.7 ± 20.1 vs 51.0 ± 15.5, respectively; p = 0.81), but more female patients and diabetics in the EWB group. Fracture types were similar between both cohorts (p = 0.51). Complication rate in the EWB group was not significantly different to the LWB group (5 vs 9, p > 0.05).
CONCLUSION
No increase in complication rate was identified by commencing weightbearing early at two weeks after ankle fixation compared to six weeks. We therefore suggest EWB if appropriate, given its associated benefits including restoration of patient independence and improved quality of life.
LEVEL OF EVIDENCE
Therapeutic, Level IV.
Topics: Humans; Female; Ankle Fractures; Ankle; Retrospective Studies; Quality of Life; Fracture Fixation, Internal; Weight-Bearing; Treatment Outcome
PubMed: 37843568
DOI: 10.1007/s00590-023-03758-w -
Journal of the American Podiatric... 2022To evaluate complications and risk factors for nonunion in patients with diabetes after ankle fracture.
BACKGROUND
To evaluate complications and risk factors for nonunion in patients with diabetes after ankle fracture.
METHODS
We conducted a retrospective study of 139 patients with diabetes and ankle fractures followed for 1 year. We evaluated the incidence of wounds, infections, nonunions, Charcot's arthropathy, and amputations. We determined Fracture severity (unimalleolar, bimalleolar, trimalleolar), nonunion, and Charcot's arthropathy from radiographs. Nonunion was defined as a fracture that did not heal within 6 months of fracture. Analysis of variance was used to compare continuous variables, and χ2 tests to compare dichotomous variables, with α = 0.05. Logistic regression was performed with a binary variable representing nonunions as the dependent variable.
RESULTS
Complications were common: nonunion (24.5%), Charcot's arthropathy (7.9%), wounds (5.2%), wound site infection (17.3%), and leg amputation (2.2%). Patients with nonunions were more likely to be male (55.9% versus 29.5%; P = .005), have sensory neuropathy (76.5% versus 32.4%; P < .001), have end-stage renal disease (17.6% versus 2.9%; P < .001), and use insulin (73.5% versus 40.1%; P < .001), β-blockers (58.8% versus 39.0%; P = .049), and corticosteroids (26.5% versus 9.5%; P = .02). Among patients with nonunion, there was an increased risk of wounds (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.46-7.73), infection (OR, 2.04; 95% CI, 0.72-5.61), amputation (OR, 7.74; 95% CI, 1.01-100.23), and long-term bracing (OR, 9.51; 95% CI, 3.8-23.8). In the logistic regression analysis, four factors were associated with fracture nonunion: dialysis (OR, 7.7; 95% CI, 1.7-35.2), insulin use (OR, 3.3; 95% CI, 1.5-7.4), corticosteroid use (OR, 4.9; 95% CI, 1.4-18.0), and ankle fracture severity (bimalleolar or trimalleolar fracture) (OR, 2.5; 95% CI, 1.1-5.4).
CONCLUSIONS
These results demonstrate risk factors for nonunions: dialysis, insulin use, and fracture severity after ankle fracture in patients with diabetes.
Topics: Ankle Fractures; Arthropathy, Neurogenic; Diabetes Mellitus; Female; Fracture Fixation, Internal; Humans; Incidence; Insulins; Male; Retrospective Studies; Risk Factors; Treatment Outcome
PubMed: 36251594
DOI: 10.7547/20-246 -
The Journal of Foot and Ankle Surgery :... 2023The goal of this study is to evaluate the effect of time-to-surgery following closed ankle fractures on long-term patient reported outcomes, fracture healing, and wound...
The goal of this study is to evaluate the effect of time-to-surgery following closed ankle fractures on long-term patient reported outcomes, fracture healing, and wound complications. To date, little research has been done focusing on the impact "time to definitive fixation" has on patient reported outcomes. We performed a retrospective analysis of 215 patient records who underwent open reduction and internal fixation (ORIF) for an ankle fracture from July 2011 to July 2018. A total of 86 patients completed the patient reported outcome measurement information systems (PROMIS) survey at long-term follow-up. Primary outcomes were the rate of delayed union, postoperative wound complications, patient reported outcome measurement information system (PROMIS) pain interference (PI), and physical function (PF) scores. No differences were found when comparing time to surgery on a continuous scale with rates of delayed union, nonunion, or wound complications (p = .84, .47, and .63, respectively). PROMIS scores were collected at a median of 4.5 years (2.0 interquartile range (IQR), range 2.5-12.3) postoperatively. The time from ankle fracture to surgery was independently associated with worse PROMIS PI scores (unstandardized β 0.38, 95% CI 0.07-0.68) but not PROMIS PF scores. Severe Lauge-Hansen injuries were independently associated with decreased PROMIS PF scores (unstandardized β -7.02, 95% CI -12.0 to -2.04). Increased time to surgical intervention and severe Lauge-Hansen injuries were independently associated with worse long-term patient reported outcomes. Surgical timing did not impact union rates or wound complications. Surgeons should be aware that delaying ankle fracture repair beyond 12 days after injury may negatively affect long-term patient reported pain scores.
Topics: Humans; Ankle; Ankle Fractures; Fracture Fixation, Internal; Pain; Patient Reported Outcome Measures; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 37003858
DOI: 10.1053/j.jfas.2023.02.011 -
The Orthopedic Clinics of North America Jan 2017Posterior malleolus fractures vary in morphology. A computed tomography scan is imperative to evaluate fragment size, comminution, articular impaction, and syndesmotic... (Review)
Review
Posterior malleolus fractures vary in morphology. A computed tomography scan is imperative to evaluate fragment size, comminution, articular impaction, and syndesmotic disruption. Despite an increasing body of literature regarding posterior malleolus fractures, many questions remain unanswered. Although, historically, fragment size guided surgical fixation, it is becoming evident that fragment size should not solely dictate treatment. Surgical treatment should focus on restoring ankle joint structural integrity, which includes restoring articular congruity, correcting posterior talar translation, addressing articular impaction, removing osteochondral debris, and establishing syndesmotic stability.
Topics: Ankle Fractures; Ankle Joint; Fracture Fixation, Internal; Humans; Tomography, X-Ray Computed
PubMed: 27886685
DOI: 10.1016/j.ocl.2016.08.004