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European Review For Medical and... Apr 2024The long-term outcome of talus fractures is not yet sufficiently favorable despite improved resources and growing experience. With increasing fracture severity, the...
OBJECTIVE
The long-term outcome of talus fractures is not yet sufficiently favorable despite improved resources and growing experience. With increasing fracture severity, the complication rate increases. This study aimed to evaluate the mid-to-long-term clinical and radiologic outcomes using the scoring system and imaging archive in patients with talus fractures who were surgically treated in our hospital.
PATIENTS AND METHODS
The mid- to long-term outcomes of patients with talus fractures admitted to Aydın Adnan Menderes University Faculty of Medicine Hospital between January 2010 and December 2020 and treated surgically were analyzed using satisfaction and functional scoring systems.
RESULTS
Demographic data of the patients enrolled in our study indicated that talus fractures primarily developed in young males (p<0.05). The scores obtained from American Orthopaedic Foot & Ankle Society (AOFAS) scoring were consistent with patients' long-term consequences, such as avascular necrosis and post-traumatic arthritis (p<0.05). The rates of avascular necrosis and post-traumatic arthritis were lower, whereas AOFAS scores were higher in patients in whom the reduction quality was within the exact anatomical limits (p<0.05). The Hawkins sign had a positive predictive significance in patients free of avascular necrosis (p<0.05). Higher AOFAS scores were observed in patients treated with a single surgical incision (p<0.05). The timing of the surgery did not influence the results (p>0.05).
CONCLUSIONS
The outcomes of patients treated surgically for talus fracture depended on the quality of reduction. In the mid-to-long term, the satisfaction scores of our patients with talus fractures who had undergone surgical treatment were rated as moderate.
Topics: Humans; Talus; Male; Adult; Fractures, Bone; Female; Middle Aged; Young Adult; Treatment Outcome; Retrospective Studies
PubMed: 38708476
DOI: 10.26355/eurrev_202404_36033 -
Cureus Apr 2024Background Ankle fractures are very common injuries seen in an emergency setting. Initial management involves the application of below-knee plaster casts. At our local...
Background Ankle fractures are very common injuries seen in an emergency setting. Initial management involves the application of below-knee plaster casts. At our local trauma meetings, we have observed that below-knee casts are often applied incorrectly which can result in suboptimal outcomes for patients and increase the burden on plaster room services if re-application is required. This quality improvement project aimed to assess the quality of below-knee cast applications for ankle fractures in two local district general hospitals (DGHs). Methodology We performed a closed-loop audit utilising a retrospective analysis of patients who underwent casting for unstable ankle fractures. Two audit cycles were completed over a 90-day period across two DGHs. Working within our local orthopaedic unit, we created a targeted, multi-disciplinary educational programme led by experienced plaster technicians. Between audit cycles, we organised a single interactive session with specialist nurses in the urgent treatment centre (UTC) of our DGH while a second DGH did the same with junior doctors working in the emergency department. Both sessions demonstrated correct casting techniques and discussed the importance of a neutral ankle position for optimal patient recovery. Our audit criteria were based on AO Foundation guidance, which states that the ankle should be immobilised in a neutral plantigrade position. All patients with an unstable ankle fracture requiring immobilisation in a below-knee cast were included in the audit. We measured the angle of plantarflexion from neutral, with 90° representing a neutral angle. The angle between the axis of the tibia and the sole of the foot was measured and judged to be within an acceptable range if it was between 80° and 100°, representing a stable ankle position. The audit findings were presented in our local audit meeting. Results In our first audit cycle, we collected data from 65 patients across both sites (N = 32 for DGH 1 and N = 33 for DGH 2). The mean angle was 108.5° and 18 of the 65 (27.7%) patients had angles of ankle plantarflexion that were in the acceptable range (80°-100°). Following the intervention, we again collected data from 61 patients across both sites (N = 28 for DGH 1 and N = 33 for DGH 2). The mean angle was 106.2° and 23 of the 61 (37.7%) patients had an acceptable angle of ankle plantarflexion (80°-100°). Both of our outcome measures showed an improvement but were not statistically significant. The hospital that provided an educational session for the doctors showed an improvement in acceptable ankle casts of 3% while the hospital which provided an educational session for the UTC team improved by 22%. Conclusions We demonstrated a quantifiable approach to assess and improve the quality of below-knee cast application for ankle fractures via a single intervention that would be easily reproducible in other hospitals. We suggest further studies to investigate below-knee cast application quality and its association with patient outcomes as our data and other preliminary sources suggest that current standards are unsatisfactory.
PubMed: 38699119
DOI: 10.7759/cureus.57479 -
Annals of Joint 2024Arthroscopic-assisted treatment of ankle fractures has proven useful in the adult population, but little evidence exists for the utilization of arthroscopic-assisted... (Review)
Review
BACKGROUND
Arthroscopic-assisted treatment of ankle fractures has proven useful in the adult population, but little evidence exists for the utilization of arthroscopic-assisted ankle fracture fixation in the pediatric population. The purpose of this systematic review is to examine the management of pediatric ankle fractures using arthroscopy.
METHODS
A systematic review was performed using PubMed, Web of Science, CINAHL, and MEDLINE from database inception to February 22, 2023. Inclusion criteria for this systematic review was pediatric population less than age 18, arthroscopic surgery management, and ankle fracture.
RESULTS
A total of 19 articles (n=30 patients) out of 176 articles met final inclusion criteria with all articles consisting of case reports or case series. The average patient age was 13.8±1.6 years. Sixteen of the patients (53%) had arthroscopic surgery along with an adjunct surgery as indicated, whereas 14 patients (47%) had arthroscopic surgery with or without percutaneous fixation. A high majority of patients demonstrated full range-of-motion and large improvements in function.
CONCLUSIONS
Arthroscopy is used with percutaneous fixation or in adjunct to open approaches for pediatric ankle fracture management with good results. More research is needed to determine the utility of arthroscopy in the management of pediatric ankle fractures.
PubMed: 38690074
DOI: 10.21037/aoj-23-51 -
Journal of Neuroengineering and... Apr 2024Foot and ankle unloading is essential in various clinical contexts, including ulcers, tendon ruptures, and fractures. Choosing the right assistive device is crucial for... (Comparative Study)
Comparative Study
BACKGROUND
Foot and ankle unloading is essential in various clinical contexts, including ulcers, tendon ruptures, and fractures. Choosing the right assistive device is crucial for functionality and recovery. Yet, research on the impact of devices beyond crutches, particularly ankle-foot orthoses (AFOs) designed to unload the ankle and foot, is limited. This study investigates the effects of three types of devices-forearm crutches, knee crutch, and AFO-on biomechanical, metabolic, and subjective parameters during walking with unilateral ankle-foot unloading.
METHODS
Twenty healthy participants walked at a self-selected speed in four conditions: unassisted able-bodied gait, and using three unloading devices, namely forearm crutches, iWalk knee crutch, and ZeroG AFO. Comprehensive measurements, including motion capture, force plates, and metabolic system, were used to assess various spatiotemporal, kinematic, kinetic, and metabolic parameters. Additionally, participants provided subjective feedback through questionnaires. The conditions were compared using a within-subject crossover study design with repeated measures ANOVA.
RESULTS
Significant differences were found between the three devices and able-bodied gait. Among the devices, ZeroG exhibited significantly faster walking speed and lower metabolic cost. For the weight-bearing leg, ZeroG exhibited the shortest stance phase, lowest braking forces, and hip and knee angles most similar to normal gait. However, ankle plantarflexion after push-off using ZeroG was most different from normal gait. IWalk and crutches caused significantly larger center-of-mass mediolateral and vertical fluctuations, respectively. Participants rated the ZeroG as the most stable, but more participants complained it caused excessive pressure and pain. Crutches were rated with the highest perceived exertion and lowest comfort, whereas no significant differences between ZeroG and iWalk were found for these parameters.
CONCLUSIONS
Significant differences among the devices were identified across all measurements, aligning with previous studies for crutches and iWalk. ZeroG demonstrated favorable performance in most aspects, highlighting the potential of AFOs in enhancing gait rehabilitation when unloading is necessary. However, poor comfort and atypical sound-side ankle kinematics were evident with ZeroG. These findings can assist clinicians in making educated decisions about prescribing ankle-foot unloading devices and guide the design of improved devices that overcome the limitations of existing solutions.
Topics: Humans; Biomechanical Phenomena; Male; Walking; Female; Adult; Ankle; Foot; Foot Orthoses; Self-Help Devices; Young Adult; Crutches; Cross-Over Studies; Gait
PubMed: 38689255
DOI: 10.1186/s12984-024-01333-w -
Journal of the American Academy of... May 2024Pediatric ankle fractures are prevalent injuries that make up a notable portion of all periphyseal injuries. The Salter-Harris classification is the most popular...
Pediatric ankle fractures are prevalent injuries that make up a notable portion of all periphyseal injuries. The Salter-Harris classification is the most popular classification about physeal and periepiphyseal injuries. Ogden expanded on this and described type 7 fractures which are completely intraepiphyseal and include propagation of the fracture from the articular surface through the epiphyseal cartilage and do not involve the physis. These injuries are common about the distal fibula in pediatric patients with supination-inversion type injuries. There are no specific guidelines or recommendations on treatment of these injuries in the literature. We present three cases of this injury pattern and describe our chosen management that leads each patient to full, painless ankle range of motion and return to all prior activities and sports without complication. Supination-inversion type pediatric ankle fractures are common injuries that all orthopaedic surgeons will encounter at some point throughout their practice or training. Recognizing fracture variants and understanding treatment options of pediatric ankle fractures are important for the orthopaedic community as a whole.
Topics: Humans; Fibula; Child; Male; Female; Supination; Ankle Fractures; Ankle Injuries; Adolescent; Fracture Fixation, Internal; Range of Motion, Articular; Tibial Fractures; Epiphyses; Fibula Fractures
PubMed: 38682954
DOI: 10.5435/JAAOSGlobal-D-23-00284 -
Cureus Mar 2024Background Vitamin D has been found to be crucial in musculoskeletal health. The role of vitamin D levels in orthopedic patients has become a growing area of interest...
Background Vitamin D has been found to be crucial in musculoskeletal health. The role of vitamin D levels in orthopedic patients has become a growing area of interest given its negative impact on fracture healing which can contribute to the development of nonunion following surgery. We sought to investigate the incidence of hypovitaminosis D in a cohort of patients who experienced a nonunion following a foot and ankle arthrodesis procedure. Methodology Patients who underwent a major elective foot and ankle arthrodesis procedure and developed a nonunion were given the opportunity to obtain serum vitamin D levels. All vitamin D levels were reported from percutaneous venous blood samples and compared to our institution's range of accepted normal values (25-80 ng/mL). Results A total of 13 patients who developed a nonunion agreed to have a vitamin D level obtained, and 11 of 13 patients had a low vitamin D level (average = 14.6 ng/mL, range = 9-24 ng/mL). Five patients underwent revision arthrodesis after normalization of vitamin D levels, and four out of five patients went on to successful union. Conclusions Hypovitaminosis D may be a modifiable risk factor for nonunion following a major foot and ankle arthrodesis procedure. Orthopedic surgeons should consider vitamin D screening and supplementation in patients undergoing elective arthrodesis procedures.
PubMed: 38681386
DOI: 10.7759/cureus.57028 -
Cureus Mar 2024Although calcaneal fracture is not a rare injury and nonunion is rare, proper management of a calcaneal fracture is mandatory because it can be a prerequisite for...
Although calcaneal fracture is not a rare injury and nonunion is rare, proper management of a calcaneal fracture is mandatory because it can be a prerequisite for long-term functional disabilities of the foot, including posttraumatic osteoarthritis of the hindfoot joint, chronic pain, and persistent swelling syndromes. Restoration of axial alignment and joint congruence with careful caution toward soft tissues is the basic principle of treatment; however, few literature reviews to date have addressed the characteristics of a calcaneal nonunion fracture. We discuss a case of a 30-year-old male, manual worker, and diabetic type 1 with a calcaneal fracture reaching the articular surface of the subtalar joint who underwent a simple fracture to a painful nonunion fracture after conservative treatment for seven months before presenting to our hospital being unable to walk with heel deformity. The Ilizarov frame was used to correct deformities in the hindfoot, enhance healing by compressing the fracture site, and allow early weight bearing with the maintenance of subtalar joint function. Our result demonstrates increased calcaneal healing when the Ilizarov foot frame is used, and when the calcaneal fracture site is compressed, this is a good option for maintaining foot and ankle function, even in diabetic patients.
PubMed: 38681283
DOI: 10.7759/cureus.57011 -
Bioengineering (Basel, Switzerland) Mar 2024Artificial intelligence (AI), particularly deep learning, has made enormous strides in medical imaging analysis. In the field of musculoskeletal radiology, deep-learning... (Review)
Review
Artificial intelligence (AI), particularly deep learning, has made enormous strides in medical imaging analysis. In the field of musculoskeletal radiology, deep-learning models are actively being developed for the identification and evaluation of bone fractures. These methods provide numerous benefits to radiologists such as increased diagnostic accuracy and efficiency while also achieving standalone performances comparable or superior to clinician readers. Various algorithms are already commercially available for integration into clinical workflows, with the potential to improve healthcare delivery and shape the future practice of radiology. In this systematic review, we explore the performance of current AI methods in the identification and evaluation of fractures, particularly those in the ankle, wrist, hip, and ribs. We also discuss current commercially available products for fracture detection and provide an overview of the current limitations of this technology and future directions of the field.
PubMed: 38671760
DOI: 10.3390/bioengineering11040338 -
Children (Basel, Switzerland) Apr 2024Osteochondritis dissecans (OCD) is a joint disorder predominantly affecting the knee, elbow, and ankle of children and adolescents. This comprehensive review delves into... (Review)
Review
BACKGROUND
Osteochondritis dissecans (OCD) is a joint disorder predominantly affecting the knee, elbow, and ankle of children and adolescents. This comprehensive review delves into the epidemiology, etiology, clinical manifestations, diagnostic approaches, and treatment of OCD.
RESULTS
The most common cause of OCD is repetitive microtrauma, typically associated with sports activities, alongside other significant factors such as genetic predisposition, ischemia, and obesity. In early stages or when lesions are small, OCD often presents as non-specific, vaguely localized pain during physical activity. As the condition progresses, patients may experience an escalation in symptoms, including increased stiffness and occasional swelling, either during or following activity. These symptom patterns are crucial for early recognition and timely intervention. Diagnosis in most cases is based on radiographic imaging and magnetic resonance imaging. Nonsurgical treatment of OCD in young patients with open growth plates and mild symptoms involves activity restriction, immobilization methods, and muscle strengthening exercises, with a return to sports only after symptoms are fully resolved and at least six months have passed. Surgical treatment of OCD includes subchondral drilling in mild cases. Unstable lesions involve methods like restoring the joint surface, stabilizing fractures, and enhancing blood flow, using techniques such as screws, anchors, and pins, along with the removal of fibrous tissue and creation of vascular channels. The specifics of OCD treatment largely depend on the affected site.
CONCLUSIONS
This synthesis of current research and clinical practices provides a nuanced understanding of OCD, guiding future research directions and enhancing therapeutic strategies.
PubMed: 38671714
DOI: 10.3390/children11040498 -
BMC Musculoskeletal Disorders Apr 2024This study analysed changes in gait and pedobarography and subjective and functional outcomes after isolated Chopart joint injury.
BACKGROUND
This study analysed changes in gait and pedobarography and subjective and functional outcomes after isolated Chopart joint injury.
METHODS
The results of 14 patients were reviewed. Kinematic 3D gait analysis, comparative bilateral electromyography (EMG) and pedobarography were performed.
RESULTS
On the injured side, the 3D gait analysis showed a significantly increased internal rotation and decreased external rotation of the hip and significantly decreased adduction and decreased range of motion (ROM) for the ankle. On the healthy side, the pedobarography revealed a significantly increased mean force in the forefoot, an increased peak maximum force and an increased maximum pressure in the metatarsal. When standing, significantly more weight was placed on the healthy side. The EMG measurements showed no significant differences between the healthy and injured legs.
CONCLUSIONS
After isolated Chopart injuries, significant changes in gait and pedobarography can be seen over the long term.
Topics: Humans; Male; Adult; Biomechanical Phenomena; Female; Gait; Middle Aged; Young Adult; Electromyography; Range of Motion, Articular; Ankle Injuries; Gait Analysis; Ankle Joint
PubMed: 38671405
DOI: 10.1186/s12891-024-07467-1