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Cureus Jan 2021The Tillaux fracture is an uncommon injury to the anterolateral distal tibial epiphysis. It occurs during a distinct time period when adolescent patients are... (Review)
Review
The Tillaux fracture is an uncommon injury to the anterolateral distal tibial epiphysis. It occurs during a distinct time period when adolescent patients are transitioning to skeletal maturity. Owing to its rarity, the optimal management strategy for this fracture is not well-described. The aim of this review was to assess the outcomes of operatively and nonoperatively managed displaced adolescent Tillaux fractures. We analysed articles from The Cochrane Library, PubMed, MEDLINE, and EMBASE databases that met our predetermined inclusion and exclusion criteria according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statements. A descriptive data analysis was performed. A total of 461 articles were identified from the data search, of which 13 articles were included for full-text analysis. Five of these studies reported recognised patient outcome measures and the remaining eight reported on radiographic follow-up. The reported studies included a total of 114 patients with Tillaux fractures; 58.8% of patients were female and 34.2% were male. Mean ages ranged from 12.5 to 15 years, with the youngest patient being 12 years old and the oldest 17 years old. Overall mean follow-up was 42.8 months. Of the patients, 40.4% were treated with open reduction internal fixation (ORIF), 14.9% with closed reduction internal fixation (CRIF), and 1.8% arthroscopically. The remainder were treated nonoperatively. Outcome measures were excellent for all patients irrespective of operative management choice. Follow-up radiographic deformity was only evident in Tillaux fractures that were managed nonoperatively; deformity included poor joint congruity, angular deformity, and tibial shortening. These nonoperative patients have a residual fracture displacement of 2 mm. There were no reported instances of premature physeal closure for any patient. This review shows that excellent patient outcomes have been reported for different methods of operative fixation, however, study sizes are small and data is sparse. Further robust comparative studies are required to identify definitive conclusions. The use of established clinical and radiographic outcome measures will help improve the quality of future studies for this relatively rare injury.
PubMed: 33643731
DOI: 10.7759/cureus.12860 -
Frontiers in Surgery 2020This study aims to compare the efficacy of the sinus tarsal approach (STA) with that of the conventional L-shaped lateral approach (CLSLA) in the treatment of calcaneal...
This study aims to compare the efficacy of the sinus tarsal approach (STA) with that of the conventional L-shaped lateral approach (CLSLA) in the treatment of calcaneal fractures by meta-analysis. PubMed, Embase, Web of Science, the Chinese National Knowledge Infrastructure, and China Wanfang database were searched to collect clinical randomized or non-randomized controlled trials of STA and CLSLA in the treatment of calcaneal fractures from January 2010 to May 2020. The data were analyzed by Stata 15.0 software. A total of 12 clinical trials were included, all of which were retrospective studies, including 961 patients. The results showed that when STA was compared with CLSLA, there was no difference in operation time with mean difference (MD) = -5.51 [95% confidence interval (CI): -12.57 to 1.55, > 0.05], less bleeding during operation with MD = -18.49 (95% CI:-23.79 to -13.18), no difference in Böhler angle after an operation with MD = 0.78 (95% CI: -0.09 to 1.65) and in Gissane angle with MD = -0.07 (95% CI: -1.90 to 1.77), no difference in American Orthopedic Foot and Ankle Society score with MD = 2.16 (95% CI: -1.07 to 5.38), higher-excellent and better rate of Maryland food function with relative ratio = 1.12 (95% CI: 1.04 to 1.20), and lower of incidence of postoperative complications with relative ratio = 0.23 (95% CI: 0.14-0.37). STA was more effective than CLSLA in the treatment of calcaneal fractures. Moreover, STA had advantages in less intraoperative bleeding, higher-excellent and better rate of Maryland foot function, lower incidence of postoperative complications, and higher safety.
PubMed: 33585545
DOI: 10.3389/fsurg.2020.602053 -
Sports Medicine - Open Jan 2021Netball is estimated to be played by more than 20 million people worldwide, but there is evidence of high injury incidence. A thorough understanding of the types and...
BACKGROUND
Netball is estimated to be played by more than 20 million people worldwide, but there is evidence of high injury incidence. A thorough understanding of the types and rates of netball injuries is essential for effective injury management and prevention strategies to be developed and implemented. This systematic review summarises the published findings with respect to injury types, participant characteristics and any identified risk factors for netball injuries.
METHODS
A librarian-assisted computer search of seven scientific databases was conducted for studies reporting on netball injuries. Inclusion criteria were studies published in English, in peer-reviewed journals, which reported data on injuries and variables (e.g. age and competition level) that have been proposed as possibly associated with netball injury risk.
RESULTS
Forty-six studies (43.5% prospective, 37% hospital/insurance records, 19.5% retrospective) from 45 articles were included after screening. The majority of studies (74%) were conducted in Australia or New Zealand. There was little consistency in the definition of 'injury'. Elite or sub-elite level players were included in 69% of studies where the level of competition was reported. The duration of injury surveillance was generally related to the format of competition from which data were collected. Self-report questionnaires were used in 48% of studies and only 26% of studies used qualified health professionals to collect data courtside. Injuries to the ankle and knee were the most common (in 19 studies) although the incidence varied considerably across the studies (ankle 13-84% and knee 8-50% of injuries). Prevention of ankle and knee injuries should be a priority. Children sustained more upper limb injuries (e.g. fractures) compared with adults who sustained more lower limb injuries (e.g. ankle and knee sprains/strains). A large number of potential risk factors for injury in netball have been investigated in small numbers of studies. The main circumstances of injury are landings, collisions and falls.
CONCLUSION
Further studies should be directed towards recreational netball, reporting on injury incidence in players by age and utilising high-quality, standardised methods and criteria. Specific injury diagnosis and a better understanding of the circumstances and mechanisms of injury would provide more meaningful data for developing prevention strategies.
PubMed: 33409965
DOI: 10.1186/s40798-020-00290-7 -
Sensors (Basel, Switzerland) Nov 2020This present review includes a systematic search for peer-reviewed articles published between March 2009 and March 2020 that evaluated the effects of wearable devices...
This present review includes a systematic search for peer-reviewed articles published between March 2009 and March 2020 that evaluated the effects of wearable devices with biofeedback on the biomechanics of running. The included articles did not focus on physiological and metabolic metrics. Articles with patients, animals, orthoses, exoskeletons and virtual reality were not included. Following the PRISMA guidelines, 417 articles were first identified, and nineteen were selected following the removal of duplicates and articles which did not meet the inclusion criteria. Most reviewed articles reported a significant reduction in positive peak acceleration, which was found to be related to tibial stress fractures in running. Some previous studies provided biofeedback aiming to increase stride frequencies. They produced some positive effects on running, as they reduced vertical load in knee and ankle joints and vertical displacement of the body and increased knee flexion. Some other parameters, including contact ground time and speed, were fed back by wearable devices for running. Such devices reduced running time and increased swing phase time. This article reviews challenges in this area and suggests future studies can evaluate the long-term effects in running biomechanics produced by wearable devices with biofeedback.
Topics: Biofeedback, Psychology; Biomechanical Phenomena; Female; Gait; Humans; Male; Running; Wearable Electronic Devices
PubMed: 33228137
DOI: 10.3390/s20226637 -
Medical Ultrasonography May 2021Foot and ankle injuries are a common presenting complaint in the emergency department. The diagnosis of foot and ankle fractures is conventionally accomplished through... (Meta-Analysis)
Meta-Analysis
AIMS
Foot and ankle injuries are a common presenting complaint in the emergency department. The diagnosis of foot and ankle fractures is conventionally accomplished through X-rays. Whether ultrasound (US) can be considered as a primary scanning modality is still a controversial issue; therefore, we did a meta-analysis to synthesize the diagnostic performance ofultrasound for foot and ankle fractures.
MATERIAL AND METHODS
A comprehensive search was carried out to identify studies in which patients with clinically suspected foot and ankle fractures were assessed by US. Two investigators independently screened the literature and extracted the data. Any discrepancies were resolved via discussion. Study quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies 2 tool, and pooled sensitivity and specificity of various US findings were determined.
RESULTS
Ten studies with a total of 1065 patients were included. There was significant heterogeneity across the included studies. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio for the diagnosis of foot and ankle fractures by US were 0.96 (95% confidence interval [CI], 0.90-0.99), 0.94 (95% CI, 0.88-0.97), 15.0 (95% CI, 7.9-28.6), 0.04 (95% CI, 0.02-0.11), and 367 (95% CI, 101-1338), respectively. Furthermore, the summary receiver operating characteristic area under the curve was calculated to be 0.99.
CONCLUSIONS
Ultrasound has an excellent diagnostic performance for foot and ankle fractures and should be considered as a primary and radiation-free scanning modality in the diagnosis of foot and ankle fractures.
Topics: Ankle Fractures; Ankle Injuries; Humans; Radiography; Sensitivity and Specificity; Ultrasonography
PubMed: 33220035
DOI: 10.11152/mu-2659 -
Archives of Orthopaedic and Trauma... Jan 2021Despite successful osteosynthesis, some patients report residual symptoms after ankle fractures. One of the reasons behind the postoperative complaints might be... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Despite successful osteosynthesis, some patients report residual symptoms after ankle fractures. One of the reasons behind the postoperative complaints might be traumatic concomitant chondral lesions (CL) and/or osteochondral lesions (OCL) within the ankle joint. The study aims to systematically review the incidence of CL and/or OCL in ankle fractures and to assess their effect on the clinical outcome.
MATERIALS AND METHODS
This work was conducted according to PRISMA checklists. A systematic literature search was performed using following keywords: "Ankle Fractures" OR "Trimalleolar Fracture" OR "Bimalleolar Fracture" OR "Maisonneuve fracture" OR "Malleolus Fracture" AND "Cartilage" OR "Cartilage Diseases" OR "Cartilage, Articular" OR "chondral" up to March 2020. The identified articles were analysed to determine the incidence of CL and/or OCL. Included studies in the meta-analysis assessed possible cartilage damage through arthroscopy or MRI immediately after traumatic ankle fractures and described the postoperative clinical outcome.
RESULTS
The search identified a total of 111 publications; 19 described the incidence of CL and/or OCL after ankle fractures; six met the criteria to be included in the meta-analysis: five (n = 293) diagnosed CL and/or OCL through arthroscopy during ORIF and one study (n = 153) used preoperative MRI. The clinical outcome was evaluated in four studies (n = 177) using AOFAS score and in two (n = 269) using FAOS score. The mean incidence of arthroscopically detected CL and/or OCL was 65 ± 21% [95% CI 53.9 to 76.72]. The cumulative meta-analysis sample size comprised a total of 400 Patients (170 with and 230 without CL and/or OCL) available for a mean follow-up of 23.9 ± 11.5 months [95% CI 11.79 to 36.07]. The average age was 44.3 ± 5.5 years [95% CI 38.57 to 50.13]. The meta-analysis revealed a mean AOFAS score of 91.2 ± 4.8 [95% CI 83.53 to 98.93] with versus 94.4 ± 4.7 [95% CI 86.81 to 102.07] without CL and/or OCL (p = 0.15) and a mean FAOS score of 73.2 ± 11.31 [95% CI - 28.44 to 174.85] with versus 79.0 ± 18.4 [95% CI - 86.77 to 244.87] without CL and/or OCL (p = 0.18).
CONCLUSIONS
CL and/or OCL appear very frequently after ankle fractures. A tendency towards a favourable short- to mid-term clinical outcome was noticed in ankle fractures without CL and/or OCL, however without reaching statistical significance.
LEVEL OF EVIDENCE
Level I.
Topics: Adult; Ankle Fractures; Ankle Joint; Arthralgia; Cartilage Diseases; Humans; Incidence; Middle Aged; Pain, Postoperative; Treatment Outcome
PubMed: 33128607
DOI: 10.1007/s00402-020-03647-5 -
Osteoporosis and Sarcopenia Sep 2020Ankle fractures are common in the elderly. However, their association with osteoporosis remains controversial. This systematic review aims to determine the relationship...
OBJECTIVES
Ankle fractures are common in the elderly. However, their association with osteoporosis remains controversial. This systematic review aims to determine the relationship between ankle fracture and bone mineral density (BMD), and to investigate the risk of subsequent fractures after ankle fracture.
METHODS
MEDLINE and Scopus publications were searched from inception to March and April 2019, respectively. Articles were selected by 2 independent reviewers for cross-sectional, cohort, or case-control studies comparing BMD or subsequent fracture risk in low-energy ankle fractures patients with that of the normal population. Data extraction was performed by 2 investigators. Discrepancies were resolved with the third reviewer. Quality assessment was conducted using the modified Newcastle-Ottawa Scale.
RESULTS
Overall, 19 articles were included. The quality assessment showed a generally low-to-moderate risk of bias among studies, mainly due to potential confounders and inadequate follow-up. Of 13 studies exploring BMD in ankle fractured-patients, lower central and peripheral BMD was found in 3 and 2 studies, respectively. The risk of subsequent fracture was examined in 11 studies with relative risks ranging from 0.7 to 4.59. An increased risk of any subsequent fractures in women, both genders, and men was found in 5, 2, and 1 articles, respectively.
CONCLUSIONS
Despite the lack of clear association with BMD, the contribution of ankle fracture to increased subsequent fracture risk and its associated microarchitectural changes cannot be overlooked. Moreover, its potential role as an early predictor of future fracture may promote secondary prevention. Further studies with longer follow-up and stricter confounder control are recommended.
PubMed: 33102810
DOI: 10.1016/j.afos.2020.08.003 -
Journal of Orthopaedic Surgery (Hong... 2020There has been a global trend towards individually packaged screws for orthopaedic operations. Traditional practice makes use of screw caddies that require...
INTRODUCTION
There has been a global trend towards individually packaged screws for orthopaedic operations. Traditional practice makes use of screw caddies that require re-sterilization. Individually wrapped screws (IWS) are purported to decrease infection rates and avoid the deleterious effects of repeated screw sterilizations, despite marginal evidence. This review aimed to evaluate the safety, effectiveness and economics of screw caddies with IWS.
MATERIAL AND METHODS
The literature was surveyed in a systematic fashion between 1998 and 2017 and all relevant health technology assessments, systematic reviews, meta-analyses, randomized controlled trials, cohort studies, case-controlled studies and case series were sought. Any benefits or otherwise of IWS over screw caddies were then evaluated in the areas of safety, effectiveness and economics.
RESULTS
Two level III-3 papers suggested the use of caddies at least as safe as individual screws. Four level III-2 papers demonstrated that screws from caddies were as effective as individual alternatives, while a level III-3 paper reported that individual screws were significantly more expensive than screw caddies. Cost increases to our regional health service from ankle open reduction and internal fixations alone of at least $50,112 (AUD) per annum were calculated.
CONCLUSIONS
From the results obtained, the authors recommend the continued use of screw caddies for orthopaedic procedures.
Topics: Ankle Joint; Bone Screws; Equipment Design; Fracture Fixation, Internal; Humans; Risk Factors; Surgical Wound Infection
PubMed: 32830601
DOI: 10.1177/2309499020944086 -
Foot and Ankle Surgery : Official... Apr 2021The aim of this study is to systematically review the literature on clinical outcomes of patients who have undergone autologous matrix-induced chondrogenesis (AMIC) for... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The aim of this study is to systematically review the literature on clinical outcomes of patients who have undergone autologous matrix-induced chondrogenesis (AMIC) for treatment of osteochondral lesions of the talus (OCL) and compare the studies' outcomes.
METHODS
Pubmed and Embase were searched in January 2020 for articles concerning OCL surgery. Studies were included if they had a minimum 1-year follow-up and the primary measures were functional outcomes. The meta-analysis compared the Visual Analogic Score (VAS), the American Orthopedic Foot and Ankle Score (AOFAS), and the Foot Function Index (FFI) between baseline and follow-up of 1-2years, and 3-5years. A random effects model was used to evaluate outcome changes.
RESULTS
The search returned 15 studies, with a total of 492 patients. The VAS improved 4.45 and 4.6 points from baseline to the 1-2year and 3-5yearfollow-up, respectively (p<0.001). AOFAS improved 31.59 and 32.47 points from baseline to the 1-2year and 3-5yearfollow-up, respectively (p<0.001). The FFI showed a significant improvement of 30.93 points from baseline to year 3-5 (p<0.001). A total of 6 patients with revision surgeries have been reported within the follow up period. It was not possible to correlate clinical features like lesion size, surgical approach, and bone marrow stimulation technique to the reported outcome.
CONCLUSION
Surgical treatment of OCL via the AMIC procedure provided significant improvement in the functional outcome and pain scores when compared to the pre-operative values. Improvements were observed up to 5years post-operatively.
Topics: Adolescent; Adult; Aged; Ankle Injuries; Ankle Joint; Cartilage, Articular; Child; Chondrogenesis; Female; Follow-Up Studies; Humans; Intra-Articular Fractures; Male; Middle Aged; Reoperation; Talus; Transplantation, Autologous; Treatment Outcome; Visual Analog Scale; Young Adult
PubMed: 32811744
DOI: 10.1016/j.fas.2020.07.011 -
Knee Surgery, Sports Traumatology,... May 2021To determine the incidence and location of osteochondral lesions (OCLs) following ankle fractures as well as to determine the association between fracture type and the...
PURPOSE
To determine the incidence and location of osteochondral lesions (OCLs) following ankle fractures as well as to determine the association between fracture type and the presence of OCLs. Up to 50% of patients with ankle fractures that receive surgical treatment show suboptimal functional results with residual complaints at a long-term follow-up. This might be due to the presence of intra-articular osteochondral lesions (OCL).
METHODS
A literature search was carried out in PubMed (MEDLINE), EMBASE, CDSR, DARE and CENTRAL to identify relevant studies. Two authors separately and independently screened the search results and conducted the quality assessment using the MINORS criteria. Available full-text clinical articles on ankle fractures published in English, Dutch and German were eligible for inclusion. Per fracture classification, the OCL incidence and location were extracted from the included articles. Where possible, OCL incidence per fracture classification (Danis-Weber and/or Lauge-Hansen classification) was calculated and pooled. Two-sided p values of less than 0.05 were considered statistically significant.
RESULTS
Twenty articles were included with a total of 1707 ankle fractures in 1707 patients. When focusing on ankle fractures that were assessed directly after the trauma, the OCL incidence was 45% (n = 1404). Furthermore, the most common location of an OCL following an ankle fractures was the talus (43% of all OCLs). A significant difference in OCL incidence was observed among Lauge-Hansen categories (p = 0.049). Post hoc pairwise comparisons between Lauge-Hansen categories (with adjusted significance level of 0.01) revealed no significant difference (n.s.).
CONCLUSION
OCLs are frequently seen in patients with ankle fractures when assessed both directly after and at least 12 months after initial trauma (45-47%, respectively). Moreover, the vast majority of post-traumatic OCLs were located in the talus (42.7% of all OCLs). A higher incidence of OCLs was observed with rotational type fractures. The clinical relevance of the present systematic review is that it provides an overview of the incidence and location of OCLs in ankle fractures, hereby raising awareness to surgeons of these treatable concomitant injuries. As a result, this may improve the clinical outcomes when directly addressed during index surgery.
LEVEL OF EVIDENCE
IV.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ankle; Ankle Fractures; Ankle Injuries; Ankle Joint; Cartilage Diseases; Cartilage, Articular; Female; Humans; Incidence; Male; Middle Aged; Retrospective Studies; Talus; Young Adult
PubMed: 32761358
DOI: 10.1007/s00167-020-06187-y