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EFORT Open Reviews Sep 2022Fragility ankle fractures are traditionally managed conservatively or with open reduction internal fixation. Tibiotalocalcaneal (TTC) nailing is an alternative option... (Review)
Review
INTRODUCTION
Fragility ankle fractures are traditionally managed conservatively or with open reduction internal fixation. Tibiotalocalcaneal (TTC) nailing is an alternative option for the geriatric patient. This meta-analysis provides the most detailed analysis of TTC nailing for fragility ankle fractures.
METHODS
A systematic search was performed on MEDLINE, EMBASE, Cochrane Library, and Web of Science, identifying 14 studies for inclusion. Studies including patients with a fragility ankle fracture, defined according to NICE guidelines as a low-energy fracture obtained following a fall from standing height or less, that were treated with TTC nail were included. Patients with a previous fracture of the ipsilateral limb, fibular nails, and pathological fractures were excluded. This review was registered in PROSPERO (ID: CRD42021258893).
RESULTS
A total of 312 ankle fractures were included. The mean age was 77.3 years old. In this study, 26.9% were male, and 41.9% were diabetics. The pooled proportion of superficial infection was 10% (95% CI: 0.06-0.16), deep infection 8% (95% CI: 0.06-0.11), implant failure 11% (95% CI: 0.07-0.15), malunion 11% (95% CI: 0.06-0.18), and all-cause mortality 27% (95% CI: 0.20-0.34). The pooled mean post-operative Olerud-Molander ankle score was 54.07 (95% CI: 48.98-59.16). Egger's test (P = 0.56) showed no significant publication bias.
CONCLUSION
TTC nailing is an adequate alternative option for fragility ankle fractures. However, current evidence includes mainly case series with inconsistent post-operative rehabilitation protocols. Prospective randomised control trials with long follow-up times and large cohort sizes are needed to guide the use of TTC nailing for ankle fractures.
PubMed: 36125009
DOI: 10.1530/EOR-22-0017 -
Journal of Patient-reported Outcomes Dec 2019Ankle fractures are painful and debilitating injuries that pose a significant burden to society and healthcare systems. Patient reported outcome measures (PROMs) are... (Review)
Review
BACKGROUND
Ankle fractures are painful and debilitating injuries that pose a significant burden to society and healthcare systems. Patient reported outcome measures (PROMs) are commonly used outcome measures in clinical trials of interventions for ankle fracture but there is little evidence on their validity and reliability. This systematic review aims to identify and appraise evidence for the measurement properties of ankle specific PROMs used in adults with an ankle fracture using Consensus Based Standards for the Selection of Health Measurement Instrument (COSMIN) methodology.
METHODS
We searched MEDLINE, Embase and CINAHL online databases for evidence of measurement properties of ankle specific PROMs. Articles were included if they assessed or described the development of the PROM in adults with ankle fracture. Articles were ineligible if they used the PROM to assess the measurement properties of another instrument. Abstracts without full articles and conference proceedings were ineligible, as were articles that adapted the PROM under evaluation without any formal justification of the changes as part of a cross-cultural validation or translation process. Two reviewers completed the screening. To assess methodological quality we used COSMIN risk of bias checklist and summarised evidence using COSMIN quality criteria and a modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Two reviewers assessed the methodological quality and extracted the data for a sample of articles.
RESULTS
The searches returned a total of 377 articles. From these, six articles were included after application of eligibility criteria. These articles evaluated three PROMs: A-FORM, OMAS and AAOS. The A-FORM had evidence of a robust development process within the patient population, however lacks post-formulation testing. The OMAS showed sufficient levels of reliability, internal consistency and construct validity. The AAOS showed low quality evidence of sufficient construct validity.
CONCLUSIONS
There is insufficient evidence to support the recommendation of a particular PROM for use in adult ankle fracture research based on COSMIN methodology. Further validation of these outcome measures is required in order to ensure PROMs used in this area are sufficiently valid and reliable to assess treatment effects. This would enable high quality, evidenced-based management of adults with ankle fracture.
PubMed: 31848877
DOI: 10.1186/s41687-019-0159-5 -
Archives of Orthopaedic and Trauma... Nov 2022This article is a systematic review of the literature on elderly aged 80 and over with an ankle fracture. Low energy trauma fractures are a major public health burden in... (Review)
Review
INTRODUCTION
This article is a systematic review of the literature on elderly aged 80 and over with an ankle fracture. Low energy trauma fractures are a major public health burden in developed countries that have aged populations. Ankle fractures are the third most common fractures after hip and wrist fractures. The purpose of this review is to provide an overview of the treatments and the used outcome factors.
METHODS
PubMed, Embase, Cochrane Library, and CINAHL were searched to retrieve relevant studies. Studies published in English or Dutch concerning the treatment of ankle fractures in patients aged 80 and over were included.
RESULTS
Initially 2054 studies were found in the databases. After removing duplicate entries, 1182 remained. Finally, after screening six studies were included, of which three cohorts studies and three case series. Six different treatments were identified and described; ORIF, transarticular Steinmann pin, plaster cast with or without weight-bearing, Gallagher nail and the TCC nail. Furthermore, 32 outcome factors were identified.
DISCUSSION
The various studies show that practitioners are careful with early weight-bearing. However, if we look closely to the results and other literature, this seems not necessary and it could potentially be of great value to implement early weight-bearing in the treatment. Furthermore, quality of life seems underreported in this research field.
CONCLUSIONS
ORIF with plaster cast and permissive weight-bearing should be considered for this population since it seems to be a safe possibility for a majority of the relatively healthy patients aged 80 and over. In cases where surgery is contra-indicated and a plaster cast is the choice of treatment, early weight-bearing seems to have a positive influence on the outcome in the very old patient.
Topics: Aged; Aged, 80 and over; Ankle Fractures; Ankle Joint; Casts, Surgical; Female; Humans; Male; Quality of Life; Treatment Outcome
PubMed: 34546421
DOI: 10.1007/s00402-021-04161-y -
Journal of Patient-reported Outcomes Apr 2022The Patient-Reported Outcomes Information System (PROMIS®) is more and more extensively being used in medical literature in patients with an orthopedic fracture. Yet,... (Review)
Review
BACKGROUND
The Patient-Reported Outcomes Information System (PROMIS®) is more and more extensively being used in medical literature in patients with an orthopedic fracture. Yet, many articles studied heterogeneous groups with chronic orthopedic disorders in which fracture patients were included as well. At this moment, there is no systematic overview of the exact use of PROMIS measures in the orthopedic fracture population. Therefore this review aimed to provide an overview of the PROMIS health domains physical health, mental health and social health in patients suffering an orthopedic fracture.
METHODS
This systematic review was documented according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. We searched Embase, Medline, Web of Science Core Collection, and Cochrane Central Register of controlled Trials, CINAHL and Google Scholar in December 2020 using a combination of MeSH terms and specific index terms related to orthopedic fractures and PROMIS questionnaires. Inclusion criteria were available full text articles that were describing the use of any PROMIS questionnaires in both the adult and pediatric extremity fracture population.
RESULTS
We included 51 relevant articles of which most were observational studies (n = 47, 92.2%). A single fracture population was included in 47 studies of which 9 involved ankle fractures (9/51; 17.6%), followed by humeral fractures (8/51; 15.7%), tibia fractures (6/51; 11.8%) and radial -or ulnar fractures (5/51; 9.8%). PROMIS Physical Function (n = 32, 32/51 = 62.7%) and PROMIS Pain Interference (n = 21, 21/51 = 41.2%) were most frequently used questionnaires. PROMIS measures concerning social (n = 5/51 = 9.8%) and mental health (10/51 = 19.6%) were much less often used as outcome measures in the fracture population. A gradually increasing use of PROMIS questionnaires in the orthopedic fracture population was seen since 2017.
CONCLUSION
Many different PROMIS measures on multiple domains are available and used in previous articles with orthopedic fracture patients. With physical function and pain interference as most popular PROMIS measures, it is important to emphasize that other health-domains such as mental and social health can also be essential to fracture patients.
PubMed: 35384568
DOI: 10.1186/s41687-022-00440-3 -
International Orthopaedics Dec 2010A systematic review of the literature was performed in order to evaluate the role of reduction and internal fixation in the management of Lisfranc joint... (Review)
Review
A systematic review of the literature was performed in order to evaluate the role of reduction and internal fixation in the management of Lisfranc joint fracture-dislocations. Articles were extracted from the Pubmed database and the retrieved reports were included in the study only if pre-specified eligibility criteria were fulfilled. Eleven articles were eligible for the final analysis, reporting data for the management of 257 patients. Injuries of the first three metatarsal rays were treated by closed reduction and internal fixation with screws in 16.3% of the patients, open reduction and internal fixation with screws in 66.5% and open reduction and internal fixation with Kirschner wires (K-wires) in 17.1% of the patients. The preferred method for the stabilisation of the fourth and fifth metatarsal rays was K-wires. Screw-related complications were common and were reported in 16.1% of the cases. The mean American Orthopaedic Foot and Ankle Society midfoot score was 78.1 points. Post-traumatic radiographic arthritis was reported in 49.6% of the patients, but only in 7.8% of them it was severe enough to warrant an arthrodesis. We conclude that open reduction and internal fixation of the first three metatarsal rays with screws is a reliable method for the management of Lisfranc injuries. This can be complemented by K-wires application in the fourth and fifth metatarsal rays if needed.
Topics: Adolescent; Adult; Aged; Bone Screws; Bone Wires; Fracture Fixation, Internal; Fractures, Bone; Humans; Joint Dislocations; Ligaments, Articular; Metatarsophalangeal Joint; Middle Aged; Recovery of Function; Sickness Impact Profile; Young Adult
PubMed: 20683593
DOI: 10.1007/s00264-010-1101-x -
Therapeutics and Clinical Risk... 2017Patients with type 2 diabetes mellitus (T2DM) have an increased risk of bone fractures. A variable increase in fracture risk has been reported depending on skeletal... (Review)
Review
AIM
Patients with type 2 diabetes mellitus (T2DM) have an increased risk of bone fractures. A variable increase in fracture risk has been reported depending on skeletal site, diabetes duration, study design, insulin use, and so on. The present meta-analysis aimed to investigate the association between T2DM with fracture risk and possible risk factors.
METHODS
Different databases including PubMed, Institute for Scientific Information, and Scopus were searched up to May 2016. All epidemiologic studies on the association between T2DM and fracture risk were included. The relevant data obtained from these papers were analyzed by a random effects model and publication bias was assessed by funnel plot. All analyses were done by R software (version 3.2.1) and STATA (version 11.1).
RESULTS
Thirty eligible studies were selected for the meta-analysis. We found a statistically significant positive association between T2DM and hip, vertebral, or foot fractures and no association between T2DM and wrist, proximal humerus, or ankle fractures. Overall, T2DM was associated with an increased risk of any fracture (summary relative risk =1.05, 95% confidence interval: 1.04, 1.06) and increased with age, duration of diabetes, and insulin therapy.
CONCLUSION
Our findings strongly support an association between T2DM and increased risk of overall fracture. These findings emphasize the need for fracture prevention strategies in patients with diabetes.
PubMed: 28442913
DOI: 10.2147/TCRM.S131945 -
Cureus Jul 2022Ankle fractures are common injuries treated by orthopedists. Indications for operative repair of deltoid ligament (DL) injuries in ankle fracture patients are debated.... (Review)
Review
Ankle fractures are common injuries treated by orthopedists. Indications for operative repair of deltoid ligament (DL) injuries in ankle fracture patients are debated. The purpose of this review is to determine the indications for operative DL repair. Ovid MEDLINE, CINAHL, and Scopus were searched up to December 2019. Web of Science was searched up to August 2018. Search terms included "Deltoid" and "Ligament" or "Ligaments." Comparative studies assessing conservative vs operative DL repair were searched for. Articles meeting inclusion criteria were screened in two stages to determine eligibility. Out of 1,542 articles, nine were included in our qualitative synthesis. These nine studies included 449 patients, of which 233 were treated with open reduction internal fixation (ORIF) with or without trans-syndesmotic (TS) screw fixation, and 205 of which were treated with ORIF with DL repair. The remaining 21 patients were managed nonoperatively, had no evidence of DL injury, or were lost to follow-up. There is a lower rate of malreduction associated with DL repair compared to TS screw fixation. Moreover, DL repair may be useful in treating patients with Weber Type C fractures, concomitant DL-syndesmotic disruption, or residual valgus instability following ORIF in isolated lateral malleolar fractures.
PubMed: 35989770
DOI: 10.7759/cureus.27040 -
International Journal of Surgery Case... Sep 2023In rare cases of ankle fracture dislocation, PTT can be incarcerated in the ankle syndesmosis. We report a case of a patient who had a fracture-dislocation of the ankle...
Ankle fracture-dislocation with the interposition of the tibialis posterior tendon in the ankle syndesmosis and tibiotalar joint - A case report and systematic literature review.
INTRODUCTION AND IMPORTANCE
In rare cases of ankle fracture dislocation, PTT can be incarcerated in the ankle syndesmosis. We report a case of a patient who had a fracture-dislocation of the ankle with the interposition of PTT in the ankle syndesmosis and discuss a systematic review of injury mechanics, pathology, diagnosis, management, and outcomes of this injury.
CASE PRESENTATION
I reported a 43-year-old patient presented with an irreducible lateral displacement of the talus after ORIF of the malleolar ankle fractures and fixation of ankle syndesmosis. Subsequent open reduction and surgical management revealed an interposition of PTT in the syndesmosis 1- month post-operative. A systematic review was completed afterward with the following terms: "ankle fracture" OR "ankle dislocation" AND "tibialis posterior tendon interposition" OR "tibialis posterior tendon entrapment" OR "tibialis posterior tendon incarceration" on Medline, ScienceDirect, and Ovid for articles between 1970 and 2022.
CLINICAL DISCUSSION
5 months postoperative, the patient reported no pain and became capable of walking without a steppage gait. The systematic review showed that the entrapment of PTT could be concurrent with FHL, FDL, and tibial neurovascular. It usually occurs in patients with pronation/eversion injury, Weber C ankle fracture with a valgus deformity and a syndesmosis diastasis.
CONCLUSION
The PTT entrapment usually occurs in patients with pronation/eversion injury, Weber C ankle fracture, a valgus deformity, a syndesmosis diastasis. The entrapment of PTT could be concurrent with FHL, FDL, and tibial neurovascular. The tibiofibular syndesmosis and retromalleolar groove should be explored intraoperatively with suspicion of irreducible ankle fracture-dislocations.
PubMed: 37625231
DOI: 10.1016/j.ijscr.2023.108710 -
International Journal of Surgery... Aug 2018This study aims to quantitatively summarize risk factors associated with surgical site infection after open reduction and internal fixation of ankle fractures. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This study aims to quantitatively summarize risk factors associated with surgical site infection after open reduction and internal fixation of ankle fractures.
METHODS
Relevant original studies were searched in Medline, Embase, China National Knowledge Infrastructure, Wanfang database and Cochrane central database (all through April 2018). Studies eligible had to meet the quality assessment criteria by Newcastle-Ottawa Scale and to evaluate the risk factors for surgical site infection after open reduction and internal fixation of ankle fractures. The Stata 11.0 was used to this meta-analysis.
RESULTS
10 studies involving 8103 cases of ankle fracture treated by open reduction and internal fixation and 583 cases of surgical site infection were included in this meta-analysis. The incidence of surgical site infection is 7.19%. Our meta-analysis identified the significant increased risk factors with surgical site infection after open reduction and internal fixation of ankle fractures (P < 0.05) is: body mass index (both continuous and dichotomous variables); American Society of Anesthesiologists ≥3; diabetes; alcohol; open fracture; subluxation/dislocation; incision cleanness grade 2-4; high-energy mechanism; chronic heart disease; history of allergy; and use of antibiotic prophylaxis. After sensitivity analysis, meta-analysis results for these factors did not change the significance, indicating that the results were robust.
CONCLUSION
Patients involved with the above-mentioned medical conditions were at risk for surgical site infection after open reduction and internal fixation of ankle fracture. The present study may in this respect serve as a baseline reference and this knowledge will allow the formulation of public health strategies to prevent surgical site infection after orthopedic surgery.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ankle Fractures; Female; Fracture Fixation, Internal; Humans; Incidence; Male; Middle Aged; Open Fracture Reduction; Risk Factors; Surgical Wound Infection; Young Adult
PubMed: 29929022
DOI: 10.1016/j.ijsu.2018.06.018 -
Indian Journal of Orthopaedics May 2020Foot and ankle injuries in elite athletes can result in decreased performance, absence from sport and prolonged morbidity. There is paucity of data on foot and ankle...
INTRODUCTION
Foot and ankle injuries in elite athletes can result in decreased performance, absence from sport and prolonged morbidity. There is paucity of data on foot and ankle injuries in Olympics athletes.
METHODS
We conducted a systematic review of the PubMed and EMBASE databases. Studies in English language that reported the incidence and/or prevalence of foot and ankle injuries in during Olympics games (summer, winter and youth Olympics) were included. Studies in languages other than English, those that looked at injuries other than foot and ankle injuries, studies looking at injuries in non-Olympics events and those looking at Olympics trials were excluded. We determined the injury rates and burden of foot and ankle injuries. We also looked at the patterns and trends of foot and ankle injuries.
RESULTS
A total of 399 foot and ankle injuries from 25 publications were included in the review. Foot and ankle injury rates ranged from 0.09 to 0.42 injuries per athlete-years for summer Olympics and 0.02-0.35 injuries per athlete-years for winter Olympics. Quantitative analysis revealed that foot and ankle injuries contributed to 16.9% of all injuries (95% CI 8.1-31.9%) for summer Olympics and 5.1% of all injuries (95% CI 1.9-12.6%) for winter Olympics; however, a high statistical heterogeneity was noted. The three most common injuries were tendon injuries, ligament injuries and stress fractures. The rates and burden of foot and ankle injuries showed a declining trend.
CONCLUSIONS
Foot and ankle injuries are an important cause of morbidity amongst Olympics athletes. The declining trend amongst these injuries notwithstanding, there is a need for a global electronic database for reporting of injuries in Olympics athletes.
PubMed: 32399148
DOI: 10.1007/s43465-020-00058-x