-
Pain Research & Management 2022The enhanced recovery after surgery (ERAS) program is aimed to shorten patients' recovery process and improve clinical outcomes. This study aimed to compare the outcomes...
BACKGROUND
The enhanced recovery after surgery (ERAS) program is aimed to shorten patients' recovery process and improve clinical outcomes. This study aimed to compare the outcomes between the ERAS program and the traditional pathway among patients with ankle fracture and distal radius fracture.
METHODS
This is a multicenter prospective clinical controlled study consisting of 323 consecutive adults with ankle fracture from 12 centers and 323 consecutive adults with distal radial fracture from 13 centers scheduled for open reduction and internal fixation between January 2017 and December 2018. According to the perioperative protocol, patients were divided into two groups: the ERAS group and the traditional group. The primary outcome was the patients' satisfaction of the whole treatment on discharge and at 6 months postoperatively. The secondary outcomes include delapsed time between admission and surgery, length of hospital stay, postoperative complications, functional score, and the MOS item short form health survey-36.
RESULTS
Data describing 772 patients with ankle fracture and 658 patients with distal radius fracture were collected, of which 323 patients with ankle fracture and 323 patients with distal radial fracture were included for analysis. The patients in the ERAS group showed higher satisfaction levels on discharge and at 6 months postoperatively than in the traditional group ( < 0.001). In the subgroup analysis, patients with distal radial fracture in the ERAS group were more satisfied with the treatment (=0.001). Furthermore, patients with ankle fracture had less time in bed ( < 0.001) and shorter hospital stay ( < 0.001) and patients with distal radial fracture received surgery quickly after being admitted into the ward in the ERAS group than in the traditional group (=0.001).
CONCLUSIONS
Perioperative protocol based on the ERAS program was associated with high satisfaction levels, less time in bed, and short hospital stay without increased complication rate and decreased functional outcomes.
Topics: Adult; Ankle Fractures; Enhanced Recovery After Surgery; Humans; Length of Stay; Prospective Studies; Radius Fractures; Treatment Outcome
PubMed: 35711611
DOI: 10.1155/2022/3458056 -
Orthopaedics & Traumatology, Surgery &... Feb 2021The distal tibiofibular syndesmosis (DTFS) is frequently injured during ankle trauma. The sequelae can be significant, including chronic instability, early... (Review)
Review
The distal tibiofibular syndesmosis (DTFS) is frequently injured during ankle trauma. The sequelae can be significant, including chronic instability, early osteoarthritis and residual pain. The aim of this study is to summarize the current state knowledge about these injuries by answering four questions. They frequently occur in the context of an ankle sprain (20-40% of cases) or during various types of ankle fractures (20-100% of cases). They cannot be ruled out based solely on fracture type and must be investigated when a fibular or posterior malleolar fracture is present. Clinical examination and imaging are essential but do not provide a definitive diagnosis. Ultrasonography, CT scan and MRI have high sensitivity, but their static nature does not allow a treatment strategy to be defined. Dynamic radiographs must be taken, either with load or during a procedure. If instability is detected, stabilization is the general rule. In fracture cases, reduction is achieved by restoring the length and rotation of the distal fibular fragment, preferably during an open procedure. In sprain cases, reduction is not a problem unless there is ligament interposition. Tibiofibular fixation is done 1.5 to 3cm from the talocrural joint, while ensuring the reduction is perfect. The main complication-non-healing of the syndesmosis-is attributed to poor initial reduction. This or functional discomfort during weight bearing will require removal of the fixation hardware. In most cases, this allows functional recovery and correction of the inadequate reduction. Persistence of instability will require ligament reconstruction or fusion of the syndesmosis. Chronic instability can lead to ankle osteoarthritis. LEVEL OF EVIDENCE: V, expert opinion.
Topics: Ankle Fractures; Ankle Injuries; Ankle Joint; Fibula; Fracture Fixation, Internal; Humans; Joint Instability
PubMed: 33333279
DOI: 10.1016/j.otsr.2020.102778 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Jan 2022To summarize the diagnosis and treatment of fibular fracture in ankle fracture.
OBJECTIVE
To summarize the diagnosis and treatment of fibular fracture in ankle fracture.
METHODS
Relevant literature at home and abroad in recent years was widely consulted, and various types of fractures were discussed and summarized according to Danis-Weber classification.
RESULTS
Conservative treatment is not an ideal treatment for type A avulsion fracture. The operation method should be determined according to the position and size of bone mass. For simple type B fracture, both conservative treatment and surgical treatment can achieve good results. When the position of type C fracture is high and does not affect the stability of ankle joint, it can be treated conservatively, while when the position is low and affects the stability of ankle joint, it needs surgical treatment.
CONCLUSION
First of all, whether the fibular fracture in the ankle fracture is stable or not should be determined. Whether it is treated surgically or not, the purpose is to restore the tibiofibular syndesmosis and restore the motor function of the ankle.
Topics: Ankle; Ankle Fractures; Ankle Injuries; Ankle Joint; Fibula; Fracture Fixation, Internal; Humans
PubMed: 35038809
DOI: 10.7507/1002-1892.202108091 -
Orthopaedics & Traumatology, Surgery &... Feb 2022Geriatrics continues to evolve as a specialty by adapting itself to increasingly older patients. Musculoskeletal injuries are common in these patients, who can maintain... (Review)
Review
Geriatrics continues to evolve as a specialty by adapting itself to increasingly older patients. Musculoskeletal injuries are common in these patients, who can maintain their physical capacities and autonomy for a long time, but whose bone solidness is frequently reduced by osteoporosis. Falls increase with age and because of certain medical conditions. Trauma in the geriatric population involves specific risks; thus, the treatment must be adapted not only to the fracture, but to the local conditions and the patient. Ankle injuries are particularly frequent in general traumatology but even more in geriatric traumatology. They can lead to complete loss of autonomy if the treatment is delayed and/or not adapted to the local conditions or the patient. The functional prognosis is brought into play, along with the patient's life due to loss of autonomy and general complications occurring in patients who are bed-ridden. The treatment of bimalleolar ankle fractures in older adults requires rigorous analysis at all points, which starts by evaluating the cutaneous status and viability of the soft tissues upon admission. The benefit-risk balance of the various treatment options will be assessed with the main goal being that patients recover their autonomy. This article will review this topic by answering 7 questions: 1) What are the distinctive features of elderly? Dependence on others, comorbidities, bone and soft tissue fragility are the main ones, explaining these high-risk situations and frequent complications. 2) When should a bimalleolar ankle fracture be treated surgically? The surgery must be done early, preferably within 8hours of the injury occurring, once the comorbidities have been controlled. The local conditions (skin and soft tissue damage) must be evaluated carefully as they determine the treatment. Errors are not allowed in these patients, who are often fragile and in precarious health. Definitive fixation is preferred if the skin status allows it, but one must keep temporary external fixation in mind as an option. 3) Is there still a role for conservative treatment of displaced fractures? This will produce good results when it is well done; however, the indications are rare and must be selected carefully. The main risks are secondary displacement and skin lesions inside the cast, which are sources of infection. 4) Is fixation with anatomical locking plates an advance? This is definitely an advance for these fragility fractures, which are often comminuted, as it allows return to weight bearing in certain conditions. However, the implantation rules must be followed exactly, and it is preferable to use thinner plates. 5) Does transplantar Steinmann pin fixation still have a role? It has few indications, limited to salvage situations (catastrophic local conditions, very poor general condition). External tibiocalcaneal fixation, alone or in combination, is a better option. 6) Is immediate transarticular fixation with a retrograde or antegrade locked nail a reasonable option? Fixation can be done by retrograde nailing or antegrade nailing. It is proposed to patients who are not very autonomous with a poor cutaneous status and/or severe osteoporosis. It is preferable to transplantar nailing. 7) Is immediate protected weight bearing, with or without fixation, possible? This can be considered on a case-by-case basis depending on the extent of the trauma, patient compliance and treatment carried out. LEVEL OF EVIDENCE: V, Expert opinion.
Topics: Aged; Ankle Fractures; Bone Nails; Bone Plates; Fracture Fixation, Internal; Fracture Fixation, Intramedullary; Humans; Osteoporosis; Treatment Outcome
PubMed: 34757182
DOI: 10.1016/j.otsr.2021.103137 -
Journal of Orthopaedic Surgery and... Sep 2020The concurrent ipsilateral Tillaux fracture with medial malleolar fracture in adolescents commonly suffer from high-energy injury, making treatment more difficult. The...
BACKGROUND
The concurrent ipsilateral Tillaux fracture with medial malleolar fracture in adolescents commonly suffer from high-energy injury, making treatment more difficult. The aim of this study was to discuss the mechanism on injury, diagnosis, and treatment of this complex fracture pattern.
METHODS
The charts and radiographs of six patients were reviewed. The function was assessed by the American Orthopedic Foot and Ankle Society ankle-hindfoot scores.
RESULTS
The mean age at operation was 12.8 years. The mean interval from injury to operation was 7.7 days. Five Tillaux fractures and all medial malleolar fractures were shown on AP plain radiographs. One Tillaux fracture and two cases with avulsion of posterolateral tibial aspect were confirmed in axial computerized tomography. There was talar subluxation laterally with medial space widening in three and syndesmotic disruption in one. There were five patients sustaining ipsilateral distal fibular fractures. All fractures, except nonunion in two medial malleolar fractures and in one Tillaux fracture, healed within 6-8 weeks. There was one case of osteoarthritis of ankle joint. The average AOFAS score was 88.7.
CONCLUSIONS
Computerized tomography is helpful in identifying the fracture pattern. Anatomic reduction and internal fixation of Tillaux and medial malleolar fracture was recommended to restore the articular surface congruity and ankle stability.
Topics: Adolescent; Ankle Fractures; Child; Female; Fracture Fixation; Fracture Fixation, Internal; Humans; Male; Tibial Fractures; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 32943101
DOI: 10.1186/s13018-020-01961-7 -
Clinics in Orthopedic Surgery Mar 2015We assessed the frequency and types of ankle fractures that frequently occur during parachute landings of special operation unit personnel and analyzed the causes.
BACKGROUND
We assessed the frequency and types of ankle fractures that frequently occur during parachute landings of special operation unit personnel and analyzed the causes.
METHODS
Fifty-six members of the special force brigade of the military who had sustained ankle fractures during parachute landings between January 2005 and April 2010 were retrospectively analyzed. The injury sites and fracture sites were identified and the fracture types were categorized by the Lauge-Hansen and Weber classifications. Follow-up surveys were performed with respect to the American Orthopedic Foot and Ankle Society ankle-hindfoot score, patient satisfaction, and return to preinjury activity.
RESULTS
The patients were all males with a mean age of 23.6 years. There were 28 right and 28 left ankle fractures. Twenty-two patients had simple fractures and 34 patients had comminuted fractures. The average number of injury and fractures sites per person was 2.07 (116 injuries including a syndesmosis injury and a deltoid injury) and 1.75 (98 fracture sites), respectively. Twenty-three cases (41.07%) were accompanied by posterior malleolar fractures. Fifty-five patients underwent surgery; of these, 30 had plate internal fixations. Weber type A, B, and C fractures were found in 4, 38, and 14 cases, respectively. Based on the Lauge-Hansen classification, supination-external rotation injuries were found in 20 cases, supination-adduction injuries in 22 cases, pronation-external rotation injuries in 11 cases, tibiofibular fractures in 2 cases, and simple medial malleolar fractures in 2 cases. The mean follow-up period was 23.8 months, and the average follow-up American Orthopedic Foot and Ankle Society ankle-hindfoot score was 85.42. Forty-five patients (80.36%) reported excellent or good satisfaction with the outcome.
CONCLUSIONS
Posterior malleolar fractures occurred in 41.07% of ankle fractures sustained in parachute landings. Because most of the ankle fractures in parachute injuries were compound fractures, most cases had to undergo surgical repairs.
Topics: Adult; Ankle Fractures; Ankle Injuries; Ankle Joint; Aviation; Bone Plates; Fracture Fixation, Internal; Fractures, Comminuted; Fractures, Open; Humans; Male; Military Personnel; Radiography; Retrospective Studies; Young Adult
PubMed: 25729514
DOI: 10.4055/cios.2015.7.1.15 -
Journal of Perioperative Practice Nov 2022Ankle fractures are common injuries that can result in substantial morbidity in the population. This review discusses the management of closed ankle fractures and... (Review)
Review
Ankle fractures are common injuries that can result in substantial morbidity in the population. This review discusses the management of closed ankle fractures and outlines the recent evidence and guidelines on perioperative management. In general, a detailed history should be undertaken, followed by examination and imaging of the affected limb. Fixation is based on the AO principles of fracture management that aims towards restoring stability of the joint and reducing the risk of long-term complications. A multidisciplinary approach towards perioperative management is recommended in view of the increasing proportion of aging patients with significant comorbidities.
Topics: Humans; Ankle Fractures; Ankle Injuries; Fracture Fixation, Internal; Treatment Outcome; Retrospective Studies
PubMed: 34190640
DOI: 10.1177/17504589211006018 -
European Journal of Trauma and... Dec 2015Injuries of the ankle joint have a high incidence in daily life and sports, thus, playing an important socioeconomic role. Therefore, proper diagnosis and adequate... (Review)
Review
Injuries of the ankle joint have a high incidence in daily life and sports, thus, playing an important socioeconomic role. Therefore, proper diagnosis and adequate treatment are mandatory. While most of the ligament injuries around the ankle joint are treated conservatively, great controversy exists on how to treat deltoid ligament injuries in ankle fractures. Missed injuries and inadequate treatment of the medial ankle lead to inferior outcome with instability, progressive deformity, and ankle joint osteoarthritis.
Topics: Ankle Fractures; Ankle Injuries; Arthroscopy; Bone Screws; Casts, Surgical; Delayed Diagnosis; Fracture Fixation; Humans; Joint Instability; Ligaments, Articular; Osteoarthritis; Physical Examination; Physical Therapy Modalities; Rupture; Treatment Outcome
PubMed: 26141136
DOI: 10.1007/s00068-015-0548-2 -
Irish Journal of Medical Science Oct 2022Virtual fracture clinics (VFC) have been widely adopted worldwide as part of the changes in healthcare delivery during the COVID-19 pandemic. They have been shown to be...
BACKGROUND
Virtual fracture clinics (VFC) have been widely adopted worldwide as part of the changes in healthcare delivery during the COVID-19 pandemic. They have been shown to be a safe and effective method of delivering trauma care for injuries which do not require immediate intervention or specialist management, whilst maintaining high levels of patient satisfaction.
AIMS
Our aim was to evaluate whether VFCs reduce the volume of X-rays performed for common fractures of the wrist and ankle.
METHODS
A retrospective cohort review was performed. The pre-VFC group consisted of 168 wrist and 108 ankle referrals from March to September 2019. The VFC group included 75 wrist and 68 ankle referrals, during the period March to September 2020. The total number of X-ray images, carried out within a 3-month period for each fracture was summated, with statistical analysis performed following fracture pattern classification.
FINDINGS
A statistically significant decrease in mean X-rays was observed for isolated stable fracture patterns, such as non-displaced distal radius, - 0.976 (p = 0.00025), and Weber A ankle fractures, - 0.907 (p = 0.000013). A reduction was also observed for more complex fracture patterns such as dorsally displaced distal radius, - 0.701 (p = 0.129) and Weber B ankle fractures, - 0.786 (p = 0.235), though not achieving statistical significance.
CONCLUSIONS
Virtual fracture clinics can reduce X-ray frequency for common stable wrist and ankle fractures, with resultant benefits for both patients and healthcare systems. These benefits may be sustained in patient care beyond the current COVID-19 pandemic.
Topics: Ankle Fractures; COVID-19; Humans; Pandemics; Retrospective Studies; Wrist; X-Rays
PubMed: 34655402
DOI: 10.1007/s11845-021-02812-y -
Foot (Edinburgh, Scotland) Dec 2018The Cunéo and Picot fracture-dislocation is an atypical trimalleolar fracture-dislocation of the ankle with unique anatomopathologic and radiographic features, which... (Review)
Review
The Cunéo and Picot fracture-dislocation is an atypical trimalleolar fracture-dislocation of the ankle with unique anatomopathologic and radiographic features, which has not been reported in English literature. We report a case of a 42-year-old woman that was diagnosed with a trimalleolar fracture-dislocation and treated surgically with an open reduction and osteosynthesis of the lateral and medial malleolus. At one-month follow-up, X-rays showed secondary displacement of the medial malleolus requiring revision surgery. The patient complained of persisting pain, with X-rays showing no signs of apparent fracture displacement. A CT scan performed after hardware removal 10 months after trauma showed severe ankle arthritis and fracture malunion at the level of the syndesmosis. The patient was retrospectively diagnosed with a Cunéo and Picot fracture-dislocation. The treatment of trimalleolar fractures is discussed, especially regarding the correct indication of synthesis of the posterior malleolus. Cunéo and Picot fractures are usually inherently unstable even if the posterior malleolar fragment may be small and can easily be recognized from standard X-rays. Whenever this type of fracture is not correctly recognized and managed by osteosynthesis of only the medial and lateral malleolus, clinical outcomes and radiographic follow-ups tend to be unsatisfactory. Fixation of the posterior malleolus is indicated in the management of Cunéo and Picot fractures. Level of clinical evidence: 4.
Topics: Adult; Ankle Fractures; Female; Fracture Dislocation; Humans
PubMed: 30321853
DOI: 10.1016/j.foot.2018.06.003