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Terstegen J, Weel H, Frosch KH, Rolvien T, Schlickewei C, Mueller E. Classifications of posterior malleolar fractures: a systematic literature review. Arch Orthop Trauma Surg 2023; 143:4181-4220. [PMID: 36469121 PMCID: PMC10293398 DOI: 10.1007/s00402-022-04643-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/30/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Complex ankle fractures frequently involve the posterior malleolus. Many classifications describing posterior malleolar fractures (PMF) exist. The aim of this study was to provide a systematic literature review to outline existing PMF classifications and estimate their accuracy. METHODS The databases PubMed and Scopus were searched without time limits. Only specific PMF classifications were included; general ankle and/or pilon fracture classifications were excluded. Selection and data extraction was performed by three independent observers. The systematic literature search was performed according to the current criteria of Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). The methodological quality of the included studies was quantified using the modified Coleman score. RESULTS A total of 110 studies with a total of 12.614 patients were included. Four main classifications were identified: Those describing the size of the posterior malleolar fracture (n = 66), Haraguchi (n = 44), Bartoníček/Rammelt (n = 21) and Mason (n = 12). The quality of the studies was moderate to good with a median Coleman-score of 43.5 (14-79) and a weighted median Coleman-score of 42.5 points. All classifications achieved a substantial to perfect score regarding the inter- and intraobserver reliability, with Mason scoring the lowest in comparison. CONCLUSIONS None of the reviewed PMF classifications has been able to establish itself decisively in the literature. Most of the classifications are insufficient in terms of a derivable treatment algorithm or a prognosis with regard to outcome. However, as the Bartoníček/Rammelt classification has the greatest potential due to its treatment algorithm, its reliability in combination with consistent predictive values, its usage in clinical practice and research appears advisable.
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Affiliation(s)
- Julia Terstegen
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Hanneke Weel
- Department of Orthopedics, Bergman Clinics, Arnhem, The Netherlands
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics, and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Tim Rolvien
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Carsten Schlickewei
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Elena Mueller
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Pavone V, Papotto G, Vescio A, Longo G, D’Amato S, Ganci M, Marchese E, Testa G. Short and Middle Functional Outcome in the Static vs. Dynamic Fixation of Syndesmotic Injuries in Ankle Fractures: A Retrospective Case Series Study. J Clin Med 2023; 12:3637. [DOI: https:/doi.org/10.3390/jcm12113637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024] Open
Abstract
Background: Syndesmotic injuries are common lesions associated with ankle fractures. Static and dynamic fixation are frequently used in syndesmotic injury-associated ankle fractures. The purpose of this study is to compare short- and mid-term quality of life, clinical outcomes, and gait after static stabilization with a trans-syndesmotic screw or dynamic stabilization with a suture button device. Methods: Here, 230 patients were enrolled in a retrospective observational study. They were divided in two groups according to the fixation procedure (Arthrex TightRope®, Munich, Germany) synthesis vs. osteosynthesis with a 3.5 mm trans-syndesmotic tricortical screw). They then underwent clinical assessment using the American Foot and Ankle Score (AOFAS) at 1, 2, 6, 12, and 24 months after surgery. Quality of life was assessed according to the EuroQol-5 Dimension (EQ-5D) at 2 and 24 months after surgery in the follow-up; gait analysis was performed 2 and 24 months postoperatively. Results: Significant differences were found at a two-month follow-up according to the AOFAS (p = 0.0001) and EQ-5D (p = 0.0208) scores. No differences were noted in the other follow-ups (p > 0.05) or gait analysis. Conclusion: The dynamic and static fixation of syndesmotic injuries in ankle fracture are both efficacious and valid procedures for avoiding ankle instability. The suture button device was comparable to the screw fixation according to functional outcomes and gait analysis.
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico—San Marco, University of Catania, 95123 Catania, Italy
| | - Giacomo Papotto
- Department of Orthopedic Surgery, Trauma Center, Cannizzaro Hospital, 95100 Catania, Italy
| | - Andrea Vescio
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico—San Marco, University of Catania, 95123 Catania, Italy
| | - Gianfranco Longo
- Department of Orthopedic Surgery, Trauma Center, Cannizzaro Hospital, 95100 Catania, Italy
| | - Salvatore D’Amato
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico—San Marco, University of Catania, 95123 Catania, Italy
| | - Marco Ganci
- Department of Orthopedic Surgery, Trauma Center, Cannizzaro Hospital, 95100 Catania, Italy
| | - Emanuele Marchese
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico—San Marco, University of Catania, 95123 Catania, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico—San Marco, University of Catania, 95123 Catania, Italy
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Pavone V, Papotto G, Vescio A, Longo G, D'Amato S, Ganci M, Marchese E, Testa G. Short and Middle Functional Outcome in the Static vs. Dynamic Fixation of Syndesmotic Injuries in Ankle Fractures: A Retrospective Case Series Study. J Clin Med 2023; 12:jcm12113637. [PMID: 37297832 DOI: 10.3390/jcm12113637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Syndesmotic injuries are common lesions associated with ankle fractures. Static and dynamic fixation are frequently used in syndesmotic injury-associated ankle fractures. The purpose of this study is to compare short- and mid-term quality of life, clinical outcomes, and gait after static stabilization with a trans-syndesmotic screw or dynamic stabilization with a suture button device. METHODS Here, 230 patients were enrolled in a retrospective observational study. They were divided in two groups according to the fixation procedure (Arthrex TightRope®, Munich, Germany) synthesis vs. osteosynthesis with a 3.5 mm trans-syndesmotic tricortical screw). They then underwent clinical assessment using the American Foot and Ankle Score (AOFAS) at 1, 2, 6, 12, and 24 months after surgery. Quality of life was assessed according to the EuroQol-5 Dimension (EQ-5D) at 2 and 24 months after surgery in the follow-up; gait analysis was performed 2 and 24 months postoperatively. RESULTS Significant differences were found at a two-month follow-up according to the AOFAS (p = 0.0001) and EQ-5D (p = 0.0208) scores. No differences were noted in the other follow-ups (p > 0.05) or gait analysis. CONCLUSION The dynamic and static fixation of syndesmotic injuries in ankle fracture are both efficacious and valid procedures for avoiding ankle instability. The suture button device was comparable to the screw fixation according to functional outcomes and gait analysis.
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
| | - Giacomo Papotto
- Department of Orthopedic Surgery, Trauma Center, Cannizzaro Hospital, 95100 Catania, Italy
| | - Andrea Vescio
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
| | - Gianfranco Longo
- Department of Orthopedic Surgery, Trauma Center, Cannizzaro Hospital, 95100 Catania, Italy
| | - Salvatore D'Amato
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
| | - Marco Ganci
- Department of Orthopedic Surgery, Trauma Center, Cannizzaro Hospital, 95100 Catania, Italy
| | - Emanuele Marchese
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
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Lu V, Tennyson M, Zhang J, Thahir A, Zhou A, Krkovic M. Ankle fusion with tibiotalocalcaneal retrograde nail for fragility ankle fractures: outcomes at a major trauma centre. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:125-133. [PMID: 34820741 PMCID: PMC8612118 DOI: 10.1007/s00590-021-03171-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/15/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Fragility ankles fractures in the geriatric population are challenging to manage, due to fracture instability, soft tissue compromise, and patient co-morbidities. Traditional management options include open reduction internal fixation, or conservative treatment, both of which are fraught with high complication rates. We aimed to present functional outcomes of elderly patients with fragility ankle fractures treated with retrograde ankle fusion nails. METHODS A retrospective observational study was performed on patients who underwent intramedullary nailing with a tibiotalocalcaneal nail. Twenty patients met the inclusion criteria of being over sixty and having multiple co-morbidities. Patient demographics, AO/OTA fracture classification, intra-operative and post-operative complications, time to mobilisation and union, AOFAS and Olerud-Molander scores, and patient mobility were recorded. RESULTS There were seven males and thirteen females, with a mean age of 77.82 years old, five of whom are type 2 diabetics. Thirteen patients returned to their pre-operative mobility state, and the average Charlson Co-morbidity Index (CCI) was 5.05. Patients with a low CCI are more likely to return to pre-operative mobility status (p = 0.16; OR = 4.00). All patients achieved radiographical union, taking on average between 92.5 days and 144.6 days. The mean post-operative AOFAS and Olerud-Molander scores were 53.0 and 50.9, respectively. There were four cases of superficial infection, four cases of broken or loose distal locking screws. There were no deep infections, periprosthetic fractures, nail breakages, or non-unions. CONCLUSION Tibiotalocalcaneal nailing is an effective and safe option for managing unstable ankle fractures in the elderly. This technique leads to lower complication rates and earlier mobilisation than traditional fixation methods.
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Affiliation(s)
- Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP UK ,Christ’s College, St. Andrew’s Street, Cambridge, CB2 3BU UK
| | - Maria Tennyson
- Department of Trauma and Orthopaedics, Addenbrooke’s Hospital, Cambridge, CB2 0QQ UK
| | - James Zhang
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP UK
| | - Azeem Thahir
- Department of Trauma and Orthopaedics, Addenbrooke’s Hospital, Cambridge, CB2 0QQ UK
| | - Andrew Zhou
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP UK
| | - Matija Krkovic
- Department of Trauma and Orthopaedics, Addenbrooke’s Hospital, Cambridge, CB2 0QQ UK
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Deschamps K, Wouters J, Staes F, Vanstraelen E, Matricali GA, Wuite S, Hoekstra H. Evidence for symmetrically reduced foot mechanics and energetics in patients after trimalleolar fracture repair: A cross-sectional study. Gait Posture 2022; 97:13-20. [PMID: 35849967 DOI: 10.1016/j.gaitpost.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/20/2022] [Accepted: 07/09/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Trimalleolar fractures osteosynthesis is associated with a suboptimal outcome. It is hypothesized that patients with trimalleolar fractures face different ankle joint kinetics at mid- and long-term causing compensations at the distal foot joints. RESEARCH QUESTION Do patients with a history of a trimalleolar fracture demonstrate different foot joint mechanics and energetics (1) between their affected side and their matched controls? (2) between their unaffected side and their matched controls? (3) between their affected side and their unaffected side? METHODS Fifteen patients who sustained a trimalleolar fracture and underwent osteosynthesis for both the lateral, medial and posterior malleolus were compared to a asymptomatic control group which was matched for sex, age and walking speed. Three-dimensional gait analysis was used to quantify kinetic parameters in the Ankle, Chopart, Lisfranc and first metatarsophalangeal joint through a multi-segment kinetic foot model. Statistical analysis was performed using a Univariate Analysis of Covariance and/or a paired t-test. RESULTS The peak internal ankle moment was significantly lower in patients when compared to the control group (p < 0.001). Mean peak power generation and total positive work were significantly lower for the Chopart joint when comparing the patients to the control group (p < 0.001). These results were observed for both the affected and unaffected side of the patients compared to the control group, showing symmetrical changes in the patient group. SIGNIFICANCE Despite adequate radiographic quality of reduction and the fact that all patients were treated according to a fixed postoperative protocol, this study indicates that patients with a history of a trimalleolar fracture demonstrate reduced foot joint kinetics. It is hypothesized that these findings originate from extrinsic and intrinsic foot muscle strength, stiffness and pain. Future research is needed to validate this hypothesis.
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Affiliation(s)
- Kevin Deschamps
- KU Leuven, Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, Campus Brugge, Spoorwegstraat 12, 8200 Brugge, Belgium; University Hospitals Leuven, Clinical Motion Analysis Laboratorium, Campus Pellenberg, Weligerveld 1, 3212 Lubbeek, Belgium; Haute Ecole Leonard De Vinci, Institut D'Enseignement Supérieur Parnasse Deux-Alice, Division of Podiatry, Avenue E Mounier 84, 1200 Bruxelles, Belgium; Department of Podiatry, Artevelde University College, Hoogpoort 15, 9000 Gent, Belgium.
| | - Julia Wouters
- KU Leuven, Department of Rehabilitation Sciences, Campus Leuven, Tervuursevest 101, 3000 Leuven, Belgium.
| | - Filip Staes
- KU Leuven, Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, Campus Leuven, Tervuursevest 101, 3000 Leuven, Belgium.
| | - Eline Vanstraelen
- University Hospitals Leuven, Clinical Motion Analysis Laboratorium, Campus Pellenberg, Weligerveld 1, 3212 Lubbeek, Belgium.
| | - Giovanni A Matricali
- University Hospitals Leuven, Department of Orthopaedics, Herestraat 49, 3000 Leuven, Belgium; KU Leuven, Institute for Orthopaedic Research & Training, Herestraat 49, 3000 Leuven, Belgium; KU Leuven, Department of Development and Regeneration, Herestraat 49, 3000 Leuven, Belgium.
| | - Sander Wuite
- University Hospitals Leuven, Department of Orthopaedics, Herestraat 49, 3000 Leuven, Belgium; KU Leuven, Institute for Orthopaedic Research & Training, Herestraat 49, 3000 Leuven, Belgium; KU Leuven, Department of Development and Regeneration, Herestraat 49, 3000 Leuven, Belgium.
| | - Harm Hoekstra
- KU Leuven, Department of Development and Regeneration, Herestraat 49, 3000 Leuven, Belgium; University Hospitals Leuven, Department of Trauma Surgery, Herestraat 49, 3000 Leuven, Belgium.
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Neumann AP, Kroker L, Beyer F, Rammelt S. Complications following surgical treatment of posterior malleolar fractures: an analysis of 300 cases. Arch Orthop Trauma Surg 2022; 143:3129-3136. [PMID: 35849187 DOI: 10.1007/s00402-022-04536-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/22/2022] [Indexed: 11/26/2022]
Abstract
AIMS The treatment of ankle fractures and fracture-dislocations involving the posterior malleolus (PM) has undergone considerable changes over the past decade. The aim of our study was to identify risk factors related to the occurrence of complications in surgically treated ankle fractures with PM involvement. PATIENTS AND METHODS We retrospectively analyzed 300 patients at a mean age of 57 years with 300 ankle fractures involving the PM treated surgically at our institution over a 12-year period. The following relevant comorbidities were noted: arterial hypertension (43.7%; n = 131), diabetes mellitus (DM) (14.0%; n = 42), thereof insulin-dependent (3.7%; n = 11), peripheral vascular disease (0.7%; n = 2), osteoporosis (12.0%; n = 36), dementia (1.0%; n = 3), and rheumatoid arthritis (2.0%; n = 6). Furthermore, nicotine consumption was recorded in 7.3% (n = 22) and alcohol abuse in 4.0% (n = 12). RESULTS Complications occurred in 41 patients (13.7%). A total of 20 (6.7%) revision surgeries had to be performed. Patients with DM (p < 0.001), peripheral vascular disease (p = 0.003) and arterial hypertension (p = 0.001) had a significantly increased risk of delayed wound healing. Alcohol abuse was associated with a significantly higher overall complication rate (OR 3.40; 95% CI 0.97-11.83; p = 0.043), increased rates of wound healing problems (OR 11.32; 95% CI 1.94-65.60; p = 0.001) and malalignment requiring revision (p = 0.033). The presence of an open fracture was associated with an increased rate of infection and wound necrosis requiring revision (OR 14.25; 95% CI 2.39-84.84; p < 0.001). Multivariate analysis identified BMI (p = 0.028), insulin-dependent DM (p = 0.003), and staged fixation (p = 0.043) as independent risk factors for delayed wound healing. Compared to the traditional lateral approach, using the posterolateral approach for fibular fixation did not lead to increased complication rates. CONCLUSIONS Significant risk factors for the occurrence of complications following PM fracture treatment were identified. An individually tailored treatment regimen that incorporates all risk factors is important for a good outcome.
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Affiliation(s)
- Annika Pauline Neumann
- University Center of Orthopaedics,Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Livia Kroker
- University Center of Orthopaedics,Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Franziska Beyer
- University Center of Orthopaedics,Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Stefan Rammelt
- University Center of Orthopaedics,Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
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Zhu T, Wang Y, Tian F, Wang W, Zhong R, Zhai H, Wang S. Clinical assessments and gait analysis for patients with Trimalleolar fractures in the early postoperative period. BMC Musculoskelet Disord 2022; 23:663. [PMID: 35820837 PMCID: PMC9275242 DOI: 10.1186/s12891-022-05615-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/01/2022] [Indexed: 11/12/2022] Open
Abstract
Background Trimalleolar fracture is a common ankle fracture with serious complications and costly healthcare problem. Most studies used clinical assessments to evaluate the functional status of the patients. Although clinical assessments are valid, they are static and subjective. Dynamic, objective and precise evaluations such as gait analysis are needed. Ankle biomechanics studies on gait in patients with trimalleolar fractures are still rare. This study aimed to investigate the clinical outcomes and gait biomechanics in patients with trimalleolar fractures in the early postoperative period and compared to healthy controls. Methods This was a cross-sectional study. 12 patients with trimalleolar fractures were recruited, and 12 healthy people served as controls. All patients underwent clinical assessments: Olerud and Molander ankle score (OMAS), ankle swelling and passive range of motion (ROM) of ankle, and completed gait biomechanical analysis when weight-bearing was allowed: temporal-spatial parameters, plantar pressure distributions, and surface electromyography (sEMG). The control group only performed gait test. Results Patients had poor outcomes of clinical assessments in the short-term. During gait analysis, patients presented compromised gait patterns: shorter step length, larger step width, slower walking speed and shorter single support compared to healthy controls (P < 0.001), and patients showed asymmetrical gait. Symmetry index of step width and walking speed were mainly correlated with the difference of ankle inversion ROM between two sides (R = -0.750, P = 0.005; R = -0.700, P = 0.011). During walking, patients showed abnormal dynamic plantar pressure features (mainly in the hindfoot and forefoot regions), and the IEMG (integrated electromyography) of tibial anterior muscle (TA) and peroneal longus muscle (PL) were larger than healthy controls (P = 0.002, 0.050). Conclusions Patients with trimalleolar fractures showed physical impairments of the ankle, and presented altered gait parameters compared to healthy subjects in the short-term. The ankle stability of patients declined, and deficits in TA and PL muscle ability might contribute to it. Restoring complete muscle functions and improving passive ankle ROM are significant to promote the recovery of a normal gait pattern.
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Affiliation(s)
- Ting Zhu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Research Building Room No. 412, Hengren Road No. 200, Shanghai, 200438, China
| | - Ya Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Research Building Room No. 412, Hengren Road No. 200, Shanghai, 200438, China.,Yangzhi Affiliated Rehabilitation Hospital of Tongji University (Shanghai Sunshine Rehabilitation Center), Building No.2, Guangxing Road No. 2209, Shanghai, 201619, China
| | - Fei Tian
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Research Building Room No. 412, Hengren Road No. 200, Shanghai, 200438, China.,Department of Rehabilitation Medicine, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, 046000, Shanxi, China
| | - Wenjin Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Research Building Room No. 412, Hengren Road No. 200, Shanghai, 200438, China
| | - Rongzhou Zhong
- Yangzhi Affiliated Rehabilitation Hospital of Tongji University (Shanghai Sunshine Rehabilitation Center), Building No.2, Guangxing Road No. 2209, Shanghai, 201619, China
| | - Hua Zhai
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Research Building Room No. 412, Hengren Road No. 200, Shanghai, 200438, China. .,Yangzhi Affiliated Rehabilitation Hospital of Tongji University (Shanghai Sunshine Rehabilitation Center), Building No.2, Guangxing Road No. 2209, Shanghai, 201619, China.
| | - Shaobai Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Research Building Room No. 412, Hengren Road No. 200, Shanghai, 200438, China.
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Chan BHT, Snowdon DA, Williams CM. The association between person and fracture characteristics with patient reported outcome after ankle fractures in adults: A systematic review. Injury 2022; 53:2340-2365. [PMID: 35197205 DOI: 10.1016/j.injury.2022.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 02/07/2022] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Billy H T Chan
- Department of Physiotherapy, Monash University, Frankston, VIC 3199, Australia.
| | - David A Snowdon
- Department of Allied Health, Peninsula Health, Frankston, VIC 3199, Australia; Peninsula Clinical School, Monash University, Frankston, VIC 3199, Australia.
| | - Cylie M Williams
- Department of Physiotherapy, Monash University, Frankston, VIC 3199, Australia; Department of Allied Health, Peninsula Health, Frankston, VIC 3199, Australia.
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9
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Monestier L, Riva G, Coda Zabetta L, Surace MF. OUTCOMES AFTER UNSTABLE FRACTURES OF THE ANKLE: WHAT'S NEW? A SYSTEMATIC REVIEW. Orthop Rev (Pavia) 2022; 14:35688. [PMID: 35769653 PMCID: PMC9235440 DOI: 10.52965/001c.35688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 03/29/2022] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Unstable ankle fractures are very frequent. Given the instability, they often require surgical treatment, but literature scarcely reports on the outcomes of their management. QUESTIONS/PURPOSES For this systematic review we asked: (1) What are the outcomes in treatment of unstable ankle fractures? (2) What about complications of treatment in unstable fractures? (3) What factors influence the outcomes? (4) What about the role of the posterior malleolus? METHODS The electronic databases PubMed, Scopus, and Embase were interrogated using the search terms "bimalleolar" or "trimalleolar" and "fracture". Studies were included if they reported on: (1) bimalleolar or trimalleolar fracture in adults; (2) treatment; (3) outcomes reported by scales; (4) follow-up. The final review included 33 studies. The quality of the studies was evaluated with the Methodological Index for Non-randomized Studies (MINORS) questionnaire. RESULTS All the outcomes of the thirty-three selected studies were analyzed. DISCUSSION Surgical fixation of unstable ankle fractures should always be performed within the first 48 hours from the trauma, preventing instability and post-traumatic osteoarthritis. Surgeon should consider factor may influence functional outcomes. Posterior malleolar fractures should be fixed regardless the size, considering some individual factors.
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Affiliation(s)
- Luca Monestier
- Division of Orthopedics and Traumatology, ASST Sette Laghi, Varese, Italy
| | - Giacomo Riva
- Division of Orthopedics and Traumatology, ASST Sette Laghi, Varese, Italy
| | - Lorenzo Coda Zabetta
- Residency program in Orthopedics and Trauma, Department of Biotechnologies and Life Sciences (DBSV), University of Insubria, Varese, Italy
| | - Michele F Surace
- Interdisciplinary Research Center for Pathology and Surgery of the Musculoskeletal System, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy
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Bouche PA, Gaujac N, Corsia S, Leclerc P, Anract P, Auberger G. Ankle CT scan allows better management of posterior malleolus fractures than X-rays. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1301-1309. [PMID: 34468840 DOI: 10.1007/s00590-021-03104-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/23/2021] [Indexed: 01/23/2023]
Abstract
PURPOSE Undiagnosed and undertreated posterior malleolus fractures lead to early ankle instability and arthritis. A preoperative CT scan could improve the management of those fractures. This study assessed the benefits of a systematic ankle CT scanner to diagnose and manage posterior malleolus fracture. METHODS A monocentric retrospective cohort study was conducted. Sixty consecutive patients with bimalleolar fractures were operated and underwent a preoperative CT scan. The mean age was 50.0 years old (18.6 years old) with a mean body mass index of 20.3 (kg/m2) (11.4 kg/m2) and 71.7% (43/60) of women. The primary outcome was the rate of posterior malleolus fragment diagnosed on X-rays and on CT scan. Secondly, interobserver and interobserver's agreement were compared between conventional X-rays and CT scan. RESULTS Thirty-five (58.3%) posterior fragment fractures were observed on X-rays and 53 (88.3%) on the preoperative CT scan (p < 0.01). The intraobserver reproducibility for X-rays was low (0.02 [- 0.23; 0.27]) and moderate for CT scan (0.45 [0.0; 0.84]). The interobserver reproducibility for X-rays was moderate (0.39 [0.15; 0.60]) and excellent for CT scan (0.78 [0.0; 1.0]). CONCLUSION A wide proportion of bimalleolar fractures are associated with posterior malleolus fractures and undiagnosed with standard X-rays. We advocate a systematic preoperative CT scan in the management of bimalleolar fractures. LEVEL OF EVIDENCE Level IV, retrospective cohort study. TRIAL REGISTRATION NUMBER 2218999v0, date of registration: 11/08/2020 (retrospectively registered).
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Affiliation(s)
- Pierre-Alban Bouche
- Orthopaedic Department, Cochin University Hospital, APHP Paris, Paris Descartes University, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.
| | - Nicolas Gaujac
- Orthopaedic Department, Cochin University Hospital, APHP Paris, Paris Descartes University, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Simon Corsia
- Orthopaedic Department, Cochin University Hospital, APHP Paris, Paris Descartes University, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Philippe Leclerc
- Orthopaedic Department, Croix St Simon Hospital, 125 rue d'Avron, 75020, Paris, France
| | - Philippe Anract
- Orthopaedic Department, Cochin University Hospital, APHP Paris, Paris Descartes University, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Guillaume Auberger
- Orthopaedic Department, Croix St Simon Hospital, 125 rue d'Avron, 75020, Paris, France
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Increasing age and modifiable comorbidities are associated with short-term complications after open reduction and internal fixation of ankle fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:113-119. [PMID: 33759030 DOI: 10.1007/s00590-021-02927-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Ankle fractures are common orthopedic injuries with complication rates fixation of up to 40%. Limited evidence exists in the literature regarding complications in the elderly population, and moreover, these studies frequently define elderly arbitrarily at 60-65 years old. The purpose of the present study was to utilize a large, validated database to evaluate whether there is an inflection point of age when postoperative complications after an ankle fracture significantly increase. METHODS A retrospective review of all patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent fixation of an ankle fracture between 2012 and 2018 was performed. Patients were identified within the database using the Current Procedural Terminology codes. Appropriate statistical analysis was performed with p value less than 0.05 considered statistically significant. RESULTS A total of 27,633 fractures were including and comprised of 221 posterior malleolar, 1567 medial malleolar, 8495 lateral malleolar, 10,175 bimalleolar, and 7175 trimalleolar. A total of 1545 complications were encountered (5.6%). There was a statistically significant association between increasing age and complications (OR = 1.03; p < 0.001). Further analysis shows the largest spike in complications within the age 78 + bracket. There were no overall interaction effects between age and fracture subtype (p = 0.223). CONCLUSION ORIF of ankle fractures is a common orthopedic procedure performed on patients of all ages, with complications ranging in severity. In order to best counsel patients on their individual postoperative risks, large datasets are often necessary to prognosticate. This study found that postoperative complications increase with advanced age. The incidence of complications did not spike for patients around the age of 65, but rather followed an incremental linear pattern with the largest increase in odds ratio occurring at age 78 and above. Complication rate was not associated with specific fracture type based off of ICD codes.
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12
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Faber RM, Parry JA, Haidukewych GH, Koval KJ, Langford JL. Complications after fibula intramedullary nail fixation of pilon versus ankle fractures. J Clin Orthop Trauma 2021; 16:75-79. [PMID: 33717942 PMCID: PMC7920162 DOI: 10.1016/j.jcot.2020.12.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/05/2020] [Accepted: 12/27/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Intramedullary nail (IMN) fixation of the fibula in malleolar ankle fractures has been shown to result in less wound complications then plate fixation. Therefore, IMN fibula fixation may also be associated with lower rates of wound complications when used for higher-risk pilon fractures. The purpose of this study was to compare complications of fibula IMN fixation in pilon versus malleolar ankle fractures. METHODS A retrospective cohort comparison was performed at an urban level one trauma center involving fibula fractures in 47 patients with AO/Orthopaedic Trauma Association (OTA) type 43 fractures and 48 patients with AO/OTA type 44 fractures being treated with fibula IMN fixation. Complications, fibula-specific complications, revision surgeries, and implant removals were reviewed. RESULTS There was no detectable difference in complications (27% vs. 23%, 95% confidence interval of the odds ratio (CIOR) 0.5 to 3.2), fibular-specific complications (6% vs. 10%, CIOR 0.1 to 3.5), revision surgeries (4% vs. 4%, CIOR 0.1 to 7.5), or symptomatic fibula implant removals (13% vs. 21%, CIOR 0.1 to 1.6) between pilon and ankle fracture groups, respectively. There was one (2%) fibular nonunion and one wound complication (2%) in each of the fracture groups. CONCLUSION Fibula IMN fixation of pilon versus ankle fractures resulted in a similar number of complications. Comparative studies of fibula IMN and plate fixation are necessary to determine if the benefits of fibula IMN in ankle fractures extends to pilon fractures. LEVEL OF EVIDENCE Level III, retrospective cohort.
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Affiliation(s)
- Rachel M. Faber
- Department of Orthopaedics, Orlando Health, Orlando, FL, USA
| | - Joshua A. Parry
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, USA,Corresponding author. Denver Health, 777 Bannock St, MC 0188, Denver, CO, 80204, USA.
| | | | - Kenneth J. Koval
- Department of Orthopaedics, Memorial Hospital, Gulfport, MS, USA
| | - Joshua L. Langford
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, USA
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Rydberg EM, Zorko T, Sundfeldt M, Möller M, Wennergren D. Classification and treatment of lateral malleolar fractures - a single-center analysis of 439 ankle fractures using the Swedish Fracture Register. BMC Musculoskelet Disord 2020; 21:521. [PMID: 32758193 PMCID: PMC7409659 DOI: 10.1186/s12891-020-03542-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023] Open
Abstract
Background The decision regarding which trans syndesmotic ankle fractures to treat surgically and which to treat non-surgically is a matter of debate. The aim of this study was to describe the epidemiology of ankle fractures treated at Sahlgrenska University Hospital (SU) during a 2-year period and analyze the current diagnostic process, classification and choice of treatment for lateral malleolar fractures at the level of the syndesmosis. Methods Observational data regarding all ankle fractures treated at SU between 1 April 2012 and 31 March 2014 was collected from the Swedish Fracture Register. For identified AO/OTA44-B1 fractures, medical records and radiographs were reviewed and analyzed. Results The study included 1332 ankle fractures. 838 (63%) were B-fractures and 512 (38%) of these were B1 fractures. 439 of the patients with B1 fractures were included in the detailed study and of these 309 (70%) were treated non-surgically and 130 patients (30%) surgically. According to the preoperative physical examination described in the medical records, medial tenderness was found in 73 (24%) of the non-surgically treated patients. Among the surgically treated patients 18% (n = 24) were found to have no medial tenderness. For the non-surgically treated patients with medial tenderness, the treatment plan was changed to surgical treatment after the 1-week radiographic follow-up in 1 patient (1%) and 1 patient (1%) was treated surgically after 3 months due to non-union. Conclusions The current study demonstrates the difficulty involved in distinguishing whether or not a trans-syndesmotic lateral malleolar fracture has an associated medial ligament injury or not. As this distinguishes if the fracture is stable or not it affects the choice of subsequent treatment. The results of the study also indicate a lack of consensus on how to classify and treat lateral malleolar fractures at the level of the syndesmosis. The study further suggests that there is no need to check non-surgically treated stable fractures with follow-up radiographic examination at 1 week.
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Affiliation(s)
- Emilia Möller Rydberg
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Orthopaedics, Sahlgrenska University Hospital, Göteborgsvägen 31, SE-431 80, Gothenburg/Mölndal, Sweden.
| | - Tina Zorko
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Sundfeldt
- Department of Orthopaedics, Sahlgrenska University Hospital, Göteborgsvägen 31, SE-431 80, Gothenburg/Mölndal, Sweden
| | - Michael Möller
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Göteborgsvägen 31, SE-431 80, Gothenburg/Mölndal, Sweden
| | - David Wennergren
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Göteborgsvägen 31, SE-431 80, Gothenburg/Mölndal, Sweden
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