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Olías-López B, Boluda-Mengod J, Rendón-Díaz D, Ojeda-Jiménez J, Martín-Herrero A, Morales-Mata E, Herrera-Pérez M. Fractures of the peroneal malleolus: Current concepts. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:502-512. [PMID: 38885878 DOI: 10.1016/j.recot.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024] Open
Abstract
Ankle fractures represent up to 9% of all fractures, with an increased incidence in the elderly population. Among these fractures, isolated fractures of the lateral malleolus are the most common, representing 65-70% of all cases. The therapeutic decision-making primarily relies on the stability of the ankle ring, considering it stable if affected at one point and unstable if two or more points are affected. Surgical treatment focuses on restoring the length of the fibula, joint reconstruction, stabilizing the syndesmosis, and providing a stable fixation. It is crucial to rule out associated injuries that may influence therapeutic management. This article reviews the evaluation and management of lateral malleolus fractures, proposes a decision-making algorithm, and examines several fibular fixation options.
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Affiliation(s)
- B Olías-López
- Unidad de Trauma, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Islas Canarias, España.
| | - J Boluda-Mengod
- Unidad de Trauma, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Islas Canarias, España
| | - D Rendón-Díaz
- Unidad de Pie y Tobillo, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Islas Canarias, España
| | - J Ojeda-Jiménez
- Unidad de Pie y Tobillo, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Islas Canarias, España
| | - A Martín-Herrero
- Unidad de Trauma, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Islas Canarias, España
| | - E Morales-Mata
- Unidad de Trauma, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Islas Canarias, España
| | - M Herrera-Pérez
- Unidad de Pie y Tobillo, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Islas Canarias, España
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2
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Olías-López B, Boluda-Mengod J, Rendón-Díaz D, Ojeda-Jiménez J, Martín-Herrero A, Morales-Mata E, Herrera-Pérez M. [Translated article] Fractures of the peroneal malleolus: Current concepts. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T502-T512. [PMID: 39053809 DOI: 10.1016/j.recot.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 06/14/2024] [Indexed: 07/27/2024] Open
Abstract
Ankle fractures represent up to 9% of all fractures, with an increased incidence in the elderly population. Among these fractures, isolated fractures of the lateral malleolus are the most common, representing 65-70% of all cases. The therapeutic decision-making primarily relies on the stability of the ankle ring, considering it stable if affected at one point and unstable if two or more points are affected. Surgical treatment focuses on restoring the length of the fibula, joint reconstruction, stabilising the syndesmosis, and providing a stable fixation. It is crucial to rule out associated injuries that may influence therapeutic management. This article reviews the evaluation and management of lateral malleolus fractures, proposes a decision-making algorithm, and examines several fibular fixation options.
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Affiliation(s)
- B Olías-López
- Unidad de Trauma, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Canary Islands, Spain.
| | - J Boluda-Mengod
- Unidad de Trauma, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Canary Islands, Spain
| | - D Rendón-Díaz
- Unidad de Pie y Tobillo, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Canary Islands, Spain
| | - J Ojeda-Jiménez
- Unidad de Pie y Tobillo, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Canary Islands, Spain
| | - A Martín-Herrero
- Unidad de Trauma, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Canary Islands, Spain
| | - E Morales-Mata
- Unidad de Trauma, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Canary Islands, Spain
| | - M Herrera-Pérez
- Unidad de Pie y Tobillo, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Canary Islands, Spain
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3
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Epperly S, Nedley A, Chung JH, Rodrigues E, Johnson J. Use of locking fibular plates versus non-locking dual plate fixation: A biomechanical study. J Clin Orthop Trauma 2024; 53:102439. [PMID: 39036509 PMCID: PMC11260034 DOI: 10.1016/j.jcot.2024.102439] [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: 09/27/2023] [Revised: 03/31/2024] [Accepted: 06/05/2024] [Indexed: 07/23/2024] Open
Abstract
Introduction Distal fibula osteoporotic comminuted fractures are challenging to treat and are often treated with periarticular locking plates. This study examined the biomechanical difference between locked plating and dual non-locked one-third tubular plating. Methods Using an osteoporotic Sawbones fibula model, simulated fracture were fixated with one-third tubular dual plating and locked periarticular plating. The samples were then torqued to failure and peak torque, stiffness, and displacement were recorded. Results The peak torque of the dual plating group was found to be statistically higher than the periarticular locked plating group (0.841 Nm and 0.740 Nm respectively; p = 0.024). However overall stiffness calculated at each 10° increment of displacement was noted to have no significant difference between the two constructs. Conclusion Dual non-locked plating of distal fibula osteoporotic comminuted fractures is biomechanically equivalent to locked periarticular plating.
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Affiliation(s)
| | - Allen Nedley
- Loma Linda University Department of Orthopaedics, Loma Linda, CA, United States
| | - Jun Ho Chung
- Loma Linda University Department of Orthopaedics, Loma Linda, CA, United States
| | - Evelyn Rodrigues
- Loma Linda University Department of Orthopaedics, Loma Linda, CA, United States
| | - Joseph Johnson
- University of Alabama Birmingham Department of Orthopaedics, Birmingham, AL, United States
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4
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Yurteri A, Mercan N, Gem K, Bilgiç A, Kiliç M, Doğar F. Single-plate versus double-plate comparison in the surgical treatment of comminuted clavicle fractures: Is the secondary plate reliable? Medicine (Baltimore) 2023; 102:e36711. [PMID: 38134057 PMCID: PMC10735136 DOI: 10.1097/md.0000000000036711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
The objective of this study is to retrospectively assess the use of single-plate (SP) and double-plate (DP) fixation in the open reduction and internal fixation of comminuted clavicle fractures, focusing on fracture union and complications. We retrospectively evaluated comminuted diaphyseal clavicle fractures (Arbeitsgemeinschaft für Osteosynthesefragen type 15.B1-3) treated with open reduction and internal fixation and having a minimum 1-year follow-up. Two patient cohorts were identified: DP (utilizing a superiorly located clavicle-specific plate and an anteriorly located tubular plate) and SP (utilizing a superiorly located clavicle-specific plate). These groups were compared in terms of union time, peri-incisional numbness, implant irritation, return to work time, union rates, re-operation rates, Disabilities of Arm, Shoulder and Hand (DASH), and American Shoulder and Elbow Surgeons (ASES) scores. The study included 27 SP and 23 DP patients meeting the inclusion criteria. There was no significant difference between the 2 cohorts in terms of union time, peri-incisional numbness, implant irritation, return to work time, union rates, re-operation rates, DASH, and ASES scores at the end of the first year (P = .889, P = 1.00, P = .122, P = 1.00, P = 1.00, P = .493, P = .736, P = .762, P = .937 respectively). However, it was observed that the DP group showed a significantly earlier return to work time and better DASH scores at 3rd and 6th months, whereas the SP group exhibited significantly better ASES scores at 3rd and 6th months (P = .034, P = .016, P = .032, P = .036, P = .021, respectively). No significant difference was observed in terms of union and complications in acute clavicle fractures treated with SP and DP fixation. The DP group demonstrated an earlier return to work and superior early functional scores compared to the SP group. Our findings suggest that a secondary plate can be reliably used, particularly in situations where clavicle fracture fixation is insufficient or in cases of comminuted clavicle fractures.
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Affiliation(s)
- Ahmet Yurteri
- Department of Orthopaedic and Traumatology, Konya City Hospital, Konya, Turkey
| | - Numan Mercan
- Department of Orthopaedic and Traumatology, Necip Fazil City Hospital, Kahramanmaras, Turkey
| | - Kadir Gem
- Department of Orthopaedic and Traumatology, Manisa Alaşehir State Hospital, Manisa, Turkey
| | - Abdulkadir Bilgiç
- Department of Orthopaedic and Traumatology, Manisa City Hospital, Manisa, Turkey
| | - Mehmet Kiliç
- Department of Orthopaedic and Traumatology, Konya City Hospital, Konya, Turkey
| | - Fatih Doğar
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
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DOUBLE PLATING FOR FRACTURES IN GIANT ANTEATERS ( MYRMECOPHAGA TRIDACTYLA). J Zoo Wildl Med 2021; 52:366-372. [PMID: 33827200 DOI: 10.1638/2020-0164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 11/21/2022] Open
Abstract
The fixation of fractures in wild animals has been a great challenge for veterinarians, because they will inevitably face a unique anatomical characteristic with scarce studies or reports published. Fracture fixation should promote adequate stability and early return to limb function, taking into account biomechanical characteristics of the bones, body weight, and natural habits of wildlife. Three bone fractures from two giant anteaters (Myrmecophaga tridactyla) referred at the veterinary teaching hospital on different occasions were treated by a double plating technique. The two free-ranging anteaters incurred their injuries when struck by an automobile. The first anteater (Ant 1) had a complete oblique fracture of the proximal third of the right femur and a complete comminuted fracture of the distal third of the right tibia. Surgical stabilization was performed by double plating to stabilize the femur and tibia. The second anteater (Ant 2) had a complete transverse fracture of the mid-diaphysis of the right radius and ulna, and it was fixed with a medial plate on the radius and a caudal plate on the ulna. The patients were able to walk 24 hr after the surgical procedures. Bone consolidation was observed at 60 days postoperatively, with no complications. The biggest challenges were related to anatomical characteristics for surgical approaches and the ability to promote a fixation strong enough to support the weight and strength of the animal, allowing early return to limb function.
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6
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Ochman S, Raschke MJ. [Ankle fractures in older patients : What should we do differently?]. Unfallchirurg 2021; 124:200-211. [PMID: 33566120 DOI: 10.1007/s00113-021-00953-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 02/07/2023]
Abstract
As a result of the demographic developments ankle fractures in older patients are part of routine trauma surgery. Due to comorbidities, such as diabetes mellitus, reduced bone quality and limited compliance in follow-up treatment, these fractures are prone to complications. The primary goal in the treatment of older patients with ankle fractures is to maintain mobility. In contrast to young patients most fractures are unstable pronation-abduction injuries. In the diagnostics the recognition and optimization of factors influencing the outcome, such as the blood perfusion and the generous use of computed tomography (CT) are recommended. As in the case of younger patients, conservative treatment is reserved for stable fracture forms and, if there are contraindications, should also be initiated in the case of unstable injuries. The choice of approaches is different for surgical treatment, which is adapted to the soft tissues, if necessary minimally invasive and increasingly carried out by a posterolateral approach. The initial transfixation can reduce soft tissue problems. Special surgical techniques and implants that provide a high level of stability, such as dorsal plate positioning, hook plates, angular stable plate systems and intramedullary systems as well as additional options, such as tibia pro fibula constructs are used. Primary retrograde nail arthrodesis is reserved as a salvage procedure only for exceptional cases. As part of the follow-up treatment, an interdisciplinary approach with respect for and optimization of concomitant diseases seems to make sense.
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Affiliation(s)
- Sabine Ochman
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert Schweitzer Campus 1, Gebäude W1, Waldeyerstr. 1, 48149, Münster, Deutschland.
| | - Michael J Raschke
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert Schweitzer Campus 1, Gebäude W1, Waldeyerstr. 1, 48149, Münster, Deutschland
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7
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Dual Mini-Fragment Plating Is Comparable With Precontoured Small Fragment Plating for Operative Diaphyseal Clavicle Fractures: A Retrospective Cohort Study. J Orthop Trauma 2020; 34:e229-e232. [PMID: 31868765 DOI: 10.1097/bot.0000000000001727] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare precontoured (Pc) small fragment plating to dual mini-fragment plating (DmF) for open reduction and internal fixation of diaphyseal clavicle fractures. DESIGN Retrospective cohort. SETTING Level 1 trauma center. PATIENTS/PARTICIPANTS A total of 133 patients with displaced fractures of the diaphyseal clavicle (OTA/AO 15-B1, -2, and -3) treated with open reduction and internal fixation with a minimum of 1 year follow-up or until radiographic and clinical union. INTERVENTION Two patient cohorts were identified: (1) patients treated with orthogonal DmF plate constructs and (2) patients treated with Pc clavicle-specific plates. OUTCOME MEASUREMENTS Union rate and implant removal were assessed using standard descriptive statistics. Odds ratios, 95% confidence intervals, and P values (P) were calculated. RESULTS There were 60 DmF and 74 Pc patients. There were no significant differences between groups with respect to age, sex, surgeon, body mass index, or mode of fixation. There was no significant difference in union (98.3% DmF; 100% Pc, P = 0.45) or maintenance of reduction (98.3% DmF; 100% Pc, P = 0.45). A total of 8% of DmF patients had symptomatic implant removal compared with 20% of Pc patients (odds ratio 0.36, confidence interval 0.12-1.05, P = 0.061). CONCLUSIONS This retrospective comparative study found no difference in union or maintenance of reduction for diaphyseal clavicle fractures fixed with DmF compared with Pc plating. Patients treated with DmF plates may have lower rates of symptomatic implant removal. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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8
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Agarwala S, Menon A, Bhadiyadra R. Twisted Plating - A Method of Distal Fibula Fixation. Rev Bras Ortop 2020; 55:33-39. [PMID: 32123444 PMCID: PMC7048577 DOI: 10.1055/s-0039-1700820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 11/06/2018] [Indexed: 10/31/2022] Open
Abstract
Objective The literature entails various intramedullary and extramedullary methods for distal fibula fracture fixation; with no consensus yet over the ideal method of fixation. We have retrospectively analyzed the results of using a twisted and contoured 3.5 mm locking compression plate (LCP) as a posterior buttress plate. Methods Of the 62 cases with ankle fractures managed at our institute by the senior author from 1 st January 2012 to 31 st December 2015, 41 patients met our inclusion criteria (Danis-Weber types B and C). Results All 41 distal fibular fractures healed uneventfully, at a mean of 10.4 weeks (8-14 weeks) (Figs. 6, 7, 8 to 9) with no complications. The mean American Orthopaedic Foot & Ankle Society (AOFAS) score was 92.6 (86-100) at a mean follow-up of 31.5 months (14-61 months). Conclusions We have achieved excellent clinical and radiological outcomes using a twisted 3.5 mm LCP as a posterior buttress by combining the advantages of posterior antiglide plating and lateral LCP.
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Affiliation(s)
- Sanjay Agarwala
- Departamento de Ortopedia, Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim (West), Mumbai, Maharashtra, Índia
| | - Aditya Menon
- Departamento de Ortopedia, Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim (West), Mumbai, Maharashtra, Índia
| | - Ravi Bhadiyadra
- Departamento de Ortopedia, Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim (West), Mumbai, Maharashtra, Índia
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9
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Tantigate D, Ho G, Kirschenbaum J, Bäcker HC, Asherman B, Freibott C, Greisberg JK, Vosseller JT. Functional Outcomes After Fracture-Dislocation of the Ankle. Foot Ankle Spec 2020; 13:18-26. [PMID: 30712370 DOI: 10.1177/1938640019826701] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Fracture dislocation of the ankle represents a substantial injury to the bony and soft tissue structures of the ankle. There has been only limited reporting of functional outcome of ankle fracture-dislocations. This study aimed to compare functional outcome after open reduction internal fixation in ankle fractures with and without dislocation. Methods. A retrospective chart review of surgically treated ankle fractures over a 3- year period was performed. Demographic data, type of fracture, operative time and complications were recorded. Of 118 patients eligible for analysis, 33 (28%) sustained a fracture-dislocation. Mean patient age was 46.6 years; 62 patients, who had follow-up of at least 12 months, were analyzed for functional outcome assessed by the Foot and Ankle Outcome Score (FAOS). The median follow-up time was 37 months. Demographic variables and FAOS were compared between ankle fractures with and without dislocation. Results. The average age of patients sustaining fracture-dislocation was greater (53 vs 44 years, P = .017); a greater percentage were female (72.7% vs 51.8%, P = .039) and diabetic (24.2% vs 7.1%, P = .010). Wound complications were similar between both groups. FAOS was generally poorer in the fracture-dislocation group, although only the pain subscale demonstrated statistical significance (76 vs 92, P = .012). Conclusion. Ankle fracture-dislocation occurred more frequently in patients who were older, female, and diabetic. At a median of just > 3-year follow-up, functional outcomes in fracture-dislocations were generally poorer; the pain subscale of FAOS was worse in a statistically significant fashion. Levels of Evidence: Therapeutic, Level III.
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Affiliation(s)
- Direk Tantigate
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York (DT, GH, JK, HCB, BA, CF, JKG, JTV).,Department of Orthopaedic Surgery, Siriraj Hospital Mahidol University, Bangkok, Thailand (DT)
| | - Gavin Ho
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York (DT, GH, JK, HCB, BA, CF, JKG, JTV).,Department of Orthopaedic Surgery, Siriraj Hospital Mahidol University, Bangkok, Thailand (DT)
| | - Joshua Kirschenbaum
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York (DT, GH, JK, HCB, BA, CF, JKG, JTV).,Department of Orthopaedic Surgery, Siriraj Hospital Mahidol University, Bangkok, Thailand (DT)
| | - Henrik C Bäcker
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York (DT, GH, JK, HCB, BA, CF, JKG, JTV).,Department of Orthopaedic Surgery, Siriraj Hospital Mahidol University, Bangkok, Thailand (DT)
| | - Benjamin Asherman
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York (DT, GH, JK, HCB, BA, CF, JKG, JTV).,Department of Orthopaedic Surgery, Siriraj Hospital Mahidol University, Bangkok, Thailand (DT)
| | - Christina Freibott
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York (DT, GH, JK, HCB, BA, CF, JKG, JTV).,Department of Orthopaedic Surgery, Siriraj Hospital Mahidol University, Bangkok, Thailand (DT)
| | - Justin K Greisberg
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York (DT, GH, JK, HCB, BA, CF, JKG, JTV).,Department of Orthopaedic Surgery, Siriraj Hospital Mahidol University, Bangkok, Thailand (DT)
| | - J Turner Vosseller
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York (DT, GH, JK, HCB, BA, CF, JKG, JTV).,Department of Orthopaedic Surgery, Siriraj Hospital Mahidol University, Bangkok, Thailand (DT)
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10
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Sain A, Garg S, Sharma V, Meena UK, Bansal H. Osteoporotic Distal Fibula Fractures in the Elderly: How To Fix Them. Cureus 2020; 12:e6552. [PMID: 31942269 PMCID: PMC6942499 DOI: 10.7759/cureus.6552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Osteoporotic fractures of the distal fibula in elderly patients is a challenge to manage. Non-operative management has a poor outcome so operative management is preferred. There are a variety of options for operative management such as locked plate systems, anti-glide plate construct, dual plating constructs, fibula nail, plate with tibial pro-fibular screws, and injectable bone cement (polymethylmethacrylate (PMMA), calcium phosphate). However, no clear guidelines exist for the operative management of osteoporotic distal fibula fractures. The surgeon should detect osteoporotic fractures early to make the best use of resources and avoid complications such as implant failure.
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Affiliation(s)
- Arnab Sain
- Orthopaedics, All India Institute of Medical Sciences, New Delhi, IND
| | - Sitender Garg
- Orthopaedics, All India Institute of Medical Sciences, New Delhi, IND
| | - Vijay Sharma
- Orthopaedics, All India Institute of Medical Sciences, New Delhi, IND
| | - Umesh K Meena
- Orthopaedics, All India Institute of Medical Sciences, New Delhi, IND
| | - Hemant Bansal
- Orthopaedics, All India Institute of Medical Sciences, New Delhi, IND
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11
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Tantigate D, Ho G, Kirschenbaum J, Bäcker H, Asherman B, Freibott C, Greisberg JK, Vosseller JT. Timing of Open Reduction and Internal Fixation of Ankle Fractures. Foot Ankle Spec 2019; 12:401-408. [PMID: 30426777 DOI: 10.1177/1938640018810419] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Unstable ankle fractures are treated with open reduction internal fixation (ORIF) to prevent posttraumatic arthritis. Typically, ORIF is performed as an ambulatory surgery several days to a few weeks after injury. It is unclear what effect this delay may have on functional outcome. This study aimed to assess the effect of timing of ankle ORIF on wound complications and functional outcome. Methods. A retrospective review of 121 patients who underwent ankle ORIF was performed. A total of 58 patients had a follow-up of at least 24 months. Time between injury and surgery greater than 14 days was defined as "delayed." Demographic variables, injury characteristics, length of surgery, and postoperative stay were documented. Comparison of demographic variables, wound complications, and functional outcome determined by Foot and Ankle Outcome Score (FAOS) was performed. Results. 118 patients were included. The duration between injury and surgery was 6 days in the "early" group and 19 days in the "delayed" group. There were no significant differences in demographic variables, injury characteristics, and length of surgery between the groups. Wound complications in the early and delayed groups were 5% and 11.8%, although this difference was not statistically significant. Among 58 patients who had a follow-up of at least 24 months, the median follow-up time was 38 (range, 24-76) months. Each subscale of FAOS demonstrated no significant difference. Conclusion. Ankle ORIF more than 14 days after injury did not significantly increase the rate of wound complication, nor did it impair ultimate functional outcome in this group. Levels of Evidence: Level III.
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Affiliation(s)
- Direk Tantigate
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY (DT, GH, JK, HB, BA, CF, JKG, JTV).,Department of Orthopaedic Surgery, Siriraj Hospital Mahidol University, Bangkok, Thailand (DT)
| | - Gavin Ho
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY (DT, GH, JK, HB, BA, CF, JKG, JTV).,Department of Orthopaedic Surgery, Siriraj Hospital Mahidol University, Bangkok, Thailand (DT)
| | - Joshua Kirschenbaum
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY (DT, GH, JK, HB, BA, CF, JKG, JTV).,Department of Orthopaedic Surgery, Siriraj Hospital Mahidol University, Bangkok, Thailand (DT)
| | - Henrik Bäcker
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY (DT, GH, JK, HB, BA, CF, JKG, JTV).,Department of Orthopaedic Surgery, Siriraj Hospital Mahidol University, Bangkok, Thailand (DT)
| | - Benjamin Asherman
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY (DT, GH, JK, HB, BA, CF, JKG, JTV).,Department of Orthopaedic Surgery, Siriraj Hospital Mahidol University, Bangkok, Thailand (DT)
| | - Christina Freibott
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY (DT, GH, JK, HB, BA, CF, JKG, JTV).,Department of Orthopaedic Surgery, Siriraj Hospital Mahidol University, Bangkok, Thailand (DT)
| | - Justin K Greisberg
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY (DT, GH, JK, HB, BA, CF, JKG, JTV).,Department of Orthopaedic Surgery, Siriraj Hospital Mahidol University, Bangkok, Thailand (DT)
| | - J Turner Vosseller
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY (DT, GH, JK, HB, BA, CF, JKG, JTV).,Department of Orthopaedic Surgery, Siriraj Hospital Mahidol University, Bangkok, Thailand (DT)
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12
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Randall RM, Nagle T, Steckler A, Billow D, Berkowitz MJ. Dual Nonlocked Plating as an Alternative to Locked Plating for Comminuted Distal Fibula Fractures: A Biomechanical Comparison Study. J Foot Ankle Surg 2019; 58:916-919. [PMID: 31345755 DOI: 10.1053/j.jfas.2019.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Indexed: 02/06/2023]
Abstract
The purpose of this cadaveric study was to compare the biomechanical properties of dual nonlocked plating and single-locked plating using matched pairs of isolated fibula specimens. Fractures were simulated in 10 matched pairs of isolated cadaveric fibulae and plated with a single lateral locking plate for right-sided specimens, or with a one-third tubular plate and a 7-hole 2.4-mm minifragment adaption plate for left-sided specimens. An external rotation torque was applied at a rate of 1°/second, and torque at 10° was measured. Each fibula specimen was evaluated using a micro computed tomography scanner, and bone mineral density was calculated as milligrams of bone per cubic centimeter of volume. Dual nonlocked plating and locked plating specimens demonstrated torque measurements that were not significantly different at 10° of external rotation (1.48 N·m and 1.92 N·m, respectively; p = .093). The stiffness of the dual nonlocked plated and locked plating constructs were not significantly different (p = .228 and p = .543, respectively). The effect of bone mineral density on maximum torque at failure was not a reliable predictor of maximum torque in either the dual nonlocked plating or locked plating specimens (R2 = 0.548 and R2 = 0.096, respectively). We found no differences in torque at 10° of external rotation or stiffness between locking plate and dual nonlocking plate fixation constructs. This study provides evidence that dual nonlocked plating likely constitutes adequate fixation in situations in which a locking plate is being considered for comminuted distal fibula fractures.
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Affiliation(s)
- Rachel M Randall
- Orthopaedic Surgery Resident, Department of Orthopaedics and Rheumatology, Cleveland Clinic Foundation, Cleveland, OH.
| | - Tara Nagle
- Principle Biomechanical Research Engineer, Biomechanical Engineering Department, Cleveland Clinic Foundation, Cleveland, OH
| | - Andrew Steckler
- Director of Orthopaedic Skills Laboratory, Biomechanical Engineering Department, Cleveland Clinic Foundation, Cleveland, OH
| | - Damien Billow
- Center Director for Trauma, Department of Orthopaedics and Rheumatology, Cleveland Clinic Foundation, Cleveland, OH
| | - Mark J Berkowitz
- Center Director for Foot and Ankle Surgery, Department of Orthopaedics and Rheumatology, Cleveland Clinic Foundation, Cleveland, OH
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Hsu RY, Ramirez JM, Blankenhorn BD. Surgical Considerations for Osteoporosis in Ankle Fracture Fixation. Orthop Clin North Am 2019; 50:245-258. [PMID: 30850082 DOI: 10.1016/j.ocl.2018.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
As the geriatric population and associated ankle fractures continues to increase, fracture surgeons should be prepared to surgically manage osteoporotic ankle fractures. There are abundant challenges in management, soft tissue care, and fixation of ankle fractures with poor bone quality especially in elderly patients who have difficulty limiting weight bearing. This article summarizes several different surgical techniques that can be used to optimize outcomes of these fractures.
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Affiliation(s)
- Raymond Y Hsu
- Department of Orthopedic Surgery, The Warren Alpert Medical School at Brown University, 1 Kettle Point Avenue, East Providence, RI 02915, USA.
| | - Jose M Ramirez
- Department of Orthopedic Surgery, The Warren Alpert Medical School at Brown University, 593 Eddy Street, Providence, RI 02903, USA
| | - Brad D Blankenhorn
- Department of Orthopedic Surgery, The Warren Alpert Medical School at Brown University, 1 Kettle Point Avenue, East Providence, RI 02915, USA
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