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Greenhill DA, Mundluru SN, Gomez RW, Romero J, Riccio AI. Metaphyseal Fracture Displacement is Predictive of Intra-articular Diastasis in Adolescent Triplane Ankle Fractures. J Pediatr Orthop 2024; 44:94-98. [PMID: 37779308 DOI: 10.1097/bpo.0000000000002530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
BACKGROUND Triplane fractures are rare enough that large homogeneous series to support management decisions are lacking. During initial evaluation, the addition of computed tomography (CT) to conventional X-rays (XR) does not always alter the patient's clinical course. Therefore, routine use of CT is controversial. This study aims to: (1) clarify quantitative relationships between articular displacement measured on XR versus CT and (2) identify whether metaphyseal displacement on the lateral XR predicts clinically relevant articular displacement on a CT scan. METHODS A 10-year retrospective review of consecutive triplane fractures was performed at a level 1 pediatric trauma center. Maximum articular and metaphyseal displacement were recorded from XR and CT. Quantitative relationships between XR and CT measurements were compared among imaging modalities and radiographically operative versus nonoperative fractures. RESULTS Eighty-seven patients met the inclusion criteria. XR underestimated articular displacement by 229% in the sagittal plane (1 mm on XR vs 3.3 mm on CT; P < 0.05) and 17% in the coronal plane (2.3 mm on XR vs 2.7 mm on CT; P < 0.05). XR underestimated articular step-off by 184% in the coronal plane and 177% in the sagittal plane ( P < 0.05). CT measurements more often differentiated patients who did or did not undergo surgery at our institution. Metaphyseal displacement was significantly higher in patients with traditionally operative articular displacement (≥2.5 mm on CT) versus those with articular displacement below traditionally operative thresholds (2.4 vs 0.9 mm, P = 0.001). Sixty patients had metaphyseal displacement >1 mm on the lateral XR, of whom 56 had surgical-magnitude articular displacement (≥2.5 mm) on CT (positive predictive value = 94%). CONCLUSIONS Conventional radiographs underestimate the true articular displacement of triplane fractures. Surgical-magnitude articular step-off is rare, and the largest articular gap is usually visualized on the axial CT image. Metaphyseal displacement >1 mm, which is easily measured on a lateral XR, is strongly predictive of clinically relevant articular displacement on CT. This radiographic finding should prompt advanced imaging before proceeding with nonoperative management. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Dustin A Greenhill
- Department of Orthopaedic Surgery, St. Luke's University Health Network, Bethlehem, PA
| | - Surya N Mundluru
- Department of Orthopedic Surgery, University of Texas Houston McGovern School of Medicine, Houston
| | - Robert W Gomez
- Department of Orthopaedic Surgery, St. Luke's University Health Network, Bethlehem, PA
| | - Joseph Romero
- Department of Orthopedic Surgery, University of Texas Southwestern
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Kocan J, Joseph E, Mercado P, Haider MN, Pavlesen S, Rohrbacher B. Computed Tomography Scans and Fixation Rates for Trimalleolar Ankle Fractures Over 10 Years at a Level 1 Trauma Center. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114231216984. [PMID: 38223655 PMCID: PMC10785731 DOI: 10.1177/24730114231216984] [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] [Indexed: 01/16/2024] Open
Abstract
Background The posterior malleolus component of the trimalleolar ankle fracture has posed a controversial topic for diagnostic imaging and surgical management. Preoperative computed tomography (CT) scans are used to better appreciate fracture morphology and may affect management techniques. No prior study has investigated the trend in preoperative CT scan use and the rates of posterior and syndesmotic fixation for trimalleolar injuries. Methods This retrospective cohort study evaluated the use of preoperative CT scans and the rates of posterior and syndesmotic fixation for trimalleolar ankle fractures over a 10-year period at an adult level 1 trauma center. Patients surgically managed for ankle fractures with OTA/AO classifications of 44B3, 44C3.3, 44C1.3, 44C2.3, and 44A3 were identified and included using Current Procedural Terminology codes and a prospectively collected fracture registry. Demographic information, comorbidities, fixation methods, and use of preoperative CT scan were recorded. Comparative analyses were performed to assess for yearly differences in demographic characteristics along with changes in trends of preoperative CT scans and posterior and syndesmotic fixation. Results A total of 1191 patients were included in the analyses. OTA/AO 44B3.2 fractures were the most common injuries (yearly range of 59.4%-80.1%). The rate of posterior fixation did not significantly increase during the study interval (1.4% growth per year [95% CI -0.27, 3.07]). However, the rate of preoperative CT scan use significantly increased by 2.76% (95% CI 1.99, 3.52) per year and the rate of syndesmotic fixation increased by 2.58% (95% CI 1.17, 3.99) per year. Fixation methods for both the syndesmosis and posterior malleolus changed during the study timeline. Conclusion Despite a relatively stable rate of posterior fixation, the frequency of preoperative CT scans and use of syndesmotic fixation increased significantly over a 10-year study period. Level of Evidence Level IV, descriptive pilot study.
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Affiliation(s)
- Joseph Kocan
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Elias Joseph
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Paul Mercado
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Mohammad N. Haider
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Sonja Pavlesen
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Bernard Rohrbacher
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
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Heldt B, Roepe I, Guo R, Attia E, Inneh I, Shenava V, Kushare I. All-epiphyseal versus trans-epiphyseal screw fixation for tillaux fractures: Does it matter? World J Orthop 2022; 13:131-138. [PMID: 35317400 PMCID: PMC8891663 DOI: 10.5312/wjo.v13.i2.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/05/2021] [Accepted: 01/12/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tillaux fractures occur primarily in adolescents due to the pattern of physeal closure and are classified as Salter-Harris type III physeal fractures. Operative management with screw fixation is recommended for more than 2 mm of displacement or more than 1 mm of translation. However, the efficacy and complications of trans-physeal vs all-physeal screw fixation have not been investigated extensively.
AIM To compare the clinical and functional outcomes of trans-physeal (oblique) and all-epiphyseal (parallel) screw fixation in management of Tillaux fractures among pediatric patients.
METHODS This was an ethics board approved retrospective review of pediatric patients who presented to our tertiary children’s care facility with Tillaux fractures. We included patients who had surgical fixation of a Tillaux fracture over a 10 year period. Data analysis included demographics, mode of injury, management protocols, and functional outcomes. The patients were divided into group 1 (oblique fixation) and group 2 (parallel fixation). Baseline patient characteristics and functional outcomes were compared between groups. Statistical tests to evaluate differences included Fisher’s Exact or Chi-squared and independent samples t or Mann Whitney tests for categorical and continuous variables, respectively.
RESULTS A total of 42 patients (28 females and 14 males) were included. There were no significant differences in body mass index, sex, age, or time to surgery between the groups [IK2]. Sports injuries accounted for 61.9% of the cases, particularly non-contact (57.1%) and skating (28.6%) injuries. Computed Tomography (CT) scan was ordered for 28 patients (66.7%), leading to diagnosis confirmation in 17 patients and change in management plan in 11 patients. [GRC3] Groups 1 and 2 consisted of 17 and 25 patients, respectively. For mid to long-term functional outcomes, there were 14 and 10 patients in groups 1 and 2, respectively. Statistical analysis revealed no significant differences in the functional outcomes, pain scores, or satisfaction between groups. No infections, non-unions, physeal arrest, or post-operative ankle deformities were reported. Two (4.8%) patients had difficulty returning to sports post-surgery due to pain. One was a dancer, and the other patient had pain while running, which led to hardware removal. Both patients had parallel fixation. Hardware removal for groups 1 and 2 were 4 (23.5%) and 5 (20.0%) patients, respectively. The reasons for removal was pain in 2 patients, and parental preference in the remaining.
CONCLUSION This is the largest reported series of pediatric patients with Tillaux fractures comparing functional outcomes of different methods of screw fixation orientation to the physis, which showed no difference regarding functional outcomes.
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Affiliation(s)
- Brett Heldt
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX 77030, United States
| | - Isaiah Roepe
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX 77030, United States
| | - Raymond Guo
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX 77030, United States
| | - Elsayed Attia
- Department of Orthopedic Surgery, Texas Children's Hospital, Houston, TX 77030, United States
| | - Ifeoma Inneh
- Department of Orthopedic Surgery, Texas Children's Hospital, Houston, TX 77030, United States
| | - Vinitha Shenava
- Department of Orthopedic Surgery, Texas Children's Hospital, Houston, TX 77030, United States
| | - Indranil Kushare
- Department of Orthopedic Surgery, Texas Children's Hospital, Houston, TX 77030, United States
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Clinical Outcomes of Triplane Fractures Based on Imaging Modality Utilization and Management: A Systematic Review and Meta-analysis. J Pediatr Orthop 2021; 40:e936-e941. [PMID: 32558744 DOI: 10.1097/bpo.0000000000001613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Because of the complex nature and relatively rare prevalence of triplane fractures, ideal imaging and optimal treatment remain controversial. The purpose of this investigation was to systematically review and compare clinical outcomes in skeletally immature patients with triplane fractures on the basis of imaging modalities [radiography alone vs. radiography+computed tomography (CT)] and fracture management (operative vs. nonoperative). METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement using a PRISMA checklist. All the literature related to skeletally immature patients with triplane fractures published from January 1988 to March 2020 were identified. Inclusion criteria consisted of skeletally immature patients with triplane fractures with reported imaging modality performed during diagnosis, fracture management, and postoperative outcomes on the basis of functional scores and the incidence of any complications. RESULTS A total of 11 articles met inclusion criteria, comprising a total of 203 skeletally immature patients with 203 documented triplane fractures. Male individuals were significantly older at the time of injury (14.2±0.6 y) when compared with female individuals (12.6±0.9 y) (P=0.006). Fracture diagnosis and management were evaluated using radiography+CT in 63% (128/203) of patients, whereas 37% (75/203) underwent radiography only. No significant differences in good/excellent Modified Weber Protocol scores were reported in patients treated nonoperatively versus those undergoing operative treatment (P=0.78), whereas Modified Weber Protocol scores were significantly higher in patients using radiography alone (P=0.02). No significant difference in complication incidence was reported on the basis of management type (nonoperative, 16%; operative, 15%; P=0.47). CONCLUSIONS Patients undergoing operative management of triplane fractures achieved comparable functional outcomes scores without an increased incidence of complications when compared with patients undergoing nonoperative treatment. Further investigations analyzing outcomes at middle and long-term follow-up are necessary to determine the clinical utility of CT and various treatment modalities for the management of triplane fractures. LEVEL OF EVIDENCE Level IV-Systematic review.
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Horn M, de Waal S, Kraak W. In-match penalty kick analysis of the 2009/10 to 2018/19 English Premier League competition. INT J PERF ANAL SPOR 2020. [DOI: 10.1080/24748668.2020.1855052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | | | - Wilbur Kraak
- Department of Sport Science, Faculty of Medicine and Health Science, Stellenbosch University, Matieland, Republic of South Africa
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Abstract
INTRODUCTION Paediatric ankle fractures represents about 5% of all paediatric fractures. It is the most common physis to be injured in the lower limb accounting to approximately 15-20% of all physeal injuries. This article reviews the literature on this common injury which still has many controversial areas and gives guidelines to management based on the existing evidence along with clinical experience gained from a Level I trauma center. CLASSIFICATION The original Salter-Harris Classification with the additional types is a good system to guide on the management. The transitional fractures form a separate group with technically two broad types-biplane and triplane injuries. Though there are many sub-types in this group with some popular eponymous fractures, the treatment principles remain the same. MANAGEMENT A very low threshold for CT scan is recommended when there is a clinical suspicion of fracture with a negative radiograph or an intra-articular fracture in the radiograph especially in the adolescent age group. CT scan helps in accurate quantification of the intra-articular displacement and also helps to comprehend the fracture geometry better. All the intra-articular fractures with displacement > 2 mm need perfect anatomical reduction and stabilization. Assisted closed reduction and percutaneous fixation along with arthrogram to confirm articular congruity is acceptable as long as the reduction is perfect. Irrespective of the method of treatment, in children with more than 2 years of growth remaining it is important to counsel regarding the high incidence of pre-mature physeal closure and the need for regular follow-up.
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Rammelt S, Boszczyk A. Computed Tomography in the Diagnosis and Treatment of Ankle Fractures: A Critical Analysis Review. JBJS Rev 2019; 6:e7. [PMID: 30562210 DOI: 10.2106/jbjs.rvw.17.00209] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Stefan Rammelt
- University Center for Orthopaedics & Traumatology, University Hospital Carl Gustav Carus at the TU Dresden, Dresden, Germany
| | - Andrzej Boszczyk
- Department of Traumatology and Orthopaedics, Centre of Postgraduate Medical Education, Prof. Adam Gruca Clinical Hospital, Otwock, Poland
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Schoeman R, Schall R. Team performance indicators as predictors of final log position and team success in Aviva Premiership, Guinness Pro 14, French Top 14 and Super Rugby. INT J PERF ANAL SPOR 2019. [DOI: 10.1080/24748668.2019.1655337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Riaan Schoeman
- Department of Exercise and Sport Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Robert Schall
- Department of Mathematical Statistics and Actuarial Science, Faculty of Natural and Agricultural Sciences, University of the Free State, Bloemfontein, South Africa
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Wang L, Liu X, Wu Z, Li L, Hu Y. [The treatment of Tillaux bone block in the Ruedi-Allgower type Ⅲ Pilon fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1308-1312. [PMID: 30215490 DOI: 10.7507/1002-1892.201710068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To analyze the importance and effectiveness of Tillaux bone block in Ruedi-Allgower type Ⅲ of Pilon fracture surgery. Method Twenty-one patients with Pilon fractures with Tillaux dislocation were treated between February 2010 and September 2013. There were 17 males and 4 females, aged from 28 to 68 years with an average age of 42.9 years. The causes of injury included falling from height in 13 cases, falls injury in 4 cases, crush injury in 2 cases, and sprained injury in 2 cases. X-ray film and CT examination showed that all 21 patients had fibula fracture and Tillaux bone block had obvious displacement. According to AO/OTA classification, there were 3 cases of type C1.2, 1 case of type C1.3, 10 cases of type C2, and 7 cases of type C3. The duration from injury to operation ranged from 4 to 31 days, with an average of 10 days. All cases of Pilon fracture were treated with open reduction and plate internal fixation. Steel plate or screw was used to fixation for Tillaux block; allograft bone graft was selected for compression of fracture. Results There were 2 cases of skin necrosis at the corner of wound after operation, and the wound healed after corresponding treatment; the wound healed at first intention in the other 19 cases. The effect of surgical reduction was evaluated by Burwell-Chamley imaging scoring system within 72 hours after operation, there were 19 cases of anatomical reduction and 2 cases of general reduction. All the 21 patients were followed up 18-48 months, with an average of 24.9 months. No complication such as nerve injury, loosening of internal fixation, or periprosthetic fracture was found during follow-up. All fractures obtained bone healing, which lasted from 4 to 8 months, with an average of 6 months. The ankle and hindfoot scores of the American Orthopaedic Foot and Ankle Society (AOFAS) were used to evaluate the ankle and hindfoot function at 1 year after operation or at last follow-up, the results were excellent in 13 cases, good in 6 cases, and fair in 2 cases, with an excellent and good rate of 90.5%. Internal fixator was removed from 19 patients at 15-19 months after operation. There were 17 cases of joint hyperplasia and 4 cases of osteoarthritis. All joint mobility was restored. The functional recovery of the ankle joint was evaluated according to the Olerud-Molander ankle fracture score standard, the results were good in 6 cases, fair in 8 cases, and poor in 7 cases at postoperative full weight training; and after 1 year of full weight training, the results were excellent in 10 cases, good in 3 cases, fair in 6 cases, and poor in 2 cases. Conclusion The Tillaux bone block is a reliable marker for the reduction of complex Pilon fractures. The reconstruction of the Tillaux can improve the effectiveness of complex Pilon fractures.
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Affiliation(s)
- Lei Wang
- The Fourth Trauma Department of Orthopedics, the Second Hospital of Tangshan, Tangshan Hebei, 063000,
| | - Xin Liu
- Rehabilitation Group of the Second Department of Neurosurgery, Tangshan City Workers Hospital, Tangshan Hebei, 063000, P.R.China
| | - Zhixin Wu
- The Fourth Trauma Department of Orthopedics, the Second Hospital of Tangshan, Tangshan Hebei, 063000, P.R.China
| | - Ligeng Li
- The Fourth Trauma Department of Orthopedics, the Second Hospital of Tangshan, Tangshan Hebei, 063000, P.R.China
| | - Yongcheng Hu
- Department of Orthopaedical Oncology, Tianjin Hospital, Tianjin, 300210, P.R.China
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Abstract
PURPOSE OF REVIEW Summarize classic and recent information regarding the unique subset of ankle fractures in children with open growth plates and share the authors' decision-making and surgical techniques. RECENT FINDINGS Recent research on pediatric ankle fractures has centered on the accurate prediction and prevention of growth arrest following fractures of the distal tibia. Another source of discussion is the necessity and benefit of CT scanning in classification and treatment approach. Pediatric ankle fractures continue to pose clinical challenges for orthopedic surgeons. While open anatomic reduction and internal fixation continue to produce good outcomes for intra-articular fractures, outcomes of physeal injuries are more difficult to predict. More studies are needed to determine which patients may benefit more from surgical treatment of physeal injuries.
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Affiliation(s)
- Z. Deniz Olgun
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA USA
| | - Stephanie Maestre
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA USA
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11
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Feng SM, Sun QQ, Wang AG, Li CK. "All-Inside" Arthroscopic Treatment of Tillaux-Chaput Fractures: Clinical Experience and Outcomes Analysis. J Foot Ankle Surg 2018; 57:56-59. [PMID: 29037924 DOI: 10.1053/j.jfas.2017.07.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Indexed: 02/03/2023]
Abstract
We investigated all-inside ankle arthroscopy for Tillaux-Chaput fractures. We retrospectively evaluated 19 patients (12 males [63.2%] and 7 [36.8%] females; 11 right [57.9%] and 8 left [42.1%] ankles) treated from May 2013 to January 2016. Their mean age was 28.1 (range 10 to 55) years. Sixteen (84.2%) had single Tillaux-Chaput fractures and 3 (15.8%) had combined proximal fibular fractures; 17 (89.5%) were diagnosed radiographically and 2 (10.5%) by computed tomography. Anterolateral and anteromedial ankle arthroscopy was used for closed reduction and internal fixation with 1 or 2 Herbert screws. Joint function was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale. All 19 patients healed by first intention without nerve, vessel, or tendon injuries. The follow-up was 19.0 (range 12 to 25) months; fracture union was achieved by 23.5 (range 12 to 36) weeks. At the last follow-up, the 19 patients had no restrictions in ankle function and range of motion, with no ankle or walking pain. The AOFAS score changed from 52.8 to 91.7 points, with an excellent/good rate of 100%. These results suggest that anterolateral and anteromedial all-inside ankle arthroscopy is a precise and effective method for closed reduction and internal fixation of Tillaux-Chaput fractures.
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Affiliation(s)
- Shi-Ming Feng
- Orthopaedic Surgeon, Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, China.
| | - Qing-Qing Sun
- Orthopaedic Surgeon, Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Ai-Guo Wang
- Orthopaedic Surgeon, Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, China; Professor of Medicine, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Cheng-Kun Li
- Orthopaedic Surgeon, Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, China
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Alluri RK, Hill JR, Donohoe S, Fleming M, Tan E, Marecek G. Radiographic Detection of Marginal Impaction in Supination-Adduction Ankle Fractures. Foot Ankle Int 2017; 38:1005-1010. [PMID: 28617051 DOI: 10.1177/1071100717709565] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to describe the incidence of plafond impaction in supination-adduction type II (SAD-II) ankle fractures and assess the accuracy of plain radiographs in detecting plafond impaction and predicting planned operative management compared to computed tomography (CT). METHODS Patients with SAD-II ankle fractures were retrospectively identified. All SAD-II plain radiographs were reviewed (120 fractures) and compared to CT images (55 fractures). For each plain radiograph or CT scan, 3 orthopedic surgeons were asked the following questions: (1) Is there impaction of the tibial plafond? (2) Does the impaction require direct visualization and articular reduction? The incidence of plafond impaction and the preoperative plan were calculated separately for plain radiographs and CT scans. The accuracy of plain radiographs was calculated using responses from corresponding CT imaging as the gold standard. Change in preoperative management decisions after reviewing CT images was also calculated. RESULTS In 120 SAD-II ankle fracture plain radiographs, marginal impaction of the plafond was visualized in 61% of fractures. The diagnosis of impaction using plain radiographs was correct in 84% of fractures when compared to CT imaging, resulting in a 91% positive predictive value (PPV) and a 55% negative predictive value (NPV). Plain radiographs were able to predict planned operative management after review of CT imaging with an 87% PPV and 75% NPV. CONCLUSION The majority of SAD-II ankle fractures involved marginal impaction of the tibial plafond. Plain radiographs were accurate in diagnosing impaction when it was present, but were not accurate in ruling out impaction. In the presence of impaction, CT likely will not change planned operative management. LEVEL OF EVIDENCE Level III, comparative series.
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Affiliation(s)
- Ram K Alluri
- 1 Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA, USA
| | - J Ryan Hill
- 1 Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA, USA
| | - Steven Donohoe
- 1 Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA, USA
| | - Mark Fleming
- 2 Navy Trauma Training Center, Los Angeles County + USC Medical Center, Los Angeles, CA, USA
| | - Eric Tan
- 1 Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA, USA
| | - Geoffrey Marecek
- 1 Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA, USA
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13
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Franken L, van Vuuren H, Kraak W, Vaz L. Investigation and comparison of lineouts during the 2013 the rugby championship and six-nations competition. INT J PERF ANAL SPOR 2017. [DOI: 10.1080/24748668.2017.1303989] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Luan Franken
- Department of Sport Science, Stellenbosch University, Stellenbosch, South Africa
| | - Hanno van Vuuren
- Department of Sport Science, Stellenbosch University, Stellenbosch, South Africa
| | - Wilbur Kraak
- Department of Sport Science, Stellenbosch University, Stellenbosch, South Africa
| | - Luis Vaz
- Research Center in Sports Sciences, Health and Human Development (CIDESD), University Tras-os-Montes e Alto Douro, Vila Real, Portugal
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Çiçekli Ö, Özdemir G, Uysal M, Biçici V, Bingöl İ. Percutaneous cannulated screw fixation for pediatric epiphyseal ankle fractures. SPRINGERPLUS 2016; 5:1925. [PMID: 27917331 PMCID: PMC5099300 DOI: 10.1186/s40064-016-3623-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 11/01/2016] [Indexed: 11/21/2022]
Abstract
Background Ankle injuries are among the most common injuries in children. The aim of this study was to compare the efficacies of two percutaneous fixation methods after closed reduction in physeal ankle fractures. Methods We reviewed the cases of 24 patients with a mean age of 12.29 years; 16 were male, and 8 were female. Only patients with fractures of Salter-Harris types 2, 3, and 4 with displacements greater than 2 mm were included in the study. Patients were treated with closed reduction manipulation and percutaneous screw fixation. For each patient, either cannulated or headless full threaded compressive screws were used for percutaneous fixation. Radiological and clinical healing time, range of motion (ROM), American Orthopaedic Foot and Ankle Society (AOFAS) score and physeal arrest were then measured. Results The mean follow-up time was 13 months. The mean time until cast removal was 3.5 weeks (range 2–5). A full ROM was achieved at an average of 5.7 weeks postoperatively (range 4–8). The radiologic healing time was 6.1 weeks (range 4–7). The patients’ clinical healing time averaged 6.8 weeks (range 5–8). Differences in radiologic healing time (p = 0.487), clinical healing time (p = 0.192), AOFAS score (p = 0.467), and complication rate (p = 0.519) between patients who received the headless compressive screw and those who received the cannulated screw for fixation were not statistically significant. Conclusions We demonstrate good clinical results with closed reduction and the percutaneous screw fixation method. Both cannulated and headless compressive screws can be used safely as a treatment method in physeal ankle fractures.
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Affiliation(s)
- Özgür Çiçekli
- Department of Orthopaedic Surgery and Traumatology, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Güzelali Özdemir
- Department of Orthopaedic Surgery and Traumatology, Numune Training and Research Hospital, Ankara, Turkey
| | - Mustafa Uysal
- Department of Orthopaedic Surgery and Traumatology, Sakarya University School of Medicine Training and Research Hospital, Sakarya, Turkey
| | - Vedat Biçici
- Department of Orthopaedic Surgery and Traumatology, Yenimahalle Training and Research Hospital, Ankara, Turkey
| | - İzzet Bingöl
- Department of Orthopaedic Surgery and Traumatology, 29 Mayıs State Hospital, Ankara, Turkey
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Abstract
Current clinical concepts are reviewed regarding the epidemiology, anatomy, evaluation, and treatment of pediatric ankle fractures. Correct diagnosis and management relies on appropriate examination, imaging, and knowledge of fracture patterns specific to children. Treatment is guided by patient history, physical examination, plain film radiographs and, in some instances, computed tomography. Treatment goals are to restore acceptable limb alignment, physeal anatomy, and joint congruency. For high-risk physeal fractures, patients should be monitored for growth disturbance as needed until skeletal maturity.
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Affiliation(s)
- Alvin W Su
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; School of Medicine, National Yang-Ming University, No. 155, Section 2, Linong Street, Beitou, Taipei, Taiwan
| | - A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
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16
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Eismann EA, Stephan ZA, Mehlman CT, Denning J, Mehlman T, Parikh SN, Tamai J, Zbojniewicz A. Pediatric Triplane Ankle Fractures: Impact of Radiographs and Computed Tomography on Fracture Classification and Treatment Planning. J Bone Joint Surg Am 2015; 97:995-1002. [PMID: 26085533 DOI: 10.2106/jbjs.n.01208] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to compare the reliability of triplane fracture classification, displacement measurement, and treatment planning with the use of radiographs with and without computed tomography. METHODS One pediatric radiologist, one musculoskeletal radiologist, and three fellowship-trained pediatric orthopaedic surgeons rated a spectrum of twenty-five triplane fractures with use of radiographs alone and then with computed tomography scans on two separate occasions (two to four weeks apart). Raters classified the fracture pattern with use of the Rapariz classification system, measured the maximum intra-articular displacement, and drew the fracture on four outlines of the distal part of the tibia: one lateral view, one anteroposterior view, one axial view above the tibial physis, and one axial view below the physis. Reliability was assessed with kappa values and intraclass correlation coefficients. RESULTS The Rapariz triplane fracture classification had poor inter-rater reliability (a kappa of 0.17) and intra-rater reliability (a kappa of 0.31) with radiographs alone but moderate inter-rater reliability (a kappa of 0.41) and intra-rater reliability (a kappa of 0.54) with the addition of computed tomography. After reviewing computed tomography, raters changed the fracture pattern in 46% of ratings, the displacement from ≤2 mm to >2 mm in 39% of ratings, the treatment from nonoperative to operative in 27% of ratings, and either the orientation or number of screws in 41% of ratings. CONCLUSIONS Computed tomography had a definite impact on the fracture classification, displacement, and treatment plan, supporting its use as an adjunct to radiographs for the treatment of pediatric triplane fractures.
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Affiliation(s)
- Emily A Eismann
- Division of Pediatric Orthopaedic Surgery (E.A.E., Z.A.S., C.T.M., J.D., S.N.P., and J.T.) and Department of Radiology (T.M. and A.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229. E-mail address for C.T. Mehlman:
| | - Zachary A Stephan
- Division of Pediatric Orthopaedic Surgery (E.A.E., Z.A.S., C.T.M., J.D., S.N.P., and J.T.) and Department of Radiology (T.M. and A.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229. E-mail address for C.T. Mehlman:
| | - Charles T Mehlman
- Division of Pediatric Orthopaedic Surgery (E.A.E., Z.A.S., C.T.M., J.D., S.N.P., and J.T.) and Department of Radiology (T.M. and A.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229. E-mail address for C.T. Mehlman:
| | - Jaime Denning
- Division of Pediatric Orthopaedic Surgery (E.A.E., Z.A.S., C.T.M., J.D., S.N.P., and J.T.) and Department of Radiology (T.M. and A.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229. E-mail address for C.T. Mehlman:
| | - Tracey Mehlman
- Division of Pediatric Orthopaedic Surgery (E.A.E., Z.A.S., C.T.M., J.D., S.N.P., and J.T.) and Department of Radiology (T.M. and A.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229. E-mail address for C.T. Mehlman:
| | - Shital N Parikh
- Division of Pediatric Orthopaedic Surgery (E.A.E., Z.A.S., C.T.M., J.D., S.N.P., and J.T.) and Department of Radiology (T.M. and A.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229. E-mail address for C.T. Mehlman:
| | - Junichi Tamai
- Division of Pediatric Orthopaedic Surgery (E.A.E., Z.A.S., C.T.M., J.D., S.N.P., and J.T.) and Department of Radiology (T.M. and A.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229. E-mail address for C.T. Mehlman:
| | - Andrew Zbojniewicz
- Division of Pediatric Orthopaedic Surgery (E.A.E., Z.A.S., C.T.M., J.D., S.N.P., and J.T.) and Department of Radiology (T.M. and A.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229. E-mail address for C.T. Mehlman:
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17
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Thornton MD, Della-Giustina K, Aronson PL. Emergency department evaluation and treatment of pediatric orthopedic injuries. Emerg Med Clin North Am 2015; 33:423-49. [PMID: 25892730 DOI: 10.1016/j.emc.2014.12.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Orthopedic injuries in children are unique when compared to those of adults because of the physiologic differences, especially the growth plates, stronger periosteum, and dynamic state of growth. The approach to the orthopedically injured child requires a gentle yet thorough focus with consideration of the growth plates as a primary area of weakness and growth when the child sustains an injury. Understanding the developmental stages of bones is paramount to being able to manage any injuries. Finally, what appears to be a benign injury may portend more serious issues, because nonaccidental trauma must always be considered in the evaluation of the injured child.
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Affiliation(s)
- Matthew D Thornton
- Department of Emergency Medicine, Bay State Medical Center, 759 Chestnut Street, Springfield, MA 01199, USA
| | - Karen Della-Giustina
- Department of Emergency Medicine, Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610, USA.
| | - Paul L Aronson
- Department of Pediatric Emergency Medicine, Yale New Haven Childrens Hospital, 100 York Street, Suite 1F, New Haven, CT 06511, USA
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