Equivalent Fracture Patterns Demonstrate Poorer Postoperative Functional Outcomes Among Pronation-External Rotation IV Ankle Fractures

BACKGROUND

Pronation-external rotation IV (PER IV) ankle fractures are relatively uncommon among rotational ankle fractures, but they are the most severe type. Although recent studies have shown satisfactory functional recovery in PER IV after surgical treatment, the different outcomes between fracture patterns and equivalent fracture patterns have not yet been evaluated. This study aims to compare short-term outcomes in PER IV ankle injuries between fracture patterns and equivalent fracture patterns.

METHODS

This retrospective study was conducted at Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, China, from July 2023 to October 2023. A total of 41 PER IV injuries from 2018 to 2022 were included and followed for at least one year. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle‑Hindfoot Scale, Ankle Range of Motions (ROM), and Visual Analogue Scale (VAS) for pain scores were the main outcome measures. The rate of postoperative complications was the secondary outcome measure. Patient demographics were compared in PER IV fractures and PER IV ankle equivalent fractures.

RESULTS

The mean follow-up time was 18.2 ± 4.2 (range, 12-24) months. Postoperative X-ray and CT scans showed a satisfactory reduction of the ankle joint and syndesmosis. No reduction loss of distal tibiofibular syndesmosis or ankle joints was found at the 12-month follow-up. The average AOFAS scores after one year in both groups were satisfactory (fracture group vs. fracture equivalent group, 96.72 ± 4.21 vs. 92.63 ± 5.36; P < 0.05). The average VAS scores after one year in both groups were satisfactory (fracture group vs. fracture equivalent group, 1.45 ± 2.01 vs. 1.38 ± 1.96; P > 0.05). The average ROM scores after one year in both groups were satisfactory (dorsiflexion, fracture group vs. fracture equivalent group, 15.21 ± 5.62 vs. 13.46 ± 4.35; P > 0.05; plantar flexion, fracture group vs. fracture equivalent group, 38.62 ± 9.68 vs. 42.32 ± 5.28; P > 0.05).

CONCLUSION

For patients with PER-IV ankle injuries, the fracture mode had a better prognosis than the fracture equivalent mode.

Efficacy and Safety of Platelet-Rich Plasma Injection for Chronic Plantar Fasciitis: A Prospective Study on Functional Restoration and Pain Relief

Background Heel discomfort and functional impairment are frequently caused by plantar fasciitis, and treating it can be extremely difficult for clinicians and occasionally have unfavorable clinical consequences. Recently, platelet-rich plasma (PRP) has been used as an alternative therapy for plantar fasciitis (PF) to reduce heel pain and improve functional restoration. We evaluated the current evidence concerning the efficacy and safety of PRP as a treatment for PF. Methodology This was a hospital-based prospective study on patients with plantar fasciitis with a symptom duration of six months or more with failed conservative therapy. All patients included in the study were assessed clinically and by a visual analog score (VAS) for heel pain, the Ankle-Hindfoot Scale (AHS) component of the American Orthopedic Foot and Ankle Society (AOFAS) and Foot and Ankle Ability Measure (FAAM) scores before injection, and at three weeks, three and six-months post-PRP treatment follow-up. Ultrasonography (USG) measurement of plantar fascia thickness was done pre-injection and at the six-month follow-up for clinical outcomes and any complications. Results The study included 25 patients with plantar fasciitis, with the majority (48%) in the age group of 21-30 years. Females accounted for 64% of the patients while males accounted for 36%. Most patients (56%) had a moderately active daily activity level. The study found that 16 patients had bilateral plantar fasciitis while nine had unilateral plantar fasciitis. Among the patients with bilateral plantar fasciitis, a total of 32 heels were affected while the 9 patients with unilateral plantar fasciitis had 9 affected heels. Most female patients (75%) had bilateral plantar fasciitis while most male patients (56%) had unilateral plantar fasciitis. Before PRP therapy, both male and female patients reported high pain scores on the VAS for both heels. However, after PRP infiltration, the VAS scores significantly decreased at three weeks, three months, and six months post-injection, indicating pain relief. The AOFAS hindfoot and ankle scores and FAAM scores showed improvement over the follow-up period. Both male and female patients experienced significant improvements in functional outcomes, with increases in AOFAS (p-value 0.45) and FAAM scores (p-value 0.31) at three weeks, three months, and six months post-injection compared to baseline. Statistical analysis revealed a significant decrease in pain scores (73% pain relief), as well as significant improvements in AOFAS scores with an average of 22.33 from baseline (mean = 67.75±9.7) to final follow-up (mean = 90.08±7.9) and FAAM scores with an average of 23.72 from baseline (mean = 49.38±5.2) to final follow-up (mean = 73.10±5.2) after PRP infiltration. Conclusion The outcomes of a single dosage of PRP injections demonstrate clinically and statistically substantial improvements in functional outcome scores, plantar fascia thickness evaluated by USG, and VAS scores for heel pain. According to the results of this study, local PRP injection is an effective treatment for chronic plantar fasciitis.

Ankle Arthrodesis: Indications, Outcomes, and Patient Satisfaction

Background

Osteoarthritis of the ankle, which has a prevalence of 3.4% in the general population and affects 70% of candidates post-traumatically, is less common than hip or knee arthritis. Despite the recent progress in ankle arthroplasty surgery, ankle arthrodesis is still considered the gold-standard treatment for severe osteoarthritis of the ankle joint and can achieve impressive improvements in pain and function in the majority of patients. Our objective is to assess the clinical and functional outcomes of ankle arthrodesis, postoperative complications, and patient satisfaction.

Methodology

This was a descriptive cross-sectional study that took place at Future Hospital in Khartoum, Sudan, from July 2015 to July 2022. Our institute performed 102 ankle fusion surgeries; 14 patients were excluded from the study because they did not show up for their follow-up visit, meaning 88 candidates were included. Two cannulated screws (6.5 mm) were used for ankle fixation in all patients. The outcome was assessed two years after surgery. The American Orthopaedic Foot and Ankle Society (AOFAS) score was used to assess ankle function before surgery and two years after the procedure. Postoperative complications and patient satisfaction were reported. The primary researcher collected data through direct interviews.

Result

The mean age of the study participants was 52.2 years, with 36.4% being between 40 and 50 years of age. The study consisted of 43 women and 45 men. The male-to-female ratio was almost 1:1. In 56.8% of candidates, the right ankle was involved. The overall rate of complications was 11.4%. Concerning patient satisfaction, 75% of the patients were fully satisfied. Moreover, significant correlations were found between the mean postoperative AOFAS score and age group, diabetes mellitus, complications, and patient satisfaction.

Conclusion

Ankle arthrodesis was demonstrated to be an excellent surgical method for reducing pain and enhancing ankle joint function. The most frequent complications were delayed wound healing, infection, and non-union. The functional outcome and patient satisfaction of this procedure were statistically high; patients with a higher functional score had higher levels of satisfaction. In contrast, diabetic and elderly patients had higher rates of complications.

Operative Treatment of Ankle Fractures: Predictive Factors Affecting Outcome

Purpose

Surgical management of ankle fractures has been extensively studied in literature but studies investigating validated clinical results are lacking and controversial. The purpose of this study was to evaluate functional and health-related quality of life (HRQL) outcomes after surgically treated ankle fractures and to detect some of their predictors.

Methods

Two hundred sixty-six skeletally mature patients who underwent surgery for an isolated ankle fracture from 2006 to 2017 were retrospectively identified from our hospital records and included in the study. All patients were evaluated at one, three, six and 12 months post-injury with clinical and radiographic examination. Outcome measures recorded at final two years minimum follow-up included patient-reported pain, patient satisfaction, functional (American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score) and quality of life (Short Form (SF) 36 score) status.

Results

Patient satisfaction score was 8.4 out of 10, Visual Analogue Scale mean score was 2.3, complication rate was 36.5% and mean AOFAS ankle-hindfoot score was 87.3. Mean SF36-physical summary score was 77.9 and SF36-mental summary score was 81.1. The injury demonstrated a significant effect on physical function, role-physical, bodily pain and social functioning SF-36 subdomains. Functional outcome was significantly related to occupation, syndesmotic lesion, number of fractured malleoli and delay to surgery. Main predictors of quality of life were age, occupation, cause of injury, syndesmotic lesion, number of fractured malleoli and waiting time to surgery.

Conclusions

Ankle fractures have a considerable impact on functional and quality of life status of patients. Occupation, presence of syndesmotic injury, Pott's classification and surgery delay must be considered as predictors of final outcome.

The effect of postoperative wound infections on functional outcome following intra-articular calcaneal fractures

INTRODUCTION

High rates of postoperative wound infections (POWI) are reported following the operative treatment of calcaneal fractures. This leads to additional therapy, prolonged hospital stay, burden for patients and increased costs. The primary aim of this study is to evaluate the effect of POWI following the extended lateral approach of displaced intra-articular calcaneal fractures on functional outcome. Secondary aims are assessment of health-related quality of life and patient satisfaction.

PATIENTS AND METHODS

All consecutive adult patients with a calcaneal fracture treated between 2000 and 2011 with open reduction and internal fixation through an extended lateral approach were retrospectively included and sent a questionnaire. Functional outcome was measured using the Foot Function Index (FFI, best score 0 points) and the American Orthopaedic Foot and Ankle Society (AOFAS, best score 100 points) hindfoot score. The EuroQOL-5D was used for quality of life (QOL) and a Visual Analogue Scale (VAS, best score 10 points) for overall patients satisfaction.

RESULTS

Of 135 eligible patients, 94 returned the questionnaire (response rate 70 %). The median FFI was 12 points (IQR 3-33) and AOFAS 79 points (IQR 61-90). The FFI and AOFAS were, respectively, 17 and 9 points higher in favour of patients without POWI (n = 69) compared to patients with POWI (n = 25). Albeit large differences, they were not statistically significant given the current number of patients. Patients without POWI scored better on all health-related aspects of QOL in the EQ-5D, but this did not reach statistical significance. However, the VAS on overall patient satisfaction did show a statistically significant difference of 1.3 points (9.0 vs 7.7; p = 0.01) in favour of patients without POWI. Importantly, a clinically relevant difference was found with the FFI as the estimated minimal clinical important difference of the FFI is 10 points.

CONCLUSION

Our results implicate that postoperative wound infection leads lower functional outcome scores following calcaneal fracture surgery, but no statistical significance was reached. In addition, patients do not report significant worse QOL or physical impairment. Overall patient satisfaction measured by a VAS was significantly lower in case of a POWI, reflecting the burden caused by a wound complication.