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Weinraub GM, Vijayakumar A. Arthroscopy for Traumatic Ankle Injuries. Clin Podiatr Med Surg 2023; 40:529-537. [PMID: 37236689 DOI: 10.1016/j.cpm.2022.12.003] [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: 05/28/2023]
Abstract
Using ankle arthroscopy in conjunction to open reduction internal fixation of traumatic ankle injuries can play an important role in the management of these injuries by way of treating intra-articular pathologies, leading to improved patient outcomes. While a majority of these injuries are not treated with concurrent arthroscopy, its addition may lead to more prognostic information to dictate the patient's course. This article has illustrated its use in managing malleolar fractures, syndesmotic injuries, pilon fractures and pediatric ankle fractures. While additional studies may be needed to further support AORIF, it may prove to play a vital role in the future.
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Affiliation(s)
- Glenn M Weinraub
- Department of Orthopaedic Surgery, Kaiser Permanente, San Leandro, CA, USA.
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Chou TFA, Tzeng YH, Teng MH, Huang YC, Wang CS, Lin CC, Chiang CC. Trimalleolar Fractures Treated by Open Reduction Internal Fixation Compared With Arthroscopically Assisted Reduction and Minimally Invasive Surgery. Foot Ankle Int 2023; 44:431-442. [PMID: 36946569 DOI: 10.1177/10711007231157676] [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] [Indexed: 03/23/2023]
Abstract
BACKGROUND Currently, the standard of treatment for trimalleolar (TM) fracture is osteosynthesis through open reduction and internal fixation (ORIF). This study assessed whether arthroscopically assisted reduction and minimally invasive surgery (AARMIS) can be an alternative surgical method for TM fractures. METHODS This retrospective cohort study included 49 patients with TM that were surgically treated. 27 patients received ORIF and 22 patients underwent AARMIS . At baseline, we recorded the patient's demographic features, fracture pattern (AO-OTA and Haraguchi classification), and surgical method. For postoperative results, we examined the patient's radiographic outcome, including time to union, quality of fracture reduction, as well as functional outcomes (American Orthopaedic Foot & Ankle Society ankle hindfoot score, ankle range of motion, and visual analog scale of pain) and perioperative complications. RESULTS At mean follow-up of 46.6±24.6 (ORIF) and 36.4±18.5 months (AARMIS), both groups had comparable radiographic outcomes. No significant difference in rates of early ankle OA were detected. In terms of functional outcome, VAS pain and AOFAS score at postoperative day 3, postoperative month 3, and at final follow-up were not different. In terms of range of motion, we did not find a significant difference in mean range of motion. CONCLUSION Patients with TM fractures treated with AARMIS achieved satisfactory results and was not significantly different in radiographic and functional performance compared with ORIF. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Te-Feng Arthur Chou
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Yun-Hsuan Tzeng
- Division of Medical Imaging for Health Management, Cheng-Hsin General Hospital, Taipei
- Department of Radiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Ming-Hung Teng
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Yen-Chun Huang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Chien-Shun Wang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Chun-Cheng Lin
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Chao-Ching Chiang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei
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Comparison between cotton test and tap test for the assessment of coronal syndesmotic instability: A cadaveric study. Injury 2021; 52 Suppl 3:S84-S88. [PMID: 34088466 DOI: 10.1016/j.injury.2021.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In surgically treated rotational malleolar fractures, residual syndesmotic instability is typically assessed following fixation with the widely used intraoperative Cotton test. However, due to its dynamic nature, there are inconsistencies of the magnitude and direction of the distraction force when attempting to pull the fibula away from the tibia using a bone hook. The novel Tap test advances a cortical tap through a drilled hole in the fibula with a stable, unidirectional distraction force applied to the tibia. The objective of this cadaveric study was to compare the Cotton and Tap tests as diagnostic tools for coronal plane syndesmotic instability. METHODS Tibiofibular Clear Space (TFCS) of 10 cadaveric specimens was measured for: intact, non-stressed; intact, stressed; injured, non-stressed; and injured, stressed (Tap and Cotton tests). In injured conditions, the syndesmotic ligamentous complex was sectioned using an anterolateral longitudinal approach. Perfect fluoroscopic Mortise images were acquired for all conditions. Two independent and blinded Orthopaedic Foot and Ankle Surgeons measured TFCS 1 cm proximal to the ankle joint line. Intra and interobserver reliabilities were assessed by Intraclass Correlation Coefficient. Syndesmotic TFCS values for all conditions were compared by paired Wilcoxon. Diagnostic performance of the Cotton and Tap tests was assessed using a relative increase of TFCS > 2 mm when comparing intact stressed and injured stressed conditions. P-values <0.05 were considered significant. RESULTS The intraclass correlation coefficient for intraobserver and interobserver reliability was respectively 0.96 and 0.79. TFCS measurements were similar in intact non-stressed, intact stressed (both Cotton and Tap tests) and injured non-stressed conditions, with mean values and 95% Confidence Intervals of: intact non-stressed, 3.5 mm; intact stressed, 3.6 mm (Cotton test) and 4.0 mm (Tap test); injured non-stressed, 3.8 mm. The Cotton test and Tap test had, respectively, 73.3% and 70% sensitivity, 100% and 90% specificity, 86.7% and 80% diagnostic accuracy. CONCLUSIONS Our cadaveric study compared the Cotton and Tap tests for detection of coronal plane syndesmotic instability. Both tests demonstrated similar increases in the TFCS measurements in stressed injured conditions when compared to intact non-stressed and stressed conditions, as well as injured non-stressed conditions.
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de Cesar Netto C, Pinto M, Roberts L, Lee SR, Roney AR, Naranje S, Godoy-Santos AL, Shah A. Intraoperative tap test for coronal syndesmotic instability: A cadaveric study. Injury 2018; 49:1758-1762. [PMID: 30115447 DOI: 10.1016/j.injury.2018.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/09/2018] [Accepted: 08/06/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Precise diagnosis of distal tibiofibular syndesmotic injury is challenging, and a gold standard diagnostic test has still not been established. Tibiofibular clear space identified on radiographic imaging is considered the most reliable indicator of the injury. The Cotton test is the most widely used intraoperative technique to evaluate the syndesmotic integrity although it has its limitations. We advocate for a novel intra operative test using a 3.5 mm blunt cortical tap. METHODS Tibiofibular clear space was assessed in nine cadaveric specimens using three sequential fluoroscopic images. The first image was taken prior to the application of the tap test (intact, non-stressed). Then, a 2.5 mm hole was drilled distally on the lateral fibula, and a 3.5 mm cortical tap was then threaded in the hole. The tap test involved gradually advancing the blunt tip against the lateral tibia, providing a tibiofibular separation force (intact, stressed). This same stress was then applied after all syndesmotic ligaments were released (injured, stressed). Measurements were compared by one-way ANOVA and paired Student's t-test. Intra and inter-observer agreements were evaluated by intraclass correlation coefficient (ICC). P-values <.05 were considered significant. RESULTS We found excellent intra-observer (0.97) and inter-observer (0.98) agreement following the imaging assessment. Significant differences were found in the paired comparison between the groups (p < .05). When using an absolute value for TFCS >6 mm as diagnostic for coronal syndesmotic instability, the tap test demonstrated a 96.3% sensitivity and specificity, a 96.3% PPV and NPV and a 96.3% accuracy in diagnosing coronal syndesmotic instability. CONCLUSIONS Our cadaveric study demonstrated that this novel coronal syndesmotic instability test using a 3.5 mm blunt cortical tap is a simple, accurate and reliable technique able to demonstrate significant differences in the tibiofibular clear space when injury was present. It could represent a more controlled and stable alternative to the most used Cotton test.
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Affiliation(s)
- Cesar de Cesar Netto
- Hospital for Special Surgery, Department of Foot and Ankle Orthopedics, 535 East 70thStreet, New York, NY, 10021, United States; University of Alabama at Birmingham (UAB), Department of Orthopedics, Birmingham, AL, United States.
| | - Martim Pinto
- University of Alabama at Birmingham (UAB), Department of Orthopedics, Birmingham, AL, United States
| | - Lauren Roberts
- Hospital for Special Surgery, Department of Foot and Ankle Orthopedics, 535 East 70thStreet, New York, NY, 10021, United States
| | - Sung Ro Lee
- University of Alabama at Birmingham (UAB), Department of Orthopedics, Birmingham, AL, United States
| | - Andrew R Roney
- Hospital for Special Surgery, Department of Foot and Ankle Orthopedics, 535 East 70thStreet, New York, NY, 10021, United States
| | - Sameer Naranje
- University of Alabama at Birmingham (UAB), Department of Orthopedics, Birmingham, AL, United States
| | | | - Ashish Shah
- University of Alabama at Birmingham (UAB), Department of Orthopedics, Birmingham, AL, United States
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Chen XZ, Chen Y, Liu CG, Yang H, Xu XD, Lin P. Arthroscopy-Assisted Surgery for Acute Ankle Fractures: A Systematic Review. Arthroscopy 2015; 31:2224-31. [PMID: 26051353 DOI: 10.1016/j.arthro.2015.03.043] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 03/17/2015] [Accepted: 03/24/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To summarize the clinical findings of adult patients undergoing arthroscopy-assisted open reduction-internal fixation for acute ankle fractures. METHODS A systematic electronic search of the PubMed databases was performed for all published literature on December 8, 2014. All English-language clinical studies on acute ankle fractures treated with arthroscopy-assisted open reduction-internal fixation were eligible for inclusion. Basic information related to the surgical procedure was collected. RESULTS The search criteria initially identified 187 articles, and 10 studies were included in this systematic review. There were 2 prospective, randomized studies; 2 prognostic studies; and 6 case-series studies. There were a total of 861 patients included in this systematic review. Danis-Weber type B fractures (335 of 483 patients) and supination-external rotation fractures (187 of 366 patients) were the most common types of all the ankle fractures. Concomitant injuries were common: 63.3% of patients had chondral lesions, 60.9% had deltoid ligament injuries, and 77.9% had tibiofibular syndesmosis injuries. Lavage and debridement of the ankle joint were performed by almost all the surgeons. Chondral lesions were treated with shaving, excision, or microfracture. The mean American Orthopaedic Foot & Ankle Society hindfoot score was 91.7. Only mild complications were reported. CONCLUSIONS Acute ankle fractures are commonly concomitant with multiple soft-tissue injuries in which arthroscopy may serve as a method for accurate diagnosis and appropriate treatment. LEVEL OF EVIDENCE Level IV, systematic review of Level I, II, III, and IV studies.
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Affiliation(s)
- Xing-Zuo Chen
- Orthopaedic Trauma Department, China-Japan Friendship Hospital, Beijing, China
| | - Ying Chen
- Orthopaedic Trauma Department, China-Japan Friendship Hospital, Beijing, China
| | - Cheng-Gang Liu
- Orthopaedic Trauma Department, China-Japan Friendship Hospital, Beijing, China
| | - Huan Yang
- Orthopaedic Trauma Department, China-Japan Friendship Hospital, Beijing, China
| | - Xiao-Dong Xu
- Orthopaedic Trauma Department, China-Japan Friendship Hospital, Beijing, China
| | - Peng Lin
- Orthopaedic Trauma Department, China-Japan Friendship Hospital, Beijing, China.
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Abstract
UNLABELLED The use of arthroscopy in the management of acute traumatic conditions of the foot and ankle has increased in recent years, primarily because of an appreciation of fracture morphology and the utility of reducing the surgical footprint. This article presents an overview of the use of this modality in foot and ankle trauma and presents an anatomical survey of the various fractures where arthroscopic assistance can be of benefit. In addition, a discussion of the seminal articles on this subject is included. LEVEL OF EVIDENCE Therapeutic Level IV: Review.
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Affiliation(s)
- David A Wood
- Swedish Medical Center, Seattle, Washington (DAW)Department of Orthopedics, Swedish Medical Center, Seattle, Washington (JCC)Kaiser Foundation Hospital, San Francisco, California (JMS)
| | - Jeffrey C Christensen
- Swedish Medical Center, Seattle, Washington (DAW)Department of Orthopedics, Swedish Medical Center, Seattle, Washington (JCC)Kaiser Foundation Hospital, San Francisco, California (JMS)
| | - John M Schuberth
- Swedish Medical Center, Seattle, Washington (DAW)Department of Orthopedics, Swedish Medical Center, Seattle, Washington (JCC)Kaiser Foundation Hospital, San Francisco, California (JMS)
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Schoepp C, Rixen D. [Arthroscopy-guided fracture management. Ankle joint and calcaneus]. Unfallchirurg 2013; 116:318-25. [PMID: 23515645 DOI: 10.1007/s00113-012-2347-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Arthroscopic fracture management of the ankle and calcaneus requires a differentiated approach. The aim is to minimize surgical soft tissue damage and to visualize anatomical fracture reduction arthroscopically. Moreover, additional cartilage damage can be detected and treated. The arthroscopic approach is limited by deep impressions of the joint surface needing cancellous bone grafting, by multiple fracture lines on the articular side and by high-grade soft tissue damage. An alternative to the minimally invasive arthroscopic approach is open arthroscopic reduction in conventional osteosynthesis. This facilitates correct assessment of surgical reduction of complex calcaneal fractures, otherwise remaining non-anatomical reduction might not be fluoroscopically detected during surgery.
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Affiliation(s)
- C Schoepp
- Berufsgenossenschaftliche Unfallklinik Duisburg, Großenbaumer Allee 250, 47249 Duisburg.
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