Percutaneous screw fixation for painful non-union of lateral malleolus ankle fractures

Epidemiology, Etiology, Timing and Severity of Open Fracture - a Five Years Review From a Tertiary Trauma Center, Eastern Province, Saudi Arabia

Background

Open fractures are severe injuries resulting from the bone breaking through the skin, and they have a negative impact on patients' physical, mental, and financial well-being as well as that of the healthcare system. The incidence of open fractures varies globally. These injuries can lead to prolonged disability, increased healthcare costs, and psychological distress. The Gustilo-Anderson classification system is used to classify open fractures into three categories which surgeons use as an index for the severity of an injury and as a prognostic tool. Management involves a multidisciplinary approach, focusing on preventing infection, promoting wound healing, and restoring function.

Objective

The objective of this study is to provide statistics on the epidemiology of open fractures presented to the emergency department to be used later to create management protocols.

Methods

This 5-year retrospective observational analysis of open fracture patients at King Fahad Hospital, a tertiary trauma care institute in Alkhobar from 2018-2023, aimed to understand socio-demographics, injury mechanisms, fracture patterns, and timing. Data were collected electronically, and found 373 cases which were reviewed, and only 138 open fractures fit our inclusion and exclusion criteria and were added to the study.

Results

The study analyzed 138 openly fractured bones in 132 patients aged 2 to 68. Most bones affected were in the lower extremities, the most common being the forefoot bones. The most common mode of injury was a motorbike, followed by MVA. The most common Gustilo type was type 2, with no significant correlation between gender and severity. Musculoskeletal system injury was the highest associated system. Furthermore, we observe a slight increase in cases in Winter/Fall weather seasons.

Conclusion

Total amount of 84.8% of patients with open fractures are men, compared to 15.2% of women. The average age of patients is 25.6 ± 15.6 years. Motorbike accidents, then MVA, are the two leading causes of open fractures. Weather seasons, especially in fall and winter, may also contribute to an increase in open fractures. We found that type 2 is the most common Gustilo type among the injured bones (59.1%).

Transverse Weber A fracture atrophic non-union. A single centre case series

INTRODUCTION

Weber A ankle fractures are isolated fibula fractures distal to the level of the ankle joint line. They are regarded as stable injuries that usually heal successfully without intervention. We have identified several patients that have developed symptomatic atrophic non-union of transverse Weber A fractures that are not simple avulsion fractures of the anterior talo-fibular ligament. We explored variations to the blood supply of the distal fibula as a potential cause of this rare complication.

CASES

Five patients presented with ongoing ankle pain following a period of non-operative management. All shared a similar transverse atrophic non-union fracture pattern.Surgical management with open reduction and internal fixation with or without the use of bone graft achieved successful union and resolution of symptoms in all cases.

CONCLUSIONS

Atrophic fracture non-unions usually result from a disruption to the blood supply at the site of injury. The arterial supply to the distal fibula consists of a complex of arterial loops which usually enable fracture healing. However, there are anatomical variations to the blood supply that potentially could account for the rare outcome of non-union of Weber A fracture patterns. Weber A fractures are generally benign ankle fractures that heal well with non-operative treatment. No alterations should be made to the management of such injuries, but patients should be counselled about the risk of a symptomatic non-union outcome.