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Liu N, Zhang M, Feng SM, Bi YL, Zhai HW, Meng Q. Effect of hip strategy-based motion control training on walking function restoration after ankle joint injury. Jt Dis Relat Surg 2024; 35:54-61. [PMID: 38108166 PMCID: PMC10746916 DOI: 10.52312/jdrs.2023.1277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/22/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVES The study aimed to explore the effect of hip strategybased motion control training on the recovery of walking function after ankle injury and the optimization of the rehabilitation program. PATIENTS AND METHODS In the study, 62 patients with ankle injuries were randomly divided into the observation group (n=30; 24 males, 6 females; mean age: 41.9±8.5 years; range, 28 to 56 years) and the control group (n=32; 26 males, 6 females; mean age: 42.0±9.3 years; range, 27 to 55 years) between September 2021 and September 2022. Both groups were treated using routine rehabilitation training, including conventional drug and rehabilitation treatment. The observation group additionally received hip strategy-based motion control training, which included hip muscle strength training, hip joint stability control training, balance testing and training system training, and three-dimensional gait analysis system training for six weeks. All patients were evaluated before and after the treatment using the balance function parameters (motion length and motion ellipse area), Berg Balance Scale, the timed up-and-go test, and three-dimensional gait analysis system (step length and step frequency). RESULTS There was no significant difference in the evaluation indexes between the two groups before treatment (p>0.05). After treatment, the evaluation indexes of the two groups were significantly better than those before treatment (p<0.05), and all the indexes in the observation group were significantly better than those in the control group (p<0.05). CONCLUSION Hip strategy-based motion control training could significantly improve the recovery of walking function in patients with ankle injuries.
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Affiliation(s)
| | | | | | | | - Hong-Wei Zhai
- Department of Rehabilitation Medicine, Xuzhou Rehabilitation Hospital, No. 10 of Kuizhong Lane, Yunlong District, Xuzhou 221000, China
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Nguyen MQ, Broström A, Iversen MM, Harboe K, Paulsen A. Assessing the content validity of the Manchester-Oxford Foot Questionnaire in surgically treated ankle fracture patients: a qualitative study. J Orthop Surg Res 2023; 18:941. [PMID: 38066592 PMCID: PMC10704649 DOI: 10.1186/s13018-023-04418-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Roughly 10% of fractures in adults are ankle fractures. These injuries are found in both sexes and present with different fracture characteristics. The treatment varies with the patients' biology and fracture type, and the goals are to restore stability, prevent pain and maintain ankle function. Clinicians generally use outcomes like assessment of radiography, pain level, or function. The use of patient-reported outcome measures is increasing, and the Manchester-Oxford Foot Questionnaire (MOXFQ) has been shown to have good measurement properties when validated in patients with foot and ankle disorders. However, the instrument has not been validated for ankle fracture patients. This study aims to assess the content validity of the items in MOXFQ in surgically treated ankle fracture patients. METHODS A qualitative deductive design was used to investigate patients' response process of the MOXFQ. Individual interviews were conducted using cognitive interviewing based on the theoretical framework of the 4-step model by Tourangeau. Adult patients that were surgically treated for an ankle fracture between four weeks and 18 months were purposively sampled, and interviews followed a semi-structured interview guide. The predetermined categories were comprehension, retrieval, judgement, and response. RESULTS Seventeen respondents (65% females) were interviewed. Respondents' age ranged from 27 to 76 years. Some of the respondents in the early recovery phase were limited by post-operative restrictions and did not find the items in the walking/standing domain relevant. Respondents that were allowed weight-bearing as tolerated (WBAT) were able to recall relevant information for most items. Respondents with time since surgery more than 12 months had less pain and remembered fewer relevant episodes in the recall period. Items in the social interaction domain contained ambiguous questions and were generally considered less important by respondents. The summary index score lacked important concepts in measuring overall quality of life. CONCLUSIONS Pain was a central concept in the post-operative recovery of ankle fracture patients. The MOXFQ-subscales for pain and walking/standing had acceptable content validity in patients that were allowed WBAT. The social interaction-subscale and the summary index score had insufficient content validity for this patient population.
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Affiliation(s)
- Michael Q Nguyen
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
- Department of Orthopedic Surgery, Stavanger University Hospital, Helse Stavanger HF, Stavanger, Norway.
- Department of Orthopedic Surgery, The Fracture Registry of Western Norway, Stavanger University Hospital, Helse Vest RHF, Stavanger, Norway.
| | - Anders Broström
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Marjolein M Iversen
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Centre on Patient-Reported Outcomes, Department of Research and Development, Haukeland University Hospital, Helse Bergen HF, Bergen, Norway
| | - Knut Harboe
- Department of Orthopedic Surgery, Stavanger University Hospital, Helse Stavanger HF, Stavanger, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Anesthesia, Stavanger University Hospital, Helse Stavanger HF, Stavanger, Norway
| | - Aksel Paulsen
- Department of Orthopedic Surgery, Stavanger University Hospital, Helse Stavanger HF, Stavanger, Norway
- Department of Orthopedic Surgery, The Fracture Registry of Western Norway, Stavanger University Hospital, Helse Vest RHF, Stavanger, Norway
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Walley KC, Gong DC, Hearty TM, Holmes JR, Talusan PG, Walton DM. Positioning Pearls in Foot and Ankle Surgery: A Contemporary Review. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231201833. [PMID: 37789874 PMCID: PMC10542325 DOI: 10.1177/24730114231201833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Affiliation(s)
- Kempland C. Walley
- Department of Orthopaedic Surgery, University of Michigan | Michigan Medicine, Ann Arbor, MI, USA
| | - Davin C. Gong
- Department of Orthopaedic Surgery, University of Michigan | Michigan Medicine, Ann Arbor, MI, USA
| | - Thomas M. Hearty
- Department of Orthopaedic Surgery, Trinity Health IHA Ann Arbor, Ypsilanti, MI, USA
| | - James R. Holmes
- Department of Orthopaedic Surgery, University of Michigan | Michigan Medicine, Ann Arbor, MI, USA
| | - Paul G. Talusan
- Department of Orthopaedic Surgery, University of Michigan | Michigan Medicine, Ann Arbor, MI, USA
| | - Davin M. Walton
- Department of Orthopaedic Surgery, University of Michigan | Michigan Medicine, Ann Arbor, MI, USA
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Terstegen J, Weel H, Frosch KH, Rolvien T, Schlickewei C, Mueller E. Classifications of posterior malleolar fractures: a systematic literature review. Arch Orthop Trauma Surg 2023; 143:4181-4220. [PMID: 36469121 PMCID: PMC10293398 DOI: 10.1007/s00402-022-04643-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/30/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Complex ankle fractures frequently involve the posterior malleolus. Many classifications describing posterior malleolar fractures (PMF) exist. The aim of this study was to provide a systematic literature review to outline existing PMF classifications and estimate their accuracy. METHODS The databases PubMed and Scopus were searched without time limits. Only specific PMF classifications were included; general ankle and/or pilon fracture classifications were excluded. Selection and data extraction was performed by three independent observers. The systematic literature search was performed according to the current criteria of Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). The methodological quality of the included studies was quantified using the modified Coleman score. RESULTS A total of 110 studies with a total of 12.614 patients were included. Four main classifications were identified: Those describing the size of the posterior malleolar fracture (n = 66), Haraguchi (n = 44), Bartoníček/Rammelt (n = 21) and Mason (n = 12). The quality of the studies was moderate to good with a median Coleman-score of 43.5 (14-79) and a weighted median Coleman-score of 42.5 points. All classifications achieved a substantial to perfect score regarding the inter- and intraobserver reliability, with Mason scoring the lowest in comparison. CONCLUSIONS None of the reviewed PMF classifications has been able to establish itself decisively in the literature. Most of the classifications are insufficient in terms of a derivable treatment algorithm or a prognosis with regard to outcome. However, as the Bartoníček/Rammelt classification has the greatest potential due to its treatment algorithm, its reliability in combination with consistent predictive values, its usage in clinical practice and research appears advisable.
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Affiliation(s)
- Julia Terstegen
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Hanneke Weel
- Department of Orthopedics, Bergman Clinics, Arnhem, The Netherlands
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics, and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Tim Rolvien
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Carsten Schlickewei
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Elena Mueller
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Zheng H, Xia Y, Ni X, Wu J, Li Y, Zhang P, Wu X, Lu K, Zhao Q. Clinical effects of 3D printing-assisted posterolateral incision in the treatment of ankle fractures involving the posterior malleolus. Front Surg 2023; 10:1176254. [PMID: 37292486 PMCID: PMC10244554 DOI: 10.3389/fsurg.2023.1176254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/03/2023] [Indexed: 06/10/2023] Open
Abstract
Objective To explore the clinical outcomes of a 3D printing-assisted posterolateral approach for the treatment of ankle fractures involving the posterior malleolus. Methods A total of 51 patients with ankle fractures involving the posterior malleolus admitted to our hospital from January 2018 to December 2019 were selected. The patients were divided into 3D printing group (28 cases) and control group (23 cases). 3D printing was performed for ankle fractures, followed by printing of a solid model and simulation of the operation on the 3D model. The operation was then performed according to the preoperative plan, including open reduction and internal fixation via the posterolateral approach with the patient in the prone position. Routine x-ray and CT examinations of the ankle joint were performed, and ankle function was evaluated using the American Foot and Ankle Surgery Association (AOFAS) ankle-hindfoot score. Results All patients underwent x-ray and CT examinations. All fractures healed clinically, without loss of reduction or failure of internal fixation. Good clinical effects were achieved in both groups of patients. The operation time, intraoperative blood loss and intraoperative fluoroscopy frequency in the 3D printing group were significantly less than those in the control group (p < 0.05). There was no significant difference between the two groups in the anatomical reduction rate of fractures or the incidence of surgical complications (p > 0.05). Conclusion The 3D printing-assisted posterolateral approach is effective in the treatment of ankle fractures involving the posterior malleolus. The approach can be well planned before the operation, is simple to perform, yields good fracture reduction and fixation, and has good prospects for clinical application.
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Affiliation(s)
- Hongming Zheng
- Department of Orthopedic Surgery, Affiliated Danyang Hospital of Nantong University, Danyang, China
| | - Yan Xia
- Department of Orthopedic Surgery, Affiliated Danyang Hospital of Nantong University, Danyang, China
| | - Xiaohui Ni
- Department of Orthopedics, Dafeng People’s Hospital, Yancheng, China
| | - Jieshi Wu
- Department of Orthopaedics, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Yankun Li
- Department of Orthopaedics, Guizhou Provincial People's Hospital, Guiyang, China
| | - Pengpeng Zhang
- Department of Orthopaedics, Guizhou Provincial People's Hospital, Guiyang, China
| | - Xinglin Wu
- Department of Orthopaedics, Guizhou Provincial People's Hospital, Guiyang, China
| | - Kaihang Lu
- Department of Orthopaedics, Guizhou Provincial People's Hospital, Guiyang, China
| | - Quanming Zhao
- Department of Orthopaedics, Guizhou Provincial People's Hospital, Guiyang, China
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Fernández-Rojas E, Herrera-Pérez M, Vilá-Rico J. [Translated article] Posterior malleolar fractures: Indications and surgical approaches. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T160-T169. [PMID: 36574833 DOI: 10.1016/j.recot.2022.12.017] [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: 09/20/2022] [Accepted: 10/27/2022] [Indexed: 12/25/2022] Open
Abstract
Posterior malleolus fractures are frequent injuries, present in 7-44% of all ankle fractures. The objective of this study is to review the evidence to indicate the fixation of this fracture and to choose the appropriate surgical approach. The classic indications for fixation were fragment size greater than 25-30% of the articular surface and displacement greater than 2mm. However, current evidence suggests that, rather than size, factors such as syndesmotic instability, intra-articular step-off greater than 1-2mm, plafond impaction and the presence of intercalary fragments should be considered. When comparing the different surgical approaches, the literature supports the use of posterior approaches and reserves the recommendation of the traditional approach for exceptional cases. For the treatment of this injury it is essential to know the anatomy of the ankle and to consider all the factors described above, in addition to the presence of concomitant injuries.
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Affiliation(s)
- E Fernández-Rojas
- Equipo de Tobillo y Pie, Servicio de Traumatología y Ortopedia, Hospital Las Higueras, Talcahuano, Chile; Universidad Católica de la Santísima Concepción, Concepción, Chile.
| | - M Herrera-Pérez
- Unidad de Pie y Tobillo, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Islas Canarias, Spain; Escuela de Medicina, Universidad de La Laguna, Santa Cruz de Tenerife, Islas Canarias, Spain
| | - J Vilá-Rico
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, Spain; Departamento de Cirugía, Universidad Complutense de Madrid, Madrid, Spain
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Fernández-Rojas E, Herrera-Pérez M, Vilá-Rico J. Posterior malleolar fractures: Indications and surgical approaches. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:160-169. [PMID: 36371071 DOI: 10.1016/j.recot.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/10/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022] Open
Abstract
Posterior malleolus fractures are frequent injuries, present in 7-44% of all ankle fractures. The objective of this study is to review the evidence to indicate the fixation of this fracture and to choose the appropriate surgical approach. The classic indications for fixation were fragment size greater than 25-30% of the articular surface and displacement greater than 2 mm. However, current evidence suggests that, rather than size, factors such as syndesmotic instability, intra-articular step-off greater than 1-2 mm, plafond impaction and the presence of intercalary fragments should be considered. When comparing the different surgical approaches, the literature supports the use of posterior approaches and reserves the recommendation of the traditional approach for exceptional cases. For the treatment of this injury it is essential to know the anatomy of the ankle and to consider all the factors described above, in addition to the presence of concomitant injuries.
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Affiliation(s)
- E Fernández-Rojas
- Equipo de Tobillo y Pie, Servicio de Traumatología y Ortopedia, Hospital Las Higueras, Talcahuano, Chile; Universidad Católica de la Santísima Concepción, Concepción, Chile.
| | - 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; Escuela de Medicina, Universidad de La Laguna, Santa Cruz de Tenerife, Islas Canarias, España
| | - J Vilá-Rico
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España; Departamento de Cirugía, Universidad Complutense de Madrid, Madrid, España
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Rajan L, Eble S, Kim J, Kukadia S, Kumar P, Day J, Cho D, Drakos M, Ellis S. Risk Factors Associated With Worse Clinical Outcomes of Ankle Fractures Involving the Posterior Malleolus. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231154217. [PMID: 36860801 PMCID: PMC9969454 DOI: 10.1177/24730114231154217] [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: 03/03/2023] Open
Abstract
Background Ankle fractures involving the posterior malleolus (PM) tend to result in inferior clinical outcomes compared to other ankle fractures. However, it is unclear which specific risk factors and fracture characteristics are associated with negative outcomes in these fractures. The aim of this study was to identify risk factors for poor postoperative patient-reported outcomes in patients with fractures involving the PM. Methods This retrospective cohort study included patients who sustained ankle fractures involving the PM between March 2016 and July 2020 and had preoperative computed tomography (CT) scans. In total, 122 patients were included for analysis. One patient (0.8%) had an isolated PM fracture, 19 (15.6%) had bimalleolar ankle fractures involving the PM, and 102 (83.6%) had trimalleolar fractures. Fracture characteristics including the Lauge-Hansen (LH) and Haraguchi classifications and posterior malleolar fragment size were collected from preoperative CT scans. Patient Reported Outcome Measurement Information System (PROMIS) scores were collected preoperatively and at a minimum of 1 year postoperatively. The association between various demographic and fracture characteristics with postoperative PROMIS scores was assessed. Results Involvement of more malleoli was associated with worse PROMIS Physical Function (P = .04), Global Physical Health (P = .04), and Global Mental Health (P < .001), and Depression scores (P = .001). Elevated BMI was also associated with worse PROMIS Physical Function (P = .0025), Pain Interference (P = .0013), and Global Physical Health (P = .012) scores. Time to surgery, fragment size, Haraguchi classification, and LH classification were not associated with PROMIS scores. Conclusion In this cohort, we found that trimalleolar ankle fractures were associated with inferior PROMIS outcomes compared with bimalleolar ankle fractures involving the PM in multiple domains. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Lavan Rajan
- Hospital for Special Surgery, New York,
NY, USA,Lavan Rajan, BA, Research Assistant,
Hospital for Special Surgery, 523 East 72nd St, 5th Floor, New York, NY 10021,
USA.
| | | | | | | | | | | | - David Cho
- Hospital for Special Surgery, New York,
NY, USA
| | - Mark Drakos
- Hospital for Special Surgery, New York,
NY, USA
| | - Scott Ellis
- Hospital for Special Surgery, New York,
NY, USA
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Liu Y, Guo D, Zhou X, Wang B, Li P, Li T. Effect of infrared irradiation combined with mannitol and kinesiology tape on postoperative swelling and pain in patients with a periarticular ankle fracture. Pak J Med Sci 2023; 39:257-261. [PMID: 36694737 PMCID: PMC9842990 DOI: 10.12669/pjms.39.1.5869] [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: 12/12/2021] [Revised: 11/02/2022] [Accepted: 11/15/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives To explore the effect of infrared irradiation combined with mannitol and Kinesiology tape on postoperative swelling and pain in patients with a periarticular ankle fracture. Methods The research subjects of this study were 88 patients with periarticular ankle fracture treated by surgery in the Department of Orthopedics of Baoding No.1 Central Hospital from October, 2019 to May, 2021. They were randomly divided into the observation group and the control group based on the random number table method, with 44 cases in each group. All patients were treated after the operation. Patients in the control group were treated with conventional drugs; while those in the observation group were provided with infrared irradiation combined with mannitol and Kinesiology tape. Further comparison was conducted on the degree of swelling, pain and satisfaction after treatment at three, five and seven days after operation. Results At three, five and seven days after operation, the cross-section diameter of the injured limb was significantly smaller in the observation group than that in the control group, and the difference was statistically significant (p<0. 05). The degree of pain in both groups was significantly lower at three, five and seven days after operation than that before treatment; moreover, the degree of pain in the observation group was significantly lower than that in the control group, and the difference was statistically significant (p<0. 05). Besides, the comparison of posttreatment satisfaction in both groups after treatment revealed that the total satisfaction of patients in the observation group (97.73%) was higher than that in the control group (79.55%), with a statistically significant difference (p<0.05). Conclusion Infrared irradiation combined with mannitol and Kinesiology tape can effectively alleviate postoperative swelling and pain of patients with a periarticular ankle fracture.
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Affiliation(s)
- Yuanyuan Liu
- Yuanyuan Liu, Department of Orthopedics, Baoding NO.1 Central Hospital, Baoding, Hebei, 071000, China
| | - Deli Guo
- Deli Guo, Department of Orthopedics, Baoding NO.1 Central Hospital, Baoding, Hebei, 071000, China
| | - Xinghua Zhou
- Xinghua Zhou, Department of Orthopedics, Baoding NO.1 Central Hospital, Baoding, Hebei, 071000, China
| | - Bo Wang
- Bo Wang, Department of Orthopedics, Baoding NO.1 Central Hospital, Baoding, Hebei, 071000, China
| | - Panxiang Li
- Panxiang Li, Department of Orthopedics, Baoding NO.1 Central Hospital, Baoding, Hebei, 071000, China
| | - Tao Li
- Tao Li, Department of Orthopedics, Baoding NO.1 Central Hospital, Baoding, Hebei, 071000, China
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Open fixation of the posterior malleolus increases the morbidity of trimalleolar ankle fracture fixation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03455-0. [PMID: 36581699 DOI: 10.1007/s00590-022-03455-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/01/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To assess the morbidity of open reduction internal fixation (ORIF) of posterior malleolus fractures (PMFs) in the setting of trimalleolar ankle fractures. METHODS A retrospective review of 79 trimalleolar ankle fractures was performed to identify need for syndesmotic fixation, blood loss, operative/tourniquet time, complications, and reoperations. Patients with PMF ORIF (n = 38) were compared to those with no fixation (n = 41). A subanalysis of patients with small PMFs (< 25%) was performed. RESULTS The PMF ORIF group required less syndesmosis fixation (proportional difference (PD) - 44.6%, 95% confidence interval (CI) - 61.8 to - 23.0%), had more blood loss (MD 20 ml, CI 0-40), longer operative times (MD 53.0 min, CI 35.9-70.1), longer tourniquet times (MD 26 min, CI 4-33), and had no difference in postoperative joint step-off or concentrically reduced joints. The PMF ORIF group had more postoperative complications (PD 26.9%, CI 6.3-44.8%) and a trend for more reoperations (PD 13.6%, CI -3.4 to 29.6%). Wound complications were more common in the PMF ORIF group (PD 26.5%, CI 6.9-43.6%), resulting in 5 (16.1%) irrigation and debridement procedures. On analysis of patients with small PMFs (n = 42), PMF ORIF (n = 15) resulted in longer operative/tourniquet times and had no observed difference in postoperative joint step-off, concentrically reduced joints, need for syndesmotic fixation, blood loss, or complications/reoperations. CONCLUSION PMF ORIF in the setting of trimalleolar ankle fractures was associated with increased operative/tourniquet times, blood loss, wound complications, and did not eliminate the need for syndesmosis fixation.
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Wu X, Gu Q. Comparison of different treatment methods for supination-lateral rotation ankle fractures. Jt Dis Relat Surg 2022; 34:16-23. [PMID: 36700259 PMCID: PMC9903107 DOI: 10.52312/jdrs.2023.814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/12/2022] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES This study aims to compare the therapeutic effects of fixation with fibular approach, fixation with posterolateral fibular approach, and conservative therapy on supination-lateral rotation ankle fractures. PATIENTS AND METHODS A total of 189 patients (103 males, 86 females; mean age: 45.7±4.7 years; range, 40 to 51 years) with supination-lateral rotation ankle fractures treated in our hospital between March 2020 and March 2021 were included in this prospective study. The patients were assigned into conservative therapy, fibular approach, and posterolateral approach groups including 63 patients in each group. Clinical conservative therapy was performed for conservative therapy group, while fibular approach and posterolateral approach groups were given fixation with fibular approach and posterolateral fibular approach, respectively. Their routine parameters, body stress, ankle function, treatment efficacy and safety were compared. RESULTS The length of hospital stay was shorter in the fibular approach and posterolateral approach groups than the conservative therapy group, particularly in the fibular approach group (p<0.05). The pain stress and oxidative stress were lower in the fibular approach and posterolateral approach groups than the conservative therapy group, particularly in the posterolateral approach group (p<0.05). Compared to the conservative therapy group, the fibular approach and posterolateral approach groups had significantly recovered ankle function, with better recovery in the posterolateral approach group (p<0.05). The response rate was higher in the fibular approach and posterolateral approach groups than the conservative therapy group, being higher in the posterolateral approach group (p<0.05). CONCLUSION For patients with supination-lateral rotation ankle fractures, fixation with posterolateral fibular approach is more effective for expediting the recovery of ankle joints than conservative therapy and fixation with fibular approach, accompanied by higher safety.
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Affiliation(s)
- Xiaoshu Wu
- Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Qiangrong Gu
- Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing Medical University, 210006 Nanjing, China
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Cici H, Ozmanevra R, Bektas YE, Ciklacandir S, Demirkiran ND, Isler Y, Erduran M, Basci O. Biomechanical Comparison of a Closed-Loop Double Endobutton to a Lag Screw in Fixation of Posterior Malleolar Fractures. J Foot Ankle Surg 2022; 61:975-978. [PMID: 35016833 DOI: 10.1053/j.jfas.2021.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/28/2021] [Accepted: 12/12/2021] [Indexed: 02/03/2023]
Abstract
Anteroposterior (AP) lag screw, posteroanterior (PA) lag screw, or posterior buttress plate are usually performed for posterior malleolar fixation, but the biomechanically strongest technique is unclear. The aim of our study was to biomechanically compare 3 different fixation methods for posterior malleolar fractures; AP lag screw, PA lag screw, and closed-loop double endobutton. Fracture models were created using a thin blade power saw after drawing the fracture line. The resultant fracture involved 30% of the joint on the distal tibial joint surface and extends with an angulation of approximately 50 degrees using 15 tibia composite bone samples. After anatomical reduction, fixation was achieved with 3.5 mm cortical screw in PA direction and in AP direction for group PA and AP, respectively. In Group DL, fixation was achieved with a closed-loop double endobutton (double lift loop, Orthomed, Turkey). The highest compression force to generate all displacement amounts was required for the double loop group (Group DL). The strongest fixation against compression was a double loop. The PA group was the second strongest fixation, and the AP group was the biomechanically weakest among these 3 fixation techniques. The closed-loop double endobutton technique was found biomechanically superior to anterior to posterior or posterior to anterior screw fixation techniques for posterior malleolar fracture.
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Affiliation(s)
- Hakan Cici
- Department of Orthopedics and Traumatology, İzmir Atatürk Training and Research Hospital, İzmir, Turkey
| | - Ramadan Ozmanevra
- Department of Orthopedics and Traumatology, University of Kyrenia, Kyrenia, Cyprus.
| | - Yunus Emre Bektas
- Department of Orthopedics and Traumatology, Gaziemir State Hospital, İzmir, Turkey
| | - Samet Ciklacandir
- Department of Biomedical Engineering, İzmir Katip Çelebi University, İzmir, Turkey
| | | | - Yalcin Isler
- Department of Biomedical Engineering, İzmir Katip Çelebi University, İzmir, Turkey
| | - Mehmet Erduran
- Department of Orthopedics and Traumatology, Dokuz Eylül University, İzmir, Turkey
| | - Onur Basci
- Department of Orthopedics and Traumatology, Dokuz Eylül University, İzmir, Turkey
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Littlefield CP, Drake JH, Egol KA. Unstable Rotational Ankle Fractures Treated With Anatomic Mortise Repair and Direct Posterior Malleolus Fixation. Foot Ankle Spec 2022:19386400221110087. [PMID: 35861248 DOI: 10.1177/19386400221110087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: The purpose of this study was to evaluate patient outcomes following a standardized algorithmic approach to ankle mortise stabilization, following rotational fracture, utilizing direct repair of the posterior malleolus in the prone position. Methods: Eighty consecutive patients with unstable rotational ankle fractures that involved the posterior malleolus were analyzed. All underwent direct repair of the posterior malleolus regardless of size through a posterolateral approach. Electronic records were retrospectively reviewed for demographic information, initial injury and operation details, healing status, and complications. Preoperative and postoperative radiographs were obtained to assess the initial injury and healing was determined both by radiographic and clinical progress at follow-up visits. Results: Average posterior malleolus fragment width was 8.1 ± 3.7 mm (range = 2.1-19.9 mm) and percentage of the articular surface was 23.6% (range = 7.1%-56.7%) on the lateral radiograph. Overall, 80/80 (100%) patients healed their ankle fractures by a mean 2.9 ± 1.1 months. Only 1 (1.3%) patient required transsyndesmotic fixation following posterior malleolus repair. Mean range of ankle motion was as follows: dorsiflexion 20° ± 10°, plantarflexion 34° ± 10°, inversion 8° ± 4°, and eversion 7° ± 4°. Seventy-nine patients (98.8%) had an anatomic mortise reduction. Nine patients (11.3%) had a superficial wound complication, 3 patients (3.8%) had dysesthesia in the sural nerve distribution, and 1 patient (1.3%) lost reduction of the medial malleolus. Conclusion: Patients who undergo direct repair of the posterior malleolus in the prone position can expect a high rate of healing with superficial wound breakdown being the biggest problem, which was associated with an ankle fracture dislocation. Posterior malleolus fixation may obviate the need of transsyndesmotic stabilization.Levels of Evidence: Retrospective Level IV.
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Affiliation(s)
- Connor P Littlefield
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York (CPL, JHD, KAE)
- Jamaica Hospital Medical Center, Queens, New York (KAE)
| | - Jack H Drake
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York (CPL, JHD, KAE)
- Jamaica Hospital Medical Center, Queens, New York (KAE)
| | - Kenneth A Egol
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York (CPL, JHD, KAE)
- Jamaica Hospital Medical Center, Queens, New York (KAE)
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14
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Neumann AP, Kroker L, Beyer F, Rammelt S. Complications following surgical treatment of posterior malleolar fractures: an analysis of 300 cases. Arch Orthop Trauma Surg 2022; 143:3129-3136. [PMID: 35849187 DOI: 10.1007/s00402-022-04536-9] [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: 04/16/2022] [Accepted: 06/22/2022] [Indexed: 11/26/2022]
Abstract
AIMS The treatment of ankle fractures and fracture-dislocations involving the posterior malleolus (PM) has undergone considerable changes over the past decade. The aim of our study was to identify risk factors related to the occurrence of complications in surgically treated ankle fractures with PM involvement. PATIENTS AND METHODS We retrospectively analyzed 300 patients at a mean age of 57 years with 300 ankle fractures involving the PM treated surgically at our institution over a 12-year period. The following relevant comorbidities were noted: arterial hypertension (43.7%; n = 131), diabetes mellitus (DM) (14.0%; n = 42), thereof insulin-dependent (3.7%; n = 11), peripheral vascular disease (0.7%; n = 2), osteoporosis (12.0%; n = 36), dementia (1.0%; n = 3), and rheumatoid arthritis (2.0%; n = 6). Furthermore, nicotine consumption was recorded in 7.3% (n = 22) and alcohol abuse in 4.0% (n = 12). RESULTS Complications occurred in 41 patients (13.7%). A total of 20 (6.7%) revision surgeries had to be performed. Patients with DM (p < 0.001), peripheral vascular disease (p = 0.003) and arterial hypertension (p = 0.001) had a significantly increased risk of delayed wound healing. Alcohol abuse was associated with a significantly higher overall complication rate (OR 3.40; 95% CI 0.97-11.83; p = 0.043), increased rates of wound healing problems (OR 11.32; 95% CI 1.94-65.60; p = 0.001) and malalignment requiring revision (p = 0.033). The presence of an open fracture was associated with an increased rate of infection and wound necrosis requiring revision (OR 14.25; 95% CI 2.39-84.84; p < 0.001). Multivariate analysis identified BMI (p = 0.028), insulin-dependent DM (p = 0.003), and staged fixation (p = 0.043) as independent risk factors for delayed wound healing. Compared to the traditional lateral approach, using the posterolateral approach for fibular fixation did not lead to increased complication rates. CONCLUSIONS Significant risk factors for the occurrence of complications following PM fracture treatment were identified. An individually tailored treatment regimen that incorporates all risk factors is important for a good outcome.
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Affiliation(s)
- Annika Pauline Neumann
- University Center of Orthopaedics,Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Livia Kroker
- University Center of Orthopaedics,Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Franziska Beyer
- University Center of Orthopaedics,Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Stefan Rammelt
- University Center of Orthopaedics,Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
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15
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Pilskog K, Gote TB, Odland HEJ, Fjeldsgaard KA, Dale H, Inderhaug E, Fevang JM. Association of Delayed Surgery for Ankle Fractures and Patient-Reported Outcomes. Foot Ankle Int 2022; 43:762-771. [PMID: 35184581 PMCID: PMC9168892 DOI: 10.1177/10711007211070540] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several studies probe the association between prolonged time to surgery and postoperative complications in ankle fractures, but little is known about how a longer wait time affects clinical outcomes. The present study aims to assess the association between time from injury to surgery and patient-reported outcomes after operative treatment of severe ankle fractures. METHOD Patients treated operatively for low-energy ankle fractures that also involve the posterior malleolus from 2014 to 2016 were included. Patient charts were reviewed for patient demographics, type of trauma, fracture characteristics, treatment given, and complications. Ankle function was evaluated on a follow-up visit by clinical examination, radiographs, and patient-reported outcome measures (Self-Reported Foot and Ankle Score [SEFAS], RAND-36, visual analog scale [VAS] of Pain, VAS of Satisfaction). We compared patients treated within 1 week to those treated later than a week from injury for analyses. RESULTS Follow-up visits of 130 patients were performed at mean 26 (SD 9) months after surgery. Patient demographics and fracture characteristics were similar between groups. Mean SEFAS was 34 (SD 10) in patients treated later than a week from injury vs 38 (SD 9) in those treated earlier (P = .012). Patients operated on later than 7 days from injury reported more pain (P = .008) and lower satisfaction than those treated earlier (P = .016). CONCLUSION In this retrospective patient series of low-energy ankle fractures with posterior malleolar fragments, we found that waiting >7 days for definitive surgery was associated with poorer clinical outcomes and more pain compared with those who had surgery earlier. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Kristian Pilskog
- Orthopedic department, Haukeland University Hospital, Norway,Clinical Institute 1, The University of Bergen,Kristian Pilskog, MD, Orthopedic Department, Haukeland University Hospital, Pb. 1400, Bergen, 5021, Norway.
| | | | | | | | - Håvard Dale
- Orthopedic department, Haukeland University Hospital, Norway,Clinical Institute 1, The University of Bergen
| | - Eivind Inderhaug
- Orthopedic department, Haukeland University Hospital, Norway,Clinical Institute 1, The University of Bergen
| | - Jonas Meling Fevang
- Orthopedic department, Haukeland University Hospital, Norway,Clinical Institute 1, The University of Bergen
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16
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Hembree WC, Gallagher BW, Guyton GP. What's New in Foot and Ankle Surgery. J Bone Joint Surg Am 2022; 104:857-863. [PMID: 35316249 DOI: 10.2106/jbjs.21.01562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Walter C Hembree
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland
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17
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How the Direction of Screws Affects the Primary Stability of a Posterior Malleolus Osteosynthesis under Torsional Loading: A Biomechanical Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12083833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Insufficient fixation of a posterior malleolus fracture (PM) can lead to posttraumatic complications such as osteoarthritis and chronic pain. The purpose of this biomechanical study was to test the hypothesis of whether the direction of PM screw fixation has an impact on the primary stability of osteosynthesis of a PM under torsional loading. PM fractures of 7 pairs human cadaveric lower leg specimens were stabilized with posterior to anterior (p.a.) or anterior to posterior (a.p.) screw fixation. Stability of the osteosynthesis was biomechanically tested using cyclic external torsional loading levels, in 2 Nm steps from 2 Nm up to 12 Nm, under constant monitoring with 3D ultrasonic marker (Zebris). The primary stability does not differ between both stabilizations (p = 0.378) with a medium effect size (η2p = 0.065). The movement of the PM tends to be marginally greater for the osteosynthesis with a.p. screws than with p.a. screws. Whether a.p. screws or the alternative p.a. screw fixation is performed does not seem to have an influence on the primary stability of the osteosynthesis of the PM fixation under torsional loading. Although osteosynthesis from posterior seems to be more stable, the biomechanical results in the torsional test show quite equivalent stabilities. If there is no significant dislocation of the PM, a.p. screw fixation could be a minimally invasive but stable surgical strategy.
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18
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Beak JS, Kim YT, Lee SH. Predisposing Factors for Posttraumatic Osteoarthritis After Malleolus Fracture Fixation in Patients Younger Than 50 Years. Foot Ankle Int 2022; 43:389-397. [PMID: 34677107 DOI: 10.1177/10711007211050039] [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: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to identify the risk factors for posttraumatic osteoarthritis (OA) after surgery for ankle fractures in patients aged ≤50 years. METHODS We performed a retrospective review of consecutive patients who underwent surgery for ankle fractures and were followed up for a minimum period of 5 years. The patients were assigned to 2 groups according to the presence of advanced OA at the last follow-up. Binary logistic regression was used to model the correlation between risk factors and OA. Functional outcomes were assessed using the Foot and Ankle Outcome Score. RESULTS The data of 332 patients who met the inclusion criteria were included in the analysis. The overall rate of posttraumatic arthritis was 27.7% (nonarthritis group: 240 patients, arthritis group: 92 patients). The arthritic change was significantly affected by BMI (95% confidence interval [CI] 1.29-19.76; adjusted odds ratio [OR] ≥ 30, 6.56), fracture-dislocation injury (CI 1.66-11.57; adjusted OR, 4.06), posterior malleolus (PM) fracture (CI 1.92-12.73, adjusted OR > 25% of the articular surface, 5.72), and postoperative articular incongruence (CI 1.52-18.10; adjusted OR, 7.21). The mean scores of the arthritis group were lower than those in the nonarthritis group (P < .05). CONCLUSION Obesity, fracture-dislocation injury, concomitant large PM fracture, and articular incongruence were risk factors of posttraumatic OA after surgery for ankle fractures. Surgeons should be aware that accurate reduction is critical in patients with ankle fractures with associated large PM fractures, especially those with obesity or severe initial injuries such as fracture-dislocation. LEVEL OF EVIDENCE Level III, case control study.
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Affiliation(s)
- Jong Seok Beak
- Department of Orthopedic Surgery, School of Medicine, Wonkwang University Hospital, Iksan, Republic of Korea
| | - Yeong Tae Kim
- Department of Orthopedic Surgery, School of Medicine, Wonkwang University Hospital, Iksan, Republic of Korea
| | - Sung Hyun Lee
- Department of Orthopedic Surgery, School of Medicine, Wonkwang University Hospital, Iksan, Republic of Korea
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19
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Heyes GJ, Khashkhusha TR, Mason L. Posterolateral Approach to Posterior Malleolar Fractures: A Literature Review. Foot Ankle Spec 2021; 16:149-158. [PMID: 34353143 DOI: 10.1177/19386400211009366] [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] [Indexed: 02/05/2023]
Abstract
This study reviews the current evidence on the indications and outcomes of the posterolateral approach in the treatment of posterior malleolar fractures. PubMed and Google Scholar search engines were used to construct a review of the literature for all studies detailing the posterolateral approach for posterior malleolar fracture fixation. A total of 11 studies met our inclusion criteria. In total, 332 fractures were identified. Overall superficial infection occurred in 4.5%, skin necrosis in 4.5%, and nerve injury in 4.5%. Hardware irritation that required removal occurred in 13.6%. None of the hardware removals involved posterior malleolus fixation. A total of 51 (15.4%) cases of arthritis were reported, follow-up ranged from a mean of 5.3 months to a mean 7.9 years. Regardless the majority of patient reported outcomes were excellent/good at final follow-up. Thresholds for joint reduction were not uniformly described or even quantified at all in some of the included studies. Variable indications for fixation were reported without reference to posterior malleolus fracture morphology. The posterolateral approach provides a satisfactory approach for fracture reduction with similar complication rates to that reported for other ankle fracture approaches. Further research is required on posterior malleolus fracture morphology, optimal fracture fixation and longer term functional and radiological outcomes.Levels of Evidence: Level III: Systematic review of retrospective cohort studies.
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Affiliation(s)
- Gavin J Heyes
- Consultant Trauma and Orthopaedic Surgeon, Liverpool University Hospitals NHS Foundation Trust, Aintree University Hospital, Trauma and Orthopaedics Department, Liverpool, UK
| | | | - Lyndon Mason
- Consultant Trauma and Orthopaedic Surgeon, Liverpool University Hospitals NHS Foundation Trust, Aintree University Hospital, Trauma and Orthopaedics Department, Liverpool, UK
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