Cross-Sectional Study to Assess the Functional Outcome of Neglected Bimalleolar Fracture

A Unique Physical Therapy Approach in a Complex Case of Pott's Fracture: A Case Report

The ankle joint is a complex joint that bears the human body's weight throughout daily activities. Unimalleolar, bimalleolar, and trimalleolar fractures are the three subgroups that make up the category of ankle fractures. Determining the risk-benefit tradeoffs between non-operative and surgical therapy still requires a thorough initial examination of the fracture pattern, soft tissue condition, and patient characteristics. Ankle fractures that are stable and well-aligned respond well to conservative therapy. Open reduction and internal fixation is the current gold standard of treatment for displaced and unstable fracture patterns, with historical data revealing good to outstanding outcomes for the majority of these patients. We present a case of a 19-year-old female sustaining a Pott's fracture following a road traffic accident. The overall treatment technique used included the overload principle, task-specific training, and an impairment-based strategy. The patient's impairments with regard to the range of motion, strength, edema, discomfort, wound healing, and functional limitations were handled by the therapist using exercises, manual therapy, and compressive cryotherapy. A clinically significant rehabilitation protocol for treating Pott's fracture is established in this case report.

Radiological outcomes of bimalleolar fractures: Are timing of surgery and type of reconstruction important?

OBJECTIVE

The goal of open reduction and internal fixation (ORIF) of bimalleolar ankle fractures is to reconstitute ankle anatomy. The most commonly used radiological parameters to assess adequacy of reduction are talocrural angle (TCA), medial clear space (MCS), tibiofibular overlap (TFO) and tibiofibular clear space (TFCS). There is little research about the radiological outcomes of surgery in bimalleolar fractures. We aimed at assessing the adequacy of ORIF and the factors involved in anatomical restoration (specifically time to surgery), postoperatively and at follow-up.

METHODS

TCA, MCS, TFO and TFCS were measured in preoperative and postoperative radiographs of 107 bimalleolar ankle fractures and in 83 follow-up radiographs, accounting for a total of 297 radiographs and 1182 measurements. Preoperative radiographs were categorized according to Danis-Weber classification. For all included cases, basic demographic data, dates of radiographs and surgery, and type of fixation used were acquired. Variables associated with postoperative and follow-up total anatomical reconstitution (i.e., when the four assessed radiological parameters were normalized), normalization of each radiological parameter, and improvement in the number of normalized radiological parameters were identified through univariable Cox regression analysis.

RESULTS

In our sample, 23.8% of the ankle fractures in postoperative radiographs and 28% in follow-up radiographs achieved a complete anatomical restoration. Type C fractures (hazard ratio [HR]=0.1, 95% confidence interval [CI]=0.02-0.7, P=0.021) were associated with lower chances of total anatomical reconstitution. The use of reconstruction plates (HR=0.1, 95% CI=0.03-0.7, P=0.014) and one third tubular plates (HR=0.2, 95% CI=0.03-0.8, P=0.026) decreased the chances of improving the number of normalized radiological parameters. Waiting days until surgery impaired total anatomical reconstitution (HR=0.8, 95% CI=0.6-0.9, P=0.012) and also reduced the chances of improving the number of normalized radiological parameters (HR=0.9, 95% CI=0.9-1.0, P=0.045).

CONCLUSION

The radiological results for the treatment of bimalleolar fractures are time sensitive, and surgery should thus be performed as soon as possible, using adequate fixation materials, in order to achieve a better restoration of ankle anatomy.

LEVEL OF EVIDENCE

IV, retrospective study.