1
|
Chen B, Ye Z, Wu J, Wang G, Yu T. The effect of early weight-bearing and later weight-bearing rehabilitation interventions on outcomes after ankle fracture surgery: A systematic review and meta-analysis of randomised controlled trials. J Foot Ankle Res 2024; 17:e12011. [PMID: 38635458 DOI: 10.1002/jfa2.12011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/29/2024] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVE This systematic review aimed to analyse the effect of early weight bearing versus late weight bearing on rehabilitation outcomes after ankle fractures, which primarily include ankle function scores, time to return to work/daily life and complication rates. METHODS The China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, China Science and Technology Journal, Web of Science, PubMed, Embase and Cochrane Library databases were searched. The focus was on identifying randomised controlled trials centred on early weight-bearing interventions for post-operative ankle fracture rehabilitation. All databases were searched for eligible studies published within the period from database inception to 20 June 2023. The eligible studies were screened according to the inclusion criteria. Study quality was evaluated using the methodology recommended by the Cochrane Handbook for the Systematic Evaluation of Interventions. Two authors independently performed the literature search and data extraction. Eligible studies were subjected to meta-analyses using Review Manager 5.3. Based on the time points at which post-operative ankle function was reported in the studies included in this paper, we decided to perform a meta-analysis of ankle function scores at 6 weeks post-operatively, 12 weeks post-operatively, 24-26 weeks post-operatively and 1 year post-operatively. RESULTS A total of 11 papers, comprising 862 patients, were included. Meta-analysis indicated that patients receiving early weight-bearing interventions, which referred to weight-bearing for 6 weeks post-operatively, experienced enhancements in ankle function scores (Olerud-Molander score, AOFAS score or Baird-Jackson score) at various post-operative milestones: 6 weeks (SMD = 0.69, 95% CI: 0.49-0.88 and p < 0.01), 12 weeks (SMD = 0.57, 95% CI: 0.22-0.92 and p < 0.01) and the 24-26 weeks range (SMD = 0.52, 95% CI: 0.20-0.85 and p < 0.01). The results of subgroup analyses revealed that the effects of early weight-bearing interventions were influenced by ankle range-of-motion exercises. Additionally, early weight bearing allows patients to return to daily life and work earlier, which was evaluated by time when they resumed their preinjury activities (MD = -2.74, 95% CI: -3.46 to -2.02 and p < 0.01), with no distinct elevation in the incidence of complications (RR = 1.49, 95% CI: 0.85-2.61 and p > 0.05). CONCLUSION The results showed that early weight bearing is effective in improving ankle function among post-operative ankle fracture patients and allows patients to return to daily life earlier. Significantly, the safety profile of early weight bearing remains favourable, with no higher risk of complications than late weight bearing.
Collapse
Affiliation(s)
- Bocheng Chen
- Physical Education and Sports School of Soochow University, Soochow University, Suzhou, Jiangsu Province, China
| | - Ziyan Ye
- Physical Education and Sports School of Soochow University, Soochow University, Suzhou, Jiangsu Province, China
| | - Jiaxin Wu
- Physical Education and Sports School of Soochow University, Soochow University, Suzhou, Jiangsu Province, China
| | - Guoxiang Wang
- Physical Education and Sports School of Soochow University, Soochow University, Suzhou, Jiangsu Province, China
| | - Tiancheng Yu
- Physical Education and Sports School of Soochow University, Soochow University, Suzhou, Jiangsu Province, China
| |
Collapse
|
2
|
Hollawell SM, Yancovitz S, Casciato DJ, Coleman MR. Safety and Outcome Measures of Ankle Open Reduction and Internal Fixation in an Ambulatory Surgical Center. J Foot Ankle Surg 2024; 63:376-379. [PMID: 38266809 DOI: 10.1053/j.jfas.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 12/28/2023] [Accepted: 01/13/2024] [Indexed: 01/26/2024]
Abstract
The transition of traditionally hospital-based orthopedic procedures to the ambulatory surgery center setting provides many benefits from a patient care and financial perspective. Specifically, closed ankle fractures can potentially be managed at such centers without needing hospitalization. Adding to the paucity of data, this study describes the safety, cost, and outcomes of patients undergoing ankle fracture repair in an ambulatory surgery center. A retrospective chart review of 100 patients who underwent ankle fracture open reduction and internal fixation from a single ambulatory surgery center by 1 surgeon were reviewed. Demographic data, surgical characteristics including operating time and cost were collected. Short- and long-term complications, as well as, reoperation rates were reported and functional outcomes were described. Of the 100 patients, 59% were female and the overall average age was 50 ± 16 years. The average cost per case was $8,709.63 ± 6,360.18. The short-term complication rate was 16%, with surgical site infection reported as the most common complication. No postoperative hospital admissions were reported. Planned and unplanned hardware removal was performed in 7% and 5% of patients, respectively. The delayed union rate was 13%, in which 86% shared a history of smoking. Smoking history was the only statistically significant predictor of prolonged bone healing (p = .002). This investigation demonstrates low complications rates for surgeries performed in a surgery center when compared to historical rates of those procedures performed in the hospital. These results suggest that ambulatory surgery center-based ankle fracture repair does not increase complications while may decrease overall cost when compared to ankle ORIF in a hospital setting.
Collapse
Affiliation(s)
- Shane M Hollawell
- Orthopaedic Institute Brielle Orthopedics Foot and Ankle Fellowship, Wall Township, NJ
| | - Sara Yancovitz
- Orthopaedic Institute Brielle Orthopedics Foot and Ankle Fellowship, Wall Township, NJ.
| | | | - Meagan R Coleman
- Orthopaedic Institute Brielle Orthopedics Foot and Ankle Fellowship, Wall Township, NJ
| |
Collapse
|
3
|
Welzel L, Omar M, Müller CW. Complications following surgical treatment of ankle fractures in the elderly: can they be avoided? Orthop Rev (Pavia) 2024; 16:116370. [PMID: 38666190 PMCID: PMC11043027 DOI: 10.52965/001c.116370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/24/2024] [Indexed: 04/28/2024] Open
Abstract
Background Following surgical treatment of ankle fractures, geriatric patients face high complication rates (CR) in literature. Commonly used diagnostic and treatment algorithms fail to consider requirements of ageing patients which increases the risk of postoperative complications. Objective Present study critically evaluated surgical management of ankle fractures in patients over 65 years old, with focus on identifying modifiable risk factors and effective comorbidity management strategies. Methods We conducted a retrospective single-center study on patients who underwent surgical treatment of an ankle fracture. Based on their age, participants were divided into non-geriatric patients (NGP<65y) and geriatric patients (GP≥65y). We analyzed overall CR and number of minor and major complications in relation to timing of surgery, biological sex, injury pattern, osteosynthesis, pre-existing medical conditions, and postoperative care. Results 402 patients were included. GP encountered significantly higher overall (p<0.001), minor (p<0.001) and major (p=0.003) complications. They presented more complex, displaced and open fractures. Predominant factor contributing to higher CR in NGP and markedly in GP was concomitant diseases, presenting a strong OR of 19,290 (p<0.001) and 17,022 (p<0.001). Delaying surgery and managing comorbidities preoperatively had a favorable impact. Conclusion We revealed a high significant correlation between pre-existing medical conditions and postoperative results. To ascertain viability of delayed surgery in facilitating additional diagnostics and treatment of comorbidities, further comparative trials with a larger cohort are imperative.
Collapse
Affiliation(s)
- Lukas Welzel
- Department of Orthopedics and Traumatology Asklepios Klinik Wandsbek
- Department of Traumatology Hannover Medical School
- Department of Orthopedics and Traumatology Schön Klinik Neustadt
| | - Mohamed Omar
- Department of Traumatology Hannover Medical School
| | | |
Collapse
|
4
|
Xiao B, Lu M, Chen X, Qiu D, He Y, Li X. Study on the risk factors of postoperative wound complications in patients with ankle fracture. Int Wound J 2024; 21:e14845. [PMID: 38584355 PMCID: PMC10999563 DOI: 10.1111/iwj.14845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Wound complications after surgery for ankle fractures can lead to catastrophic consequences. The purpose of this study was to evaluate the risk factors of postoperative wound complications in patients with ankle fracture and to determine their effects on prognosis. 200 patients with ankle fracture treated in our hospital from October 2021 to December 2023 were analysed retrospectively. The total incidence of postoperative wound complications was 19% (38/200). Type of complications: wound edge necrosis 15 cases (39.47%), dehiscence (reopening of wound) 13 cases (34.21%), delayed healing (>30 days) 10 cases (26.32%); Univariate analysis showed that patients' age, body mass index (BMI), current smoking, alcoholism, diabetes mellitus, injury mechanism, open fracture, wound classification, higher American Society of Anesthesiologists (ASA) score and operation time were all associated with postoperative wound complications. Multivariate Logistic regression model shows: age ≥60 years old OR3.671 (1.875-5.937), BMI OR1.198 (1.143-1.324), current smoking OR2.727 (1.251-5.602), alcoholism OR1.143 (1.034-1.267), complicated with diabetes OR2.763 (1.236-4.852), injury mechanism (high vs. low and medium energy) OR2.437 (1.238-4.786), open fracture OR1.943 (1.8262.139), wound classification (II vs. I) OR4.423 (1.73511.674), ASA score (III-IV vs. I-II) OR1.307 (1.113-2.194) was an independent risk factor for postoperative wound complications in patients with ankle fracture. Further, ROC curves showed that these nine independent influences had high accuracy and validity in predicting postoperative wound complications in patients with ankle fractures. In conclusion, independent risk factors for postoperative complications of ankle fracture were age >60 years, BMI, injury mechanism, open fracture, wound classification (II vs. I), ASA score, current smoking, and alcoholism. The wound classification (II vs. I) has the highest diagnostic value.
Collapse
Affiliation(s)
- Ben Xiao
- Orthopedic DepartmentBeijing TongRen Hospital Affiliated Capital Medical UniversityBeijingChina
| | - Meng Lu
- Orthopedic DepartmentBeijing TongRen Hospital Affiliated Capital Medical UniversityBeijingChina
| | - Xiaobin Chen
- Orthopedic DepartmentBeijing TongRen Hospital Affiliated Capital Medical UniversityBeijingChina
| | - Daojing Qiu
- Orthopedic DepartmentBeijing TongRen Hospital Affiliated Capital Medical UniversityBeijingChina
| | - Yuanming He
- Orthopedic DepartmentBeijing TongRen Hospital Affiliated Capital Medical UniversityBeijingChina
| | - Xuejun Li
- Orthopedic DepartmentBeijing TongRen Hospital Affiliated Capital Medical UniversityBeijingChina
| |
Collapse
|
5
|
Swenson R, Paull T, Moua G, Weatherby D, Azzam K, Wojahn R, Anderson S, Cole PA, Nguyen M. Does Transparency of Ankle Implant Costs Influence Surgeon Behavior? Foot Ankle Orthop 2024; 9:24730114241247826. [PMID: 38659719 PMCID: PMC11041529 DOI: 10.1177/24730114241247826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Background Ankle fractures are a common injury treated by orthopaedic surgeons. Unstable, displaced ankle fractures are often fixed with open reduction internal fixation (ORIF) using different implant constructs at various cost. No study to date has looked at transparency in ankle implant costs to surgeon behavior. Our surgeons self-identified that the biggest barrier for lowering implant cost was the lack of cost transparency. This was a surgeon-led-study to evaluate whether increased transparency in implant costs affected surgeon behavior. Methods Monthly operative logs from December 2021 to September 2022 were reviewed at our level 1 trauma center for operative fixation of ankle fractures. The cost data of each fixation construct was reported to trauma-trained surgeons at the end of each month from March 2022 to June 2022. Average costs of implants were compared before and after education. A linear mixed model was used to explore what factors were associated with changes in costs. Surgeons also participated in a poststudy survey. Results The implant costs of 110 ankle fracture fixations were reviewed over the period before education (n = 60), during education (n = 30), and after education (n = 20). The mean implant cost difference for unimalleolar fractures was -$204.80 (P = .68), whereas the mean cost difference for bimalleolar fractures was -$9.82 (P = .98). Trimalleolar fractures had a mean cost difference of +$94.47 (P = .84). Linear mixed model demonstrated fracture pattern as the only factor significantly associated with implant costs (P < .01). Post-education surgeon survey revealed that 6 of 7 surgeons felt that monthly updates affected their implant selection. However, only 2 surgeons demonstrated a change in practice with decreased implant costs during the study. Conclusion The majority of surgeons self-reported being influenced by the implant cost education, but the detected change in implant cost was only observed in less than one-third of surgeons. Our results suggest implant selection and related costs are not influenced by increased cost transparency education alone. Level of Evidence Level III, case control study.
Collapse
Affiliation(s)
| | - Thomas Paull
- University of Minnesota, Minneapolis, MN, USA
- Regions Hospital, Saint Paul, MN, USA
| | - Gaonhia Moua
- University of Minnesota, Minneapolis, MN, USA
- Regions Hospital, Saint Paul, MN, USA
| | - David Weatherby
- University of Minnesota, Minneapolis, MN, USA
- Regions Hospital, Saint Paul, MN, USA
| | - Khalid Azzam
- University of Minnesota, Minneapolis, MN, USA
- Regions Hospital, Saint Paul, MN, USA
| | - Robert Wojahn
- University of Minnesota, Minneapolis, MN, USA
- Regions Hospital, Saint Paul, MN, USA
| | - Sarah Anderson
- University of Minnesota, Minneapolis, MN, USA
- Regions Hospital, Saint Paul, MN, USA
| | - Peter A. Cole
- University of Minnesota, Minneapolis, MN, USA
- Regions Hospital, Saint Paul, MN, USA
| | - Mai Nguyen
- University of Minnesota, Minneapolis, MN, USA
- Regions Hospital, Saint Paul, MN, USA
| |
Collapse
|
6
|
Yin C, Sun L. Risk factors contributing to postoperative surgical site infections in patients undergoing ankle fracture fixation: A systematic review and meta-analysis. Int Wound J 2024; 21:e14639. [PMID: 38153200 PMCID: PMC10961858 DOI: 10.1111/iwj.14639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/17/2023] [Accepted: 12/17/2023] [Indexed: 12/29/2023] Open
Abstract
Surgical site infections (SSIs) following ankle fracture fixation pose significant challenges in patient recovery and healthcare management. Identifying risk factors contributing to SSIs can aid in developing targeted prevention and treatment strategies. This systematic review and meta-analysis were conducted according to the PRISMA guidelines and the PICO framework. A comprehensive literature search across major databases, including PubMed, Embase, Web of Science and the Cochrane Library, was completed on September 26, 2023. The inclusion criteria encompassed peer-reviewed studies of various designs that investigated risk factors for SSIs post-ankle fracture fixation. Quality assessment was performed using the Newcastle-Ottawa Scale. Statistical analyses assessed heterogeneity and calculated combined effect sizes using fixed- or random-effects models, depending on the heterogeneity observed. The initial search yielded 1250 articles, with seven meeting the inclusion criteria after rigorous screening and full-text review. The included studies, conducted between 2006 and 2019, predominantly utilized case-control designs. The meta-analysis identified diabetes, open fractures, smoking, age, alcohol consumption, ASA score ≥3, high BMI, contaminated incisions, fracture dislocation and heart disease as significant risk factors for postoperative SSIs. Publication bias assessment showed no significant bias across studies. The identification of key risk factors such as diabetes, open fractures, smoking, advanced age, alcohol consumption, high ASA score, elevated BMI, contaminated incisions, fracture dislocation and heart disease is essential in managing SSIs post-ankle fracture fixation. Targeted interventions addressing these risk factors are crucial to reduce the incidence of SSIs and improve overall patient outcomes.
Collapse
Affiliation(s)
- Changxin Yin
- Department of Micro OrthopedicsShandong University of Traditional Chinese MedicineJinanChina
| | - Lu Sun
- Department of Micro OrthopedicsShandong Provincial Hospital of Traditional Chinese MedicineJinanChina
| |
Collapse
|
7
|
Arif HA, LeBrun G, Moore ST, Friscia DA. Analysis of the Most Popular Online Ankle Fracture-Related Patient Education Materials. Foot Ankle Orthop 2024; 9:24730114241241310. [PMID: 38577700 PMCID: PMC10989055 DOI: 10.1177/24730114241241310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Background Given the increasing accessibility of Internet access, it is critical to ensure that the informational material available online for patient education is both accurate and readable to promote a greater degree of health literacy. This study sought to investigate the quality and readability of the most popular online resources for ankle fractures. Methods After conducting a Google search using 6 terms related to ankle fractures, we collected the first 20 nonsponsored results for each term. Readability was evaluated using the Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), and Gunning Fog Index (GFI) instruments. Quality was evaluated using custom created Ankle Fracture Index (AFI). Results A total of 46 of 120 articles met the inclusion criteria. The mean FKGL, FRE, and GFI scores were 8.4 ± 0.5, 57.5 ± 3.2, and 10.5 ± 0.5, respectively. The average AFI score was 15.4 ± 1.4, corresponding to an "acceptable" quality rating. Almost 70% of articles (n = 32) were written at or below the recommended eighth-grade reading level. Most articles discussed the need for imaging in diagnosis and treatment planning while neglecting to discuss the risks of surgery or potential future operations. Conclusion We found that online patient-facing materials on ankle fractures demonstrated an eighth-grade average reading grade level and an acceptable quality on content analysis. Further work should surround increasing information regarding risk factors, complications for surgery, and long-term recovery while ensuring that readability levels remain below at least the eighth-grade level.
Collapse
Affiliation(s)
- Haad A. Arif
- School of Medicine, University of California Riverside, Riverside, CA, USA
| | | | - Simon T. Moore
- School of Medicine, University of California Riverside, Riverside, CA, USA
| | - David A. Friscia
- School of Medicine, University of California Riverside, Riverside, CA, USA
- Eisenhower Desert Orthopedic Center, Rancho Mirage, CA, USA
| |
Collapse
|
8
|
Han X, Chu F, Jia D, Gao M, Zhang R, Zhang X, Wang H. Wound complication risk factors following open reduction and internal fixation of ankle fractures. Int Wound J 2024; 21:e14581. [PMID: 38112250 PMCID: PMC10961896 DOI: 10.1111/iwj.14581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023] Open
Abstract
This study was designed to identify risk factors for wound complications including surgical site infection (SSI) and wound healing issues following open reduction and internal fixation (ORIF) of ankle fractures. A retrospective analysis of individuals with ankle fractures treated with ORIF was undertaken. Study subjects were divided into a wound complications (WC) group and a no wound complication (NWC) group. The WC group was further divided into an SSI group and wound healing issues group. Twenty-one potential risk factors associated with wound complications after ORIF were tracked. Uni- and multivariate binary logistical regression analyses were used to identify risk factors associated with wound complications, ISS and wound healing issues. In total, 613 individuals, who had undergone surgery for ankle fractures formed the study cohort. The incidence of postoperative wound complications was 10.3% (63 cases), including 5.2% of SSI (32 cases) and 5.1% of wound healing issues (31 cases). The independent risk factors for wound complications were age 65 years or older, preoperative serum albumin level below 35 g/L, peripheral neuropathy, open fracture, fewer than seven cases per year in surgical volume, and attending surgeon level. The independent risk factors for SSI were age 65 years or older, preoperative serum albumin level below 35 g/L, open fracture and fewer than seven cases per year in surgical volume. The independent risk factors for wound healing issues were preoperative serum albumin level below 35 g/L, peripheral neuropathy, open fracture and attending surgeon level. Herein we found both factors inherent to the injury and individual and those pertaining to the surgical team affected the frequency of wound complications after ORIF of ankle fractures. Specifically, advanced age and low surgical volume were associated with a greater risk of SSI. Peripheral neuropathy and the low expertise level on the part of the surgeon were associated with a greater risk of wound healing issues. Hypoproteinaemia and open fracture were both associated with a greater risk of both SSI and wound healing issues.
Collapse
Affiliation(s)
- Xiuguo Han
- Department of Emergency SurgeryAffiliated Hospital of Jining Medical UniversityJiningChina
| | - Fenglong Chu
- Department of Orthopedic TraumaAffiliated Hospital of Jining Medical UniversityJiningChina
| | - Dailiang Jia
- Department of Emergency SurgeryAffiliated Hospital of Jining Medical UniversityJiningChina
| | - Ming Gao
- Department of Orthopedic TraumaAffiliated Hospital of Jining Medical UniversityJiningChina
| | - Rui Zhang
- Department of Orthopedic TraumaAffiliated Hospital of Jining Medical UniversityJiningChina
| | - Xu Zhang
- Department of Emergency SurgeryAffiliated Hospital of Jining Medical UniversityJiningChina
| | - Haibin Wang
- Department of Emergency SurgeryAffiliated Hospital of Jining Medical UniversityJiningChina
- Department of Orthopedic TraumaAffiliated Hospital of Jining Medical UniversityJiningChina
| |
Collapse
|
9
|
Rammelt S, Walther EJ. Joint-Preserving Osteotomy of the Lateral Tibial Plafond for Posttraumatic Osteonecrosis: A Prospective Cohort Study. Foot Ankle Int 2024; 45:328-337. [PMID: 38389195 DOI: 10.1177/10711007241227928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
BACKGROUND Posttraumatic osteonecrosis (ON) of the lateral distal tibia is a rare but severe complication of malleolar fractures. Treatment options include ankle fusion, arthroplasty, osteotomy, and drilling but clinical data on outcomes are limited to single case reports. The aim of this study was to prospectively evaluate the outcome following joint-preserving reconstruction. METHODS Over a 10-year period, 10 patients (8 females and 2 males, average age 36 years; range, 27-68 years) with posttraumatic ON were treated with intra-articular osteotomy of the distal tibia and bone grafting. All patients initially sustained a closed pronation injury, 7 with initial tibiotalar subluxation. Chronic syndesmotic instability following initial treatment was present in 4 patients and 5 were smokers. All patients were followed for a median of 68 (range, 12-103) months, 7 returned in person for clinical and radiographic follow-up. RESULTS No immediate postoperative complications were seen. Secondary ankle fusion was necessary in 1 case (10%) because of progressive osteoarthritis. At the time of follow-up, anterior ankle arthritis leading to impingement and requiring cheilectomy was noted in 4 cases, partial graft necrosis, and secondary syndesmotic instability requiring revision surgery was seen in 1 case each. Compared with the preoperative values, significant improvement in the Olerud-Molander Ankle Score (P = .012), EuroQuol-5 Score (P = .008), and Foot Function Index (FFI-D pain, P = .028; FFI-D restriction, P = .038) was seen. Average range of motion at the ankle was 45 degrees. CONCLUSION In our limited series of patients with posttraumatic ON of the lateral distal tibia, we found that joint-preserving reconstruction using an intra-articular distal tibial osteotomy with autologous bone grafting usually provided significant functional improvement and pain relief. In our cohort secondary fusions by a median 5.5-year follow-up were rare, but secondary, joint-sparing surgeries were common. LEVEL OF EVIDENCE Level III, prospective study.
Collapse
Affiliation(s)
- Stefan Rammelt
- University Center of Orthopaedics, Trauma and Plastic Surgery, Dresden, Germany
- University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany
| | - Eric Jörg Walther
- University Center of Orthopaedics, Trauma and Plastic Surgery, Dresden, Germany
- University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany
| |
Collapse
|
10
|
Guryel E, McEwan J, Qureshi AA, Robertson A, Ahluwalia R. Consensus on managing open ankle fractures in the frail patient. Bone Jt Open 2024; 5:236-242. [PMID: 38516934 PMCID: PMC10958533 DOI: 10.1302/2633-1462.53.bjo-2023-0155.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Aims Ankle fractures are common injuries and the third most common fragility fracture. In all, 40% of ankle fractures in the frail are open and represent a complex clinical scenario, with morbidity and mortality rates similar to hip fracture patients. They have a higher risk of complications, such as wound infections, malunion, hospital-acquired infections, pressure sores, veno-thromboembolic events, and significant sarcopaenia from prolonged bed rest. Methods A modified Delphi method was used and a group of experts with a vested interest in best practice were invited from the British Foot and Ankle Society (BOFAS), British Orthopaedic Association (BOA), Orthopaedic Trauma Society (OTS), British Association of Plastic & Reconstructive Surgeons (BAPRAS), British Geriatric Society (BGS), and the British Limb Reconstruction Society (BLRS). Results In the first stage, there were 36 respondents to the survey, with over 70% stating their unit treats more than 20 such cases per year. There was a 50:50 split regarding if the timing of surgery should be within 36 hours, as per the hip fracture guidelines, or 72 hours, as per the open fracture guidelines. Overall, 75% would attempt primary wound closure and 25% would utilize a local flap. There was no orthopaedic agreement on fixation, and 75% would permit weightbearing immediately. In the second stage, performed at the BLRS meeting, experts discussed the survey results and agreed upon a consensus for the management of open elderly ankle fractures. Conclusion A mutually agreed consensus from the expert panel was reached to enable the best practice for the management of patients with frailty with an open ankle fracture: 1) all units managing lower limb fragility fractures should do so through a cohorted multidisciplinary pathway. This pathway should follow the standards laid down in the "care of the older or frail orthopaedic trauma patient" British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) guideline. These patients have low bone density, and we should recommend full falls and bone health assessment; 2) all open lower limb fragility fractures should be treated in a single stage within 24 hours of injury if possible; 3) all patients with fragility fractures of the lower limb should be considered for mobilisation on the day following surgery; 4) all patients with lower limb open fragility fractures should be considered for tissue sparing, with judicious debridement as a default; 5) all patients with open lower limb fragility fractures should be managed by a consultant plastic surgeon with primary closure wherever possible; and 6) the method of fixation must allow for immediate unrestricted weightbearing.
Collapse
Affiliation(s)
| | - Jo McEwan
- University Hospital Southampton, Southampton, UK
| | | | | | | | | |
Collapse
|
11
|
Gregersen MG, Dalen AF, Skrede AL, Bjelland Ø, Nilsen FA, Molund M. Effects of Fibular Plate Fixation on Ankle Stability in a Weber B Fracture Model With Partial Deltoid Ligament Sectioning. Foot Ankle Int 2024:10711007241235903. [PMID: 38501723 DOI: 10.1177/10711007241235903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Weber B fractures with concomitant deltoid ligament injury have traditionally been operated with open reduction and internal fixation of the fibular fracture. More recently, clinical studies have suggested that some fractures have concomitant partial deltoid ligament injury with the deep posterior tibiotalar ligament intact (SER4a), allowing for nonoperative treatment in this subgroup. This study explores whether plate fixation of the fibula improves ankle stability in an SER4a injury model. And if so, does it restore native ankle stability? METHODS Fifteen cadaver ankle specimens were tested in 3 states using an industrial robot: intact joint, SER4a models without plate fixation of the fibula, and SER4a models with plate fixation of the fibula. The robot measured ankle stability in lateral translation, valgus, and internal and external rotation in 3 talocrural joint positions: 10 degrees dorsiflexion, neutral, and 20 degrees plantar flexion. Furthermore, fluoroscopic mortise view radiographs were taken to measure isolated talar shift and talar tilt. RESULTS The talar shift and tilt tests showed no differences between the SER4a injury model with and without fibular plate fixation at neutral ankle position with a mean difference of -0.16 mm (95% CI -0.33 to 0.01 mm, P = .071) for talar shift and -0.15 degrees (95% CI -0.01 to 0.30 degrees, P = .068) for talar tilt. However, plate fixation increased external rotation stability, with mean improvements ranging from -7.43 to -9.52 degrees (P < .001 for all comparisons), but did not restore intact ankle stability. For internal rotation, plate fixation resulted in minor differences. CONCLUSION The results of this suggest that plate fixation of the fibular fracture primarily improves external rotation stability but does not substantially improve lateral translation, valgus, or internal rotation stability in SER4a injury models. In this robotic cadaver model, fibular plate fixation did not fully restore intact ankle stability after simulated SER4a injury. CLINICAL RELEVANCE This study offers insights into the effects of fibular plate fixation on Weber B/SER4a injury models and may assist informed decisions when selecting treatments for these types of fractures.
Collapse
Affiliation(s)
- Martin G Gregersen
- Department of Physical Medicine and Rehabilitation, Østfold Hospital Trust, Grålum, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Andreas F Dalen
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Orthopaedic Surgery, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Aleksander L Skrede
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of ICT and Natural Sciences, Norwegian University of Science and Technology, Ålesund, Norway
| | - Øystein Bjelland
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of ICT and Natural Sciences, Norwegian University of Science and Technology, Ålesund, Norway
| | - Fredrik A Nilsen
- Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway
| | - Marius Molund
- Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway
| |
Collapse
|
12
|
Shibuya N, Jupiter DC. Effectiveness of Concurrent Ankle Arthroscopy During Open Reduction and Internal Fixation of Malleolar Fractures in Prevention of Common Short-Term Complications. J Foot Ankle Surg 2024:S1067-2516(24)00053-X. [PMID: 38438101 DOI: 10.1053/j.jfas.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/04/2024] [Accepted: 02/09/2024] [Indexed: 03/06/2024]
Abstract
Rotational malleolar fractures result in a high prevalence of intra-articular pathologies; therefore, routine arthroscopic assessment may be beneficial in the surgical treatment of ankle fractures. However, the clinical studies regarding the effectiveness of arthroscopy thus far have mixed results. We investigated the efficacy of concurrent arthroscopy during the treatment of malleolar fractures using a large U.S. healthcare data set. Those who had arthroscopy were compared with those who did not, during the surgical treatment of malleolar fractures, while adjusting for covariates of clinical relevance. The analysis showed that concurrent arthroscopy is protective against postoperative repeat surgery (OR = 0.13, 95CI = 0.02-0.41) and wound dehiscence (OR = 0.18, 95CI = 0.03-0.56). The number of added arthroscopy cases needed to avoid one repeat surgery was 74, while that of wound dehiscence was 52. Further studies are needed to determine if routine use of arthroscopy is justifiable in the surgical treatment of malleolar fractures, given the additional costs and time to the healthcare system.
Collapse
Affiliation(s)
- Naohiro Shibuya
- Clinical Professor, School of Podiatric Medicine, University of Texas Rio Grande Valley, Harlingen, TX.
| | - Daniel C Jupiter
- Associate Professor, Department of Biostatistics and Data Science, Department of Orthopaedic Surgery and Rehabilitaion, The University of Texas Medical Branch, Galveston, TX
| |
Collapse
|
13
|
Wang J, Jia HB, Li HM, Jiang HQ, Zhao JG. Intramedullary Nailing Versus Open Reduction and Plate Fixation for Lateral Malleolar Fractures: A Meta-Analysis. J Foot Ankle Surg 2024; 63:275-280. [PMID: 38052379 DOI: 10.1053/j.jfas.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 12/07/2023]
Abstract
The fixation for lateral malleolar fracture in ankle fractures is still controversial. The purpose of this meta-analysis is to compare clinical and radiological outcomes between intramedullary nail (IMN) and plate for lateral malleolar fractures in ankle fractures. The PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials (RCTs) from databases inception to June 2023. Data on outcomes were extracted and the methodological quality of the included studies were assessed. A meta-analysis was performed using RevMan 5.3 software when the data extracted from included studies could be synthesized. Seven RCTs were included. The methodological quality of the included studies was moderate to high. The meta-analysis results showed that the infection rate of the IMN group was significantly lower than that of the plate group (RR = 0.38; 95%CI 0.18-0.82; p = .01). There were no significant differences between the 2 groups in Olerud and Molander Ankle Score (OMAS), union rate, radiological outcomes, nerve injury rate, reoperation rate, loss of reduction, and total complication rate. Our present meta-analysis demonstrated that the IMN might be a better method for the fixation of lateral malleolar fracture in ankle fracture, as the infection rate was significantly lower than a plate.
Collapse
Affiliation(s)
- Jie Wang
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Hao-Bo Jia
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Hao-Min Li
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | | | - Jia-Guo Zhao
- Department of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
14
|
Gökçeoğlu YS, İncesu AN, Dağ EE, Özger EY, Akgül T. Assessing the Quality and Clarity of YouTube Videos as an Informational Source for Ankle Fractures: A Study of the Turkish Population. Cureus 2024; 16:e55891. [PMID: 38476504 PMCID: PMC10932549 DOI: 10.7759/cureus.55891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 03/14/2024] Open
Abstract
Background and objective The significance of YouTube as a prominent source of healthcare-related information cannot be overstated. Its influence on patient education is substantial. However, despite its popularity, there has been little research into the quality and comprehensibility of videos related to ankle fractures, a condition with increasing incidence rates, particularly in the context of Turkey. To address this gap in the literature and the growing reliance on digital platforms for health information during the coronavirus disease 2019 (COVID-19) pandemic, this study aims to assess the quality, clarity, and pedagogical value of YouTube videos on ankle fractures for the Turkish population. Methodology A comprehensive examination of 150 YouTube videos concerning ankle fractures, employing exacting inclusion and exclusion criteria to identify 52 videos for in-depth analysis was undertaken. The investigation entailed an assessment of content quality, presentation style, and user interaction, utilizing the criteria established by the Journal of the American Medical Association (JAMA) and the Patient Education Materials Assessment Tool (PEMAT), as well as a novel measurement known as the Ankle Fracture Content Score (AFCS). A statistical analysis was executed to gauge the educational value and dependability of the information presented. Results The majority of ankle fracture management videos were found to be uploaded by medical professionals, covering various aspects such as rehabilitation and patient testimonials. However, the overall educational quality was suboptimal, with patient-shared videos lacking in depth and accuracy. Statistical analysis showed no significant differences in content quality across different uploader categories, except for notably lower educational quality in videos shared by patients. Conclusions The findings underscore a significant need for healthcare professionals and academic institutions in Turkey to produce and share high-quality, reliable, and comprehensible videos on ankle fractures. Leveraging YouTube's extensive reach can significantly improve health literacy among the Turkish public, ensuring access to accurate and trustworthy health information.
Collapse
Affiliation(s)
- Yaşar Samet Gökçeoğlu
- Orthopedics and Traumatology, School of Medicine, Istanbul University, Istanbul, TUR
| | - Ayşe Nur İncesu
- Orthopedics and Traumatology, Faculty of Medicine, Istanbul University, Istanbul, TUR
| | - Elif Eda Dağ
- Orthopedics and Traumatology, Faculty of Nursing, Istanbul University, Istanbul, TUR
| | - Elif Yağmur Özger
- Physical Medicine and Rehabilitation, Istanbul University Cerrahpaşa School of Medicine, Istanbul, TUR
| | - Turgut Akgül
- Orthopedics and Traumatology, Faculty of Medicine, Istanbul University, Istanbul, TUR
| |
Collapse
|
15
|
Gwak HC, Kim JH, Park DH, Kim JY, Seo WS, Lee HY, Kim DY. Patterns of Anterior Inferior Tibiofibular Ligament Avulsion Fracture Accompanied by Ankle Fracture. J Foot Ankle Surg 2024; 63:127-131. [PMID: 37898330 DOI: 10.1053/j.jfas.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/22/2023] [Accepted: 06/23/2023] [Indexed: 10/30/2023]
Abstract
The anterior inferior tibiofibular ligament (AITFL) avulsion fracture accompanying an ankle fracture can compromise ankle stability, necessitating accurate evaluation and a clear understanding of its pathophysiology.. The aim of this study was to investigate the association between AITFL avulsion fracture and Lauge-Hansen, Wagstaffe classification. A retro-prospective study was conducted at a university-affiliated tertiary care medical center. We selected 128 patients who underwent surgery at our institution between January 2013 and July 2017 and analyzed the association between AITFL avulsion fracture and the foot position. According to the modified Wagstaffe classification system, there were 39 cases of type II, followed by 9 cases of type III and 8 cases of type IV. Of the7 pronation-abduction fractures, 3 were AITFL avulsion fracture (43%), while of the 21 pronation-external rotation fractures, 9 were AITFL avulsion fracture (43%). Of the 95 supination-external rotation fractures, there were 56 cases (59%) of AITFL avulsion fractures. Of the pronation fractures, 0% were fibular avulsion fractures and 43% were tibial avulsion fractures. Of the supination fractures, 44% were fibular avulsion fractures and 16% were tibial avulsion fracture. The difference in the ratio of fibular to tibial avulsion fractures between pronation and supination fractures was significant (p < .001). These results suggest that tibial avulsion fractures of type IV in the modified Wagstaffe classification and pronation fractures occur due to collision with the anterolateral corners of the distal bone when the talus externally rotates. Moreover, in cases of pronation fractures, a new type of AITFL avulsion fracture has been observed.
Collapse
Affiliation(s)
| | - Jung-Han Kim
- Department of Orthopedic Surgery, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Dae-Hyun Park
- Department of Orthopedic Surgery, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Ji-Youn Kim
- Department of Orthopedic Surgery, Kosin University Gospel Hospital, Busan, Korea
| | - Won-Seok Seo
- Department of Orthopedic Surgery, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Hyo-Young Lee
- Department of Orthopedic Surgery, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Dae-Yoo Kim
- Department of Orthopedic Surgery, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea.
| |
Collapse
|
16
|
Saliba I, Cannell S, Valentin E, Dagher T, Bauer T, Anract P, Feruglio S, Vialle R, Moussellard HP, Hardy A. Validation of the Ankle Ligament Reconstruction-Return to Sports after Injury (ALR-RSI) Score as a Tool to Assess Psychological Readiness to Return to Sport in an Active Population After Ankle Fracture Surgery: A Cross-sectional Study. J Foot Ankle Surg 2024; 63:295-299. [PMID: 38151113 DOI: 10.1053/j.jfas.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/05/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023]
Abstract
Ankle injuries account for 15% to 25% of all sports injuries resulting in significant pain and loss of function. The purpose of this cross-sectional study was to validate a scale to help surgeons quantify the psychological readiness to Return To Sport (RTS) in patients undergoing ankle fracture surgery. ALR-RSI was used to assess the psychological readiness for RTS in athletic patients who underwent ankle fracture fixation between January 2020 and January 2021. Participants filled out ALR-RSI and 2 Patient-Related Outcome Measurement (PROM) tools: Olerud-Molander Ankle Score (OMAS) and Self-Reported Foot and Ankle Score (SEFAS). A total of 93 patients were included. There was a strong correlation between ALR-RSI and both OMAS and SEFAS, with Pearson coefficients of r = 0.58 and 0.53, respectively. ALR-RSI was significantly higher in the RTS group than in those who no longer practiced their main preinjury sport. Moreover, the discriminant validity of ALR-RSI (AUC = 0.81) was better than that of the SEFAS and OMAS (AUC = 0.64 and 0.65, respectively, p = .001). The intra-class correlation coefficient ρ of 0.94 showed excellent reproducibility. At an optimal cutoff value of 76.7, ALR-RSI had a sensitivity of 81% and a specificity of 75% with a Youden index of 0.56. In conclusion, ALR-RSI was a valid and reproducible tool to evaluate the psychological readiness for RTS in an active population after an ankle fracture. This score could help surgeons identify athletes who may have unfavorable postoperative outcomes and provide support on the ability to RTS.
Collapse
|
17
|
Galasso A, Caughman AM, Griffith A, Hoch C, Rex J, Scott DJ, Gross CE. A Detailed Analysis of Workplace Foot and Ankle Injuries. Foot Ankle Spec 2024:19386400241233844. [PMID: 38424705 DOI: 10.1177/19386400241233844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
INTRODUCTION This study analyzes the incidence rate and median workdays missed due to foot and ankle injuries across age groups, sexes, and industries. METHODS Workplace injury data from 2003 to 2019 were obtained using the Nonfatal Cases Involving Day Away from Work: Selected Characteristics database provided by the Bureau of Labor Statistics (BLS). The data were grouped by injury location (ie, foot, ankle), injury type (ie, fracture, sprain), and industry, and reported with injury incidence rates and median workdays missed. RESULTS The incidence rate of foot and ankle injuries significantly decreased from 2003 to 2019 (P < .001). With increasing age, the incidence rate of foot and ankle injuries decreased (P < .001) and median workdays missed increased (P < .001). Men had significantly higher rates of foot and ankle injuries (P < .001). Agriculture, forestry, fishing, and hunting (foot=10.23%, ankle=10.41%); construction (foot=8.14%, ankle=8.68%); and transportation and warehousing (foot=11.06%, ankle=13.80%) industries had the highest injury incidence rates. Transportation and warehousing (foot=16.8 days, ankle=16.3 days), mining (foot=44.9 days, ankle=17.1 days), and utilities (foot=26.7 days, ankle=24.4 days) industries had the highest median workdays missed. CONCLUSION Increased incidence and severity of workplace foot and ankle injuries are associated with male sex and heavy labor industries. Age was positively associated with severity and negatively associated with incidence of workplace ankle injuries. LEVELS OF EVIDENCE Level III, Retrospective cohort study.
Collapse
Affiliation(s)
- Annemarie Galasso
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | | | - Adam Griffith
- Department of Orthopaedic Surgery and Rehabilitation Services, University of Chicago, Chicago, Illinois
| | - Caroline Hoch
- University of North Carolina, Gillings School of Global Public Health, Charleston, South Carolina
| | - James Rex
- Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Daniel J Scott
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Christopher E Gross
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| |
Collapse
|
18
|
Lorente A, Pelaz L, Palacios P, Benlloch M, de la Rubia Ortí JE, Barrios C, Mariscal G, Lorente R. Predictive Factors of Functional Outcomes and Quality of Life in Patients with Ankle Fractures: A Systematic Review. J Clin Med 2024; 13:1188. [PMID: 38592026 PMCID: PMC10932135 DOI: 10.3390/jcm13051188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/17/2024] [Accepted: 02/10/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Evaluating the predictors of unfavorable outcomes in patients with ankle fractures is crucial for identifying high-risk patients and implementing personalized treatment strategies. This study aimed to analyze factors that influence quality of life in patients with ankle fractures. Methods: Four databases were consulted. The main outcomes were functionality and quality of life scales combined using the standard mean difference (SMD) (Review Manager 5.4). Results: Eight studies with 2486 patients were included. A significant correlation was found between female sex and worse functionality scores (beta 4.15, 95% CI 1.84-6.46). Additionally, older age was correlated with worse functionality scores (beta -0.24, 95% CI -0.29 to -0.19). Patients with diabetes or metabolic syndrome also had worse outcomes (SMD 0.27, 95% CI 0.18-0.36). High BMI and obesity were also associated with worse quality of life scores (beta 2.62, 95% CI 0.77-4.48). Smokers had greater disability in the analyzed scales (SMD 0.22, 95% CI 0.05-0.39). No significant differences were observed with respect to syndesmotic involvement. Conclusions: Age, sex, diabetes, high BMI, and smoking negatively impact functional outcomes and quality of life in patients with ankle fractures.
Collapse
Affiliation(s)
- Alejandro Lorente
- Ankle and Foot Surgery Unit, Department of Traumatology and Orthopaedic Surgery, University Hospital Ramón y Cajal, 28034 Madrid, Spain; (A.L.); (L.P.)
| | - Leire Pelaz
- Ankle and Foot Surgery Unit, Department of Traumatology and Orthopaedic Surgery, University Hospital Ramón y Cajal, 28034 Madrid, Spain; (A.L.); (L.P.)
| | - Pablo Palacios
- Department of Traumatology and Orthopaedic Surgery, Sanchinarro University Hospital, 28050 Madrid, Spain;
| | - María Benlloch
- Department of Basic Medical Sciences, Catholic University of Valencia, 46001 Valencia, Spain; (M.B.); (J.E.d.l.R.O.)
| | - José Enrique de la Rubia Ortí
- Department of Basic Medical Sciences, Catholic University of Valencia, 46001 Valencia, Spain; (M.B.); (J.E.d.l.R.O.)
| | - Carlos Barrios
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, 46001 Valencia, Spain;
| | - Gonzalo Mariscal
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, 46001 Valencia, Spain;
| | - Rafael Lorente
- Department of Orthopedic Surgery and Traumatology, University Hospital of Badajoz, 06006 Badajoz, Spain;
| |
Collapse
|
19
|
Le V, Viskontas D, Lohre R, Yan J, Stone T, Perey B, Moola F, Boyer D, Lemke HM, Apostle K. Immediate Unprotected Weightbearing vs 2 Weeks Nonweightbearing After Open Reduction Internal Fixation of Ankle Fractures. Foot Ankle Int 2024; 45:103-114. [PMID: 38156640 DOI: 10.1177/10711007231217675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Postoperative care protocols for ankle fracture surgery remain controversial with variability among care providers. This prospective controlled trial compared 12-week postoperative outcomes for immediate unprotected weightbearing (IMWB) vs nonweightbearing (NWB) for 2 weeks in a splint followed by weightbearing as tolerated (WBAT) in a boot after surgical fixation of selected low-energy ankle fractures without superior articular involvement. METHODS Eighty-seven patients undergoing surgical fixation of ankle fractures at a single level 1 trauma center were recruited according to specific criteria and enrolled by presentation date. The first 43 eligible patients were allocated to the control group, with NWB in a splint for 2 weeks followed by WBAT in a walker boot. The next 44 patients recruited were allocated to the IMWB group. The primary outcome was the Olerud-Molander score (OMAS). Secondary outcome measures included the Euroquol-5D (EQ5D) score and Work Productivity and Activity Impairment: Specific Health Problem (WPAI:SHP) scores, ankle range of motion (ROM), wound complications, time to return to work, radiograph measurements, and fracture reduction loss. In this perioperative-focused study, we collected data on patients until 12 weeks postoperation. RESULTS The IMWB group had 5 superficial wound complications vs 1 in the control group. At 12 weeks, we found no difference in OMAS, EQ5D, WPAI:SHP scores, ROM, time to return to work, or radiographic measurements. CONCLUSION In this short-term and relatively small prospective trial, we found more wound complications among patients treated with immediate unprotected weightbearing compared with patients treated with 2 weeks of NWB followed by protected weightbearing. Given the low incidence and small sample size, we do not know if these observed findings are generalizable. However, we also found no difference in functional outcomes at 12 weeks postoperation between these 2 groups. In light of that, we do not recommend IMWB after open reduction internal fixation of low-energy ankle fractures with plate and/or screw fixation. LEVEL OF EVIDENCE Level II, prospective controlled trial.
Collapse
Affiliation(s)
- Vu Le
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Darius Viskontas
- Department of Orthopaedics, University of British Columbia, BC, Canada
| | - Ryan Lohre
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - James Yan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Trevor Stone
- Department of Orthopaedics, University of British Columbia, BC, Canada
| | - Bertrand Perey
- Department of Orthopaedics, University of British Columbia, BC, Canada
| | - Farhad Moola
- Department of Orthopaedics, University of British Columbia, BC, Canada
| | - Dory Boyer
- Department of Orthopaedics, University of British Columbia, BC, Canada
| | - H Michael Lemke
- Department of Orthopaedics, University of British Columbia, BC, Canada
| | - Kelly Apostle
- Department of Orthopaedics, University of British Columbia, BC, Canada
| |
Collapse
|
20
|
Lehto PM, Kortekangas T, Vakkala M, Ohtonen P, Nyman ES, Karvonen K, Liisanantti J, Kaakinen TI. The effect of tourniquet use on postoperative opioid consumption after ankle fracture surgery - a retrospective cohort study. Scand J Pain 2024; 24:sjpain-2023-0051. [PMID: 38126186 DOI: 10.1515/sjpain-2023-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES A pneumatic tourniquet is often used during ankle fracture surgery to reduce bleeding and enhance the visibility of the surgical field. Tourniquet use causes both mechanical and ischemic pain. The main purpose of this study was to evaluate the effect of tourniquet time on postoperative opioid consumption after ankle fracture surgery. METHODS We retrospectively reviewed the files of 586 adult patients with surgically treated ankle fractures during the years 2014-2016. We evaluated post hoc the effect of tourniquet time on postoperative opioid consumption during the first 24 h after surgery. The patients were divided into quartiles by the tourniquet time (4-43 min; 44-58 min; 59-82 min; and ≥83 min). Multivariable linear regression analysis was used to evaluate the results. RESULTS Tourniquets were used in 486 patients. The use of a tourniquet was associated with an increase in the total postoperative opioid consumption by 5.1 mg (95 % CI 1.6-8.5; p=0.004) during the first 24 postoperative hours. The tourniquet time over 83 min was associated with an increase in the mean postoperative oxycodone consumption by 5.4 mg (95 % CI 1.2 to 9.7; p=0.012) compared to patients with tourniquet time of 4-43 min. CONCLUSIONS The use of a tourniquet and prolonged tourniquet time were associated with higher postoperative opioid consumption during the 24 h postoperative follow-up after surgical ankle fracture fixation. The need for ethical approval and informed consent was waived by the Institutional Review Board of Northern Ostrobothnia Health District because of the retrospective nature of the study.
Collapse
Affiliation(s)
- Pasi M Lehto
- Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Research Center of Oulu University, Oulu University Hospital, Oulu, Finland
| | - Tero Kortekangas
- Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Research Center of Oulu University, Oulu University Hospital, Oulu, Finland
| | - Merja Vakkala
- Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Research Center of Oulu University, Oulu University Hospital, Oulu, Finland
| | - Pasi Ohtonen
- Research Service Unit, Oulu University Hospital, Oulu, Finland
| | - Emma-Sofia Nyman
- Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Research Center of Oulu University, Oulu University Hospital, Oulu, Finland
| | - Kaisu Karvonen
- Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Research Center of Oulu University, Oulu University Hospital, Oulu, Finland
| | - Janne Liisanantti
- Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Research Center of Oulu University, Oulu University Hospital, Oulu, Finland
| | - Timo I Kaakinen
- Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Research Center of Oulu University, Oulu University Hospital, Oulu, Finland
| |
Collapse
|
21
|
Yüce A, Erkurt N, Yerli M, Saygılı MS, Özkan CB. Morphology of Fibular Incisura is a Deciding Factor Between Posterior Malleolus Avulsion Fracture or Syndesmotic Ligament Injury in Ankle Fractures. J Foot Ankle Surg 2024; 63:18-21. [PMID: 37572828 DOI: 10.1053/j.jfas.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/18/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023]
Abstract
The bone anatomy of tibiofibular syndesmosis has been a topic of interest. Fibular incisura morphology has been analyzed on cadaver specimens, plain radiographs, or CT images. The aim of this study is to examine the effects of fibula incisura features and fibula morphology in ankle injuries, especially involving posterior malleolus and posteroinferior tibiofibular ligament injuries. From 2017 through 2022, A total of 59 patients with isolated lateral malleolar fracture, Mason-Malloy type 1 posterior malleolar fracture, syndesmosis injury in those without posterior malleolar fracture, supination external rotation type 3 injuries according to Lauge-Hansen classification, and preoperative bilateral ankle computed tomography images were included in the study. Fibula morphologies and syndesmosis measurements were made from preoperative computed tomography images using axial CT images from 1 cm proximal to the tibial plafond. The diagnosis of posterior malleolar fractures was made using the CT classification system of Mason and Malloy, and the diagnosis of syndesmosis injury was made with a cotton test during surgery. Age, gender, fractured side, incisura type, incisor depth, width, anterior and posterior facet lengths, incisor version (antevert-retrovert), the angle between the anterior and posterior facets, and fibula type were recorded. There was a statistically significant difference between the groups in posterior facet length and incisura width. Morphological features of fibular incisura may be the determinant of PITFL injury or PMA injury in fibular fractures caused by an external rotation mechanism.
Collapse
Affiliation(s)
- Ali Yüce
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey.
| | - Nazım Erkurt
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Mustafa Yerli
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Mehmet Selçuk Saygılı
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Can Burak Özkan
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| |
Collapse
|
22
|
Wu W, Liu B, Wang C. Equivalent Fracture Patterns Demonstrate Poorer Postoperative Functional Outcomes Among Pronation-External Rotation IV Ankle Fractures. Cureus 2024; 16:e53348. [PMID: 38435888 PMCID: PMC10908427 DOI: 10.7759/cureus.53348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Wangsheng Wu
- Orthopaedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, CHN
- Orthopaedics, Affiliated Tumor Hospital of Xinjiang Medical University, Ürümqi, CHN
| | - Bingsheng Liu
- Orthopaedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, CHN
| | - Chengwei Wang
- Orthopaedics, Affiliated Tumor Hospital of Xinjiang Medical University, Ürümqi, CHN
| |
Collapse
|
23
|
Kocan J, Joseph E, Mercado P, Haider MN, Pavlesen S, Rohrbacher B. Computed Tomography Scans and Fixation Rates for Trimalleolar Ankle Fractures Over 10 Years at a Level 1 Trauma Center. Foot Ankle Orthop 2024; 9:24730114231216984. [PMID: 38223655 PMCID: PMC10785731 DOI: 10.1177/24730114231216984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Background The posterior malleolus component of the trimalleolar ankle fracture has posed a controversial topic for diagnostic imaging and surgical management. Preoperative computed tomography (CT) scans are used to better appreciate fracture morphology and may affect management techniques. No prior study has investigated the trend in preoperative CT scan use and the rates of posterior and syndesmotic fixation for trimalleolar injuries. Methods This retrospective cohort study evaluated the use of preoperative CT scans and the rates of posterior and syndesmotic fixation for trimalleolar ankle fractures over a 10-year period at an adult level 1 trauma center. Patients surgically managed for ankle fractures with OTA/AO classifications of 44B3, 44C3.3, 44C1.3, 44C2.3, and 44A3 were identified and included using Current Procedural Terminology codes and a prospectively collected fracture registry. Demographic information, comorbidities, fixation methods, and use of preoperative CT scan were recorded. Comparative analyses were performed to assess for yearly differences in demographic characteristics along with changes in trends of preoperative CT scans and posterior and syndesmotic fixation. Results A total of 1191 patients were included in the analyses. OTA/AO 44B3.2 fractures were the most common injuries (yearly range of 59.4%-80.1%). The rate of posterior fixation did not significantly increase during the study interval (1.4% growth per year [95% CI -0.27, 3.07]). However, the rate of preoperative CT scan use significantly increased by 2.76% (95% CI 1.99, 3.52) per year and the rate of syndesmotic fixation increased by 2.58% (95% CI 1.17, 3.99) per year. Fixation methods for both the syndesmosis and posterior malleolus changed during the study timeline. Conclusion Despite a relatively stable rate of posterior fixation, the frequency of preoperative CT scans and use of syndesmotic fixation increased significantly over a 10-year study period. Level of Evidence Level IV, descriptive pilot study.
Collapse
Affiliation(s)
- Joseph Kocan
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Elias Joseph
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Paul Mercado
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Mohammad N. Haider
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Sonja Pavlesen
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Bernard Rohrbacher
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| |
Collapse
|
24
|
Filippi J, Gutiérrez P, Quezada J, Massri-Pugin J, Bastías GF, Melo R, Vidal C, Silvestre R. Role of Lateral Ankle Ligaments in Vertical Stability of the Fibula: A Cadaveric Model. Foot Ankle Int 2023; 44:1192-1198. [PMID: 37646284 DOI: 10.1177/10711007231192465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND In unstable ankle fractures, the role of the deltoid and syndesmosis ligaments has been widely studied. However, it is uncertain what the importance of the lateral ankle ligament complex (LALC) is in the vertical stability of the fibula. Given its anatomical position, it should prevent the proximal translation of the fibula. This study aims to evaluate the role of the LALC in stabilizing the fibula in the vertical plane. METHODS Eleven below-knee cadaveric specimens were used in this study. Proximal traction of the fibula was performed by applying 50 N in the intact state and after sequential transection of the syndesmotic ligaments, anterior talofibular ligament (ATFL), and the calcaneofibular ligament (CFL). At each stage, the proximal displacement of the fibula was measured. One-way repeated measures analysis of variance with post hoc Bonferroni correction was carried out to determine any significant differences between the groups. A P value <.05 was considered statistically significant. RESULTS The vertical displacement of the fibula in the intact state, and after sequential transection of syndesmotic ligaments, ATFL, and CFL was 1.96 ± 1.19 mm, 3.96 ± 1.33 mm, 5.9 ± 1.73 mm, and 10.22 ± 2.76 mm, respectively. There was no significant difference in the proximal displacement of the fibula between the intact and the syndesmotic ligaments groups (P < .05). However, when the syndesmotic ligaments were transected in conjunction with ATFL ± CFL, a significant difference was observed compared to the intact state (P < .001). CONCLUSION The complete disruption of syndesmotic ligaments did not significantly increase the proximal displacement of the fibula. However, when the ATFL ± CFL were additionally disrupted, there was a significant increase in the vertical translation of the fibula. CLINICAL RELEVANCE To our knowledge, this is the first study describing that LALC plays a paramount role in the vertical stability of the fibula. Concomitant syndesmosis and LALC should be suspected in an axially unstable fibular fracture with a significant proximal displacement.
Collapse
Affiliation(s)
- Jorge Filippi
- Department of Orthopaedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Jafet Massri-Pugin
- Department of Orthopaedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Rodrigo Melo
- Clínica Las Condes, Santiago, Chile
- Hospital del Trabajador, Santiago, Chile
| | - Catalina Vidal
- Department of Orthopaedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rony Silvestre
- Unidad de Biomecánica Deportiva, Clínica MEDS, Santiago, Chile
- Departamento de Ciencias de la Salud, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
25
|
Nakajima H, Yamaguchi S, Kimura S, Mikami Y, Watanabe S, Toguchi K, Ito R, Sakamoto T, Sasho T, Ohtori S. Validity of the Center-Center Method for the Syndesmotic Fixation Axis Compared to the Transsyndesmotic Axis. Foot Ankle Int 2023; 44:1166-1173. [PMID: 37750413 DOI: 10.1177/10711007231198818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND Placement of clamp forceps along the transsyndesmotic (TS) axis reduces the risk of iatrogenic syndesmotic malreduction during ankle fracture surgery with tibiofibular diastasis. This study aimed to measure the difference between the TS axis and the axis determined by an intraoperative fluoroscopic technique using the center-center (CC) method. We also compared the values obtained when the CC method was performed at different heights from the tibial plafond. METHODS We evaluated the computed tomography scans of 150 patients with normal syndesmosis. The CC method was simulated using digitally reconstructed radiographs. The TS and CC axes were projected onto an axial computed tomographic image linked to digitally reconstructed radiography. The angle between the two axes (interaxis angle) and the distance between the intersection of these axes and the medial tibial cortex (interaxis distance) were measured. The procedures were performed 0, 10, and 20 mm proximal to the tibial plafond, and the measurements were compared among the different heights using a 1-way repeated-measures analysis of variance. RESULTS The TS axis was found to be externally rotated to the CC axis, with an interaxis angle of 8.5 degrees (SD, 6.8 degrees). The interaxis angle increased from 1.9 degrees at a height of 0 mm to a greater angle at higher heights (P < .001). The overall interaxis distance was 7.7 (SD, 6.3) mm, increasing from 2.0 mm at a height of 0 mm to a greater distance at higher heights (P < .001). CONCLUSION The TS axis was externally rotated relative to the CC axis, and the difference between the 2 axes was greater when the CC method was performed on the higher heights from the tibial plafond. To clamp the syndesmosis along the TS axis, the CC method should be applied close to the ankle joint. LEVEL OF EVIDENCE Level IV, case series.
Collapse
Affiliation(s)
- Hirofumi Nakajima
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Satoshi Yamaguchi
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
- Graduate School of Global and Transdisciplinary Studies, Chiba University, Inage-ku, Chiba-shi, Chiba, Japan
| | - Seiji Kimura
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Yukio Mikami
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Shotaro Watanabe
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Kaoru Toguchi
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Ryu Ito
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Takuya Sakamoto
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Takahisa Sasho
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
- Center for Preventive Medical Sciences, Chiba University, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Seiji Ohtori
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chuo-ku, Chiba-shi, Chiba, Japan
| |
Collapse
|
26
|
Nassour N, Akhbari B, Ranganathan N, Tawakol A, Rosovsky RP, Guss D, DiGiovanni CW, Ashkani-Esfahani S. Correlation Between Statin Use and Symptomatic Venous Thromboembolism Incidence in Patients With Ankle Fracture: A Machine Learning Approach. Foot Ankle Spec 2023:19386400231207692. [PMID: 37905534 DOI: 10.1177/19386400231207692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND Identifying factors that correlate with the incidence of venous thromboembolism (VTE) has the potential to improve VTE prevention and positively influence decision-making regarding prophylaxis. In this study, we aimed to investigate the correlation between statin consumption and the incidence of VTE in patients who sustained an ankle fracture. METHODS In this retrospective, case-controlled study, cases were those who developed VTE and controls were those who had no VTE, and the ratio was 1:4. Patients' demographics, history of hyperlipidemia, and reported statins use were obtained. A random forest classifier (RFC) model was used to predict whether statin consumers were at risk of VTE after ankle fracture regardless of VTE prophylaxis administration based on statin consumption, body mass index (BMI), age, and biological sex. RESULTS Of the 1175 patients with ankle fractures, 238 had confirmed VTE (case group), and 937 had no symptomatic VTE (control group; ratio 1:4). Fifty (21%) cases and 407 (43%) controls were on a statin. Statin users had a significantly lower incidence of VTE after ankle fracture, odds ratio (OR) = 0.35, 95% CI: 0.25, 0.49, P < .001. Our model showed an area under the receiving operator curve (AUROC) of 78%, a sensitivity of 73%, and a specificity of 83% in predicting the risk of VTE. The importance of the predictors of VTE, other than the use of statins (model importance = 0.1), were age (model importance of 0.72), BMI (model importance of 0.24), and biological sex (model importance of 0.02). CONCLUSION Statins were significantly associated with a lower rate of VTE in our population of patients who sustained an ankle fracture. LEVELS OF EVIDENCE 3.
Collapse
Affiliation(s)
- Nour Nassour
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bardiya Akhbari
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Noopur Ranganathan
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ahmed Tawakol
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Rachel P Rosovsky
- Division of Hematology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Daniel Guss
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Foot and Ankle Division, Department of Orthopaedic Surgery, Massachusetts General Hospital, Newton Wellesley Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher W DiGiovanni
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Foot and Ankle Division, Department of Orthopaedic Surgery, Massachusetts General Hospital, Newton Wellesley Hospital, Harvard Medical School, Boston, Massachusetts
| | - Soheil Ashkani-Esfahani
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Foot and Ankle Division, Department of Orthopaedic Surgery, Massachusetts General Hospital, Newton Wellesley Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
27
|
Darwich A, Nörenberg D, Adam J, Hetjens S, Schilder A, Obertacke U, Gravius S, Jawhar A. A Multi-Disciplinary MRI Assessment May Optimize the Evaluation of Chondral Lesions in Acute Ankle Fractures: A Prospective Study. Diagnostics (Basel) 2023; 13:3220. [PMID: 37892043 PMCID: PMC10605548 DOI: 10.3390/diagnostics13203220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
Chondral lesions (CL) in the ankle following acute fractures are frequently overlooked immediately after the injury or diagnosed at a later stage, leading to persistent symptoms despite successful surgery. The literature presents a wide range of discrepancies in the reported incidence of CLs in acute ankle fractures. The objective of this prospective study is to provide a precise assessment of the occurrence of chondral lesions (CLs) in acute ankle fractures through MRI scans conducted immediately after the trauma and prior to scheduled surgery. Furthermore, the study aims to highlight the disparities in the interpretation of these MRI scans, particularly concerning the size and extent of chondral damage, between radiologists and orthopedic surgeons. Over the period of three years, all patients presenting with an unstable ankle fracture that underwent operative treatment were consecutively included in this single-center prospective study. Preoperative MRIs were obtained for all included patients within 10 days of the trauma and were evaluated by a trauma surgeon and a radiologist specialized in musculoskeletal MRI blinded to each other's results. The location of the lesions was documented, as well as their size and ICRS classification. Correlations and kappa coefficients as well as the p-values were calculated. A total of 65 patients were included, with a mean age of 41 years. The evaluation of the orthopedic surgeon showed CLs in 52.3% of patients. CLs occurred mainly on the tibial articular surface (70.6%). Most talar lesions were located laterally (11.2%). The observed CLs were mainly ICRS grade 4. According to the radiologist, 69.2% of the patients presented with CLs. The most common location was the talar dome (48.9%), especially laterally. Most detected CLs were graded ICRS 3a. The correlation between the two observers was weak/fair regarding the detection and classification of CLs and moderate regarding the size of the detected CLs. To enhance the planning of surgical treatment for ankle chondral lesions (CLs), it may be beneficial to conduct an interdisciplinary preoperative assessment of the performed scans. This collaborative approach can optimize the evaluation of ankle CLs and improve overall treatment strategies.
Collapse
Affiliation(s)
- Ali Darwich
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.A.); (A.S.); (U.O.); (S.G.); (A.J.)
| | - Dominik Nörenberg
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany;
| | - Julia Adam
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.A.); (A.S.); (U.O.); (S.G.); (A.J.)
| | - Svetlana Hetjens
- Institute of Medical Statistics and Biomathematics, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany;
| | - Andreas Schilder
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.A.); (A.S.); (U.O.); (S.G.); (A.J.)
| | - Udo Obertacke
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.A.); (A.S.); (U.O.); (S.G.); (A.J.)
| | - Sascha Gravius
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.A.); (A.S.); (U.O.); (S.G.); (A.J.)
| | - Ahmed Jawhar
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.A.); (A.S.); (U.O.); (S.G.); (A.J.)
- Department of Orthopedics, Traumatology and Sports Medicine, Marienhaus Hospital Hetzelstift/Teaching Hospital University Mainz, Stiftstraße 10, 67434 Neustadt an der Weinstraße, Germany
| |
Collapse
|
28
|
Bergström J, Möller Rydberg E, Wennergren D, Svensson Malchau K. Incidence and Risk Factors for Surgical Site Infection in Ankle Fractures: An Observational Study of 480 Patients in Sweden. J Clin Med 2023; 12:6464. [PMID: 37892601 PMCID: PMC10607575 DOI: 10.3390/jcm12206464] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Surgical site infection (SSI) is a frequently reported complication after ankle fracture surgery. To our knowledge, no study has been conducted on its incidence in Sweden. The present study aimed to determine the incidence of, risk factors for, and most common causative pathogen of SSI. METHODS Patients who underwent primary surgery for an ankle fracture between 1 September 2017 and 31 August 2019 at the Sahlgrenska University Hospital were identified. Data on potential SSI risk factors and clinical outcome (infected/non-infected) were retrieved from medical records. Cox regression analysis and descriptive statistics were used. RESULTS Of the 480 reviewed patients, 49 developed SSI (10.2%), of which 35 (7.3%) were superficial and 14 (2.9%) were deep. Open fractures (p < 0.001) and age (p = 0.016) were statistically significant risk factors for SSI in the univariate analysis. In the multivariable analysis, only open fracture was statistically significant (HR = 3.0; 95% C.I. = 1.3-6.9, p = 0.013). Cases of Staphylococcus aureus (S. aureus) were most common (n = 12, 24.5%). Methicillin resistance was uncommon (n = 2, 4.1%). CONCLUSIONS An incidence of 10.2% was established, which is comparable to international findings. Infection monitoring is an important part of tackling the global challenge of antibiotic resistance. Future prospective studies to further establish risk factors are warranted to decrease the incidence of SSI.
Collapse
Affiliation(s)
- Johanna Bergström
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (E.M.R.); (D.W.); (K.S.M.)
| | - Emilia Möller Rydberg
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (E.M.R.); (D.W.); (K.S.M.)
- Department of Orthopaedics, Sahlgrenska University Hospital, 413 80 Gothenburg, Sweden
| | - David Wennergren
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (E.M.R.); (D.W.); (K.S.M.)
- Department of Orthopaedics, Sahlgrenska University Hospital, 413 80 Gothenburg, Sweden
| | - Karin Svensson Malchau
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (E.M.R.); (D.W.); (K.S.M.)
- Department of Orthopaedics, Sahlgrenska University Hospital, 413 80 Gothenburg, Sweden
| |
Collapse
|
29
|
Abstract
BACKGROUND The incidence of ankle fractures is increasing, and risk factors for prolonged opioid use after ankle fracture fixation are unknown. Accordingly, the purpose of this study was to investigate risk factors that lead to prolonged opioid use after surgery. METHODS The Truven MarketScan database was used to identify patients who underwent ankle fracture surgery from January 2009 to December 2018 based on CPT codes. Patient characteristics were collected, and patients separated into 3 cohorts based on postoperative opioid use (no refills, refills within 6 months postoperative, and refills within 1 year postoperatively). The χ2 test and multivariate analysis were performed to assess the association between risk factors and prolonged use. RESULTS In total, 34 691 patients were analyzed. Comorbidities most highly associated with prolonged opioid use include 2+ preoperative opioid prescriptions (odds ratio [OR] = 11.92; P < .001), tobacco use (OR = 2.03; P < .001), low back pain (OR = 1.81; P < .001), depression (OR = 1.48; P < .001), diabetes (OR = 1.34; P < .001), and alcohol abuse (OR = 1.32; P < .001). CONCLUSION Opioid use after ankle fracture surgery is common and may be necessary; however, prolonged opioid use and development of dependence carries significant risk. Identifying those patients at an increased risk for prolonged opioid use can aid providers in tailoring their postoperative pain regimen. LEVELS OF EVIDENCE Prognostic, Level III.
Collapse
Affiliation(s)
| | | | - Corey Spenser
- Department of Orthopaedics, Emory University, Atlanta, Georgia
| | | | | |
Collapse
|
30
|
González-Alonso M, Trapote-Cubillas AR, Madera-González FJ, Fernández-Hernández Ó, Sánchez-Lázaro JA. Spanish Translation, Cross-Cultural Adaptation, and Validation of the Olerud-Molander Ankle Score (OMAS) for Ankle Fractures. Foot Ankle Orthop 2023; 8:24730114231213594. [PMID: 38058977 PMCID: PMC10697036 DOI: 10.1177/24730114231213594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
Background The aim of this study was to translate and cross-culturally adapt the Olerud-Molander Ankle Score (OMAS) into Spanish and to assess its reliability and validity. Methods The translation and adaptation to develop the Spanish version of the OMAS (OMAS-Sp) was performed according to current international guidelines. The OMAS-Sp was administered to 98 patients with a surgically treated ankle fracture, and it was repeated 7-14 days later to assess construct reliability of each question's score and the total score. Test-retest reliability and the internal consistency were calculated, and concurrent validity was assessed by comparing the OMAS-Sp with the Foot and Ankle Outcome Score (FAOS). The presence of floor and ceiling effects was also analyzed. Results Adequate internal consistency was found with a Cronbach α of 0.821. Excellent test-retest reliability was demonstrated with an interclass correlation coefficient for the total score of 0.970 (95% CI 0.956-0.980; P < .001). Spearman correlation coefficients (r's) between the OMAS-Sp total score and the 5 FAOS subscales ranged from 0.944 to 0.951 (P < .001). No floor or ceiling effects were found. Conclusion The OMAS-Sp demonstrated adequate psychometric properties and is a valid and reliable tool for assessing outcomes in Spanish-speaking patients with surgically treated ankle fractures. Level of Evidence Level II, prospective cohort study.
Collapse
Affiliation(s)
| | | | | | | | - Jaime A. Sánchez-Lázaro
- University Hospital of Leon, Leon, Spain
- University of Salamanca, Salamanca, Spain
- Institute of Biomedicine (IBIOMED), University of Leon, Leon, Spain
| |
Collapse
|
31
|
Gregersen MG, Justad-Berg RT, Gill NEQ, Saatvedt O, Aas LK, Molund M. Functional orthosis versus cast immobilization for weightbearing stable Weber B ankle fractures with concomitant unstable gravity stress tests. Bone Jt Open 2023; 4:713-719. [PMID: 37725035 PMCID: PMC10508240 DOI: 10.1302/2633-1462.49.bjo-2023-0012.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
Aims Treatment of Weber B ankle fractures that are stable on weightbearing radiographs but unstable on concomitant stress tests (classified SER4a) is controversial. Recent studies indicate that these fractures should be treated nonoperatively, but no studies have compared alternative nonoperative options. This study aims to evaluate patient-reported outcomes and the safety of fracture treatment using functional orthosis versus cast immobilization. Methods A total of 110 patients with Weber B/SER4a ankle fractures will be randomized (1:1 ratio) to receive six weeks of functional orthosis treatment or cast immobilization with a two-year follow-up. The primary outcome is patient-reported ankle function and symptoms measured by the Manchester-Oxford Foot and Ankle Questionnaire (MOxFQ); secondary outcomes include Olerud-Molander Ankle Score, radiological evaluation of ankle congruence in weightbearing and gravity stress tests, and rates of treatment-related adverse events. The Regional Committee for Medical and Health Research (approval number 277693) has granted ethical approval, and the study is funded by South-Eastern Norway Regional Health Authority (grant number 2023014). Discussion Randomized controlled trials are needed to evaluate alternative nonoperative treatment options for Weber B/SER4a ankle fractures, as current clinical guidelines are based on biomechanical reasoning. The findings will be shared through publication in peer-reviewed journals and presentations at conferences.
Collapse
Affiliation(s)
- Martin G. Gregersen
- Department of Physical Medicine and Rehabilitation, Østfold Hospital Trust, Grålum, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Nicolaj E. Q. Gill
- Department of Orthopaedic Surgery, Innlandet Hospital Trust, Gjøvik Hospital, Gjøvik, Norway
| | - Ola Saatvedt
- Department of Orthopaedic Surgery, Innlandet Hospital Trust, Gjøvik Hospital, Gjøvik, Norway
| | - Lars K. Aas
- Orthopaedic Department, Møre og Romsdal Hospital Trust, Ålesund Hospital, Alesund, Norway
| | - Marius Molund
- Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway
| |
Collapse
|
32
|
Dong QY, Wu Y, Wang CH, Park YW. A Novel Flexible Fixation Method for Syndesmotic Injury. Foot Ankle Int 2023; 44:854-861. [PMID: 37329236 DOI: 10.1177/10711007231177044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND This study aims to evaluate the results and the safety of a novel fixation method we developed for syndesmosis injuries that we call the "embrace" technique. METHODS Between March 2018 and October 2020, a total of 67 patients with ankle fractures and syndesmotic injuries underwent syndesmosis fixation with the embrace technique at our institute. Plain radiographs and computed tomographic (CT) scans were obtained preoperatively. Postoperative radiographic assessment included anteroposterior (AP) and lateral radiographs and CT scans of both ankles. Additionally, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score, Olerud-Molander Ankle Score, and visual analog scale (VAS) score were used for postoperative assessment. RESULTS The mean age was 27.6 ± 10.9 (range, 14-56) years. The mean follow-up time was 30.3 ± 6.2 (range, 24-48) months. There were no malreductions indicated by any CT parameter except fibular rotation in a postoperative comparison between 2 sides. We found significant preoperative-postoperative changes in anterior difference, posterior difference, and fibular rotation but no significant preoperative-postoperative difference in fibular translation. There was no significant postoperative difference between the affected-side and normal-side measurements of any parameter. Complications included delayed wound healing, lateral pain because of wire knot irritation (11.9%), and medial fiber wire irritation (7.5%). The mean AOFAS, Olerud-Molander, and VAS scores at the last follow-up were 94.4 ± 6.8 (range, 84-100), 95.4 ± 6.1 (range, 80-100), and 0.68 ± 1.0 (range, 0-3) points, respectively. CONCLUSION In our cohort, this novel technique proved to be an effective method for syndesmosis fixation in patients with ankle fractures associated with very good radiologic and patient-reported outcomes. LEVEL OF EVIDENCE Level IV, case series.
Collapse
Affiliation(s)
- Quan Yu Dong
- Department of Hand, Foot and Microsurgery, the Affiliated Hospital of Qingdao University, Qingdao City, Shandong Province, China
| | - Yong Wu
- Department Foot and Ankle Surgery, Yueyang People's Hospital of Hunan Province, Yue Yang, China
| | - Chen Han Wang
- Department of Hand, Foot and Microsurgery, the Affiliated Hospital of Qingdao University, Qingdao City, Shandong Province, China
| | - Yong Wook Park
- Department of Hand, Foot and Microsurgery, the Affiliated Hospital of Qingdao University, Qingdao City, Shandong Province, China
| |
Collapse
|
33
|
Corin N, Pearkes T, Hristova K, Nagaraj P, Bassett J, Riddick A, Harries W, Hepple S, Winson I, Robinson P. The Use of Hindfoot Nails for Elderly Complex Distal Tibial and Ankle Fractures. J Foot Ankle Surg 2023; 62:797-801. [PMID: 37086906 DOI: 10.1053/j.jfas.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 03/15/2023] [Accepted: 03/29/2023] [Indexed: 04/24/2023]
Abstract
Elderly patients who sustain complex ankle or distal tibial fractures are often frail and comorbid and need surgery to contain the talus underneath the tibia in order to protect the soft tissue envelope and allow early unrestricted weightbearing. We performed a retrospective observational review of patients >65 years old who underwent a hindfoot nail fixation of an ankle or distal tibial fracture in our institution. Data collected included: injury sustained, open or closed injury, ASA grade, age at time of surgery, length of stay, postoperative mortality, complications, and further treatment. The primary outcome was reoperation. Secondary outcomes were infection and 1 year mortality. Seventy hind foot nailing procedures were undertaken. Sixty-three out of 70 patients were female. The average age of those who died within 1 year of surgery was 84 years. Forty-five out of 70 were open injuries. Eleven out of 70 patients died with 1 year of surgery (range 1-358 days postsurgery). Five out of 70 (7%) patients developed an infection. Four out of 5 of these injuries were open. Three out of 5 underwent removal of the nail due to infection. Two out of 5 had the infection suppressed with antibiotics. Ten out of 70 (14%) patients underwent locking bolt removal due to it backing out or being prominent and causing wound healing issues. Two out of 70 (3%) patients went on to have below knee amputations. Both were due to ongoing wound problems following open fractures. The hindfoot nail is an important implant when treating complex ankle and distal tibial fractures in an elderly population. It facilitates early mobilization to avoid deconditioning and other medical complications.
Collapse
Affiliation(s)
- Nicole Corin
- Department of Trauma and Orthopaedics, Southmead Hospital, Bristol, United Kingdom.
| | - Timothy Pearkes
- Department of Trauma and Orthopaedics, Southmead Hospital, Bristol, United Kingdom
| | - Kalina Hristova
- Department of Trauma and Orthopaedics, Southmead Hospital, Bristol, United Kingdom
| | - Prashanth Nagaraj
- Department of Trauma and Orthopaedics, Southmead Hospital, Bristol, United Kingdom
| | - James Bassett
- Department of Trauma and Orthopaedics, Southmead Hospital, Bristol, United Kingdom
| | - Andrew Riddick
- Department of Trauma and Orthopaedics, Southmead Hospital, Bristol, United Kingdom
| | - William Harries
- Department of Trauma and Orthopaedics, Southmead Hospital, Bristol, United Kingdom
| | - Steven Hepple
- Department of Trauma and Orthopaedics, Southmead Hospital, Bristol, United Kingdom
| | - Ian Winson
- Department of Trauma and Orthopaedics, Southmead Hospital, Bristol, United Kingdom
| | - Peter Robinson
- Department of Trauma and Orthopaedics, Southmead Hospital, Bristol, United Kingdom
| |
Collapse
|
34
|
Lee YK, Oh YS, Lee DK, Lee MJ, Song YN, Lee HS, Yeo ED. Evaluation of Contact Area and Pressure After Malreduction in Isolated Medial Malleolar Fractures With 2 mm of Displacement: A Cadaveric Study. J Foot Ankle Surg 2023; 62:774-778. [PMID: 37003511 DOI: 10.1053/j.jfas.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 03/03/2023] [Accepted: 03/18/2023] [Indexed: 04/03/2023]
Abstract
This study was performed to evaluate the changes in contact area and pressure in the tibiotalar joint, with a 2 mm displacement after IMMF (isolated medial malleolar fracture). Ten cadavers with pairs were used to establish a situation in which IMMF occurred during ankle injury. We performed IMMF corresponding to types C and D of the Herscovici classification, and it was displaced by 2 mm. The normal group was defined as a normal tibiotalar joint, the TF (transverse fracture) group as a 2 mm transverse displacement corresponding to the Herscovici classification type C, and the OF (oblique fracture) group as a 2 mm oblique displacement corresponding to the Herscovici classification type D. We measured the contact area and pressure at the tibiotalar joint. The film was scanned and analyzed using the digital imaging software, Scion Image (Scion Crop. Frederick, MD). In normal group, the average contact area of the tibiotalar joint was 317 mm2 (IQR; interquartile range, 256; 347) and 308 mm2 (IQR, 262; 364), average pressure was 2.19 N/mm2 (IQR, 1.94; 2.27) and 2.15 N/mm2 (IQR, 2.06; 2.53). In the TF and OF groups, the average contact area of the tibiotalar joint decreased by 9% and 12%, respectively, and the average pressure increased by 8% and 14%, respectively. There was no statistical difference in peak pressure between the normal, TF, and OF groups. In the case of transverse and oblique fractures, a 2 mm displacement showed significant changes in contact area and contact pressure compared to the normal tibiotalar joint, but there were no significant changes pertaining to type, between the 2 fractures.
Collapse
Affiliation(s)
- Young Koo Lee
- Department of Orthopedic Surgery, Soonchunhyang University, Bucheon Hospital, Bucheon-Si, Gyeonggi-Do, Republic of Korea
| | - Yong Seung Oh
- Department of Orthopedic Surgery, Good Samsun Hospital, Sasang-gu, Busan, Republic of Korea
| | - Do Kwan Lee
- School of Mechanical Engineering, Korea University, Seongbuk-gu, Seoul, Republic of Korea
| | - Myoung Jin Lee
- Department of Orthopedic Surgery, Dong-A University Medical Center, Seo-gu, Busan, Republic of Korea
| | - Yong Nam Song
- Department of Orthopedic Surgery, Good Samsun Hospital, Sasang-gu, Busan, Republic of Korea
| | - Hong Seop Lee
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Eui Dong Yeo
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Gangdong-gu, Seoul, Republic of Korea.
| |
Collapse
|
35
|
So E, Juels C, Scott RT, Sietsema DL. A Comparison of Ankle Fractures Relative to Other Fragility Fractures: A Review and Analysis of the American Orthopaedic Association's Own the Bone Database. Foot Ankle Int 2023; 44:879-887. [PMID: 37300238 DOI: 10.1177/10711007231178536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Ankle fragility fractures (AFX) continue to increase in the elderly population. There is limited knowledge of AFX characteristics compared to nonankle fragility fractures (NAFX). The American Orthopaedic Association's Own the Bone (OTB) is a fragility fracture initiative. This robust data set was used to examine and compare characteristics of patients presenting with AFX to those with NAFX. METHODS The OTB database contained 72,617 fragility fractures between January 2009 and March of 2022 and were reviewed in our secondary cohort comparative analysis. After exclusions, AFX accounted for 3229 patients and 54,772 patients were in the NAFX cohort. Bivariate analysis and logistic regression compared the AFX and NAFX groups concerning demographics, bone health factors, medication use, and prior fragility fracture. RESULTS AFX patients were found to have a higher likelihood to be younger (67.6 years old), female (81.4%), non-Caucasian (11.7%) and have a higher BMI (30.6) compared to NAFX. Prior AFX predicted the risk of a future AFX. The probability of an AFX increased with increased age and BMI. CONCLUSION A prior AFX is independently predictive of subsequent AFX. Therefore, these fractures should be considered a sentinel event. These patients are more likely to have higher BMI, to be of female gender, non-Caucasian race, and are younger compared to patients with NAFX. LEVEL OF EVIDENCE Level III, retrospective cohort.
Collapse
Affiliation(s)
- Eric So
- Capital Foot and Ankle - Bryan Physician Network, Lincoln, NE, USA
| | | | | | - Debra L Sietsema
- The CORE Institute (retired), Phoenix, AZ, USA
- MORE Foundation (retired), Phoenix, AZ, USA
| |
Collapse
|
36
|
Ifarraguerri AM, Gupta P, Quan T, Cohen JS, Chen FR, Zeitlin J, Manzi JE, Farley B, Ramamurti P, Tabaie S. Risks of Immunosuppressive Therapy in Patients Undergoing Open Reduction Internal Fixation for Ankle Fractures. J Foot Ankle Surg 2023; 62:802-806. [PMID: 37086904 DOI: 10.1053/j.jfas.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 04/24/2023]
Abstract
Chronic steroid and immunosuppressant use have been shown to increase the risk for postoperative complications in orthopedic surgery. Further understanding of the risks of immunosuppression is necessary to aid in risk stratification and patient counseling. However, these risks have not yet been explored in ankle fracture patients. Thus, the purpose of this study is to determine whether patients taking immunosuppressives are at an increased risk for morbidity and mortality following open reduction and internal fixation (ORIF) of ankle fractures. Patients undergoing operative treatment for ankle fractures from 2006 to 2018 were identified in the National Surgical Quality Improvement Program database. Patients were categorized based on their use of immunosuppressive medications. Postoperative outcomes assessed included superficial surgical site infections, deep surgical site infections, organ space infections, wound dehiscence, pneumonia, unplanned intubation, pulmonary embolism, urinary tract infection, renal failure, blood transfusion requirement, deep vein thrombosis, sepsis, cardiac arrest, extended length of hospital stay, readmission, reoperation, and mortality. Univariate and multivariate analyses were performed. In total, 10,331 patients underwent operative treatment for ankle fracture. Total 10,153 patients (98.3%) were not taking immunosuppressants and 178 (1.7%) were taking these medications. In multivariate analysis, patients taking immunosuppressants were at increased risk of pulmonary embolism (odds ratio [OR] 4.382; p = .041) and hospital readmission (OR 2.131; p = .021). Use of immunosuppressive medications is an independent risk factor for pulmonary embolism and readmission following ORIF for ankle fractures. Notably, no association with wound complications, infections, or sepsis was identified.
Collapse
Affiliation(s)
- Anna M Ifarraguerri
- Department of Orthopaedic Surgery, The George Washington School of Medicine and Health Sciences, Washington, DC
| | - Puneet Gupta
- Department of Orthopaedic Surgery, The George Washington School of Medicine and Health Sciences, Washington, DC
| | - Theodore Quan
- Department of Orthopaedic Surgery, The George Washington School of Medicine and Health Sciences, Washington, DC.
| | - Jordan S Cohen
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Frank R Chen
- Department of Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | | | - Benjamin Farley
- Department of Orthopaedic Surgery, The George Washington School of Medicine and Health Sciences, Washington, DC
| | - Pradip Ramamurti
- Department of Orthopaedic Surgery, University of Virginia Medical Center, Charlottesville, VA
| | - Sean Tabaie
- Department of Orthopaedic Surgery, Children's National Health System, Washington, DC
| |
Collapse
|
37
|
Kirchner GJ, Kim AH, Martinazzi BJ, Sudah SY, Lieber AM, Aynardi MC. Factors Associated With Amputation Following Ankle Fracture Surgery. J Foot Ankle Surg 2023; 62:792-796. [PMID: 37086905 DOI: 10.1053/j.jfas.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/03/2023] [Accepted: 04/09/2023] [Indexed: 04/24/2023]
Abstract
Patients with diabetes mellitus (DM) are at increased risk of complications following ankle fracture surgery. Previous research suggests that patients of low socioeconomic status are at increased risk of amputation following orthopedic complications. The purpose of this research was to determine if low socioeconomic status increases risk of below-knee amputation (BKA) following ankle fractures among patients with DM. The National Inpatient Sample (NIS) was queried from 2010 to 2014 to identify 125 diabetic patients who underwent ankle fracture surgical fixation followed by BKA. Two cohorts (BKA vs no BKA) and a multivariate logistic regression model were created to compare the effects of independent variables, including age, sex, race, primary payer, median household income by ZIP code, hospital location/teaching status, and comorbidities. The most predictive variables for BKA were concomitant peripheral vascular disease (odds ratio [OR] 5.35, 95% confidence interval [CI] 3.51-8.15), history of chronic diabetes-related medical complications (OR 3.29, CI 2.16-5.01), age in the youngest quartile (OR 2.54, CI 1.38-4.67), and male sex (OR 2.28, CI 1.54-3.36). Patient race and median household income were not significantly associated with BKA; however, risk of BKA was greater among patients with Medicaid (OR 2.23, CI 1.09-4.53) or Medicare (OR 1.85, CI 1.03-3.32) compared to privately insured patients. Diabetic inpatients with Medicaid insurance are at over twice the odds of BKA compared to privately insured patients following ankle fracture. Furthermore, peripheral vascular diseases, uncontrolled diabetes, younger age, and male sex each independently increase risk of BKA.
Collapse
Affiliation(s)
- Gregory J Kirchner
- Department of Orthopaedics & Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Andrew H Kim
- Department of Orthopaedics & Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, PA.
| | - Brandon J Martinazzi
- Department of Orthopaedics & Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Suleiman Y Sudah
- Department of Orthopedic Surgery, Monmouth Medical Center, Long Branch, NJ
| | - Alexander M Lieber
- Department of Orthopaedic Surgery, Mount Sinai School of Medicine, New York, NY
| | - Michael C Aynardi
- Department of Orthopaedics & Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, PA
| |
Collapse
|
38
|
Dalen AF, Gregersen MG, Skrede AL, Bjelland Ø, Myklebust TÅ, Nilsen FA, Molund M. Effects of Progressive Deltoid Ligament Sectioning on Weber B Ankle Fracture Stability. Foot Ankle Int 2023; 44:895-904. [PMID: 37480255 PMCID: PMC10500948 DOI: 10.1177/10711007231180212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
BACKGROUND Conventionally, transsyndesmotic fibula fractures with concomitant signs of deltoid ligament injury have been considered unstable and thus treated operatively. Recent studies have indicated that partial deltoid ligament rupture is common and may allow for nonoperative treatment of stress-unstable ankles if normal tibiotalar alignment is obtained in the weightbearing position. Biomechanical support for this principle is scarce. The purpose of this study was to evaluate the biomechanical effects of gradually increasing deltoid ligament injury in transsyndesmotic fibula fractures. METHODS Fifteen cadaveric ankle specimens were tested using an industrial robot. All specimens were tested in 4 states: native, SER2, SER4a, and SER4b models. Ankle stability was measured in lateral translation, valgus, and internal and external rotation stress in 3 talocrural joint positions: 20 degrees plantarflexion, neutral, and 10 degrees dorsiflexion. Talar shift and talar valgus tilt in the talocrural joint was measured using fluoroscopy. RESULTS In most tests, SER2 and SER4a models resulted in a small instability increase compared to native joints and thus were deemed stable according to our predefined margins. However, SER4a models were unstable when tested in the plantarflexed position and for external rotation in all positions. In contrast, SER4b models had large-magnitude instability in all directions and all tested positions and were thus deemed unstable. CONCLUSION This study demonstrated substantial increases in instability between the SER4a and SER4b states. This controlled cadaveric simulation suggests a significant ankle-stabilizing role of the deep posterior deltoid after oblique transsyndesmotic fibular fracture and transection of the superficial and anterior deep deltoid ligaments. CLINICAL RELEVANCE The study provides new insights into how the heterogenicity of deltoid ligament injuries can affect the natural stability of the ankle after Weber B fractures. These findings may be useful in developing more targeted and better treatment strategies.
Collapse
Affiliation(s)
- Andreas F. Dalen
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Orthopaedic Surgery, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Martin G. Gregersen
- Department of Physical Medicine and Rehabilitation, Østfold Hospital Trust, Grålum, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Aleksander L. Skrede
- Department of ICT and Natural Sciences, Norwegian University of Science and Technology, Ålesund, Møre og Romsdal, Norway
| | - Øystein Bjelland
- Department of ICT and Natural Sciences, Norwegian University of Science and Technology, Ålesund, Møre og Romsdal, Norway
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Fredrik A. Nilsen
- Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway
| | - Marius Molund
- Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway
| |
Collapse
|
39
|
Yoon SJ, Yeo ED, Jung KJ, Hong YC, Hong CH, Won SH, Lee KJ, Ji JY, Byeon JY, Lee DW, Kim WJ. Evaluating the Efficacy of Tension Band Wiring Fixation for Chaput Tubercle Fractures. J Clin Med 2023; 12:5490. [PMID: 37685557 PMCID: PMC10488479 DOI: 10.3390/jcm12175490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/11/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Chaput tubercle fractures, located at the attachment site of the anterior inferior tibiofibular ligament (AITFL) on the distal tibia, have the potential to destabilize the syndesmosis joint. This study aims to assess the effectiveness of tension band wiring (TBW) as a surgical intervention for managing Chaput fractures and the consequent syndesmosis instability. METHODS A retrospective review of patient charts was undertaken for those who had undergone ankle fracture surgery from April 2019 through May 2022. The surgical procedure involved direct fixation of the Chaput fractures using the TBW method. Radiological assessments were performed using postoperative simple radiographs and computed tomography (CT) scans, while clinical outcomes were evaluated using the Olerud-Molander Ankle Score (OMAS) and the visual analog scale (VAS). RESULTS The study included 21 patients. The average OMAS improved significantly, rising from 5.95 preoperatively to 83.57 postoperatively. Similarly, the average VAS score dropped from 7.95 before the surgery to 0.19 thereafter. Minor wound complications were reported by three patients, and one case of superficial infection was resolved with antibiotic therapy. CONCLUSIONS Our findings suggest that the TBW technique is an effective surgical approach for treating Chaput fractures and associated syndesmosis instability. It provides reliable fixation strength and leads to improved long-term functional outcomes. Further research is needed to compare the TBW technique with alternative methods and optimize the treatment strategies for these complex ankle fractures.
Collapse
Affiliation(s)
- Sung-Joon Yoon
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Republic of Korea; (S.-J.Y.); (K.-J.J.); (Y.-C.H.); (C.-H.H.)
| | - Eui-Dong Yeo
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul 05368, Republic of Korea;
| | - Ki-Jin Jung
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Republic of Korea; (S.-J.Y.); (K.-J.J.); (Y.-C.H.); (C.-H.H.)
| | - Yong-Cheol Hong
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Republic of Korea; (S.-J.Y.); (K.-J.J.); (Y.-C.H.); (C.-H.H.)
| | - Chang-Hwa Hong
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Republic of Korea; (S.-J.Y.); (K.-J.J.); (Y.-C.H.); (C.-H.H.)
| | - Sung-Hun Won
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul 04401, Republic of Korea;
| | - Kyung-Jin Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, 170, Jomaru-ro, Bucheon-si 14584, Republic of Korea;
| | - Jae-Young Ji
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Republic of Korea;
| | - Je-Yeon Byeon
- Department of Plastic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Republic of Korea;
| | - Dhong-Won Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, 120-1, Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea;
| | - Woo-Jong Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Republic of Korea; (S.-J.Y.); (K.-J.J.); (Y.-C.H.); (C.-H.H.)
| |
Collapse
|
40
|
Heeran N, Gomaa AR, Mason L, Bond AP. The arterial risk posed by the posterolateral approach: An anatomical cadaveric study of the fibular artery and its variability. Clin Anat 2023. [PMID: 37596869 DOI: 10.1002/ca.24108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/27/2023] [Accepted: 07/24/2023] [Indexed: 08/20/2023]
Abstract
The posterior malleolus of the tibia is commonly accessed surgically through the posterolateral approach. This approach gives good access to the fibula and lateral aspect of the posterior tibia, however; there is little known on the vascular risks with this approach. The aim of this study was to assess and describe the anatomy of the fibular artery and its branches at the ankle region and relate it to the surgical access of the posterior malleolus. Eleven cadaveric foot and ankle specimens were dissected in layers, preserving the fibular artery, anterior tibial artery (ATA), and posterior tibial artery (PTA). Five distinct variations were found in the fibular artery: variable terminal branching with a hyperplastic fibular artery; a superficially located fibular artery; variation in the level and number of anastomoses; variation in the muscular branches; and a variable anterior perforating branch. The mean proximal distance from a horizontal line drawn through the medial protuberance of the medial malleolus of the tibia (horizontal line reference point-HLRP) to the posterior communicating branch of the fibular artery was 37.93 mm (range 19.03-85.43 mm). The mean proximal distance between HLRP and the anterior perforating branch of the fibular artery was 44.23 mm (range 35.44-62.32 mm). In 10 specimens, the fibular artery was immobile distal to its anterior perforating branch. The posterolateral approach specifically puts the fibular artery at risk and knowledge of its anatomy and variability is important when undertaking this approach. Understanding the common variations within the ankle's arterial anatomy can help surgeons protect these vessels from damage during the surgical approach.
Collapse
Affiliation(s)
- Niamh Heeran
- Human Anatomy and Resource Centre, University of Liverpool, Liverpool, UK
| | - Abdul-Rahman Gomaa
- Human Anatomy and Resource Centre, University of Liverpool, Liverpool, UK
| | - Lyndon Mason
- Human Anatomy and Resource Centre, University of Liverpool, Liverpool, UK
- Liverpool Orthopaedic and Trauma Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Alistair P Bond
- Human Anatomy and Resource Centre, University of Liverpool, Liverpool, UK
| |
Collapse
|
41
|
James HK, Griffin DR, Griffin J, Fisher JD, Pattison GTR. Ankle fracture internal fixation performed by cadaveric simulation-trained versus standard-trained orthopaedic trainees: a preliminary, multicentre randomized controlled trial. Bone Jt Open 2023; 4:594-601. [PMID: 37586708 PMCID: PMC10546066 DOI: 10.1302/2633-1462.48.bjo-2022-0144.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Aims Ankle fracture fixation is commonly performed by junior trainees. Simulation training using cadavers may shorten the learning curve and result in a technically superior surgical performance. Methods We undertook a preliminary, pragmatic, single-blinded, multicentre, randomized controlled trial of cadaveric simulation versus standard training. Primary outcome was fracture reduction on postoperative radiographs. Results Overall, 139 ankle fractures were fixed by 28 postgraduate year three to five trainee surgeons (mean age 29.4 years; 71% males) during ten months' follow-up. Under the intention-to-treat principle, a technically superior fixation was performed by the cadaveric-trained group compared to the standard-trained group, as measured on the first postoperative radiograph against predefined acceptability thresholds. The cadaveric-trained group used a lower intraoperative dose of radiation than the standard-trained group (mean difference 0.011 Gym2, 95% confidence interval 0.003 to 0.019; p = 0.009). There was no difference in procedure time. Conclusion Trainees randomized to cadaveric training performed better ankle fracture fixations and irradiated patients less during surgery compared to standard-trained trainees. This effect, which was previously unknown, is likely to be a consequence of the intervention. Further study is required.
Collapse
Affiliation(s)
- Hannah K. James
- Department of Trauma & Orthopaedic Surgery, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, Coventry, UK
| | - Damian R. Griffin
- Department of Trauma & Orthopaedic Surgery, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, Coventry, UK
| | - James Griffin
- Warwick Clinical Trials Unit, Warwick Medical School, Coventry, UK
| | - Joanne D. Fisher
- Warwick Clinical Trials Unit, Warwick Medical School, Coventry, UK
| | - Giles T. R. Pattison
- Department of Trauma & Orthopaedic Surgery, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| |
Collapse
|
42
|
Cho D, Kukadia S, Drakos M. Common Football Foot and Ankle Injuries: Non-Surgical and Surgical Management. HSS J 2023; 19:322-329. [PMID: 37435125 PMCID: PMC10331273 DOI: 10.1177/15563316231160458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/13/2022] [Indexed: 07/13/2023]
Affiliation(s)
- David Cho
- Hospital for Special Surgery, New York, NY, USA
| | | | - Mark Drakos
- Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
43
|
Steiger C, De Marco G, Cuérel C, Tabard-Fougère A, Chargui M, Dayer R, Ceroni D. A retrospective epidemiological cohort study of ankle fractures in children and teenagers. J Child Orthop 2023; 17:348-353. [PMID: 37565007 PMCID: PMC10411379 DOI: 10.1177/18632521231182424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/15/2023] [Indexed: 08/12/2023] Open
Abstract
Background Ankle fracture is one of the most frequent pediatric lower-limb fractures and may result in serious complications. Objective This study aimed to determine the epidemiology of ankle fractures, defining fracture types, treatments, and complications in a pediatric population below 16 years old. Methods Medical records of all the ankle fracture patients treated in our hospital during 2004-2020 were retrospectively reviewed. Data regarding age, sex, mechanism of injury, fracture type, treatment modalities, and complications were collected. Results We examined records involving 328 children with 331 ankle fractures, with a ratio of 1:2 male per female. Mean annual prevalence was 24.3 per 100,000 children. Mean patient age was 11.2 ± 4.2 years, with 75.3% of them aged over 10 years. Sports activities accounted for the largest percentage of fractures (162 cases; 49.4%), followed by falls (67; 20.4%) and road traffic accidents (37; 11.3%). Physeal fractures were the most frequent type of lesion (223 cases). Most ankle fractures (60%) were managed using closed reduction and casting; for the remaining 40% of cases, fracture fixation was performed after closed or open reduction to correct the articular step-off and ensure the anatomical restoration of the physis. The main ankle fracture complication was premature growth arrest (12.1% of all physeal fractures). Conclusion Pediatric ankle fractures primarily affect children older than 10 years. Most of these fractures were caused by sports injuries or low-energy trauma. The majority of these fractures are physeal, and the distal tibial physis is affected 10 times more frequently than the distal fibular physis. Level of evidence Level III.
Collapse
Affiliation(s)
- Christina Steiger
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Department of Women, Child, and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - Giacomo De Marco
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Department of Women, Child, and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - Céline Cuérel
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Department of Women, Child, and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - Anne Tabard-Fougère
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Department of Women, Child, and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - Moez Chargui
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Department of Women, Child, and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - Romain Dayer
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Department of Women, Child, and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - Dimitri Ceroni
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Department of Women, Child, and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| |
Collapse
|
44
|
Sanchez T, Sankey T, Scheinberg MB, Schick S, Singh S, Cheppalli N, Davis C, Shah A. Factors and Radiographic Findings Influencing Patient-Reported Outcomes Following Maisonneuve Fractures. Cureus 2023; 15:e43536. [PMID: 37719488 PMCID: PMC10501688 DOI: 10.7759/cureus.43536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND This research adds to the literature by providing prognostic information for physicians and patients regarding the outcomes of operative management of Maisonneuve fractures (MFs). To date, this is the only cohort study of patient-reported outcomes measurement information systems (PROMIS) scores following surgical fixation of MF. Patient outcomes were compared focusing on the mean population with an inter-analysis using basic demographic information, radiographic findings, and patient comorbidities and their respective impact on PROMIS scores. METHODS A total of 24 patients between 2012 and 2020 met the inclusion criteria and completed PROMIS surveys at a minimum of 18 months postoperatively. Patient charts were reviewed through the electronic medical record (EMR) for demographic information and comorbidities as well as operative variables. PROMIS scores for physical function (PF), pain interference (PI), and depression were obtained via follow-up visits and phone calls. The impact of categorical variables on complications was compared using Chi-Squared tests. Variables were analyzed with a type 3 SS test to stratify independent risk factors' effect on PROMIS scores and to account for confounding variables. RESULTS PROMIS PF averaged 44.84 and was significantly affected by BMI>30 (p=.033), hypertension (HTN) (p=.026), patients with clinical anxiety or depression (p=.047), and subsequent screw removal (p=.041). PROMIS PI averaged a score of 54.57 and was significantly affected by BMI>30 (p=.0046), coronary artery disease (CAD) (p=.0123), patients with clinical anxiety or depression (p=.0206), and subsequent screw removal (p=.0039). PROMIS depression scores averaged 46.03 and were significantly affected by the presence of CAD (p=.049) and subsequent screw removal (p=.023). CONCLUSION Patient-reported outcomes following MF surgery demonstrated PROMIS scores within +/- 1 standard deviation of the population-based control, and thus many patients can reasonably expect to return to a level of function comparable to the general population. Nonetheless, the significant effects of patient comorbidities and surgical variables ought to be evaluated and utilized as prognostic indicators when managing patient expectations prior to operative treatment of an MF injury.
Collapse
Affiliation(s)
- Thomas Sanchez
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Turner Sankey
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Mila B Scheinberg
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Samuel Schick
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Swapnil Singh
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | | | - Chandler Davis
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Ashish Shah
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| |
Collapse
|
45
|
Lee JK, Lee GS, Kim SB, Kang C, Kim KS, Song JH. A Comparative Analysis of Pain Control Methods after Ankle Fracture Surgery with a Peripheral Nerve Block: A Single-Center Randomized Controlled Prospective Study. Medicina (Kaunas) 2023; 59:1302. [PMID: 37512113 PMCID: PMC10386082 DOI: 10.3390/medicina59071302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Patients experience severe pain after surgical correction of ankle fractures. Although their exact mechanism is unknown, dexamethasone and epinephrine increase the analgesic effect of anesthetics in peripheral nerve blocks. This study aimed to compare the postoperative pain control efficacy of peripheral nerve blocks with ropivacaine combined with dexamethasone/epinephrine and peripheral nerve blocks with only ropivacaine and added patient-controlled analgesia in patients with ankle fractures. Materials and Methods: This randomized, controlled prospective study included patients aged 18-70 years surgically treated for ankle fractures between December 2021 and September 2022. The patients were divided into group A (n = 30), wherein pain was controlled using patient-controlled analgesia after lower extremity peripheral nerve block, and group B (n = 30), wherein dexamethasone/epinephrine was combined with the anesthetic solution during peripheral nerve block. In both groups, ropivacaine was used as the anesthetic solution for peripheral nerve block, and this peripheral nerve block was performed just before ankle surgery for the purpose of anesthesia for surgery. Pain (visual analog scale), patient satisfaction, and side effects were assessed and compared between the two groups. Results: The patients' demographic data were similar between groups. Pain scores were significantly lower in group B than in group A postoperatively. Satisfaction scores were significantly higher in group B (p = 0.003). There were no anesthesia-related complications in either group. Conclusions: Dexamethasone and epinephrine as adjuvant anesthetic solutions can effectively control pain when performing surgery using peripheral nerve blocks for patients with ankle fractures.
Collapse
Affiliation(s)
- Jeong-Kil Lee
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon 34134, Republic of Korea
| | - Gi-Soo Lee
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon 34134, Republic of Korea
| | - Sang-Bum Kim
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon 34134, Republic of Korea
| | - Chan Kang
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon 34134, Republic of Korea
| | - Kyong-Sik Kim
- Department of Anaesthesia, Chungnam National University Sejong Hospital, Sejong 30099, Republic of Korea
| | - Jae-Hwang Song
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon 35365, Republic of Korea
| |
Collapse
|
46
|
Roward Z, Latt LD. Republication of "Fracture Through a Distal Fibular Tunnel Used for an Anatomic Lateral Ankle Ligament Reconstruction". Foot Ankle Orthop 2023; 8:24730114231188115. [PMID: 37506167 PMCID: PMC10369089 DOI: 10.1177/24730114231188115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
Anatomic lateral ankle ligament reconstruction using free tendon graft with osseous tunnels has become a popular technique for revision reconstruction of the lateral ankle ligaments. With the procedure's burgeoning popularity, an accompanying increase in postoperative complications is likely to occur. We report on one such complication: traumatic distal fibula fracture through the transosseous tunnels.
Collapse
Affiliation(s)
- Zachary Roward
- Department of Orthopaedic Surgery, Brooke Army Medical Center, San Antonio, TX, USA
| | - L Daniel Latt
- Department of Orthopaedic Surgery, University of Arizona, Tucson, AZ, USA
| |
Collapse
|
47
|
Fu MC, Young K, Cody E, Schairer WW, Demetracopoulos CA, Ellis SJ. Republication of "Most Readmissions Following Ankle Fracture Surgery Are Unrelated to Surgical Site Issues: An Analysis of 5056 Cases". Foot Ankle Orthop 2023; 8:24730114231188103. [PMID: 37506165 PMCID: PMC10369096 DOI: 10.1177/24730114231188103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
Background Ankle fracture surgeries are generally safe and effective procedures; however, as quality-based reimbursement models are increasingly affected by postoperative readmission, we aimed to determine the causes and risk factors for readmission following ankle fracture surgery. Methods Ankle fracture cases were identified from the prospectively collected American College of Surgeons National Surgical Quality Improvement Program from 2013 to 2014. Demographics, comorbidities, and fracture characteristics were collected. Rates of 30-day adverse events and readmissions were determined as well as the causes for readmission. Multivariable logistic regression analyses were performed to identify risk factors associated with having any adverse events and being readmitted within 30 days of surgery. Results There were 5056 patients included; 167 (3.3%) were open fractures. The rate of any postoperative adverse event was 5.2%. There were 116 unplanned readmissions, with a readmission rate of 2.3%. Of the 116 unplanned readmissions, 49 (42.2%) were for reasons related to the surgery or surgical site, with the most common causes being deep surgical site/hardware infections (12.9%), superficial site infections (11.2%), and wound disruption (6.9%). Most readmissions were for reasons unrelated to the surgical site (51.7%), including cardiac disorders (8.6%), pulmonary disorders (7.8%), and neurological/psychiatric disorders (6.9%). The cause of readmission was unknown for 6% of readmissions. With multivariable logistic regression, the strongest risk factors for readmission were a history of pulmonary disease (odds ratio [OR], 2.29), American Society of Anesthesiologists (ASA) class ≥3 (OR, 2.28), and open fractures (OR, 2.04) (all P < .05). Conclusion In this cohort of 5056 ankle fracture cases, 2.3% of patients were readmitted within 30 days, with at least 51.7% of all unplanned readmissions due to causes unrelated to the surgery or surgical site. Predictors of readmission included a history of pulmonary disease, higher ASA class, and open fractures. Based on these findings, we advocate close medical follow-up with nonorthopaedic providers after discharge for high-risk patients. Level of Evidence Level III.
Collapse
Affiliation(s)
- Michael C Fu
- Foot and Ankle Service, Hospital for Special Surgery, NY, USA
| | - Kelsey Young
- Foot and Ankle Service, Hospital for Special Surgery, NY, USA
| | - Elizabeth Cody
- Foot and Ankle Service, Hospital for Special Surgery, NY, USA
| | | | | | - Scott J Ellis
- Foot and Ankle Service, Hospital for Special Surgery, NY, USA
| |
Collapse
|
48
|
Ge L, Holmes JR, Talusan PG, Walton DM. Lateral Talar Subluxation Measurements in Nonoperatively Managed Weber B Ankle Fractures. Foot Ankle Orthop 2023; 8:24730114231187887. [PMID: 37492127 PMCID: PMC10363887 DOI: 10.1177/24730114231187887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
Background Lateral talar subluxation (LTS) was introduced as a measurement tool for evaluating isolated Weber B ankle fractures, with LTS >4 mm on gravity stress (GS) radiographs possibly indicating need for surgery. This study reviews LTS measurements in nonoperatively managed isolated Weber B fibula fractures to further investigate the validity of this previously stated cutoff. Methods The senior authors previously reported outcomes of a novel algorithm for nonoperative management of isolated Weber B ankle fractures. Outcome scores reported include American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot, Olerud-Molander (OMA), Foot and Ankle Ability Measure for activities of daily living (FAAM/ADL), and visual analog scale (VAS) scores. All patients achieved union of their fracture. LTS was measured on GS radiographs of both injured and contralateral uninjured extremities. Results Forty-two patients were included with minimum 1-year follow-up. Average age was 49 years (range 19-72). Mean measurements on injury GS radiographs were as follows: medial clear space (MCS) 4.45 mm (SD = 0.93), superior clear space (SCS) 3.46 mm (SD = 0.70), and LTS 2.33 mm (SD = 1.57, range 0-4.7 mm), with 35 (83.3%) patients having injury LTS ≤4 mm. Mean measurements on contralateral (uninjured) GS radiographs were as follows: MCS 3.39 mm (SD = 0.63), SCS 3.15 mm (SD = 0.50), and LTS 1.30 mm (SD = 1.28, range 0-4.8 mm). There was no statistically significant difference in all outcome measures based on amount of LTS (<2 mm, 2-4 mm, >4 mm). Conclusion Most patients had injury LTS ≤4 mm, although those with LTS >4 mm had excellent outcome scores. LTS measurements on normal ankles reveal a large range. LTS may be a useful adjunct in evaluating isolated Weber B ankle fractures but the 4-mm cutoff may not be entirely reliable. Further studies are required to validate LTS as a decision-making tool. Level of Evidence Level IV, case series.
Collapse
Affiliation(s)
- Laurence Ge
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - James R. Holmes
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Paul G. Talusan
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - David M. Walton
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
49
|
Kang HJ, Kwon YM, Byeon SJ, Kim HN, Sung IH, Subramanian SA, Kim SJ. Trends and Risk Factors for Surgical Site Infection after Treatment of the Ankle Fracture: National Cohort Study. J Clin Med 2023; 12:4215. [PMID: 37445250 DOI: 10.3390/jcm12134215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/13/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Surgical site infection (SSI) is a major complication after the surgical treatment of ankle fractures that can result in catastrophic consequences. This study aimed to determine the incidence of SSI in several cohorts from national insurance databases over the past 12 years and identify its predictors. The claimed data for patients (n = 1,449,692) with ankle fractures between 2007 and 2019 were investigated, and a total of 41,071 patients were included in the final analysis. The covariates included were age, sex, season, fracture type (closed vs. open), type of surgical fixation procedure, and comorbidities of each patient. All subjects were divided into two groups according to the SSI after the surgical fixation of the ankle fracture (no infection group vs. infection group). The number of SSIs after the surgical treatment of ankle fractures was 874 (2.13%). Open fractures [odds ratio, (OR) = 4.220] showed the highest risk for SSI, followed by the male sex (OR = 1.841), an increasing number of comorbidities (3-5, OR = 1.484; ≥6, OR = 1.730), a history of dementia (OR = 1.720) or of myocardial infarction (OR = 1.628), and increasing age (OR = 1.010). The summer season (OR = 1.349) showed the highest risk among the four seasons for SSI after ankle fracture surgery.
Collapse
Affiliation(s)
- Hwa-Jun Kang
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
| | - Young-Min Kwon
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
| | - Sun-Ju Byeon
- Department of Pathology, Yuseong Sun Hospital, Daejeon 34084, Republic of Korea
| | - Hyong Nyun Kim
- Department of Orthopedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea
| | - Il-Hoon Sung
- Department of Orthopedic Surgery, Hanyang University Hospital, Seoul 04763, Republic of Korea
| | - Sivakumar Allur Subramanian
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
| | - Sung Jae Kim
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
| |
Collapse
|
50
|
Abstract
Pilon fractures are complex injuries that require an individualized approach to treatment to avoid complications and achieve good outcomes. Staged open reduction internal fixation remains the gold standard for most cases to achieve anatomic articular reduction while minimizing soft tissue complications and infection. Careful preoperative planning based on computed tomography dictates the surgical approach for reduction. A subset of cases may be amenable to early definitive or provisional open reduction and internal fixation based on fracture pattern. In some cases of severe articular comminution where reconstruction is not possible, primary ankle arthrodesis may be a good alternative.
Collapse
Affiliation(s)
- Michael Flores
- University of California, San Francisco, Department of Orthopaedic Surgery, San Francisco, CA
| | - Matthew Ciminero
- University of California, San Francisco, Department of Orthopaedic Surgery, San Francisco, CA
| | | | - Daniel Botros
- Stony Brook University, Department of Orthopaedic Surgery, Stony Brook, NY; and
| | - Boris A. Zelle
- UT Health San Antonio, Department of Orthopaedics, San Antonio, TX
| | - David W. Shearer
- University of California, San Francisco, Department of Orthopaedic Surgery, San Francisco, CA
| |
Collapse
|