scholarly journals High incidence of (osteo)chondral lesions in ankle fractures

2020 ◽  
Author(s):  
Hugo A. Martijn ◽  
Kaj T. A. Lambers ◽  
Jari Dahmen ◽  
Sjoerd. A. S. Stufkens ◽  
Gino M. M. J. Kerkhoffs
Keyword(s):  
Ankle Fractures ◽  
Chondral Lesions ◽  
High Incidence

scholarly journals Arthroscopically Assisted Treatment of Complex Ankle Fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0038
Author(s):  
Hans Polzer ◽  
Sebastian Baumbach ◽  
Mareen Braunstein
Keyword(s):  
Ankle Fractures ◽  
Secondary Outcome ◽  
Chondral Lesions ◽  
Standardized Protocol ◽  
Trimalleolar Fractures ◽  
Arthroscopic Findings ◽  
Arthroscopically Assisted ◽  
The Mean ◽  
Lost To Follow Up

Category: Arthroscopy Introduction/Purpose: Especially after complex ankle fractures, patients suffer from residual pain, swelling and stiffness. Evidence suggests that this poor outcome might be related to occult intraarticular injuries. Recent studies documented chondral lesions in up to 89%. Therefore, many authors emphasize the value of ankle arthroscopy in acute fracture treatment (AORIF). Only few studies reported on the findings of AORIF, even less documented the subjective and objective outcome thereafter. Aim of this study was to evaluate the intraarticular lesions and the results following AORIF for complex ankle fractures after 1-year of follow-up. Methods: Patients presenting with closed, complex ankle fractures were included. AORIF was performed following a standardized protocol. Primary outcome was the AOFAS Score. Secondary outcome parameters were the Olerud and Molander Score, Tegner activity scale, arthroscopic findings, functional assessment and complications. Statistical analysis was performed using SSPS 22.0 (IBM). Results: Between 05/13-12/14, 32 patients were enrolled (56% female, 45±16 years). Three patients were lost to follow-up. 16% suffered from uni-, 22% from bi- and 62% from trimalleolar fractures. Chondral lesions were observed in 91% (ICRS 2.9±0.9). In 34% micro fracturing was performed. Full thickness lesions were observed exclusively in in bi- and trimalleolar fractures. Three patients suffered from minor complications. After 1 year, the mean AOFAS was 93±6 and the mean OMAS was 88±8. Linear regression revealed no significant variables affecting the outcome. Conclusion: Intra-articular injuries are common in complex ankle fractures requiring chondral therapy in 34%. AORIF leads to good-excellent results in all but one patient, including those with bi- and trimalleolar fractures without increasing the risk for complications.

scholarly journals Ankle Arthroscopy for Diagnosis and Treatment of Full Thickness Cartilage Lesions in the Setting of Ankle Fracture

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Sydney Karnovsky ◽  
Mark Drakos ◽  
William Schairer ◽  
Rachael Da Cunha
Keyword(s):  
Clinical Outcomes ◽  
Ankle Fracture ◽  
Ankle Arthroscopy ◽  
Chondral Lesion ◽  
Ankle Fractures ◽  
Full Thickness ◽  
Talar Dome ◽  
Fracture Characteristics ◽  
Chondral Lesions ◽  
Chondral Injury

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Ankle fractures treated with anatomic open reduction and internal fixation (ORIF) can still be associated with poor clinical outcomes. The presence of radiographically occult intra-articular chondral injury is a known entity, however the clinical relevance in the setting of ankle fractures is not well established. The purpose of this study aims to evaluate the prevalence of chondral lesions, in particular full thickness talar dome lesions, with concurrent arthroscopy in acute ankle fracture ORIF and determine if there is a correlation with patient and fracture characteristics. In addition, we aimed to evaluate the treatment effect on clinical outcomes to establish the role of concurrent arthroscopy in ankle fracture management. Methods: A retrospective chart review was conducted from prospectively collected registry data at the investigators’ institution from 2011 to 2016. All patients that underwent an acute ankle fracture ORIF with concurrent arthroscopy were identified. Patients with concomitant injuries were excluded. Baseline patient and fracture characteristics were recorded. Fracture type by the Lauge-Hansen classification as well as by anatomic location were determined. Charts were reviewed to determine the prevalence and grade of chondral lesions. The treatment performed for each chondral lesion was determined. Clinical outcomes with a minimum of one year follow up were assessed using the Foot and Ankle Outcome Score (FAOS). Results: One hundred and sixteen consecutive patients undergoing acute ankle fracture ORIF with concurrent arthroscopy were included. A chondral lesion was identified in 78% (90/116). Of those, a Grade IV full thickness talar dome chondral lesion was identified in 43% (39/90). Patient age was a significant predictor, with patients less than thirty being less likely to have a chondral injury compared to those greater than thirty (59% vs 85%, p=0.0077). Of the patients that sustained a dislocation at the time of injury, 100% had a chondral lesion which was statistically significant (p=0.039). Patients with complete syndesmosis disruption and instability were also more likely to have a chondral lesion (96% vs 73%, p=0.013). Patients with chondral lesions had statistically significant worse clinical outcomes than those without (Table). Conclusion: Arthroscopy performed concomitantly with ankle ORIF is useful in diagnosing chondral injuries. In particular, full thickness talar dome chondral lesions are quite common. Increased fracture severity, as indicated by the presence of a dislocation at presentation, and a syndesmotic injury may be more likely to present with a chondral lesion and thus should raise suspicion and prompt evaluation. The presence of a concurrent talar chondral injury has a negative impact on clinical outcomes. Concurrent arthroscopy allows for simultaneous diagnosis and acute treatment of full thickness talar lesions.

scholarly journals Ankle Fracture-Dislocations

2018 ◽  
Vol 3 (3) ◽  
pp. 247301141876512 ◽  
Author(s):  
Kevin A. Lawson ◽  
Alfonso E. Ayala ◽  
Matthew L. Morin ◽  
L. Daniel Latt ◽  
Jason R. Wild
Keyword(s):  
Patient Outcomes ◽  
Ankle Fracture ◽  
Musculoskeletal Injuries ◽  
Ankle Fractures ◽  
Long Term Outcomes ◽  
Loose Bodies ◽  
Chondral Lesions ◽  
Joint Dislocations ◽  
Fracture Dislocations

Ankle fractures are common musculoskeletal injuries that may result in tibiotalar joint dislocations. Ankle fracture-dislocations occur via similar mechanisms as ankle fractures, although the persistence or magnitude of the deforming force is sufficient to disrupt any remaining bony or soft-tissue stability. Ankle fracture-dislocations likely represent distinct clinical entities, as the pathology, management, and patient outcomes following these injuries differ from those seen in more common ankle fractures without dislocation. Ankle fracture-dislocations have higher rates of concomitant injury including open fractures, chondral lesions, and intra-articular loose bodies. Long-term outcomes in ankle fracture-dislocations are worse than ankle fractures without dislocation. Higher rates of posttraumatic osteoarthritis and chronic pain have also been reported. In this review, we discuss the current literature regarding the history, management, and outcomes of ankle-fracture dislocations and highlight the need for future study.

scholarly journals Incidence of Chondral and Osteochondral Lesions in Ankle Fracture Patients Identified with Ankle Arthroscopy Following Rotational Ankle Fracture

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0049
Author(s):  
Emilie Williamson ◽  
Kevin Rosas ◽  
John Dankert ◽  
James P. Toale ◽  
Eoghan T. Hurley ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
Ankle Arthroscopy ◽  
Chondral Lesion ◽  
Lateral Malleolus ◽  
Ankle Fractures ◽  
Medial Malleolus ◽  
Fracture Type ◽  
Malleolar Fracture ◽  
Chondral Lesions ◽  
Chondral Injury

Category: Ankle; Trauma Introduction/Purpose: It is controversial whether routine arthroscopy is beneficial at the time of ankle fracture fixation. This may be, in part, due to sparse information regarding the incidence of chondral injury in the setting of ankle fractures.The purpose of this study is to systematically review the incidence of chondral injures in patients with ankle fractures and to further characterize intra-articular chondral injuries of the talus, tibial plafond, medial malleolus, and lateral malleolus in patients who undergo ankle arthroscopy following an ankle fracture. Methods: The literature search was performed based on the PRISMA guidelines. Studies evaluating the incidence of chondral lesions at the time of arthroscopy for ankle fractures were included. The incidence of intraarticular chondral lesions was recorded, as well as location within the ankle, ankle fracture type, time of arthroscopy, characterization of chondral injury, complications, and outcome if available. All statistical analyses were carried out with statistical software package SPSS 24.0 (SPSS, Chicago, IL, USA). Multiple comparisons were used to compare incidence rates of chondral injury based on Weber classification, malleolar fracture type, and Lauge-Hansen classification, using Pearson chi-square test. For all analyses, p < 0.05 was considered statistically significant. Results: Fifteen studies with 1,355 ankle fractures were included. Of those ankles, 738 demonstrated evidence of chondral or osteochondral lesion (54.5%). Overall, 648 ankles had chondral lesions on the talus (47.8%), 207 ankles had lesions on the tibial plafond (15.3%), 165 has lesions of the lateral malleolus (12.2%), and 133 had lesions of the medial malleolus (9.8%). Weber C group had significantly higher incidence than Weber A group (p=0.015). Trimalleolar and isolated lateral malleolar fracture groups had significantly higher incidence of chondral injury than bimalleolar and isolated medial malleolar fracture groups (p<0.001). A significant difference was found in occurrence rate of chondral injury among Lauge-Hansen classification, with supination-adduction having the lowest incidence (p=0.001). Conclusion: Our study found a high incidence of intra-articular chondral lesion in the setting of ankle fractures as demonstrated by arthroscopy, with more than half of all patients having a chondral lesion. Talar lesions were most common. This study may help direct greater attention to the Talus as a source of chondral injury particularly in higher grade fracture patterns.

High Incidence of spring ligament laxity in ankle fractures with complete deltoid ruptures and secondary first ray instability

The Foot ◽  
2020 ◽  
pp. 101720
Author(s):  
Chandra Pasapula ◽  
Ahmad M.S. Ali ◽  
Biju Kiliyanpilakkil ◽  
Antonia Hardcastle ◽  
Mandeep Koundu ◽  
...  
Keyword(s):  
Ankle Fractures ◽  
Spring Ligament ◽  
High Incidence ◽  
First Ray ◽  
Ligament Laxity

Incidence of Chondral Lesions of Talar Dome in Ankle Fracture Types

2008 ◽  
Vol 29 (3) ◽  
pp. 287-292 ◽  
Author(s):  
Seref Aktas ◽  
Baris Kocaoglu ◽  
Arel Gereli ◽  
Ufuk Nalbantodlu ◽  
Osman Güven
Keyword(s):  
Ankle Fracture ◽  
Fracture Repair ◽  
Ankle Fractures ◽  
Talar Dome ◽  
Distal Fibula ◽  
Chondral Lesions ◽  
Anatomic Reduction ◽  
Arthroscopically Assisted ◽  
Male Patients ◽  
Fracture Types

Background: Although the surgical treatment of ankle fractures is well known, a paucity of literature exists correlating chondral lesions with ankle fracture types. Materials and Methods: This study is a retrospective review of patients with absence or presence of chondral lesions that underwent arthroscopically assisted open reduction and internal fixation between June 2002 and April 2005. There were 38 female and 48 male patients (mean age, 41.4 years; mean followup, 33.9 months), and all had an Ankle-Hindfoot Scale score. The relationship between fracture types and presence of lesions was evaluated. Results: Four of 27 fractures with chondral lesions consisted of the bimalleolar type, 6 of 15 fractures with chondral lesions consisted of the trimalleolar type, and 14 of 20 distal fibula fractures had chondral lesions. There was significant greater incidence of chondral lesions associated with distal fibula fractures. The mean AOFAS score was 95.6 among all fractures. Conclusion: There is clear evidence that despite anatomic reduction, postoperative results of ankle fracture repair are not free of complications. We believe inspection of the talar dome should be routinely considered in the surgical repair ankle fractures.

scholarly journals Second-Look Arthroscopic Findings and Clinical Outcomes After Management of Intra-Articular Lesions in Acute Ankle Fractures with Arthroscopy

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Jeon-Gyo Kim ◽  
Heuichul Gwak ◽  
Sangmyung Roh
Keyword(s):  
Clinical Outcomes ◽  
Ankle Fracture ◽  
Arthroscopic Surgery ◽  
Osteochondral Lesion ◽  
Ankle Arthroscopy ◽  
Ankle Fractures ◽  
Chondral Lesions ◽  
Second Look ◽  
Initial Surgery ◽  
Arthroscopic Finding

Category: Ankle, Arthroscopy, Trauma Introduction/Purpose: Anatomically successful surgical reduction of ankle fractures does not always result in a clinically favorable outcome. The purpose of the present study was to compare initial and second look arthroscopic finding of acute ankle fracture and to evaluate clinical outcomes. Methods: A total of 39 patients (40 ankles, 20 male, 20 female) who underwent surgery for ankle fracture between March 2009 and August 2016 were retrospectively reviewed. All patients gave consent to the exploratory arthroscopic surgery for the removal of internal fixation devices placed in the initial surgery. Intra-articular lesions (osteochondral lesion, loose body, injury of ligaments and fibrosis) were evaluated via ankle arthroscopy. Arthroscopic finding of osteochondral lesion were classified using the Ferkel and Cheng staging system, and cartilage repair was assessed using the international Cartilage Repar System (ICRS). Clinicial outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and Visual Analogue Scale (VAS) Results: Chondral lesions were found in 26 ankles (65%) with initial arthroscopic finding of acute ankle fracture. Newly discovered chondral lesions in second-look arthroscopy was 15 cases. Accoding to the Ferkel and Cheng staging at second-look arthroscopy, 4 of 23 ankles with chondral lesions of talus was getting worse (more than stage D). In terms of ICRS overall repair grades, 4 ankle (15%) were abnormal (grade III). Diffuse synovitis and arthrofibrosis were found in 12 and 7 ankles respectively in second-look arthroscopy. Correlation were found between AOFAS scores, VAS and intra-articular lesions with second-look arthroscopy. Conclusion: Second-look arthroscopic examination combined with treatment of intra-articular lesion arising from ankle fracture surgery may consider to improve clinical outcomes.

High incidence of osteochondral lesions after open reduction and internal fixation of displaced ankle fractures: Medium-term follow-up of 100 cases

Injury ◽  
2016 ◽  
Vol 47 (3) ◽  
pp. 757-761 ◽  
Author(s):  
Marc Regier ◽  
Jan Philipp Petersen ◽  
Ahmet Hamurcu ◽  
Eik Vettorazzi ◽  
Cyrus Behzadi ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Ankle Fractures ◽  
Osteochondral Lesions ◽  
Medium Term ◽  
High Incidence

The observation of defects on (100) CdTe surfaces by chemical etching

1992 ◽  
Vol 50 (2) ◽  
pp. 1424-1425
Author(s):  
M.E. Lee
Keyword(s):  
Single Crystal ◽  
Grain Boundaries ◽  
Single Crystals ◽  
Chemical Etching ◽  
Crystalline Perfection ◽  
Crystalline Defects ◽  
High Incidence ◽  
Crystallographic Defects ◽  
Cdznte Substrates ◽  
Device Technology

The crystalline perfection of bulk CdTe substrates plays an important role in their use in infrared device technology. The application of chemical etchants to determine crystal polarity or the density and distribution of crystallographic defects in (100) CdTe is not well understood. The lack of data on (100) CdTe surfaces is a result of the apparent difficulty in growing (100) CdTe single crystal substrates which is caused by a high incidence of twinning. Many etchants have been reported to predict polarity on one or both (111) CdTe planes but are considered to be unsuitable as defect etchants. An etchant reported recently has been considered to be a true defect etchant for CdTe, MCT and CdZnTe substrates. This etchant has been reported to reveal crystalline defects such as dislocations, grain boundaries and inclusions in (110) and (111) CdTe. In this study the effect of this new etchant on (100) CdTe surfaces is investigated.The single crystals used in this study were (100) CdTe as-cut slices (1mm thickness) from Bridgman-grown ingots.

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