Bone density correlates with clinical outcomes after ankle fracture fixation

Background: There is no consensus on the optimal treatment or preferred method of operation for the management of acute deltoid ligament injuries during an ankle fracture fixation. This study aimed to analyze the outcomes of repairing the deltoid ligament during the fixation of an ankle fracture compared to conservative management. Methods: We retrospectively evaluated 78 consecutive cases of a ruptured deltoid ligament with an associated ankle fracture between 2001 and 2016. All of the ankle fractures were treated with a plate and screw fixation. Patients in the conservative treatment for ruptured deltoid ligament underwent management from 2001 to 2008 (37 fractures, group 1), while the operative treatment for ruptured deltoid ligament was included from 2009 to 2016 (41 fractures, group 2). The outcome measures included radiographic findings, the American Orthopaedic Foot & Ankle Society ankle-hindfoot scores, visual analog scale scores, and the Foot Function Index. All patients were followed for an average of 17 months. Results: Radiologic findings in both groups were comparable, but the final follow-up of the medial clear space (MCS) was significantly smaller in the group 2 ( P < .01). Clinical outcomes were similar between the two groups ( P > .05). Comparing those who underwent syndesmotic fixation between both groups, group 2 showed a significantly smaller final follow-up MCS, and all clinical outcomes were better in group 2 ( P < .05). Linear regression analysis showed that the final follow-up MCS had a significant influence on clinical outcomes ( P < .05). Conclusion: Although the clinical outcomes were not significantly different between the 2 groups, we obtained a more favorable final follow-up MCS in the deltoid repair group. Particularly when accompanied by a syndesmotic injury, the final follow-up MCS and the clinical outcomes were better in the deltoid repair group. In the case of high-grade unstable fractures of the ankle with syndesmotic instability, a direct repair of the deltoid ligament was adequate for restoring medial stability. Level of Evidence: Level III, retrospective comparative case series.

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Perioperative vitamin D levels correlate with clinical outcomes after ankle fracture fixation

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-015-2376-6 ◽

2015 ◽

Vol 136 (3) ◽

pp. 339-344 ◽

Cited By ~ 8

Author(s):

Stephen J. Warner ◽

Matthew R. Garner ◽

Joseph T. Nguyen ◽

Dean G. Lorich

Keyword(s):

Vitamin D ◽

Clinical Outcomes ◽

Fracture Fixation ◽

Ankle Fracture ◽

Vitamin D Levels

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Bone density of the calcaneus correlates with radiologic and clinical outcomes after calcaneal fracture fixation

Injury ◽

10.1016/j.injury.2020.03.063 ◽

2020 ◽

Vol 51 (8) ◽

pp. 1910-1918

Author(s):

Sang Min Lee ◽

Jae Seung Seo ◽

Sang Ho Kwak ◽

Won Chul Shin ◽

Jung Yun Bae ◽

...

Keyword(s):

Bone Density ◽

Clinical Outcomes ◽

Fracture Fixation ◽

Calcaneal Fracture

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Clinical outcomes following ankle fracture: a cross-sectional observational study

Journal of Foot and Ankle Research ◽

10.1186/s13047-014-0050-9 ◽

2014 ◽

Vol 7 (1) ◽

Cited By ~ 19

Author(s):

Ganit Segal ◽

Avi Elbaz ◽

Alon Parsi ◽

Ziv Heller ◽

Ezequiel Palmanovich ◽

...

Keyword(s):

Observational Study ◽

Clinical Outcomes ◽

Ankle Fracture ◽

Cross Sectional

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The use and efficacy of intra-operative stress tests in supination-external rotation IV ankle fracture fixation

The Surgeon ◽

10.1016/j.surge.2014.02.002 ◽

2015 ◽

Vol 13 (1) ◽

pp. 9-14 ◽

Cited By ~ 5

Author(s):

Sarah L. Gill ◽

Amy Behman ◽

Lynda A. Cochrane ◽

Gavin J. Love

Keyword(s):

Fracture Fixation ◽

Ankle Fracture ◽

External Rotation ◽

Stress Tests ◽

Operative Stress ◽

Supination External Rotation

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A Retrospective Case Series of Carbon Fiber Plate Fixation of Ankle Fractures

Foot & Ankle Specialist ◽

10.1177/1938640017718343 ◽

2017 ◽

Vol 11 (3) ◽

pp. 223-229 ◽

Cited By ~ 1

Author(s):

Zachariah W. Pinter ◽

Kenneth S. Smith ◽

Parke W. Hudson ◽

Caleb W. Jones ◽

Ryan Hadden ◽

...

Keyword(s):

Carbon Fiber ◽

Fracture Fixation ◽

Complication Rate ◽

Ankle Fracture ◽

Case Series ◽

Complication Rates ◽

Union Rate ◽

Retrospective Case ◽

Retrospective Case Series

Distal fibula fractures represent a common problem in orthopaedics. When fibula fractures require operative fixation, implants are typically made from stainless steel or titanium alloys. Carbon fiber implants have been used elsewhere in orthopaedics for years, and their advantages include a modulus of elasticity similar to that of bone, biocompatibility, increased fatigue strength, and radiolucency. This study hypothesized that carbon fiber plates would provide similar outcomes for ankle fracture fixation as titanium and steel implants. A retrospective chart review was performed of 30 patients who underwent fibular open reduction and internal fixation (ORIF). The main outcomes assessed were postoperative union rate and complication rate. The nonunion or failure rate for carbon fiber plates was 4% (1/24), and the union rate was 96% (23/24). The mean follow-up time was 20 months, and the complication rate was 8% (2/24). Carbon fiber plates are a viable alternative to metal plates in ankle fracture fixation, demonstrating union and complication rates comparable to those of traditional fixation techniques. Their theoretical advantages and similar cost make them an attractive implant choice for ORIF of the fibula. However, further studies are needed for extended follow-up and inclusion of larger patient cohorts. Levels of Evidence: Level IV: Retrospective Case series

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Screw Fixation of the Posterior Malleolus Fragment in Ankle Fracture: Cadaveric and Clinical Studies

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00267 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0026

Author(s):

Gisoo Lee ◽

Chan Kang ◽

Yougun Won ◽

Jae Hwang Song ◽

Byungki Cho

Keyword(s):

Clinical Outcomes ◽

Ankle Fracture ◽

Screw Fixation ◽

Articular Surface ◽

Cannulated Screw ◽

Ankle Fractures ◽

Neutral Position ◽

Early Recovery ◽

Malleolar Fracture ◽

Posterior Malleolus

Category: Ankle, Trauma Introduction/Purpose: Previously, a posterior malleolus fragment (PMF) covering 25–30% of the articular surface was a known indication for surgical fixation for ankle fractures. This study aimed to compare the outcomes of screw fixation for PMF comprising <25% of the articular surface and to evaluate the results of cadaver experiments. Methods: The clinical study enrolled ankle fracture patients with PMFs who planned to undergo surgery between March 2014 and February 2017. Among them, 62 with type 1 PMF comprising <25% of the articular surface were included: 32 patients underwent cannulated screw fixation for PMF after fixation for lateral and/or medial malleolar fracture (A group), whereas the other 30 patients underwent internal fixation for lateral and/or medial malleolar fracture but no screw fixation (B group). Clinical outcomes were determined at the 3-, 6-, 12-, and 18-month visits. Additionally, cadaver studies were conducted to evaluate cannulated screw fixation or no fixation in cases of PMFs comprising <25% of the articular surface and >1 mm displacement. Ankle joint stability was measured under external torque on the ankle in the neutral position. The level of significance was set at P < .05. Results: Clinical outcomes at 6 and 12 months after surgery were significantly higher in group A than in group B. However, there was no significant intergroup difference in clinical outcomes at 18 months of follow-up. In the cadaver study, PMF screw fixations were significantly more stable under external rotation force. Conclusion: Screw fixation was significantly useful during early recovery and in short-term clinical outcomes owing to stabilization of ankle fractures with PMF involving <25% of the articular surface.

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Reduction and fixation of anterior inferior tibiofibular ligament avulsion fracture without syndesmotic screw fixation in rotational ankle fracture

Journal of International Medical Research ◽

10.1177/0300060519882550 ◽

2019 ◽

Vol 48 (4) ◽

pp. 030006051988255

Author(s):

Kee Jeong Bae ◽

Seung-Baik Kang ◽

Jihyeung Kim ◽

Jaewoo Lee ◽

Tae Won Go

Keyword(s):

Fracture Fixation ◽

Ankle Fracture ◽

Avulsion Fracture ◽

Screw Fixation ◽

Malleolar Fracture ◽

Tibiofibular Ligament ◽

Radiographic Parameters ◽

Syndesmotic Screw ◽

Anterior Inferior Tibiofibular Ligament ◽

American Orthopaedic

Objective We aimed to present the radiographic and functional outcomes of anatomical reduction and fixation of anterior inferior tibiofibular ligament (AITFL) avulsion fracture without syndesmotic screw fixation in rotational ankle fracture. Methods We retrospectively reviewed 66 consecutive patients with displaced malleolar fracture combined with AITFL avulsion fracture. We performed reduction and fixation for the AITFL avulsion fracture when syndesmotic instability was present after malleolar fracture fixation. A syndesmotic screw was inserted only when residual syndesmotic instability was present even after AITFL avulsion fracture fixation. The radiographic parameters were compared with those of the contralateral uninjured ankles. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were assessed 1 year postoperatively. Results Fifty-four patients showed syndesmotic instability after malleolar fracture fixation and underwent reduction and fixation for AITFL avulsion fracture. Among them, 45 (83.3%) patients achieved syndesmotic stability, while 9 (16.7%) patients with residual syndesmotic instability needed additional syndesmotic screw fixation. The postoperative radiographic parameters were not significantly different from those of the uninjured ankles. The mean AOFAS score was 94. Conclusion Reduction and fixation of AITFL avulsion fracture obviated the need for syndesmotic screw fixation in more than 80% of patients with AITFL avulsion fracture and syndesmotic instability.

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