Ankle fracture management using smartphone multimedia messaging service (MMS) imaging — How reliable and to what point?

2021 ◽  
Author(s):  
William B. O’Callaghan ◽  
David E.A. Nielsen ◽  
Matthew J. Hope ◽  
Sarah L. Whitehouse ◽  
S.L. Ezekiel Tan
Keyword(s):  
Ankle Fracture ◽  
Fracture Management ◽  
Multimedia Messaging Service

State-of-the-Art in Ankle Fracture Management in Chile

2016 ◽  
Vol 21 (2) ◽  
pp. 367-389
Author(s):  
Cristián A. Ortiz ◽  
Pablo Wagner ◽  
Emilio Wagner
Keyword(s):  
Ankle Fracture ◽  
State Of The Art ◽  
Fracture Management

Advances in Ankle Fracture Management

2018 ◽  
Vol 17 (4) ◽  
pp. 162
Author(s):  
J. Turner Vosseller
Keyword(s):  
Ankle Fracture ◽  
Fracture Management

scholarly journals 2017 J. Leonard Goldner Award Winner

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Samuel Adams ◽  
Rachel Reilly ◽  
Janet Huebner ◽  
Virginia Kraus ◽  
Dana Nettles
Keyword(s):  
Ankle Fracture ◽  
Clinical Intervention ◽  
Joint Space ◽  
Therapeutic Interventions ◽  
Metabolic Derangement ◽  
Fracture Management ◽  
Temporal Grouping ◽  
Exact Etiology ◽  
Anti Inflammatory ◽  
Time Of Presentation

Category: Ankle,Ankle Arthritis,Basic Sciences/Biologics,Trauma Introduction/Purpose: Intra-articular ankle fracture (IAF) is known to cause post-traumatic osteoarthritis (PTOA) of the ankle. While the exact etiology remains elusive, the sequelae of intra-articular inflammation has been suggested and our previous work demonstrated a highly pro-inflammatory environment at the time of IAF fixation. ORIF of an IAF can occur 10-14days, or later, after fracture, subjecting the cartilage to this pro-inflammatory environment during this time. Therefore, there is ample time to intervene with an anti-inflammatory agent, yet the exact synovial fluid (SF) composition is unknown. This study examined the effect of time and fracture severity on the SF microenvironment during the acute phase following IAF. Knowledge of the intra- articular metabolic derangement after IAF will help to understand the pathology of PTOA and to develop therapeutic interventions. Methods: Ankle SF was collected from 54 patients with an IAF at the time of surgery for initial external fixation or definitive ORIF and analyzed for concentrations of 10 cytokines, 5 matrix metalloprotienases, 2 products of cartilage catabolism, and combined products of heme metabolism. All analytes were correlated with time from fracture and further analyzed for an effect of 3 clinically relevant time subgroups that correspond to potential clinical intervention time points for ankle fracture management: 0-2 days (initial ER presentation), 3-9 days (clinic presentation), and =10 days (definitive fixation). The effect of fracture severity was determined by grouping SF according to the number of radiographic intra-articular fracture lines. Results: Correlation analysis revealed a significant relationship with time from fracture for 15 of 18 analytes (Figure 1). Temporal grouping of SF revealed an initial (0-2 days) spike of pro-inflammatory (IL-12p70, IL-1?, IL-6) and anti-inflammatory (IL-10 and IL-4) cytokines, MMP-9, and sGAG, followed immediately (3-9 days) by exposure of the joint space to heme breakdown products and an accompanying surge in mediators and products of cartilage catabolism (MMP-1, MMP-2, MMP-3, MMP-10 and CTX-II). After 10 days there was a decrease in pro- and anti-inflammatory cytokines, but a persistence of mediators of cartilage matrix catabolism. While fracture severity had a significant effect on SF levels of MMP-2, MMP-9, and CTXII, there was no clear relationship between the number of fracture lines and SF levels of analytes. Conclusion: This study provides novel insights into temporal inflammatory fluctuations following acute IAF of the ankle and supports consideration of an early evacuation of the jointspace to reduce the intra-articular inflammatory burden and exposure of the cartilage and synovium to these detrimental factors. Moreover, this study identifies the temporal composition of SF products that are known to cause osteoarthritis. Therefore, this information can be used to develop novel therapeutics that can tailored to the time of presentation after intra-articular ankle fracture.

The effect of inclement weather on ankle fracture management in an Irish trauma unit

2013 ◽  
Vol 182 (3) ◽  
pp. 397-401 ◽  
Author(s):  
B. J. O’Neill ◽  
E. G. Kelly ◽  
O. C. Breathnach ◽  
P. Keogh ◽  
P. J. Kenny ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
Trauma Unit ◽  
Inclement Weather ◽  
Fracture Management

scholarly journals Clinical audit of ankle fracture management in the elderly

2016 ◽  
Vol 6 ◽  
pp. 96-101 ◽  
Author(s):  
Langhit Kurar
Keyword(s):  
Ankle Fracture ◽  
Clinical Audit ◽  
The Elderly ◽  
Fracture Management

scholarly journals EP.FRI.849 Quality Improvement Project for Management of Unstable Ankle Fracture in Scunthorpe General Hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Jian Zi Poh
Keyword(s):  
Ankle Fracture ◽  
Ankle Fractures ◽  
Prospective Data ◽  
Improvement Project ◽  
Good Communication ◽  
Clinical Notes ◽  
Root Cause ◽  
Fracture Management ◽  
Skin Integrity ◽  
Change In Practice

Abstract Introduction In SGH, little emphasis is placed on ankle fracture as compared to hip fracture. Hence, an audit was done to compare management of unstable ankle fracture in adherence to BOAST guidelines. It was found out that few aspects of management in A&E were inadequate. Analyzing the root cause of non-adherence to guideline can lead to better care for these patients. Aim Primary aim is to ensure that ankle fractures are treated effectively in line with BOAST guidelines. Secondary aim is to ensure that ankle fractures are treated in a timely manner. Change in practice Discussion was held between Orthopaedic consultant and A&E consultant. Firstly, poster displaying algorithm for ankle fracture management displayed in A&E. Secondly, Orthopaedics doctor would come to A&E to reduce fracture after first failed attempt. Methods Prospective data is collected. Patients with unstable ankle fracture who are admitted in SGH are assessed in regards to BOAST guidelines via WebV, PACS and clinical notes. Results Major improvement is seen in different aspects. The documentation of neurovascular assessment and skin integrity in A&E department is improved by 57%. Additional radiographs of the whole leg when clinical examination suggests a more proximal fracture of the fibula (Maisonneuve injury) was performed in 60% more patients as compared to previously. Adequacy of reduction done in A&E is improved by 25%. Conclusion Small changes can make a big difference. Good communication and teamwork between different departments is the best way to provide better care for patients.

scholarly journals Ankle Home Stay Programme:- A review of ankle fracture management and costs at a busy district general hospital

2020 ◽  
Vol 50 ◽  
pp. 6-9
Author(s):  
Raghbir Khakha ◽  
Onur Berber ◽  
Amit Patel ◽  
Langhit Kurar ◽  
Laurence James
Keyword(s):  
General Hospital ◽  
Ankle Fracture ◽  
District General Hospital ◽  
Fracture Management

scholarly journals Fixation of ankle fractures – a major trauma centre’s experience in improving quality

2019 ◽  
Vol 101 (6) ◽  
pp. 387-390 ◽  
Author(s):  
S Whitehouse ◽  
LW Mason ◽  
L Jayatilaka ◽  
AP Molloy
Keyword(s):  
Ankle Fracture ◽  
Major Complication ◽  
Image Intensifier ◽  
Deep Infection ◽  
Improved Outcomes ◽  
Audit Data ◽  
Fracture Management ◽  
Major Complication Rate ◽  
Picture Archiving And Communication ◽  
Data Collections

BackgroundAnkle fracture malreduction has been shown to result in poor long-term functional outcomes. Varying methods can be used to change practice and thereby outcomes. We present over four years’ worth of results with the effects of different techniques for change.MethodsTwo audit cycles were performed incorporating three audit data collections; an initial standard setting audit in 2013, with re-audits in 2015 and 2017. Between the first and second audit was a period of education and reflection. Between the second and third audit there was a change in process in ankle fracture management supported by education. Image intensifier films were reviewed on the hospital picture archiving and communication system, by at least two blinded observers in each cycle. These were scored based on the criteria published by Pettrone et al.ResultsIn the initial audit in 2013, there were 94 patients, with a malreduction rate of 33%. In the second audit in 2015, there were 68 patients, with an increase in malreduction rate to 43.8%. In the third audit in 2017, there were 205 patients, with a significant decrease in malreduction rate to 2.4%. The final major complication rate was 0.98%. The rate of deep infection was 0.5%.ConclusionsBy recognising and addressing the need to improve the quality of ankle fracture fixation, we have made significant improvements in radiological outcomes. Education alone, without system change, was not successful in our department in achieving improved outcomes.

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