High sensitivity of sonography in ankle fractures: a case report on a missed ankle fracture on plain radiographs

2021 ◽  
Author(s):  
Eckehart Schöll ◽  
Markus Knupp
Keyword(s):  
Case Report ◽  
Ankle Fracture ◽  
High Sensitivity ◽  
Ankle Fractures ◽  
Plain Radiographs

Posterior Tibialis Tendon Rupture in a Closed Bimalleolar-Equivalent Ankle Fracture: Case Report

2017 ◽  
Vol 10 (6) ◽  
pp. 572-577 ◽  
Author(s):  
Richard M. Wardell ◽  
Andrew E. Hanselman ◽  
Scott D. Daffner ◽  
Robert D. Santrock
Keyword(s):  
Case Report ◽  
Ankle Fracture ◽  
Single Case ◽  
Case Reports ◽  
Distal Segment ◽  
Ankle Fractures ◽  
Fracture Dislocation ◽  
Single Case Report ◽  
Joint Identification ◽  
High Level

Ankle fractures with an associated posterior tibialis tendon (PTT) rupture are rare injuries and have only been described in a number of case reports. These prior reports include patients that had an open fracture and/or an associated medial malleolar fracture component. In this unique case report, we present a patient that sustained a closed bimalleolar-equivalent ankle fracture/dislocation without medial malleolar involvement which was irreducible due to a PTT rupture and subsequent distal segment interposition in the tibiotalar joint. Identification of acute PTT rupture with associated ankle fracture is important because early repair is associated with significantly better functional outcomes compared with late repair. These injury patterns may easily be missed due to the limitations with physical examination and standard imaging often encountered during initial evaluation of routine ankle fractures. Therefore, physicians should maintain a high level of suspicion in the appropriate clinical setting in order to provide appropriate diagnosis and timely surgical intervention. Levels of Evidence: Descriptive, Level V: Single case report

scholarly journals P109 Sherlock Holmes in Clinical Practice: The Deduction of the Pattern and Mechanism of Injury in Ankle Fractures Using Lauge-Hansen System

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Fang Fang Quek ◽  
Fang Fang Quek
Keyword(s):  
Case Report ◽  
Ankle Fracture ◽  
External Rotation ◽  
Ankle Fractures ◽  
X Rays ◽  
Mechanism Of Injury ◽  
Proximal Fibula ◽  
Maisonneuve Fracture ◽  
Fibular Fracture ◽  
The Right

Abstract Introduction Ankle fractures are among the commonest fractures in adults and as population ages, the incidence is also increasing. It is crucial to ascertain the mechanism of injury of an ankle fracture as it determines the management plan. The diagnosis and management of ankle fractures are usually relatively straightforward but they are not always the case. Most patients are unable to recall the exact mechanism of injury due to the instantaneous nature of incident. We herein describe a case report of a patient who sustained an ankle fracture following a fall but was unable to recall the exact mechanisms of injury. This case report addresses the importance of recognising Maisonneuve fractures and how Lauge-Hansen Classification system might be useful in diagnosing and making management plans for ankle fractures. Case Report A 30-year-old male self-presented to the Emergency Department in a wheelchair following a fall. He tripped down the last four steps of stairs the night before, sustaining a right ankle injury as a result. He has been unable to weight-bear since. Elevation and application of ice packs have showed limited effect. Patient was unable to recall the exact mechanism of injury. On examination, the right ankle was swollen and there were bruises around the medial malleolus. Upon palpation, he complained of bony tenderness around lateral and medial malleoli. No other injury was found and patient was neurovascularly intact. A referral was made to the Orthopaedics team and further orthopaedic examinations revealed tenderness and crepitus upon palpation over the proximal fibula. Full lower leg X-rays was ordered to look for possible proximal fibula fracture. A diagnosis of closed, Maisonneuve (Weber C)/trimalleolar fracture of the right ankle was made. A CT-scan of the right ankle was requested to determine the involvement of joint surface to aid surgical planning. Both CT-scan and ankle X-rays showed disrupted syndesmosis. Disrupted syndesmosis is most commonly associated with Weber C fractures as shown in this case. Since the fibular fracture is greater than 4.5cm away from the tibial plafond, syndesmosis fixation is required. In Maisonneuve fractures, syndesmotic screws can be used to achieve anatomical reduction and ankle stability. This patient was scheduled for an ORIF surgery. Discussions Based on the findings of medial and posterior malleoli fractures from the ankle X-rays, we can deduce that the patient has most likely sustained a complete Pronation-External Rotation (PER) injury. A Maisonneuve fracture was almost missed initially due to distracting injuries and not obtaining full lower leg X-rays. However, based on Lauge-Hansen Classification, we know that it is highly unlikely to have a posterior malleolus fracture (Stage 4) without any fibular fracture (Stage 3). Hence, a full-fibula X-ray was ordered to look for proximal fibula fracture and the X-rays revealed a spiral fracture at the proximal fibula (Maisonneuve fracture). The injury force was transmitted along the interosseous membrane and exited at the shaft of proximal fibula, causing a proximal fibular fracture. PER or injury sustained from an internally rotated leg on a planted foot may cause external rotation injury, resulting in a disruption of the ligaments. The syndesmosis, which provides primary support to the ankle, if disrupted, will disrupt the ankle mortise, displacing the fibula laterally, as demonstrated in this case. Conclusion As demonstrated in this case, some fractures, like the Maisonneuve fracture, can easily be missed. Due to distracting injuries, the chief complain in most cases of Maisonneuve fracture is severe ankle pain instead of the fracture site at proximal fibula. These fractures, if not identified early, can lead to poor prognosis. It is important to consider Maisonneuve fracture in all ankle injuries. A delayed diagnosis can lead to post-traumatic arthritis and pain, leading to loss of function. This case report addresses the importance of recognising easily missed fractures and how Lauge- Hansen Classification system is useful in aiding the diagnosis and management of ankle fracture

scholarly journals Management of Ankle Fractures with Syndesmotic Disruption: A Survey of Orthopaedic Surgeons

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0040
Author(s):  
Ryan G. Rogero ◽  
Emmanuel M. Illical ◽  
Daniel Corr ◽  
Steven M. Raikin ◽  
James Krieg ◽  
...  
Keyword(s):  
Gold Standard ◽  
Ankle Fracture ◽  
Management Strategies ◽  
Ankle Fractures ◽  
Multinomial Regression ◽  
Orthopaedic Surgeons ◽  
Suture Button ◽  
Standard Management ◽  
Management Protocol ◽  
Usage Patterns

Category: Ankle; Trauma Introduction/Purpose: With an increasing frequency of syndesmotic fixation during ankle fracture ORIF and no current gold standard management protocol, it is important for surgeons to understand the frequency and usage patterns of the various techniques among other orthopaedic surgeons. The purposes of this study are to determine how orthopaedic surgeons currently manage ankle fractures with concomitant syndesmotic disruption and to identify surgeon demographics predictive of syndesmotic management. Methods: An 18-question survey, including 10 specific syndesmotic management questions was sent to the Orthopaedic Trauma Association (OTA) and Canadian Orthopaedic Association (COA), as well as sent to email addresses of foot and ankle-fellowship trained surgeons. Surgeon demographic questions included years, country, and type of practice, fellowship(s) completed, setting of ankle fracture surgery, and number of ankle fractures operated on per year. Multinomial regression analysis was performed to determine if surgeon demographics were predictive of syndesmotic management. Results: One-hundred ten orthopaedic surgeons completed our survey. Selected predictors of syndesmotic management included: private practice with academic appointments (0.077 [0.007, 0.834]; p=0.035) being predictive of not using screws through an ORIF plate; foot & ankle fellowship (9.981 [1.787, 55.764]; p=0.009) and trauma fellowship (6.644 [1.302, 33.916]; p=0.023) predictive of utilizing screws through a plate; no fellowship (14.886 [1.226, 180.695]; p=0.034) predictive of only using 1 screw; and surgeons practicing in the U.S. were more likely to not use screws across just 3 cortices (0.031 [0.810, 3.660]; p=0.009). Additionally, among those utilizing suture-button devices, foot & ankle fellowship-trained surgeons were more likely to implement suture-button through plate (7.676 [1.286, 45.806]; p=0.025). Conclusion: Several surgeon factors influence decision making in the management of ankle fractures with syndesmotic disruption. This study raises awareness of differences in management strategies that should be used for further discussion when determining a potential gold standard for management of these complex injuries.

scholarly journals Principles and guidelines in the management of ankle fractures in adults

2021 ◽  
pp. 175045892096902
Author(s):  
Harry Kyriacou ◽  
Ahmed MHAM Mostafa ◽  
Benjamin M Davies ◽  
Wasim S Khan
Keyword(s):  
Clinical Guidelines ◽  
Ankle Fracture ◽  
Ankle Fractures ◽  
Recent Developments ◽  
Psychosocial Complications ◽  
British Orthopaedic Association

Ankle fractures are common injuries that have many physical and psychosocial complications. As a result, it is important to be aware of how these patients present and are managed perioperatively. Detailed guidelines from NICE and the British Orthopaedic Association have been produced on this topic, including recent developments such as the decision to weight-bear early after surgery and the use of virtual fracture clinics. This article provides an overview of the key perioperative factors that need to be considered in cases of ankle fracture and the relevant clinical guidelines.

scholarly journals Is postoperative non-weight-bearing necessary? INWN Study protocol for a pragmatic randomised multicentre trial of operatively treated ankle fracture

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ramy Khojaly ◽  
Ruairí Mac Niocaill ◽  
Muhammad Shahab ◽  
Matthew Nagle ◽  
Colm Taylor ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
Multicentre Trial ◽  
Short Form ◽  
Plantar Flexion ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Fracture Patterns ◽  
Randomised Controlled

Abstract Background Postoperative management regimes vary following open reduction and internal fixation (ORIF) of unstable ankle fractures. There is an evolving understanding that extended periods of immobilisation and weight-bearing limitation may lead to poorer clinical outcomes. Traditional non-weight-bearing cast immobilisation may prevent loss of fixation, and this practice continues in many centres. The purpose of this trial is to investigate the safety and efficacy of immediate weight-bearing (IWB) and range of motion (ROM) exercise regimes following ORIF of unstable ankle fractures with a particular focus on functional outcomes and complication rates. Methods A pragmatic randomised controlled multicentre trial, comparing IWB in a walking boot and ROM within 24 h versus non-weight-bearing (NWB) and immobilisation in a cast for 6 weeks, following ORIF of all types of unstable adult ankle fractures (lateral malleolar, bimalleolar, trimalleolar with or without syndesmotic injury) is proposed. All patients presenting to three trauma units will be included. The exclusion criteria will be skeletal immaturity and tibial plafond fractures. The three institutional review boards have granted ethical approval. The primary outcome measure will be the functional Olerud-Molander Ankle Score (OMAS). Secondary outcomes include wound infection (deep and superficial), displacement of osteosynthesis, the full arc of ankle motion (plantar flexion and dorsal flection), RAND-36 Item Short Form Survey (SF-36) scoring, time to return to work and postoperative hospital length of stay. The trial will be reported in accordance with the CONSORT statement for reporting a pragmatic trial, and this protocol will follow the SPIRIT guidance. Discussion Traditional management of operatively treated ankle fractures includes an extended period of non-weight-bearing. There is emerging evidence that earlier weight-bearing may have equivocal outcomes and favourable patient satisfaction but higher wound-related complications. These studies often preclude more complicated fracture patterns or patient-related factors. To our knowledge, immediate weight-bearing (IWB) following ORIF of all types of unstable ankle fractures has not been investigated in a controlled prospective manner in recent decades. This pragmatic randomised-controlled multicentre trial will investigate immediate weight-bearing following ORIF of all ankle fracture patterns in the usual care condition. It is hoped that these results will contribute to the modern management of ankle fractures. Trial registration ISRCTN Registry ISRCTN76410775. Retrospectively registered on 30 June 2019.

The Foot and Ankle Outcome Score (FAOS) During Early Recovery After Ankle Fracture

2021 ◽  
pp. 107110072110028
Author(s):  
Peter Larsen ◽  
Mohammed Al-Bayati ◽  
Rasmus Elsøe
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Ankle Fracture ◽  
Minimal Clinically Important Difference ◽  
Ankle Fractures ◽  
Foot And Ankle ◽  
Early Recovery ◽  
Clinically Important Difference ◽  
Test Retest Reliability

Background: Several patient-reported outcome measures (PROMs) are available for assessing the outcomes following ankle fractures. This study aimed to evaluate validity, reliability, and responsiveness and detect the minimal clinically important difference of the Foot and Ankle Outcome Score (FAOS) in patients with ankle fractures. Methods: The study design is a prospective cohort study, including all patients treated both conservatively and surgically following an ankle fracture (AO-43A/B/C). Content validity, test-retest reliability, responsiveness, and minimal clinically important difference were evaluated from 14 days to 3 months following the fracture. Results: The study population consisted of 52 females and 24 males. The mean age was 52.0 years (range, 15-75 years). The percentage of patients at 12 weeks reporting the 5 subscales at least somewhat relevant were pain, 77%; symptoms, 75%; activities of daily living (ADL), 64%; sport, 81%; and quality of life (QOL), 88%. High test-retest reliability of the FAOS questionnaire was observed. The interclass coefficients were 0.78, 0.77, 0.71, 0.73, and 0.74 for the pain, symptoms, ADL, sport, and QOL subscales, respectively. Responsiveness was evaluated with high effect size for the symptoms (0.83), ADL (1.19), sport (4.36), and QOL (2.12) subscales. The minimal clinically important difference of the FAOS was 14 (95% CI, 12-17). Conclusion: The FAOS during early recovery after ankle fracture has high reliability and validity. Level of Evidence: Level II, prospective cohort study

First description of elevated high-sensitivity troponin I for pufferfish poisoning: a case report

2021 ◽  
Author(s):  
Akkan Avci ◽  
Hayri Cınar ◽  
Onder Yesiloglu ◽  
Begum Seyda Avci ◽  
Hasan Yesilagac ◽  
...  
Keyword(s):  
Case Report ◽  
Troponin I ◽  
High Sensitivity ◽  
High Sensitivity Troponin

Functional Outcomes After Fracture-Dislocation of the Ankle

2019 ◽  
Vol 13 (1) ◽  
pp. 18-26 ◽  
Author(s):  
Direk Tantigate ◽  
Gavin Ho ◽  
Joshua Kirschenbaum ◽  
Henrik C. Bäcker ◽  
Benjamin Asherman ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Functional Outcomes ◽  
Ankle Fracture ◽  
Statistical Significance ◽  
Ankle Fractures ◽  
Fracture Dislocation ◽  
Wound Complications ◽  
Pain Subscale ◽  
Fracture Dislocations

Background. Fracture dislocation of the ankle represents a substantial injury to the bony and soft tissue structures of the ankle. There has been only limited reporting of functional outcome of ankle fracture-dislocations. This study aimed to compare functional outcome after open reduction internal fixation in ankle fractures with and without dislocation. Methods. A retrospective chart review of surgically treated ankle fractures over a 3- year period was performed. Demographic data, type of fracture, operative time and complications were recorded. Of 118 patients eligible for analysis, 33 (28%) sustained a fracture-dislocation. Mean patient age was 46.6 years; 62 patients, who had follow-up of at least 12 months, were analyzed for functional outcome assessed by the Foot and Ankle Outcome Score (FAOS). The median follow-up time was 37 months. Demographic variables and FAOS were compared between ankle fractures with and without dislocation. Results. The average age of patients sustaining fracture-dislocation was greater (53 vs 44 years, P = .017); a greater percentage were female (72.7% vs 51.8%, P = .039) and diabetic (24.2% vs 7.1%, P = .010). Wound complications were similar between both groups. FAOS was generally poorer in the fracture-dislocation group, although only the pain subscale demonstrated statistical significance (76 vs 92, P = .012). Conclusion. Ankle fracture-dislocation occurred more frequently in patients who were older, female, and diabetic. At a median of just > 3-year follow-up, functional outcomes in fracture-dislocations were generally poorer; the pain subscale of FAOS was worse in a statistically significant fashion. Levels of Evidence: Therapeutic, Level III

Ankle Fracture Classification: A Comparison of Reliability of Three X-ray Views Versus Two

1998 ◽  
Vol 19 (8) ◽  
pp. 555-562 ◽  
Author(s):  
Michael E. Brage ◽  
Matthew Rockett ◽  
Robert Vraney ◽  
Robert Anderson ◽  
Alicia Toledano
Keyword(s):  
Ankle Fracture ◽  
Ankle Injury ◽  
Ankle Fractures ◽  
Kappa Statistics ◽  
Fracture Classification ◽  
X Ray ◽  
Good Accord ◽  
Interexaminer Reliability ◽  
Intraexaminer Reliability ◽  
Good Agreement

Our hypothesis was that malleolar ankle fractures could be classified with two radiographic views as reliably as with three views. Four different observers independently evaluated 99 sets of ankle radiographs. The examiners classified the ankle fractures by using both the Lauge-Hansen and Danis-Weber systems. The interobserver and intraobserver variations were analyzed by kappa statistics. With regard to intraexaminer reliability, the examiners demonstrated excellent accord in classifying the fractures in the Danis-Weber system with either three views or two views. The kappa values were comparable. In the Lauge-Hansen system, three examiners demonstrated excellent accord and one examiner demonstrated good accord in classifying the fractures. Similar kappa values were generated when examiners classified fractures with either three views or two views. With regard to interexaminer reliability, good to excellent accord was demonstrated overall among the four examiners when they used the Danis-Weber system with either three views or two views. The examiners were in good agreement when they used the Lauge-Hansen system. Similar kappa values were generated whether the examiners used three views or two views. Three radiographic views are usually ordered for evaluation of an acute ankle injury. Previous studies have shown that only two views are needed for diagnosis of a malleolar ankle fracture. This study demonstrates that malleolar ankle fractures can be classified with two views, lateral or mortise, with a reliability as good as that achieved with three views. The best agreement is achieved with lateral and mortise views.

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