Arthroscopically Assisted Treatment of Complex Ankle Fractures: Intra-articular Findings and 1-Year Follow-Up

2020 ◽  
Vol 59 (1) ◽  
pp. 9-15 ◽  
Author(s):  
Mareen Braunstein ◽  
Sebastian F. Baumbach ◽  
Marcel Urresti-Gundlach ◽  
Lars Borgmann ◽  
Wolfgang Böcker ◽  
...  
Keyword(s):  
Ankle Fractures ◽  
Arthroscopically Assisted

scholarly journals Effectiveness of arthroscopically assisted surgery for ankle fractures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Sonya Ahmed ◽  
Kyoung min Lee ◽  
Moon Seok Park ◽  
Ki Hyuk Sung ◽  
Seungbum Koo ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Operation Time ◽  
Ankle Fractures ◽  
Study Quality ◽  
P Values ◽  
Funnel Plot ◽  
Future Studies ◽  
Functional Scores ◽  
Arthroscopically Assisted

Category: Ankle, Arthroscopy, Trauma Introduction/Purpose: This meta-analysis was performed to determine whether the arthroscopically assisted open reduction and internal fixation (ORIF) for ankle fractures is more beneficial than the conventional ORIF. Methods: Articles in electronic medial databases were searched between March 1983 and August 2016, including Pubmed and SCOPUS. We included the studies with comparative design comparing the surgical outcomes between the arthroscopically assisted ORIF for ankle fractures and the conventional ORIF. Finally, two RCTs and two retrospective comparative studies were included for analysis. Mean and standard deviation (SD) of postoperative functional scores, number of subjects, and P-values were extracted from the studies. In addition, postoperative follow-up period, fracture type, and study quality were collected. Results: The pooled effect size of the four studies 0.535 (95% CI, 0.247 to 0.823) in Hedges’s g, which favored the arthroscopically assisted ORIF over conventional ORIF. There was no evidence of publication bias in funnel plot and in Egger’s test (p=0.534). Conclusion: The arthroscopically assisted ORIF for ankle fractures were more beneficial than the conventional ORIF in the current evidences. However, since it needs more medical cost and longer operation time, possible additional complications and cost effectiveness are to be validated in future studies.

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 Propensity Score–Matched Analysis of Arthroscopically Assisted Ankle Facture Treatment Versus Conventional Treatment

2020 ◽  
pp. 107110072096960
Author(s):  
Sebastian F. Baumbach ◽  
Marcel Urresti-Gundlach ◽  
Mareen Braunstein ◽  
Lars Borgmann ◽  
Wolfgang Böcker ◽  
...  
Keyword(s):  
Propensity Score ◽  
Internal Fixation ◽  
Open Reduction ◽  
Outcome Measurement ◽  
Ankle Fractures ◽  
Longitudinal Outcome ◽  
Patient Reported ◽  
Arthroscopically Assisted ◽  
Prospective Longitudinal

Background: The aim of this study was to assess the prospective, longitudinal outcome after arthroscopically assisted open reduction and internal fixation (AORIF) and to compare the results with open reduction and internal fixation (ORIF) in complex ankle fractures. Methods: Acute, closed, bimalleolar equivalent, bimalleolar, or trimalleolar ankle fractures were included. The AORIF cohort was enrolled prospectively. The ORIF group was identified from a retrospective database. The same inclusion and exclusion criteria were applied. The only difference was the additional arthroscopy in the AORIF cohort. The patient-reported outcome measurement (PROM) following AORIF was assessed at 1 and 4 years of follow-up using the Olerud and Molander Ankle Score (OMAS) and Tegner activity scale (TAS). The AORIF cohort was propensity score matched (nearest-neighbor matching) to the ORIF database. The OMAS and Foot and Ankle Ability Measure (FAAM) were compared between the resulting groups. Nonparametric statistics were applied; values are presented as median (interquartile range). Twenty-six AORIF patients had a prospective 4-year follow-up. Results: No significant differences (1 year vs 4 years) were identified for the OMAS (90 [10] vs 90 [11]) and TAS (4 [2] vs 5 [2]). The severity of the cartilage lesions (International Cartilage Repair Society [ICRS] grade <4 vs ICRS of 4) had no significant influence on the PROMs. Twenty-five patients per cohort (AORIF vs ORIF) were matched. The OMAS (90 [13] vs 75 [40]; P = .008) and FAAM Activities of Daily Living (ADL; 96 [11] vs 88 [30]; P = .034) revealed significantly better outcomes for AORIF. More patients in the AORIF cohort returned to sport (96% vs 77%; P = .035), with a higher FAAM Sports score (88 [37] vs 56 [47]; P = .008). Conclusion: AORIF for complex ankle fractures led to consistently good to excellent results. The propensity score–matched analysis revealed a significantly better outcome 4 years after surgery for AORIF compared with ORIF. Level of Evidence: Level III, retrospective comparative study.

Plafond Malreduction and Talar Dome Impaction Accelerates Arthrosis After Supination-Adduction Ankle Fracture

2021 ◽  
pp. 107110072110060
Author(s):  
Michael F. Githens ◽  
Malcolm R. DeBaun ◽  
Kimberly A Jacobsen ◽  
Hunter Ross ◽  
Reza Firoozabadi ◽  
...  
Keyword(s):  
Case Series ◽  
High Energy ◽  
Ankle Fractures ◽  
Posttraumatic Arthritis ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Radiographic Findings ◽  
Posttraumatic Arthrosis ◽  
Patient Reported

Background: Supination-adduction (SAD) type II ankle fractures can have medial tibial plafond and talar body impaction. Factors associated with the development of posttraumatic arthritis can be intrinsic to the injury pattern or mitigated by the surgeon. We hypothesize that plafond malreducton and talar body impaction is associated with early posttraumatic arthrosis. Methods: A retrospective cohort of skeletally mature patients with SAD ankle fractures at 2 level 1 academic trauma centers who underwent operative fixation were identified. Patients with a minimum of 1-year follow-up were included. The presence of articular impaction identified on CT scan was recorded and the quality of reduction on final intraoperative radiographs was assessed. The primary outcome was radiographic ankle arthrosis (Kellgren-Lawrence 3 or 4), and postoperative complications were documented. Results: A total of 175 SAD ankle fractures were identified during a 10-year period; 79 patients with 1-year follow-up met inclusion criteria. The majority of injuries resulted from a high-energy mechanism. Articular impaction was present in 73% of injuries, and 23% of all patients had radiographic arthrosis (Kellgren-Lawrence 3 or 4) at final follow-up. Articular malreduction, defined by either a gap or step >2 mm, was significantly associated with development of arthrosis. Early treatment failure, infection, and nonunion was rare in this series. Conclusion: Malreduction of articular impaction in SAD ankle fractures is associated with early posttraumatic arthrosis. Recognition and anatomic restoration with stable fixation of articular impaction appears to mitigate risk of posttraumatic arthrosis. Investigations correlating postoperative and long-term radiographic findings to patient-reported outcomes after operative treatment of SAD ankle fractures are warranted. Level of Evidence: Level IV, retrospective case series.

scholarly journals Profile vs Tubular Plate in Unimalleolar or Bimalleolar Fractures: is There a Real Difference in Wound complications?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0015
Author(s):  
Paolo Ceccarini ◽  
Rosario Petruccelli ◽  
Michele Bisaccia ◽  
Giuseppe Rinonapoli ◽  
Auro Caraffa
Keyword(s):  
Wound Dehiscence ◽  
Deep Infection ◽  
Ankle Fractures ◽  
Bone Union ◽  
Wound Complications ◽  
Fisher Exact Test ◽  
Superficial Infection ◽  
Operative Care ◽  
Group B

Category: Ankle; Trauma Introduction/Purpose: The aim of our study is to compare two types of plates, one third tubular plate and LCP distal fibula plate, evaluating the clinical outcome and the skin complications associated with their use. Methods: We collected the data of 122 consecutive unimalleolar or bimalleolar fractures treated by internal fixation for a closed, displaced distal closed fibular fracture. Exclusion criteria were: 1) open ankle fractures,2) trimalleolar fractures, 3) previous ankle fractures 4) severe venous insufficiency, 5) ankleosteoarthritis previous to surgery, 6) associated ankle dislocation. After this selection, 93 patients were included in our study and assigned in two groups, based on using of different implant: in group A48 patients were treated with one-third tubular and in group B 45 patients were treated with LCP distalfibula plate. There were no significant differences in the baseline characteristics. Patients received the same surgical procedure and the same post-operative care, then they were radiologically evaluated at1-3-12 months and clinical examination was made at 24 (range 15-36) months using AOFAS clinical rating system. All data were evaluated using chi-square test. Results: At the final 24-month follow-up a comparison between the two groups showed no statistical significant differences in reduction accuracy and bone union ratio at radiological examination. The wound complications rate of the overall study group was 7.6%. There were no statistical differences in the rate of wound complications between the two groups. There were no differences between both group in percentage of hardware removal at follow-up (overall 5.4%). In the group A occurred 1 deep infection, 2 superficial infection, no wound dehiscence; in group B occured 1 deep infection, 1 superficial infection and 2 wound dehiscence. There were no statistical differences in the rate of wound complications between the two groups (p=0.70; Fisher exact test). Conclusion: Our study has shown no difference in radiographic bone union rate, no significant differences in terms of clinical outcomes, in time of bone reduction and wound complication rate between the LCP distalfibula plate and conventional one-third tubular plate. RCT or metanalasys are in this case useful to improve scientific evidence and give more information for the correct surgical treatment of ankle fractures.

scholarly journals Suture button versus syndesmosis screw fixation in pronation-external rotation ankle fractures: A minimum 6-year follow-up of a randomised controlled trial

Injury ◽  
2021 ◽  
Author(s):  
Ristomatti Lehtola ◽  
Hannu-Ville Leskelä ◽  
Tapio Flinkkilä ◽  
Harri Pakarinen ◽  
Jaakko Niinimäki ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Screw Fixation ◽  
External Rotation ◽  
Controlled Trial ◽  
Ankle Fractures ◽  
Suture Button ◽  
Randomised Controlled ◽  
Syndesmosis Screw ◽  
Pronation External Rotation

Predisposing Factors for Posttraumatic Osteoarthritis After Malleolus Fracture Fixation in Patients Younger Than 50 Years

2021 ◽  
pp. 107110072110500
Author(s):  
Jong Seok Beak ◽  
Yeong Tae Kim ◽  
Sung Hyun Lee
Keyword(s):  
Risk Factors ◽  
Articular Surface ◽  
Binary Logistic Regression ◽  
Ankle Fractures ◽  
Fracture Dislocation ◽  
Posttraumatic Arthritis ◽  
Level Of Evidence ◽  
Posttraumatic Osteoarthritis ◽  
Posterior Malleolus

Background: The purpose of this study was to identify the risk factors for posttraumatic osteoarthritis (OA) after surgery for ankle fractures in patients aged ≤50 years. Methods: We performed a retrospective review of consecutive patients who underwent surgery for ankle fractures and were followed up for a minimum period of 5 years. The patients were assigned to 2 groups according to the presence of advanced OA at the last follow-up. Binary logistic regression was used to model the correlation between risk factors and OA. Functional outcomes were assessed using the Foot and Ankle Outcome Score. Results: The data of 332 patients who met the inclusion criteria were included in the analysis. The overall rate of posttraumatic arthritis was 27.7% (nonarthritis group: 240 patients, arthritis group: 92 patients). The arthritic change was significantly affected by BMI (95% confidence interval [CI] 1.29-19.76; adjusted odds ratio [OR] ≥ 30, 6.56), fracture-dislocation injury (CI 1.66-11.57; adjusted OR, 4.06), posterior malleolus (PM) fracture (CI 1.92-12.73, adjusted OR > 25% of the articular surface, 5.72), and postoperative articular incongruence (CI 1.52-18.10; adjusted OR, 7.21). The mean scores of the arthritis group were lower than those in the nonarthritis group ( P < .05). Conclusion: Obesity, fracture-dislocation injury, concomitant large PM fracture, and articular incongruence were risk factors of posttraumatic OA after surgery for ankle fractures. Surgeons should be aware that accurate reduction is critical in patients with ankle fractures with associated large PM fractures, especially those with obesity or severe initial injuries such as fracture-dislocation. Level of Evidence: Level III, case control study.

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

Arthroscopic assisted tendon reconstruction for triangular fibrocartilage complex irreparable tears

2017 ◽  
Vol 42 (4) ◽  
pp. 346-351 ◽  
Author(s):  
R. Luchetti ◽  
A. Atzei
Keyword(s):  
Late Onset ◽  
Tendon Graft ◽  
Triangular Fibrocartilage Complex ◽  
Forearm Rotation ◽  
Level Of Evidence ◽  
Evaluation Scores ◽  
Complex Reconstruction ◽  
Arthroscopically Assisted ◽  
Triangular Fibrocartilage

We report our 11-year experience of performing arthroscopically assisted triangular fibrocartilage complex reconstruction in the treatment of chronic distal radio-ulnar joint instability resulting from irreparable triangular fibrocartilage complex injuries. Eleven patients were treated. Three skin incisions were made in order to create radial and ulna tunnels for passage of the tendon graft, which is used to reconstruct the dorsal and palmar radio-ulnar ligaments, under fluoroscopic and arthroscopic guidance. At a mean follow-up of 68 months all but one had a stable distal radio-ulnar joint. Pain and grip strength, Mayo wrist score, Disability of the Arm Hand and Shoulder and patient-rated wrist and hand evaluation scores improved. The ranges of forearm rotation remained largely unchanged. Complications included an early tendon graft tear, two late-onset graft ruptures, one ulna styloid fracture during surgery and persistent wrist discomfort during forearm rotation requiring tendon graft revision in one case. An arthroscopic assisted approach for triangular fibrocartilage complex reconstruction appears safe and produces comparable results with the open technique. Level of evidence: IV

scholarly journals Three-Year Follow-up of a Trial of Close Contact Casting vs Surgery for Initial Treatment of Unstable Ankle Fractures in Older Adults

JAMA ◽  
2018 ◽  
Vol 319 (12) ◽  
pp. 1274 ◽  
Author(s):  
David J. Keene ◽  
Sarah E. Lamb ◽  
Dipesh Mistry ◽  
Elizabeth Tutton ◽  
Ranjit Lall ◽  
...  
Keyword(s):  
Older Adults ◽  
Initial Treatment ◽  
Close Contact ◽  
Ankle Fractures
Sign in / Sign up

Export Citation Format

Share Document