Comparing Functional Outcomes After Injury-Specific Fixation of Posterior Malleolar Fractures and Equivalent Ligamentous Injuries in Rotational Ankle Fractures

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

Download Full-text

Percutaneous fixation of posterior malleolar fractures in patients with unstable ankle fractures treated with a fibular intramedullary nail

Journal of Orthopaedic Trauma ◽

10.1097/bot.0000000000002262 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Sarah J. Wordie ◽

Thomas H. Carter ◽

Deborah MacDonald ◽

Andrew D. Duckworth ◽

Timothy O. White

Keyword(s):

Intramedullary Nail ◽

Ankle Fractures ◽

Percutaneous Fixation ◽

Malleolar Fractures

Download Full-text

Incidence of Hardware-Related Pain and Its Effect on Functional Outcomes After Open Reduction and Internal Fixation of Ankle Fractures

Journal of Orthopaedic Trauma ◽

10.1097/00005131-200105000-00006 ◽

2001 ◽

Vol 15 (4) ◽

pp. 271-274 ◽

Cited By ~ 149

Author(s):

Ouida L. Brown ◽

Douglas R. Dirschl ◽

William T. Obremskey

Keyword(s):

Internal Fixation ◽

Functional Outcomes ◽

Open Reduction ◽

Ankle Fractures

Download Full-text

Predictors of Patient-Reported Function and Pain Outcomes in Operative Ankle Fractures

Foot & Ankle International ◽

10.1177/1071100716688176 ◽

2017 ◽

Vol 38 (5) ◽

pp. 496-501 ◽

Cited By ~ 12

Author(s):

Daniel M. Dean ◽

Bryant S. Ho ◽

Albert Lin ◽

Daniel Fuchs ◽

George Ochenjele ◽

...

Keyword(s):

Risk Factors ◽

Physical Function ◽

Functional Outcomes ◽

Case Series ◽

Ankle Fractures ◽

Level Of Evidence ◽

Patient Reported ◽

Class B ◽

Pain Outcomes

Background: Risk factors associated with short-term functional outcomes in patients with operative ankle fractures have been established. However, no previous studies have reported the association between these risk factors and functional outcomes outside of the first postoperative year. We identified predictors of functional and pain outcomes in patients with operative ankle fractures using the Patient Reported Outcomes Measurement System (PROMIS) physical function (PF) and pain interference (PI) measures. Methods: We retrospectively reviewed a multicenter cohort of patients ≥18 years old who underwent operative management of closed ankle fractures from 2001 to 2013 with a minimum of a 2-year follow-up. Patients with pilon variants, Maisonneuve fractures, Charcot arthropathy, prior ankle surgery, and chronic ankle fractures were excluded. Patients meeting inclusion criteria were contacted and evaluated using the PROMIS PF and PI computerized adaptive tests. Patient demographic and injury characteristics were obtained through a retrospective chart review. Univariate and multivariate regression models were developed to determine independent predictors of physical function and pain at follow-up. Included in this study were 142 patients (64 women, 78 men) with a mean age of 52.7 years (SD = 14.7) averaging 6.3 years of follow-up (range 2-14). Results: Patients had a mean PF of 51.9 (SD = 10.0) and a mean PI of 47.8 (SD = 8.45). Multivariate analysis demonstrated that independent predictors of decreased PF included higher age (B = 0.16, P = .03), higher American Society of Anesthesiologists (ASA) class (B = 10.3, P < .01), and higher body mass index (BMI; B = 0.44, P < .01). Predictors of increased PI included higher ASA class (B = 11.5, P < .01) and lower BMI (B = 0.41, P < .01). Conclusion: At follow-up, increased ASA class, increased BMI, and higher age at time of surgery were independently predictive of decreased physical function. Factors that were associated with increased pain at follow-up include lower BMI and higher ASA class. ASA class had the strongest effect on both physical function and pain. Level of Evidence: Level IV, case series.

Download Full-text

Surgical Treatment of Lateral Malleolar Fractures Using the Compression Cerclage System

Journal of the American Podiatric Medical Association ◽

10.7547/14-110 ◽

2016 ◽

Vol 106 (5) ◽

pp. 313-318 ◽

Cited By ~ 3

Author(s):

Eren Cansü ◽

Mehmet B. Unal ◽

Serkan Gurcan ◽

Fatih Parmaksizoglu

Keyword(s):

Surgical Technique ◽

Kirschner Wire ◽

Ankle Fractures ◽

Wound Complications ◽

Lateral Side ◽

Cerclage Wire ◽

Malleolar Fractures ◽

Trimalleolar Fractures ◽

Weber Type

Background Lateral malleolar fractures (Weber type B or OTA 44-B) account for 60% of all ankle fractures. To achieve anatomic restoration, surgical stabilization provides better results than conservative treatment. Various fixation methods are available to treat these fractures; however, the best method is still unknown. Our objectives were to present a new, useful, and efficient surgical technique for stabilizing lateral malleolar fractures and to analyze the outcomes of patients treated with the compression cerclage system. Methods The surgical technique consists of a Kirschner wire that is passed percutaneously and perpendicular to the fracture line, and a cerclage wire that is passed in a semi-circular fashion over the ends of the Kirschner wire on the lateral side of the bone, leaving loops on each side to allow bilateral compression while twisting both wires. We retrospectively evaluated patients treated with this technique, with or without additional fractures. Follow-up of <24 months and bilateral ankle fractures were the exclusion criteria. Fractures were examined clinically and radiologically in comparison to the uninjured side and were rated according to the criteria reported by McLennon and Ungersma. Olerud and Molander ankle score was used to evaluate functional outcome. Results At the final follow-up, 15 out of 21 patients (9 women and 6 men; mean age, 48.2 years [range, 19–78 years]) were evaluated. The mean follow-up was 5.16 years (28–129 months). Five patients had an isolated lateral malleolar fracture; eight had lateral and medial malleolar fractures; and two had trimalleolar fractures. At the final follow-up, 11 patients were rated good functionally and four were fair, and all patients were rated good radiographically according to the criteria by McLennon and Ungersma. Mean Olerud and Molander ankle score was 93.3 (range, 80–100). Conclusions The compression cerclage system provides good functional and radiological outcomes in patients with lateral malleolus fractures. This method is useful, safe, and efficient with minimum hardware. It can be applied through limited soft-tissue stripping, which is especially important in patients with a high risk for wound complications.

Download Full-text

Result of Ankle Fracture Fixation, Our Hospital Experience

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i36b31959 ◽

2021 ◽

pp. 120-125

Author(s):

Ghazanfar Ali Shah ◽

Nizam Ahmed ◽

Aftab Alam Khanzada ◽

Tanveer Afzal ◽

Muhammad Rafique Joyo ◽

...

Keyword(s):

Internal Fixation ◽

Fracture Fixation ◽

Functional Outcomes ◽

Functional Result ◽

Ankle Fractures ◽

Medial Malleolus ◽

Grading System ◽

Prospective Analysis ◽

The World ◽

Cancellous Screws

Aims and Objectives: The goal of this study was to see the outcome of open reduction and internal fixation for ankle fractures. Methods: A prospective analysis of 40 ankle fractures of adult patients handled surgically using diverse approaches in the period from January 2019 to January 2020 at the Orthopedic department of SMBBIT, Dow University of Medical and Health Sciences. Karachi Pakistan. The ankle grading system developed by Baird and Jackson was used to assess the functional result. Results: We achieved 87.5 percent outstanding to good outcomes, 6.3 percent fair outcomes, and 6.2 percent bad outcomes in our study. The findings were comparable to those of other researchers around the world. Interpretation and Conclusion: In 87.5 percent of patients, the operational results were satisfactory, with good to outstanding functional outcomes. With stable fracture fixation, excellent outcomes are attained. Cancellous screws are better for internal fixation of the medial malleolus, while Malleolar screws are superior for that task. For ankle fractures treated surgically, patients may expect to have satisfactory function thereafter.

Download Full-text

Outcomes of Posterior Arthroscopic Reduction and Internal Fixation (PARIF) for the Posterior Malleolar Fragment in Trimalleolar Ankle Fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00347 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0034

Author(s):

Kevin D. Martin ◽

Jeannie Huh

Keyword(s):

Internal Fixation ◽

Patient Reported Outcomes ◽

Articular Surface ◽

Ankle Fractures ◽

Ct Scans ◽

Loose Bodies ◽

Arthroscopic Reduction ◽

Malleolar Fractures ◽

Posterior Malleolus ◽

Patient Reported

Category: Arthroscopy; Trauma Introduction/Purpose: The treatment of posterior malleolar fractures within a trimalleolar ankle fracture pattern can be challenging to manage. Due to anatomical constraints that inhibit visualization of the articular surface, reduction of the posterior malleolus relies on cortical read and/or intraoperative fluoroscopy. Posterior ankle arthroscopy is a tool that may address this shortfall by providing a means to assess the intra-articular and syndesmotic reductions, while removing any loose bodies. The purpose of this study was to determine the radiographic and patient reported outcomes of posterior arthroscopic reduction and internal fixation (PARIF) for the posterior malleolar fragment in trimalleolar ankle fractures. Methods: From November 2015 to May 2019, we prospectively enrolled consecutive trimalleolar ankle fractures that underwent PARIF for the posterior malleolar fragment by a single surgeon. Patient demographics, surgical details, and fracture characteristics, as determined by computed tomography (CT) scan, were obtained. At final follow-up the main outcome measures collected were: The Foot and Ankle Disability Index (FADI), American Orthopaedic Foot & Ankle Society (AOFAS) ankle score, Olerud and Molander Ankle Score (OSMA), the Visual Analog Score (VAS), and surgical complications. Preoperative and postoperative CT scans were interpreted and compared by two blinded musculoskeletal radiologists for articular congruity, syndesmosis congruity, and presence of loose bodies. Results: A total of 29 trimalleolar ankle fractures were treated with PARIF, including 15 fracture-dislocations. Mean patient age was 36 (range, 19-69) years. Mean prone tourniquet time was 58 (range, 35-79) minutes. Preoperative CT scans demonstrated intra-articular loose bodies in 53% of fractures and syndesmosis incongruity in 80% of fractures. Postoperative CT scans showed one ankle with a retained loose body and residual syndesmosis incongruity in 17% of fractures. 100% of fractures healed and demonstrated intra-articular reduction within 2mm. There were 2 complications (hardware irritation and sural nerve numbness). 2-year patient reported outcomes were available in 13 patients. These included mean VAS 1 (range 0-4), mean AOFAS score 84 (range, 63-100), mean FADI 85 (range, 59-100), and mean OSMA 76 (range, 40-100). Conclusion: Posterior ankle arthroscopic reduction and internal fixation (PARIF) is a safe and effective option for management of posterior malleolar fractures. The technique results in improved intra-articular and syndesmosis congruity, while removing loose bodies. Future studies are needed that compare this technique with current practices.

Download Full-text

Outcomes of Posterior Arthroscopic Reduction and Internal Fixation (PARIF) for the Posterior Malleolar Fragment in Trimalleolar Ankle Fractures

Foot & Ankle International ◽

10.1177/1071100720955149 ◽

2020 ◽

pp. 107110072095514

Author(s):

Kevin D. Martin ◽

Courtney T. Tripp ◽

Jeannie Huh

Keyword(s):

Internal Fixation ◽

Soft Tissues ◽

Case Series ◽

Ankle Fractures ◽

Ct Scans ◽

Loose Bodies ◽

Level Of Evidence ◽

Arthroscopic Reduction ◽

Malleolar Fractures ◽

Patient Reported

Background: Posterior malleolar fractures within a trimalleolar ankle fracture pattern are challenging to manage. Posterior ankle arthroscopy provides a means to assess the intra-articular and syndesmotic reductions, while removing loose bodies. The purpose of this study was to determine the radiographic and patient reported outcomes of posterior arthroscopic reduction and internal fixation (PARIF) in trimalleolar ankle fractures. Methods: From November 2015 to March 2019, we prospectively enrolled consecutive trimalleolar ankle fractures that underwent PARIF by a single surgeon. Preoperative and postoperative computed tomography (CT) scans were interpreted by 2 blinded musculoskeletal radiologists for articular reduction, syndesmosis congruity, and presence of ossific loose bodies. Patient outcomes were assessed using the Foot and Ankle Disability Index (FADI), American Orthopaedic Foot & Ankle Society (AOFAS) ankle score, Olerud-Molander Ankle Score (OMAS), and visual analog scale (VAS). A total of 28 trimalleolar ankle fractures were treated with PARIF. Mean patient age was 36 years (range, 19-69). Results: Preoperative CT identified 18 intra-articular loose bodies (range, 0-4) in 36% of ankles and 75% (n = 21) syndesmosis incongruity. Postoperative CT scans demonstrated anatomic intra-articular reduction in all fractures, 41.7% (5/12) syndesmosis incongruity without fixation, and 0% (0/9) with suture-button fixation. At mean 2-year follow-up, the results were good to excellent with mean VAS score 1 (range, 0-4), AOFAS score 84 (range, 63-100), FADI 85 (range, 59-100), and OMAS 76 (range, 40-100). Conclusion: The PARIF technique for displaced posterior malleolar fractures was effective in achieving anatomic intra-articular reduction, syndesmosis congruity, and intra-articular loose body removal, while safely preserving the soft tissues. Level of Evidence: Level IV, prospective case series.

Download Full-text

The Clinical, Radiologic Outcomes of Indirect Anteroposterior Screw Fixation for Posterior Malleolar Fracture in Rotational Ankle Fractures: Comparison with Syndesmosis Fixation

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00270 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0027

Author(s):

Sunghyun Lee ◽

Hoiyoung Kwon

Keyword(s):

Functional Outcomes ◽

Screw Fixation ◽

Fragment Size ◽

Fracture Repair ◽

Ankle Fractures ◽

Posterolateral Approach ◽

Malleolar Fracture ◽

Syndesmotic Screw ◽

Posterior Malleolus

Category: Ankle Introduction/Purpose: The posterior malleolus is an important soft tissue attachment for the posterior inferior syndesmosis ligament. Recent studies suggested that direct fixation of a sizable posterior malleolar (PM) fracture through posterolateral approach would act to stabilize the syndesmosis and minimize or eliminate the need for trans-syndesmotic fixation. Indirect anteroposterior (AP) screw fixation was an alternative method, which represent relatively low complication. However, there were few studies to evaluate the stability of syndesmosis after indirect anteroposterior screw. The purpose of this study was to define the rate of syndesmotic instability after anteroposterior screw fixation and to compare to the clinical and anatomical outcomes with indirect reduction without fixation. Methods: We performed a retrospective review between 2009 and 2015 of consecutive patients who underwent surgery with sustained rotational ankle fractures including PM fractures. The exclusion criteria included age <18 years, diabetic neuropathy, tibial pilon fractures, previous ankle fracture repair and not available at minimum 1 year follow up. After the fibula and medial malleolar fracture fixation, the PM was fixed with an AP screw, leaving some of relatively smaller and indirect reduced PM fractures unfixed. Patients were sorted into 2 groups according to the presence (group F) or absence (group N) of AP screw fixation of PM. Then, both groups were divided according to the intraoperative necessity of syndesmotic fixation. The demographics, PM fragment size and syndesmosis widening comparing intact ankle on CT at 1 year postoperatively were recorded for each fracture. The functional outcomes were assessed with the Foot and Ankle Outcome Score (FAOS). Results: A total 126 patients met the study inclusion criteria and underwent analysis. Syndesmotic fixation was required in 17 of 78 (21.8%) and 24 of 88 (72.7%) in group F and N, respectively (p=0.012). Postoperative and follow-up FAOS scores were similar in the four subgroups. The tibiofibular distance on CT was greater in the patients without syndesmotic screw fixation in group F and N (p=0.036 and 0.021, respectively). Conclusion: Indirect AP screw fixation of the PM fracture in rotational ankle fractures might be support syndesmotic stability and, thus, lower the rate of syndesmotic fixation. Also, these patients have functional outcomes at least equivalent to outcomes for patients having syndesmotic screw fixation. However, in AP screw fixation group, syndesmosis widening was evaluated without syndesmosis fixation, which could be resulted in degenerative arthritis change. Therefore, our data demonstrate that indirect AP screw fixation of PM fracture alone could not restore syndesmotic stability perfectly.

Download Full-text