Lack of Displacement of the Fibula is NOT Confirmation of Ankle Stability in SE Pattern Ankle Fractures

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Amir A. Shahien ◽  
Paul Tornetta
Keyword(s):  
Ankle Fractures ◽  
Ankle Stability

Assessment and management of adult ankle fractures: understanding the evidence

2021 ◽  
pp. 1-9
Author(s):  
Grace Yip ◽  
Daniel Hay ◽  
Tom Stringfellow ◽  
Aashish Ahluwalia ◽  
Raju Ahluwalia
Keyword(s):  
Best Practice ◽  
Screw Fixation ◽  
Operative Management ◽  
Ankle Fractures ◽  
Current Evidence ◽  
Ankle Stability ◽  
Posterior Malleolus ◽  
Injury Assessment ◽  
Non Operative Management ◽  
Tomography Scan

Ankle fractures are a common injury. Assessment should include looking at the mechanism of injury, comorbidities, associated injuries, soft tissue status and neurovascular status. Emergent reduction is required for clinically deformed ankles. Investigations should include plain radiographs and a computed tomography scan for more complex injuries or those with posterior malleolus involvement. An assessment of ankle stability determines treatment, taking into account comorbidities and preoperative mobility which need special consideration. Non-operative management includes splint or cast, allowing for early weightbearing when the ankle is stable. Operative management includes open reduction and internal fixation, intramedullary nailing (of the fibula and hindfoot) and external fixation. Syndemosis stabilisation includes suture button or screw fixation. The aim of treatment is to restore ankle stability and this article explores the current evidence in best practice.

Evaluation and Significance of Mortise Instability in Supination External Rotation Fibula Fractures: A Review Article

2018 ◽  
Vol 39 (7) ◽  
pp. 865-873 ◽  
Author(s):  
John Y. Kwon ◽  
Patrick Cronin ◽  
Brian Velasco ◽  
Christopher Chiodo
Keyword(s):  
Expert Opinion ◽  
External Rotation ◽  
Prognostic Significance ◽  
Review Article ◽  
Lateral Malleolus ◽  
Ankle Fractures ◽  
Deltoid Ligament ◽  
Level Of Evidence ◽  
Ankle Stability ◽  
Supination External Rotation

Evaluation and management of ankle fractures has progressed in parallel to an evolving understanding of ankle stability. While stability of the mortise had historically been attributed to the lateral malleolus, Lauge-Hansen’s contributions followed by multiple other investigations increased the emphasis on the significance of medial-sided injury in destabilizing the mortise. As the importance of the deltoid ligament has been elucidated, the means of assessing ligamentous incompetence and the prognostic significance of an unstable mortise continue to be defined. Level of Evidence: Level V, expert opinion.

scholarly journals The Surgical Outcomes of Unstable Ankle Fractures in Patients Aged >65 Years

2021 ◽  
Vol 12 ◽  
pp. 215145932199776
Author(s):  
Adem Sahin ◽  
Anıl Agar ◽  
Deniz Gulabi ◽  
Cemil Erturk
Keyword(s):  
Surgical Outcomes ◽  
External Rotation ◽  
High Energy ◽  
Ankle Fractures ◽  
Medial Malleolus ◽  
Aofas Score ◽  
Non Union ◽  
The Mean ◽  
Medial Malleolus Fracture ◽  
Mechanism Of Trauma

Aim: To evaluate the surgical outcomes and complications of patients over 65 years of age, with unstable ankle fractures. Material and Method: The study included 111 patients (73F/38 M) operated on between January 2015 and February 2019 and followed up for a mean of 21.2 months (range, 6-62 months).Demographic characteristics, comorbidities, fracture type, and mechanisms of injury were evaluated. Relationships between postoperative complications and comorbidities were examined. In the postoperative functional evaluations, the AOFAS score was used and pre and postoperative mobilization (eg, use of assistive devices) was assessed. Results: The mean age of the patients was 70.5 ± 6.1 years (range, 65-90 years). The mechanism of trauma was low-energy trauma in 90.1% of the fractures and high-energy trauma in 9.9%. The fractures were formed with a SER injury (supination external rotation) in 83.7% of cases and bimalleolar fractures were seen most frequently (85/111, 76%).Complications developed in 16 (14.4%) patients and a second operation was performed in 11 (9.9%) patients with complications. Plate was removed and debridement was performed in 5 of 6 patients due to wound problems. Nonunion was developed in the medial malleolus in 4 patients. Revision surgery was performed because of implant irritation in 2 patients and early fixation loss in the medial malleolus fracture in one patient. Calcaneotibial arthrodesis was performed in 3 patients because of implant failure and ankle luxation associated with non-union. A correlation was determined between ASA score and DM and complications, but not with osteoporosis. The mean follow-up AOFAS score was 86.7 ± 12.5 (range, 36-100).A total of 94 (84.7%) patients could walk without assistance postoperatively and 92 (82.9%) were able to regain the preoperative level of mobilization. Conclusion: Although surgery can be considered an appropriate treatment option for ankle fractures in patients aged >65 years, care must be taken to prevent potential complications and the necessary precautions must be taken against correctable comorbidities.

scholarly journals Complications after fibula intramedullary nail fixation of pilon versus ankle fractures

2021 ◽  
Author(s):  
Rachel M. Faber ◽  
Joshua A. Parry ◽  
George H. Haidukewych ◽  
Kenneth J. Koval ◽  
Joshua L. Langford
Keyword(s):  
Intramedullary Nail ◽  
Ankle Fractures

scholarly journals The fibula and talus position difference in functional and mechanical ankle instability: MRI findings

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902098457
Author(s):  
Chengjie Yuan ◽  
Genrui Zhu ◽  
Zhifeng Wang ◽  
Chen Wang ◽  
Xu Wang ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Ankle Instability ◽  
Medial Malleolus ◽  
Mechanical Instability ◽  
Mri Findings ◽  
Functional Instability ◽  
Post Hoc Analysis ◽  
Ankle Stability ◽  
Post Hoc

Purpose: This study aimed to use MRI to evaluate the fibula and talus position difference in functional and mechanical ankle stability patients. Methods: 61 and 68 patients with functional and mechanical instability, and 60 healthy volunteers were involved. Based on the axial MRI images, the rotation of the talus was identified through the Malleolar Talus Index (MTI). The position relative to the talus (Axial Malleolar Index, AMI) and medial malleolus (Intermalleolar Index, IMI) were used to evaluated the displacement of the fibula. Results: Post hoc analysis showed that the values of malleolar talus index was significantly larger among mechanical instability (89.18° ± 2.31°) than that in functional instability patients (86.55° ±61.65°, P < 0.001) and healthy volunteers (85.59° ± 2.42°, P < 0.001). The axial malleolar index of the mechanical instability patients (11.39° ± 1.41°) were significantly larger than healthy volunteers (7.91° ± 0.83°) (P < 0.0001). There were no statistically significant differences in the above three indexes between the functional instability patients and healthy volunteers. Conclusion: The functional instability patients didn’t have a posteriorly positioned fibula and an internally rotated talus. The malleolar talus index was significantly larger among mechanical instability patients than that in functional instability patients. Increased malleolar talus index may become a new indirect MRI sign for identifying functional and mechanical instability patients.

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