scholarly journals To fix or not to fix: a novel approach to the safe management of unstable open medial malleolar fractures

2019 ◽  
Vol 12 (4) ◽  
pp. e228965
Author(s):  
Tom H Carter ◽  
Calum HC Arthur ◽  
Andrew D Duckworth ◽  
Timothy O White
Keyword(s):  
Ankle Fracture ◽  
Weight Bearing ◽  
Fracture Dislocation ◽  
Medial Malleolus ◽  
Wound Debridement ◽  
Soft Tissue Envelope ◽  
Malleolar Fractures ◽  
Novel Approach ◽  
Safe Management ◽  
Fibular Fixation

Displaced medial malleolar fractures, either in isolation or as part of an unstable ankle fracture dislocation, are conventionally treated with internal fixation. We outline the case of a 76-year-old man with diabetes presenting with a grossly deformed open ankle fracture and extruded tibia through a large medial wound. Following irrigation, wound debridement and minimally invasive fibular fixation, the medial fracture reduced anatomically. Contrary to traditional teaching, the medial malleolus was left without fixation. The patient mobilised partially weight-bearing, progressing to both clinical and radiographic union by 3 months. Nine months following an injury, he walks unaided, can squat and drive and has no medial pain or instability with an Olerud–Molander Ankle Score of 80/100, indicating a good outcome. This is the first reported case of such unique management in the literature and highlights the potential to treat open medial malleolar fractures safely without fixation, particularly when concerned about the soft tissue envelope.

scholarly journals Simultaneous traumatic dislocation of the hip knee and ankle joints in an ipsilateral limb, does it happen? A case report

2018 ◽  
Vol 5 (7) ◽  
pp. 2660
Author(s):  
Lokesh Kumar S. N. ◽  
Deepak Kumar ◽  
Sameer Aggarwal
Keyword(s):  
Ankle Joint ◽  
Hip Joint ◽  
Weight Bearing ◽  
Posterior Dislocation ◽  
Fracture Dislocation ◽  
Radiographic Examination ◽  
Medial Malleolus ◽  
Pilon Fracture ◽  
Medial Malleolus Fracture ◽  
Dislocation Of The Hip

Simultaneous dislocation of three joints the hip knee and ankle joint in an ipsilateral limb is a very rare pattern of injury and only a single case has been reported in the literature, but it is associated with acetabulum fracture. A 34-year-old male had met with a road traffic accident involving left lower limb. Radiographic examination revealed (i) Posterior dislocation of the hip joint without any fracture (ii) Posterior dislocation of the knee joint(iii)Open fracture dislocation of the ankle joint with medial malleolus fracture tibial pilon fracture. The patient underwent an immediate closed reduction of the hip joint by Allis method. Simultaneous reduction of the knee and ankle joint was done and appropriate splintage gave. Open wounds were well debrided and trans-articular fixator was placed over knee and ankle joint. At a second stage, the medial malleolus fracture and tibia pilon fracture were fixed. MRI scan was done which revealed an anterior cruciate ligament injury of the knee. At 6-month follow-up, the patient was ambulating with full weight-bearing on both lower extremities without any assistive devices. There always lies a high risk of hemodynamic instability and other serious and life-threatening injuries due to the high velocity of trauma involved in such cases. The outcome of ipsilateral hip knee and ankle dislocation can vary widely depending on the circumstances and other associated injuries.

scholarly journals Supination External Rotational Ankle Fracture Injury Pattern Correlation With Regional Bone Density

2018 ◽  
Vol 40 (4) ◽  
pp. 384-389
Author(s):  
Stephen J. Warner ◽  
Elizabeth B. Gausden ◽  
Ashley E. Levack ◽  
Dean G. Lorich
Keyword(s):  
Bone Density ◽  
Bone Quality ◽  
Ankle Fracture ◽  
Injury Pattern ◽  
Ankle Fractures ◽  
Medial Malleolus ◽  
Injury Patterns ◽  
Specific Patient ◽  
Malleolar Fractures ◽  
Medial Malleolus Fracture

Background: Rotational ankle fractures can present with an array of possible osseous and ligamentous injury combinations in reliable anatomic locations. What accounts for these different injury patterns and whether specific patient and injury factors underlie the different injury patterns is unclear. The purpose of this study was to determine whether causative factors exist that could account for the various injury patterns seen with rotational ankle fractures. Methods: A registry of operatively treated supination external rotation stage IV (SER IV) ankle fractures was used to identify patients. Computed tomography imaging was used to calculate regional bone density by using average Hounsfield unit measurements on axial images from the distal tibia and fibula. Patients were grouped into those with no posterior or medial malleolar fracture (equivalent group), those with either a posterior or medial malleolus fracture (bimalleolar group), and those with both posterior and medial malleolar fractures (trimalleolar group). Sixty-seven patients met inclusion criteria. Results: Regional bone density at the ankle, as measured with Hounsfield units, was significantly higher in the equivalent group (371) than in the bimalleolar group (271, P < .0001) and trimalleolar group (228, P < .0001). Logistic regression analyses identified regional bone density as a significant predictor of a medial malleolus fracture ( P = .002) and of a posterior malleolus fracture ( P = .005). Conclusion: In our cohort of SER IV ankle fractures, regional bone density at the ankle significantly correlated with the presence and number of malleolar fractures compared with ligamentous ruptures. Treating surgeons can use this information to anticipate bone quality during operative fixation based on ankle fracture injury pattern. In addition, the presence of a trimalleolar ankle fracture was a significant indicator of poor bone quality and may represent the first clinical sign of abnormal bone metabolism in many patients. Level of Evidence: Level III, prognostic retrospective cohort study.

UNUSUAL ANKLE FRACTURE: A LITERATURE REVIEW

2021 ◽  
pp. 70-71
Author(s):  
Aditya Kumar Jha ◽  
Rahul Kumar ◽  
A. K. Baranwal
Keyword(s):  
Blood Supply ◽  
Ankle Fracture ◽  
Sagittal Plane ◽  
Bone Fractures ◽  
Weight Bearing ◽  
The Body ◽  
Medial Malleolus ◽  
Vertical Fracture ◽  
Body Fracture ◽  
Anatomic Reduction

Background:- Fractures of the talus are unusual, and talar body fractures in the sagittal plane are still rarer. Its treatment aims a crucial anatomic reduction to reimpose congruency of the ankle and decrease the risk of avascular necrosis by conserving any remaining blood supply. We present the case of a body talar fracture in the sagittal plane related to fracture of the medial malleolus in an adult. The mechanism of the fracture was, internal rotation, plantar hyperexion, and axial compression. We performed an open reduction and stabilization with two screws for the talus and screwed the medial malleolus. Material & Methods:- We included 30 patients in this study among which a 25 years old man presented in Department Of Orthopaedics, Mgmmch, Jamsehedpur, Jharkhand with a grossly expand and deformed right ankle. Radiographs revealed a displaced vertical fracture of the neck of the talus traversing through the body with vertical fracture of the medial malleolus and medial talar shift. Results:- Fractures of the talus have a relatively little incidence accounting for 0.3% of all bone fractures and 3% to 6% of all foot fractures.[1,2] Union of the fracture in such a case is extremely slow as it depends on a new blood supply growing into the avascular bone.[3] Hence, the fracture needs preservation for a long time, and non-weight bearing is recommended for three months or until the union has occurred. Malunion can produce substantial alteration in load across the ankle and subtalar joints and result in arthrosis. The reported case should have the best prognosis as it was closed and underwent immediate operative reduction with early signs of revascularization. After 13 months following the injury, the patient had the best range of movement with some pain. Conclusion:- Talar body fracture associated with ankle fracture is very rare. Still, the malleolar fracture that allows adequate visualisation, anatomical reduction, and appropriate fracture xation can give us hope to reduce complications.

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.

Posterior Instability of the Talus: An Anatomic Evaluation

Foot & Ankle ◽  
1989 ◽  
Vol 10 (1) ◽  
pp. 36-39 ◽  
Author(s):  
Marion C. Harper
Keyword(s):  
Internal Fixation ◽  
Cadaver Study ◽  
Lateral Radiograph ◽  
Medial Malleolus ◽  
Posterior Instability ◽  
Posterior Tibial ◽  
Malleolar Fractures ◽  
Posterior Malleolus ◽  
Supporting Structures

A cadaver study was conducted to evaluate the role of the posterior tibial margin or posterior malleolus, as well as medial and lateral supporting structures, in providing posterior stability for the talus. Posterior malleolar fractures consisting of approximately 30%, 40%, and 50% of the articular margin on the lateral radiograph were created in specimens that were then subjected to posterior stressing. No posterior talar subluxation was noted in any specimen. Repeat stressing following removal of the medial malleolus again revealed no subluxation in any specimen. The lateral supporting structures, primarily the posterior fibulotalar and fibulocalcaneal ligaments, appeared to be the key structures providing posterior talar stability. If the fibula is stable in an anatomic position, feared posterior instability of the talus would not appear to be an indication for internal fixation of posterior malleolar fractures.

Result of Fibular Fixation Using Screw in Ankle Fracture

2002 ◽  
Vol 15 (4) ◽  
pp. 477 ◽  
Author(s):  
Chung Soo Han ◽  
Yang Sun Im ◽  
Sun Teak Cheong
Keyword(s):  
Ankle Fracture ◽  
Fibular Fixation

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

scholarly journals Posterior malleolar fractures. New classification and treatment algorithm

2020 ◽  
Vol 14 (3) ◽  
pp. 254-259
Author(s):  
Diego Yearson ◽  
Ignacio Melendez ◽  
Federico Anain ◽  
Santiago Siniscalchi ◽  
Juan Drago
Keyword(s):  
Posterior Approach ◽  
Treatment Algorithm ◽  
Case Series ◽  
Fracture Pattern ◽  
Joint Surface ◽  
Medial Malleolus ◽  
New Classification ◽  
Level Of Evidence ◽  
Malleolar Fractures ◽  
Posterior Malleolus

Objective: This study proposes a new classification of posterolateral malleolar fractures and a treatment algorithm. Methods: We divided the posterolateral malleolus, which we considered as the posterior malleolus, from the posteromedial one, which we considered as being part of the medial malleolus fracture. The experience with 77 patients treated from February 2017 to February 2020 was assessed. All of them were assessed by frontal and profile radiographies and computed tomography (CT). Among the parameters to classify these fractures, we believe the most determining ones are fracture size, followed by presence of fracture displacement. Results: Fractures were divided into those whose posterior fragment was 25% smaller than the tibial joint surface and those that compromised more than 25% of this joint. The first group underwent syndesmotic opening and was subclassified into 1A (stable fractures), which do not require surgical treatment, and 1B (unstable), which require syndesmotic stabilization. The second group, which comprised the larger fractures, was subclassified into 2 A (non-displaced fractures, or with a displacement below 2 mm), which underwent percutaneous osteosynthesis, 2B (displaced fractures), and 2C (comminuted fractures), which underwent open reduction and internal fixation using a posterior approach. Conclusion: The classifications published so far are anatomic or descriptive, but none of them proposes a therapeutic algorithm for each type of fracture. We believe it will be helpful for its interpretation and decision-making on the need to perform a posterior approach, prioritizing the anatomical reduction of the joint fragment and resolution of syndesmotic instability linked to each fracture pattern using the most simple and effective method. Level of Evidence IV; Therapeutic Studies; Case Series.

scholarly journals Open anterolateral fracture dislocation of ankle joint: a rare case report

2018 ◽  
Vol 5 (1) ◽  
pp. 192
Author(s):  
Prasanna Anaberu ◽  
R. Prathik ◽  
R. Manish
Keyword(s):  
Ankle Joint ◽  
Fracture Fixation ◽  
Road Traffic ◽  
Emergency Operation ◽  
High Energy ◽  
Fracture Dislocation ◽  
Anterior Dislocation ◽  
Malleolar Fracture ◽  
Rare Injury ◽  
Wound Debridement

<p class="abstract">Anterior ankle dislocation with associated compound bi-malleolar fracture is a rare injury. Ankle fracture dislocations most frequently occurs in young males caused by high energy trauma. The direction of the joint dislocation is determined by the position of the foot and the direction of the force being applied. A middle aged male presented to us with history of road traffic accident and was diagnosed to have anterior dislocation of right ankle joint with compound bi-malleolar fracture. Patient was taken to emergency operation theatre for wound debridement and immediate ankle reduction done under sedation. Due to wound contamination fracture fixation was delayed, once the wound healed bi-malleolar fracture fixation was done.</p>

Open Fracture Dislocation of the Ankle With Loss of the Medial Malleolus in a College Tennis Player

1986 ◽  
Vol 14 (4) ◽  
pp. 81-84
Author(s):  
B. P. Tillman ◽  
C. N. Stover ◽  
J. R. McCarroll ◽  
Andrew Johnston
Keyword(s):  
Open Fracture ◽  
Tennis Player ◽  
Fracture Dislocation ◽  
Medial Malleolus
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