scholarly journals Surgery versus non-operative treatment for ER-stress unstable Weber-B unimalleolar fractures: a study protocol for a prospective randomized non-inferiority (Super-Fin) trial

2021 ◽  
Vol 3 (1) ◽  
pp. e000098
Author(s):  
Tero Kortekangas ◽  
Ristomatti Lehtola ◽  
Hannu-Ville Leskelä ◽  
Simo Taimela ◽  
Pasi Ohtonen ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Operative Treatment ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Ankle Fractures ◽  
Primary Concern ◽  
Current Standard ◽  
Cast Immobilization ◽  
Fibula Fracture ◽  
Increased Risk

Roughly two-thirds of ankle fractures are unimalleolar injuries, the Weber B-type fibula fracture being by far the most common type. Depending on the trauma and the accompanying soft-tissue injury, these fractures are either stable or unstable. Current clinical practice guidelines recommend surgical treatment for unstable Weber B-type fibula fractures. An ongoing randomized, parallel group, non-inferiority trial comparing surgery and non-operative treatment for unstable Weber B-type ankle fractures with allocation ratio 1:1. The rationale for non-inferiority design is as follows: By being able to prove non-inferiority of non-operative treatment, we would be able to avoid complications related to surgery. However, the primary concern related to non-operative treatment is increased risks of ankle mortise incongruency, leading to secondary surgery, early post-traumatic osteoarthritis and poor function. After providing informed consent, 126 patients aged 16 years or older with an unimalleolar Weber B-type unstable fibula fracture were randomly assigned to surgery (open reduction and internal fixation) or non-operative treatment (6-week cast immobilization). We have completed the patient enrolment and are currently in the final stages of the 2-year follow-up. The primary, non-inferiority outcome is the Olerud-Molander Ankle Score (OMAS) at 2 years (primary time point). The predefined non-inferiority margin is set at 8 OMAS points. Secondary outcomes include the Foot and Ankle Score, a 100 mm Visual Analogue Scale for function and pain, the RAND-36-Item Health Survey for health-related quality-of-life, the range-of-motion of the injured ankle, malunion (ankle joint incongruity) and fracture union. Treatment-related complications and harms; symptomatic non-unions, loss of congruity of the ankle joint, reoperations and wound infections will also be recorded. We hypothesize that non-operative treatment yields non-inferior functional outcome to surgery, the current standard treatment, with no increased risk of harms.

scholarly journals Management of Fracture of Posterior Malleolus, Trimalleolar Fracture, Fracture Dislocations, and Syndesmosis Injury of Ankle Joint

2017 ◽  
Vol 4 (2) ◽  
pp. 90-96
Author(s):  
Satish R Gawali ◽  
Raman O Toshniwal ◽  
Shashikant B Kukale, ◽  
Pramod V Nirvane,
Keyword(s):  
Soft Tissue ◽  
Ankle Joint ◽  
Open Reduction ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Malleolar Fractures ◽  
Posterior Malleolus ◽  
Syndesmosis Injury ◽  
Fracture Dislocations ◽  
Trimalleolar Fracture

ABSTRACT Background Malleolar fractures of ankle are usually complex injuries, as they are associated with significant ligament and soft tissue injury—injury to syndesmosis and injury to medial and lateral collateral ligaments. The open reduction and internal fixation is not feasible until recovery of significant soft tissue injury and subsidence of edema. Malleolar fractures are articular fractures and have associated subluxation and dislocation of talus. The aims of treatment are to restore normal anatomy and provide sufficient stability for early movements. Malleolar fractures more often require open reduction. Our study aimed to know efficacy and outcome of operative management of them. Materials and methods From January 2013 to March 2015, 35 patients with syndesmotic ankle injury and trimalleolar ankle fractures admitted to the Government Medical College, Latur, India, were operated and followed up prospectively. Results Mean age of patients is 35 years (25–60 years). Fracture union was seen radiologically in 3 to 4 months depending on fracture geometry. We achieved good to excellent results of 90%. Conclusion We conclude that malleolar fractures encountered in clinical practice need thorough assessment and meticulous surgical intervention, as they are associated with injury to ligament complex, i.e., ligament is a key structure in the stability of ankle mortise. Abduction and external rotation types of injuries are the most common types to be seen. We achieved stable fixation and performed early mobilization of the ankle joint, which limits the complications of mainly ankle stiffness. Each malleolus has got its inherent associated complications and calls for special attention for identifying associated conditions, such as syndesmotic injury, talus dislocation in posterior malleolar fractures, irreducible ankle dislocation with trimalleolar fracture, and entrapped fibula behind tibia with irreducible dislocation. How to cite this article Gawali SR, Kukale SB, Nirvane PV, Toshniwal RO. Management of Fracture of Posterior Malleolus, Trimalleolar Fracture, Fracture Dislocations, and Syndesmosis Injury of Ankle Joint. J Foot Ankle Surg (Asia-Pacific) 2017;4(2):90-96.

A Operative Treatment of the Tibial Pilon Fractures : For minimize soft tissue injury

1997 ◽  
Vol 10 (2) ◽  
pp. 346
Author(s):  
Jae Do Kang ◽  
Kwang Yul Kim ◽  
Hyung Chun Kim ◽  
Moon Sub Yim ◽  
Sang Hoon Ko
Keyword(s):  
Soft Tissue ◽  
Operative Treatment ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Tibial Pilon ◽  
Pilon Fractures

scholarly journals Management of Fractures of Distal third Tibia by Interlock Nailing

2016 ◽  
Vol 3 (1) ◽  
pp. 15-22
Keyword(s):  
Tissue Injury ◽  
Distal Tibia ◽  
Soft Tissue Injury ◽  
Skin Condition ◽  
Delayed Union ◽  
Fracture Site ◽  
Tibia Fracture ◽  
Asia Pacific ◽  
Fracture Geometry ◽  
Fibula Fracture

ABSTRACT Introduction Most of the distal third tibia is subcutaneous and has precarious blood supply. Fractures of the distal third tibia have comminution at the fracture site, as it is metaphyseal cancellous bone with a thin shell of cortex, and have associated significant soft tissue injury. Generally, skin condition is not satisfactory due to ecchymosis, blebs, swellings, wounds, etc. All these factors contribute to delayed union, nonunion, and malunion. The present study is about the ability to maintain a mechanically stable reduction in the distal third tibia with intramedullary nail, when lower 4 cm of tibia not fractured. If associated with fibula fracture (in lower 10 cm), it is always fixed as a rule to give stability to syndesmosis and stability to same-level tibia fracture. Materials and methods From January 2013 to March 2015, 60 patients of distal tibia fracture admitted to Government Medical College and Hospital, Latur, were operated and followed up prospectively. Results Mean age of patients was 35 years (25–50). Fracture union was seen radiologically within 3 to 4 months, depending on fracture geometry. Conclusion We conclude that results of fractures of distal third tibia not extending into lower 4 cm of tibia treated with interlock nailing were found satisfactory. Meticulous planning and placement of nail at the center of a wide metaphysis in the anteroposterior and lateral is mandatory to avoid varus, valgus, and posterior tilt. Polar screw or temporary K-wire during surgery is very helpful. Same-level fibula fracture fixation with a plate or square nail is very effective for stability of reduction. How to cite this article Gawali SR, Kukale SB, Nirvane PV, Toshniwal RO. Management of Fractures of Distal third Tibia by Interlock Nailing. J Foot Ankle Surg (Asia-Pacific) 2016;3(1):15-22.

Clinical Fracture of the Carpal Scaphoid—Supportive Bandage or Plaster Cast Immobilization?

1988 ◽  
Vol 13 (1) ◽  
pp. 75-76
Author(s):  
S. U. SJØLIN ◽  
J. C. ANDERSEN
Keyword(s):  
Soft Tissue ◽  
Sick Leave ◽  
Prospective Study ◽  
Clinical Diagnosis ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Plaster Cast ◽  
Significant Loss ◽  
Cast Immobilization ◽  
A Prospective Study

In a prospective study of 108 patients with a clinical diagnosis of fracture of the carpal scaphoid, but without radiological evidence of fracture, the patients were randomised to treatment with either a supportive bandage or a dorsal plaster cast. Four patients proved to have incomplete fractures and three to have avulsions from the scaphoid tuberosity. Two of the fractures had been suspected radiologically at the primary investigation. No complete fractures of the scaphoid were seen. The average time in plaster was 15 days and in a bandage 12.2 days. The average sick leave for manual workers was 14 days in plaster and 4 days in a bandage, a difference that represents a significant loss of productivity. Since these fractures almost always heal irrespective of treatment, they may as well be treated as a soft tissue injury with a supportive bandage.

Association of Bleeding Disorders and Risk of Complications Following Open Reduction and Internal Fixation of the Ankle

2021 ◽  
pp. 107110072110581
Author(s):  
Alisa Malyavko ◽  
Theodore Quan ◽  
William T. Stoll ◽  
Joseph E. Manzi ◽  
Alex Gu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Internal Fixation ◽  
Operative Treatment ◽  
Ankle Fracture ◽  
Open Reduction ◽  
Bleeding Disorder ◽  
Ankle Fractures ◽  
Bleeding Disorders ◽  
Increased Risk

Background: Open reduction and internal fixation (ORIF) of the ankle is a common procedure performed to correct ankle fractures in many different patient populations. Diabetes, peripheral vascular disease, and osteoporosis have been identified as risk factors for postoperative complications following surgery for ankle fractures. To date, there have not been any studies evaluating postoperative outcomes in patients with bleeding disorders undergoing operative treatment for ankle fractures. The aim of this study was to determine the postoperative complication rate following ORIF of the ankle in patients with a bleeding disorder vs those without a bleeding disorder. Methods: From 2006 to 2018, patients undergoing operative treatment for ankle fracture were identified in the National Surgical Quality Improvement Program database. Two patient cohorts were defined: patients with a bleeding disorder and patients without a bleeding disorder. Patients who underwent either inpatient or outpatient ORIF of the ankle were included in this study. In this analysis, demographics, medical comorbidities, and postoperative complications variables were assessed between the 2 cohorts. Bivariate and multivariate analyses were performed. Results: Of 10 306 patients undergoing operative treatment for ankle fracture, 9909 patients (96.1%) had no bleeding disorder whereas 397 patients (3.9%) had a bleeding disorder. Following adjustment on multivariate analysis, compared to patients who did not have a bleeding disorder, those with a bleeding disorder had an increased risk of any postoperative complications (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.05-2.08, P = .024), requirement for postoperative blood transfusion (OR 2.86, 95% CI 1.53-5.36, P = .001), and extended length of hospital stay greater than 5 days (OR 1.46, 95% CI 1.10-1.93, P = .010). Conclusion: Patients with bleeding disorders are associated with increased risk of postoperative complications following ORIF for ankle fractures. Determining patient risk factors and creating optimal preoperative and perioperative management plans in patients with bleeding disorders undergoing ORIF can be beneficial in reducing postoperative complications, improving patient outcomes, and reducing overall morbidity. Level of Evidence: Level III, retrospective cohort study.

scholarly journals Functional outcome of conservative management of acute soft tissue injury of ankle joint in adults

2019 ◽  
Vol 5 (3) ◽  
pp. 567-570
Author(s):  
Dr. Shahrukhkhan Pathan ◽  
Dr. Vijay Chaudhary ◽  
Dr. Pratik Sidhdhpuria ◽  
Dr. Hement Yadav
Keyword(s):  
Soft Tissue ◽  
Functional Outcome ◽  
Ankle Joint ◽  
Conservative Management ◽  
Tissue Injury ◽  
Soft Tissue Injury

Biomechanical Effect on Joint Stability of Including Deltoid Ligament Repair in an Ankle Fracture Soft Tissue Injury Model With Deltoid and Syndesmotic Disruption

2020 ◽  
Vol 41 (9) ◽  
pp. 1158-1164
Author(s):  
Pablo Mococain ◽  
Lorena Bejarano-Pineda ◽  
Richard Glisson ◽  
Rishin J. Kadakia ◽  
Craig C. Akoh ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Ankle Fracture ◽  
Tissue Injury ◽  
External Rotation ◽  
Soft Tissue Injury ◽  
Ankle Fractures ◽  
Deltoid Ligament ◽  
Ligament Repair ◽  
Injury Model ◽  
Biomechanical Effect

Background: The current operative standard of treatment for bimalleolar equivalent ankle fracture is open reduction and internal fixation (ORIF) of the lateral malleolus followed by syndesmotic stabilization if indicated. There is controversy surrounding the indication and need for deltoid ligament repair in this setting. The purpose of this study was to quantify the biomechanical effect of deltoid ligament repair in an ankle fracture soft tissue injury model. Methods: Nine fresh-frozen cadaveric specimens were included in this study. Each leg was tested under 5 conditions: intact, syndesmosis and deltoid ligament sectioned, syndesmosis fixed, deltoid repaired, and both the syndesmosis and deltoid ligament repaired. Anterior, posterior, lateral, and medial drawer and rotational stresses were applied to the foot, and the resulting talus displacement was documented. Results: Isolated deltoid repair significantly reduced anterior displacement to normal levels. Displacement with lateral drawer testing was not significantly corrected until both structures were repaired. Deltoid repair and syndesmosis fixation each reduced internal rotation significantly with further reduction to normal levels when both were repaired. External rotation remained elevated relative to the intact condition regardless of which structures were repaired. Conclusion: There is existing controversy regarding the importance of deltoid ligament repair in the setting of ankle fractures. The findings of this biomechanical study indicate that deltoid ligament repair enhances ankle stability in ankle fractures with both syndesmotic and deltoid disruption. Clinical Relevance: Concomitant deltoid ligament repair in addition to stabilization of fracture and syndesmosis may improve long-term functioning of the ankle joint and clinical outcomes.

Auto seat restraint soft-tissue injury

1987 ◽  
Vol 148 (2) ◽  
pp. 458-458 ◽  
Author(s):  
DR Pennes ◽  
WA Phillips
Keyword(s):  
Soft Tissue ◽  
Tissue Injury ◽  
Soft Tissue Injury
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