Single- vs 2-Screw Lag Fixation of the Medial Malleolus in Unstable Ankle Fractures

2019 ◽  
Vol 40 (7) ◽  
pp. 790-796 ◽  
Author(s):  
Jessica Mandel ◽  
Omar Behery ◽  
Rajkishen Narayanan ◽  
Sanjit R. Konda ◽  
Kenneth A. Egol
Keyword(s):  
Ankle Fracture ◽  
Fragment Size ◽  
Smoking Status ◽  
Medial Malleolus ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Initial Injury ◽  
American Society ◽  
Fixation Points ◽  
American Society Of Anesthesiologists

Background: The purpose of this study was to determine the efficacy of medial malleolar fixation with 1 vs 2 screws. Methods: Between April 2013 and February 2017, 196 patients who presented at 2 hospitals within one academic institution with an unstable rotational ankle fracture with a medial fracture and were treated operatively by a trained orthopedic surgeon were identified. These patients’ charts were reviewed and their injury, radiographic, surgical, and follow-up data recorded. Medial malleolus fragment size was assessed on the anteroposterior (AP) and lateral views of the initial injury radiograph. Functional outcome was assessed using Maryland Foot Score (MFS). Patients were grouped based upon the number of screws utilized to fox the medial malleolar fragment. Data were assessed using Fisher exact tests and independent t tests with SPSS, version 23. Results: Out of the 196 patients who met inclusion criteria, 47 patients (24%) were fixed with 1 medial malleolar screw and 149 patients (76%) were fixed with 2 screws. There were no differences among patients who received 1 vs 2 screws with regard to age, gender, body mass index, American Society of Anesthesiologists grade, or smoking status. The average malleolar fragment size was smaller in those treated with 1 screw on both the AP and lateral radiographic views than those with 2 screws ( P = .009, P = .001, respectively). There was no difference between groups in ankle dorsiflexion or plantarflexion at 1 year postoperation ( P = .451, P = .581). Patients who received 1 screw did not differ from those who received 2 screws with respect to Maryland Foot Scores ( P = .924). There was no difference in rate of revision surgery or need for hardware removal between groups ( P = .093). Furthermore, time to healing and postoperative complication rate did not differ between groups. Conclusion: The use of a single screw for medial malleolar fixation provided stable fixation to allow ankle fracture healing, without an increase in complications. This information is especially important in situations when the fragment is too small to accommodate multiple fixation points. Level of Evidence: Level III, retrospective case-control study.

scholarly journals BIMALLEOLAR ANKLE FRACTURE: A SIMPLE FRACTURE?

2017 ◽  
Vol 25 (1) ◽  
pp. 48-51 ◽  
Author(s):  
JUNJI MILLER FUKUYAMA ◽  
ROBINSON ESTEVES SANTOS PIRES ◽  
PEDRO JOSÉ LABRONICI ◽  
JOSÉ OCTÁVIO SOARES HUNGRIA ◽  
RODRIGO LOPES DECUSATI
Keyword(s):  
Ankle Fracture ◽  
Fragment Size ◽  
External Rotation ◽  
Ankle Fractures ◽  
Ligament Injury ◽  
Deltoid Ligament ◽  
Medial Malleolus ◽  
Level Of Evidence ◽  
Deltoid Ligament Injury ◽  
Supination External Rotation

ABSTRACT Objective: To evaluate the frequency of deltoid ligament injury in bimalleolar supination-external rotation type fractures and whether there is a correlation between the size of the fractured medial malleolus and deltoid ligament injury . Methods: Twenty six consecutive patients underwent magnetic resonance exams after clinical and radiographic diagnosis of bimalleolar supination-external rotation type ankle fractures . Results: Thirteen patients (50%) presented deltoid ligament injury associated to bimalleolar ankle fracture. Partial injury was present in seven (26.9%) patients and total injury in six (23.1%). Regarding medial fragment size, the average was 2.88 cm in the absence of deltoid ligament injury. Partial injuries presented 1.93 cm and total 2.1 cm on average . Conclusion: Deltoid ligament injury was present in 50% of bimalleolar ankle fractures. Smaller medial malleolus fragments, especially concerning the anterior colliculus, presented greater association with partial deltoid ligament injuries. Level of Evidence IV, Cross Sectional Study.

scholarly journals Clinical Outcomes of Decompression Alone Versus and Decompression and Fusion for First Episode Recurrent Disc Herniation

2019 ◽  
Vol 10 (7) ◽  
pp. 832-836 ◽  
Author(s):  
Leah Y. Carreon ◽  
Erica F. Bisson ◽  
Eric A. Potts ◽  
Morgan E. Brown ◽  
Stacie Gren ◽  
...  
Keyword(s):  
Disc Herniation ◽  
Patient Reported Outcomes ◽  
Smoking Status ◽  
First Episode ◽  
Recurrent Disc Herniation ◽  
Estimated Blood Loss ◽  
Patient Reported ◽  
Quality And Outcomes ◽  
American Society ◽  
American Society Of Anesthesiologists

Study Design: Longitudinal cohort. Objective: It is unclear if patients with a recurrent disc herniation benefit from a concurrent fusion compared with a repeat decompression alone. We compared outcomes of decompression alone (D0) versus decompression and fusion (DF) for recurrent disc herniation. Methods: Patients enrolled in the Quality and Outcomes Database from 3 sites with a first episode of recurrent disc herniation were identified. Demographic, surgical, and radiographic data including the presence of listhesis and extent of facet resection on computed tomography or magnetic resonance imaging prior to the index surgery were collected. Patient-reported outcomes were collected preoperatively and at 3 and 12 months postoperatively. Results: Of 94 cases identified, 55 had D0 and 39 had DF. Patients were similar in age, sex distribution, smoking status, body mass index, American Society of Anesthesiologists grade and surgical levels. Presence of listhesis (D0 = 7, DF = 5, P = .800) and extent of facet resection (D0 = 19%, DF = 16%, P = .309) prior to index surgery were similar between the 2 groups. Estimated blood loss (D0 = 26 cm3, DF = 329 cm3, P < .001), operating room time (D0 = 79 minutes, DF = 241 minutes, P < .001) and length of stay (D0 <1 day, DF = 4 days, P < .001) were significantly less in the D0 group. Preoperative and 1-year postoperative patient-reported outcomes were similar in both groups. Three patients in the D0 group and 2 patients in the DF group required revision. Regression analysis showed that presence of listhesis, extent of facet resection and fusion were not associated with the 12-month Oswestry Disability Index (ODI) score. Conclusion: For a first episode recurrent disc herniation, surgeons can expect similar outcomes whether patients are treated with decompression alone or decompression and fusion.

scholarly journals Morphological analysis of posterior malleolar fractures with intra-articular impacted fragment in computed tomography scans

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Wenyong Xie ◽  
Hao Lu ◽  
Hailin Xu ◽  
Yuan Quan ◽  
Yijun Liu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Univariate Analysis ◽  
Medial Malleolus ◽  
Retrospective Case ◽  
Chi Square ◽  
Level Of Evidence ◽  
Related Factors ◽  
Malleolar Fractures ◽  
Tibial Plafond ◽  
Common Location

Abstract Background Intraarticular impacted fragment (IAIF) of posterior malleolar fractures has been reported by a few studies. However its location, morphology, and the correlation of posterior malleolar fractures have not been described in detail. The aim of this study was to describe the morphology of IAIF in posterior malleolar fractures, to analyze the related factors between IAIF and posterior malleolar fragments, and explore the treatment of IAIF. Materials and methods Between January 2013 and December 2018, 108 consecutive patients with unilateral posterior malleolar fractures were managed in our hospital. Basic demographic and computed tomography (CT) data were collected and classified by Lauge–Hansen, OTA/AO, Haraguchi, and Mason classification. Additional radiographic data, including the length and area of posterior malleolar fragment, IAIF, and stable tibial plafond were measured. The location of IAIF was described, and involvement of the fibular notch and medial malleolus was also observed. Statistics were analyzed based on univariate analysis (Chi-square test, t-test, Mann–Whitney U test, Fisher’s test) and Spearman’s correlation test. Results Among the 108 cases of posterior malleolar fractures, 75 (69.4%) were with IAIF and 33 (30.6%) cases were without. There were 74 (68.5%) females and 34 (31.5%) males, and the average age of the patients was 49 years (18–89 years). The average LIFN/(LIFN + LSFN) [length of involving fibular notch/(length of involving fibular + length of stable notch fibular notch)] was 32.9% (11.6–64.9%). The APMF/(APMF + ASTP + AIAIF) [area of posterior malleolar fragment/(area of posterior malleolar fragment + area of IAIF + area of stable tibial plafond)] and AIAIF/APMF (area of IAIF/area of posterior malleolar fragment) were 13.1% (0.8–39.7%) and 52.6% (1.2–235.4%), respectively. Involvement of medial malleolus (fracture line extended to medial malleolus, P = 0.022), involvement of fibular notch (P = 0.021), LIFN/(LIFN + LSFN) (P = 0.037), LMPMF (P = 0.004), and APMF were significantly related to the occurrence of IAIF. Conclusion Our research indicates a high incidence of IAIF in posterior malleolar fractures. All IAIFs were found in posterior malleolar, and the most common location was within the lateral area A. Posterior malleolar fracture lines that extend to medial malleolus or fibular notch herald the incidence of IAIF. LIFN/(LIFN + LSFN), LMPMF and APMF are also associated with the incidence of IAIF. CT scans are useful for posterior malleolar fractures to determine the occurrence of IAIF and make operational plans. Operation approach selection should be based on the morphology of posterior malleolar fragments and the location of IAIF. Level of evidence Level III, retrospective case analysis.

Comparison of Outcome of Deltoid Ligament Repair According to Location of Suture Anchors in Rotational Ankle Fracture

2020 ◽  
pp. 107110072095205
Author(s):  
Young Hwan Park ◽  
Kyu Sun Jang ◽  
Eui Dong Yeo ◽  
Gi Won Choi ◽  
Hak Jun Kim
Keyword(s):  
Clinical Outcomes ◽  
Ankle Fracture ◽  
Deltoid Ligament ◽  
Medial Malleolus ◽  
Suture Anchors ◽  
Ligament Repair ◽  
Level Of Evidence ◽  
Clear Space ◽  
Retrospective Comparative Study

Background: The suture anchors for the repair of deltoid ligament in rotational ankle fracture are inserted mostly into the medial malleolus, but sometimes are placed into the talus depending on the rupture site. This study sought to compare the radiological and clinical outcomes of deltoid ligament repair according to using these 2 locations for suture anchor placement. Methods: The cases of 131 patients (114 patients with suture anchors on the medial malleolus and 17 patients with suture anchors on the talus) who underwent deltoid ligament repair along with ankle fracture fixation were retrospectively reviewed. Medial clear space oblique (MCSo), medial clear space perpendicular (MCSp), tibiofibular clear space (TFCS), and tibiofibular overlap (TFO) were measured as radiological outcomes, while the Olerud-Molander Ankle Score (OMAS) and visual analog scale (VAS) score for pain were calculated as clinical outcomes. The follow-up period did not differ between the 2 groups (16.8 ± 10.9 months in the medial malleolus group vs 17.9 ± 14.3 months in the talus group; P = .670). Results: There were no differences in MCSo, MCSp, TFCS, and TFO at 3 months after surgery and final follow-up. The OMAS and VAS for pain did not show intergroup differences at final follow-up. Conclusion: The surgical outcome of deltoid ligament repair in rotational ankle fracture did not differ whether the suture anchors were inserted into the medial malleolus or into the talus. Level of Evidence: Level III, retrospective comparative study.

Early Adverse Events Following Transcervical Hypopharyngeal Diverticulum Surgery

2020 ◽  
pp. 000348942096213
Author(s):  
Khodayar Goshtasbi ◽  
Sunil P. Verma
Keyword(s):  
Adverse Events ◽  
Surgical Complications ◽  
Smoking Status ◽  
Operation Time ◽  
Medical Complications ◽  
Improvement Program ◽  
Level Of Evidence ◽  
Vein Thrombosis ◽  
Hypopharyngeal Diverticulum ◽  
American Society

Objective: To describe rates of short-term morbidity following transcervical surgical treatment of hypopharyngeal diverticulum (HD) and analyze predictors of adverse events. Methods: The 2005 to 2017 National Surgical Quality Improvement Program database was queried to identify patients diagnosed with HD undergoing open transcervical diverticulectomy. Results: A total of 597 patients with a mean age of 71.4 ± 12.3 years were included. Thirty-day adverse events were experienced by 63 (10.6%) subjects, including 6.5% unplanned reoperations, 4.2% surgical complications, 4.4% medical complications, 2.7% readmissions, and 0.7% deaths. Medical complications notably included pneumonia (2.0%), reintubation (1.2%), sepsis (1.2%), intubation >48 hours (0.5%), urinary tract infection (0.5%), or deep vein thrombosis (0.5%), while surgical complications included organ/space infection (2.0%) and superficial (1.3%) or deep (1.0%) surgical site infection. Gender, race, functional status, diabetes, dyspnea, hypertension, steroid use, and recent weight loss were not associated with adverse events. Length of operation and hospitalization were both higher among those with adverse events (127.4 ± 107.9 vs 95.7 ± 59.8 minutes, P = 0.027, and 7.4 ± 7.4 vs 2.8 ± 3.6 days, P < 0.001). On multivariable logistic regression, high American Society of Anesthesiologists (ASA) class (OR = 2.02, P = 0.017), smoking (OR = 2.10, P = 0.044), and operation time (OR = 1.01; P = 0.005) were independent predictors of adverse events. Obesity was not associated with length of stay, readmission/reoperation, or complications. However, increased age was associated with shorter operations ( P = 0.020), higher length of hospitalization ( P < 0.001), and higher mortality ( P = 0.027) and readmission rates ( P = 0.023). Conclusion: Understanding clinical factors associated with complications following open surgery for HD such as ASA score, smoking status, length of operation, and age can help optimize surgical outcomes for at-risk patients. Level of Evidence: NA

scholarly journals The Treatment and Outcomes of Medial Malleolar Stress Fractures

2014 ◽  
Vol 6 (6) ◽  
pp. 527-530 ◽  
Author(s):  
Val Irion ◽  
Timothy L. Miller ◽  
Christopher C. Kaeding
Keyword(s):  
Stress Fracture ◽  
Treatment Options ◽  
Case Series ◽  
Return To Sport ◽  
Stress Fractures ◽  
Return To Play ◽  
Cochrane Library ◽  
Medial Malleolus ◽  
Retrospective Case ◽  
Level Of Evidence

Context: The medial malleolus is considered a high-risk stress fracture and can be debilitating to the highly active or athletic populations. A range of treatment methods have been described with varying outcomes. Currently, there is no gold standard treatment option with optimal results described. Objective: A systematic search of the literature to determine treatment options and outcomes in medial malleolus stress fractures. Data Sources: OVID/Medline, EMBASE, and the Cochrane Library from 1950 to September 2013. Study Selection: Included studies mentioned treatment and outcomes of medial malleolus stress fractures. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: The searches used combinations of the terms stress fracture, medial malleolus, management, and treatment. Two authors independently reviewed the selected articles and created individual tables, which were later compiled into a master table for final analysis. Results: Six retrospective case series were identified (n = 31 patients). Eighty percent (25/31) of patients were men, with an average age of 24.5 years. Ninety percent (28/31) of patients were at least involved in recreational athletics. All patients were able to return to sport. Complications were seen in both groups ranging from minor stiffness to nonunion requiring open reduction internal fixation. Conclusion: Nonoperative and operative interventions have proven to be successful with regard to healing and return to play for medial malleolar stress fractures in the recreational and competitive athlete. However, early operative intervention can possibly create a higher likelihood of early healing, decrease in symptoms, and return to play.

Supramalleolar Osteotomy Combined With an Intra-articular Osteotomy for the Reconstruction of Malunited Medial Impacted Ankle Fractures

2018 ◽  
Vol 39 (12) ◽  
pp. 1457-1463 ◽  
Author(s):  
Changjun Guo ◽  
Zongbao Liu ◽  
Yangbo Xu ◽  
Xingchen Li ◽  
Yuan Zhu ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
Case Series ◽  
Preoperative Assessment ◽  
Ankle Fractures ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Supramalleolar Osteotomy ◽  
Significant Difference ◽  
The Mean

Background: Malunion of a medial impacted ankle fracture may cause varus ankle deformity. This retrospective study examined the use of supramalleolar osteotomy combined with an intra-articular osteotomy in patients with malunited medial impacted ankle fractures. Methods: Twenty-four patients with malunited medial impacted ankle fracture were treated between January 2011 and December 2014. Using Weber’s classification, 10 had type A fractures and 14 had type B, and with the AO classification, 20 had 44A2 and 4 had 44B3. All of these patients had varus ankle deformity. Supramalleolar osteotomy combined with an intra-articular osteotomy was performed. The visual analog scale (VAS) for pain during daily activities, the Olerud and Molander Scale and the modified Takakura classification stage were used to determine the clinical outcomes and a radiographic analysis was performed. Results: The radiographic parameters, including the tibial ankle surface (TAS) angle and talar tilt angle (TTA), showed significant differences between the preoperative and follow-up assessments. The mean tibial lateral surface (TLS) did not show a significant change. The average Olerud and Molander Scale score improved significantly from 56.4 ± 6.21 preoperatively to 77.0 ± 6.11 at the latest follow-up ( P < .01). The mean VAS decreased significantly from 6.7 ± 0.8 preoperatively to 3.1 ± 0.6 at the latest follow-up ( P < .01). No significant difference in the modified Takakura classification stage was observed between the preoperative assessment and the last follow-up. Conclusions: The use of a supramalleolar osteotomy combined with an intra-articular osteotomy was an effective option for the treatment of malunited medial impacted ankle fractures associated with varus ankle deformity. Level of Evidence: Level IV, retrospective case series.

scholarly journals HIGHER RISK OF COMPLICATIONS AFTER TOTAL KNEE ARTHROPLASTY IN OCTOGENARIANS

2020 ◽  
Vol 28 (4) ◽  
pp. 177-181
Author(s):  
Gabriel Garcez de Araujo Souza ◽  
Raphael Soejima Correia Ramalho ◽  
Rodrigo Sattamini Pires e Albuquerque ◽  
João Maurício Barretto ◽  
Rafael Souza Mançãno Chaves ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Complications ◽  
Knee Arthroplasty ◽  
Skin Color ◽  
Control Group ◽  
Level Of Evidence ◽  
Sex Skin ◽  
Total Knee ◽  
American Society ◽  
American Society Of Anesthesiologists

ABSTRACT Objective: To evaluate the complication rate of total knee arthroplasty (TKA) in octogenarian patients and identify predictive factors. Methods: The study comprised 70 octogenarians and 70 non-octogenarian patients as control group, all submitted to TKA. We analyzed the medical records of these patients, seeking for complications during the first postoperative year. Regarding the risk factors, we evaluated: age, sex, race, American Society of Anesthesiologists score, body mass index, smoking, hypertension and diabetes mellitus. Results: In the control group, the incidence of complications was 7.1%. Whereas in the octogenarian group it was significantly higher, reaching 34.3% (OR 6.8; 95% CI 2.4-19.1). We found no association to sex, skin color, and comorbidities. Age is an independent risk factor for postoperative complications. Our data may help patients to acknowledge the risks of undergoing primary TKA and physicians to assess and adjust perioperative risk. Conclusion: The incidence of postoperative complications is significantly higher in octogenarians. Level of Evidence III, Case-control study.

Nonunion Rates in Hind- and Midfoot Arthrodesis in Current, Ex-, and Nonsmokers

2020 ◽  
pp. 107110072097126
Author(s):  
Jack Allport ◽  
Jayasree Ramaskandhan ◽  
Malik S. Siddique
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Relative Risk ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Smoking Status ◽  
Time Frame ◽  
Modifiable Risk Factor ◽  
Level Of Evidence ◽  
Significant Difference

Background: Nonunion rates in hind or midfoot arthrodesis have been reported as high as 41%. The most notable and readily modifiable risk factor that has been identified is smoking. In 2018, 14.4% of the UK population were active smokers. We examined the effect of smoking status on union rates for a large cohort of patients undergoing hind- or midfoot arthrodesis. Methods: In total, 381 consecutive primary joint arthrodeses were identified from a single surgeon’s logbook (analysis performed on a per joint basis, with a triple fusion reported as 3 separate joints). Patients were divided based on self-reported smoking status. Primary outcome was clinical union. Delayed union, infection, and the need for ultrasound bone stimulation were secondary outcomes. Results: Smoking prevalence was 14.0%, and 32.2% were ex-smokers. Groups were comparable for sex, diabetes, and body mass index. Smokers were younger and had fewer comorbidities. Nonunion rates were higher in smokers (relative risk, 5.81; 95% CI, 2.54-13.29; P < .001) with no statistically significant difference between ex-smokers and nonsmokers. Smokers had higher rates of infection ( P = .05) and bone stimulator use ( P < .001). Among smokers, there was a trend toward slower union with heavier smoking ( P = .004). Conclusion: This large retrospective cohort study confirmed previous evidence that smoking has a considerable negative effect on union in arthrodesis. The 5.81 relative risk in a modifiable risk factor is extremely high. Arthrodesis surgery should be undertaken with extreme caution in smokers. Our study shows that after cessation of smoking, the risk returns to normal, but we were unable to quantify the time frame. Level of Evidence: Level III, retrospective cohort study.

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