Midterm Outcomes of Unstable Ankle Fractures in Young Patients Treated by Closed Reduction and Fixation With an Intramedullary Fibular Nail vs Open Reduction Internal Fixation Using a Lateral Locking Plate

2021 ◽  
pp. 107110072110174
Author(s):  
Duk-hwan Kho ◽  
Byung-Ki Cho ◽  
Seung-Myung Choi
Keyword(s):  
Internal Fixation ◽  
Closed Reduction ◽  
Locking Plate ◽  
Young Patients ◽  
Plain Radiography ◽  
Ankle Fractures ◽  
Trimalleolar Fractures ◽  
Weber Type ◽  
Type C

Background: We aimed to compare midterm radiological and clinical outcomes between closed reduction and internal fixation (CRIF) using the fibular intramedullary nail (IMN) and open reduction and internal fixation (ORIF) using the locking plate for the treatment of unstable ankle fractures in active young patients. Methods: In this retrospective cohort study, 204 patients treated with CRIF using the fibular IMN (94 patients) or ORIF using the locking plate (110 patients) were included after at least 3 years of follow-up. The mean patient age was 41.4 years. Radiographic evaluation included the quality of reduction assessed by plain radiography and 3-dimensional (3D)–reconstructed computed tomography as well as the development of posttraumatic osteoarthritis (PTOA) of the ankle assessed by weightbearing plain radiography. Clinical evaluation included the American Orthopaedic Foot & Ankle Society hindfoot score, Olerud and Molander Score, the Foot and Ankle Outcome Score, and visual analog scale pain score as well as complications. Results: At median follow-up greater than 4 years, we found no significant differences in measured clinical outcomes between the 2 groups. There were significantly fewer postoperative complications in the IMN group than in the ORIF group (9.5% vs 39%, P < .001). However, we did find a greater proportion of radiographically fair or poor reductions in the IMN group than in the ORIF group ( P < .001). The poor reductions in the IMN group were primarily related to Weber type C, pronation-type injury, and comminuted fibular and trimalleolar fractures ( P < .001). PTOA was also more frequently observed in the IMN group than in the ORIF group (21.3% vs 9.1%, P = .024). Conclusion: Given the current prevailing technologies for fracture fixation, this study suggests that surgeons should consider ORIF for unstable ankle fractures in active young patients with Weber type C, pronation-type injury, and comminuted fibular and trimalleolar fractures. Level of Evidence: Level III, retrospective comparative study.

Hybrid Fixation for Danis-Weber Type C Fractures With Syndesmosis Injury

2020 ◽  
pp. 107110072096479
Author(s):  
Gi Beom Kim ◽  
Chul Hyun Park
Keyword(s):  
External Rotation ◽  
Case Series ◽  
Ankle Fractures ◽  
Syndesmotic Injury ◽  
Hybrid Fixation ◽  
Alternative Treatment Option ◽  
Syndesmosis Injury ◽  
Weber Type ◽  
Type C

Background: This study aimed to assess the clinical and radiological outcomes of hybrid fixation for Danis-Weber type C ankle fractures with a syndesmotic injury. Methods: From January 2016 to April 2018, we retrospectively reviewed consecutive patients who underwent hybrid fixation for Danis-Weber type C ankle fractures with syndesmotic injury with a minimum follow-up of 12 months. We excluded patients who achieved syndesmosis stability after fracture fixation. In all patients, we allowed partial weightbearing at 4 weeks postoperatively. We evaluated the visual analog scale for ankle pain, the Olerud-Molander ankle score, and the American Orthopaedic Foot & Ankle Society score. Malreduction of the syndesmosis was defined based on 2 previously reported methods. Fourteen patients (11 men and 3 women) were included in this study. There were 11 patients with pronation external rotation-type fractures and 3 patients with Maisonneuve fractures. The average age at operation was 37.2 years (range, 18-70 years). Results: Clinical scores were significantly improved at the last follow-up. Postoperative malreduction was observed only in 1 patient (7.1%). Conclusion: Hybrid fixation using a suture-button device combined with a syndesmotic screw in Danis-Weber type C fractures with syndesmosis injury showed a high accuracy of reduction, a low rate of diastasis, and favorable clinical outcomes. This combined method could be a good alternative treatment option for Danis-Weber type C ankle fractures with a syndesmosis injury. Level of Evidence: Level IV, case series.

scholarly journals Weber C ankle fractures with tibiofibular diastasis: syndesmosis-only fixation

2017 ◽  
Vol 25 (3) ◽  
pp. 67-70 ◽  
Author(s):  
Serkan Sipahioglu ◽  
Sinan Zehir ◽  
Erdem Isikan
Keyword(s):  
Case Series ◽  
Clinical Score ◽  
Ankle Fractures ◽  
Level Of Evidence ◽  
Lateral Incision ◽  
Weber Type ◽  
Type C ◽  
Syndesmosis Screw ◽  
Fibular Fixation

ABSTRACT OBJECTIVES: To evaluate syndesmosis-only fixation in Weber C ankle fractures with tibiofibular diastasis and to assess the need for additional fibular fixation. METHODS: Twenty-one patients with Weber C ankle fractures and tibiofibular diastasis were followed for at least 24 months after treatment. In treatment of the Weber C fractures, only a syndesmosis screw was used through a mini open lateral incision if the syndesmosis could be anatomically reduced and fibular length and rotation could be restored. At follow-up, anteroposterior tibiofibular distance, lateral fibular distance, medial mortise distance and fracture healing were compared and patients were clinically evaluated using the Olerud and Molander ankle scale scoring system. RESULTS: The average duration of follow-up was 49 months and the decreases in anteroposterior tibiofibular distance and lateral fibular distance were statistically significant. At the last follow-up the average clinical score was 86. Ankle mortise was reduced at follow-up in all cases except one, which resulted in a late diastasis. CONCLUSIONS: Syndesmosis-only fixation can be an effective method of treating Weber type-C lateral malleolar fractures with syndesmosis disruption in cases where intraoperative fibular length can be restored and anatomical syndesmosis reduction can be achieved. Level of Evidence IV, Case Series.

Surgical Treatment of Lateral Malleolar Fractures Using the Compression Cerclage System

2016 ◽  
Vol 106 (5) ◽  
pp. 313-318 ◽  
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 &lt;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.

Nonunion of a Fracture of the Lateral Malleolus: A Case Report and Review of the Literature

1997 ◽  
Vol 18 (1) ◽  
pp. 50-52 ◽  
Author(s):  
Nahshon Rand ◽  
Ram Mosheiff ◽  
Meir Liebergall
Keyword(s):  
Internal Fixation ◽  
Clinical Signs ◽  
Rare Condition ◽  
Autologous Bone Graft ◽  
Male Gender ◽  
Lateral Malleolus ◽  
Review Of The Literature ◽  
Weber Type ◽  
Type C

Nonunion of a fracture of the lateral malleolus is a rare condition. We present a case of established nonunion of a fracture of the lateral malleolus confirmed and treated surgically, using debridement and internal fixation with autologous bone graft. At 5-year follow-up, the fracture was united but the patient still showed clinical signs of reflex sympathetic dystrophy. Male gender, supination fractures, Weber type C fractures, and primary internal fixation are cited as possible risk factors. Prognosis is variable.

scholarly journals A Prospective Study on Treatment of Distal Radial Fractures Using Volar Locking Plate

2020 ◽  
Vol 3 (1) ◽  
Keyword(s):  
Internal Fixation ◽  
Distal Radius ◽  
Open Reduction ◽  
Locking Plate ◽  
Small Sample ◽  
Care Hospital ◽  
Volar Locking Plate ◽  
Distal Radial Fractures ◽  
Compression Plating

Introduction: Distal radius fractures are one of the most common injuries which come to the orthopaedic surgeons. Displaced extra-or intra-articular fractures require anatomical reduction for a good outcome. Historically, these fractures were treated with manipulation and casting, with or without Kirschner (K) wire fixation. Modern plating techniques have been advocated to restore anatomical alignment and allow early mobilisation. Despite the wide variety of treatment options available there is still debate about the best way to treat these fractures. The aim of this study was to evaluate fifty cases of fracture distal end radius treated by open reduction and internal fixation using locking compression plating (LCP). Methods: The present study was carried out on 50 cases of acute fracture distal radius admitted at a tertiary care hospital treated by open reduction and internal fixation using locking compression plating (LCP) between January 2018 and December 2018. Functional results were rated at the end of the study as excellent, good or poor as criteria laid down by Gartland and Werley’s combined subjective and objective criteria. Results: 50 cases of fracture distal radius were selected for study that fulfill the inclusion criteria, were operated and studied. 10 fractures were fixed using Extra-articular Locking Compression T-Plates, 40 fractures were fixed using Juxtaarticular Locking Compression T-Plates. According to the Gartland and Werley’s rating scale, 20 had excellent results, 23 good results, and 07 fair results during latest follow up. Conclusion: Notwithstanding a very small sample size and a short follow up, Volar locking plate osteosynthesis at the distal radius signifies a significant improvement in the treatment of distal radial fractures in terms of restoration of the shape and function of the wrist.

scholarly journals Associations Between the Fracture Type and Functional Outcomes After Distal Radial Fractures Treated With a Volar Locking Plate

Medicina ◽  
2013 ◽  
Vol 49 (9) ◽  
pp. 62
Author(s):  
Kęstutis Braziulis ◽  
Rytis Rimdeika ◽  
Rima Kregždytė ◽  
Šarūnas Tarasevičius
Keyword(s):  
Locking Plate ◽  
Hand Function ◽  
Linear Regression Analysis ◽  
Type A ◽  
Dash Score ◽  
Volar Locking Plate ◽  
Fracture Type ◽  
Type C ◽  
And Gender

Objective. The aim of this study to investigate the associations of fracture type, age, and gender with hand function after distal radius fractures treated with a volar locking plate at a 6-month follow-up. Material and Methods. A total of 120 patients with displaced distal radius fractures were included into the study. They were operated on using a volar locking plate system. All the fractures were classified according to the AO classification, and the patients were divided into 3 groups by the fracture type. The range of motion and grip strength were evaluated at the 6-month follow-up. Multivariate linear regression analysis was used to evaluate the associations of age, gender, and fracture type with the score of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The DASH questionnaire was completed as an outcome measure. Results. A total of 28 patients experienced type A fractures; 70 patients, type B fractures; and 22 patients, type C fractures. No statistically significant difference regarding age and sex among the groups was observed. At 6 months after the surgery, the mean DASH score for type A, B, and C fractures was 16, 13, and 32, respectively (P=0.01). After the surgery, the radiographic parameters such as the volar tilt and the ulnar variance were significantly worse in the patients with type C fractures. Grip strength and the range of motion of the contralateral healthy hand at the 6-month follow-up were significantly better than those of the operated hand. The linear regression analysis showed that the type C fracture was the only factor significantly associated with lower DASH score. Conclusions. The patients with type C fractures treated with a volar locking plate had a worse wrist function as compared with the patients type A and B fractures at the 6-month follow-up. The postoperative hand function was significantly associated only with the type C fracture, while age and gender had no significant impact.

scholarly journals Does the quality of preoperative closed reduction of displaced ankle fractures affect wound complications after surgical fixation?

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0018
Author(s):  
Bonnie Chien ◽  
Kristen Stupay ◽  
Christopher Miller ◽  
Jeremy Smith ◽  
Jorge Briceno ◽  
...  
Keyword(s):  
Classification System ◽  
Closed Reduction ◽  
Ankle Fracture ◽  
Ankle Fractures ◽  
Wound Complications ◽  
Complication Rates ◽  
Ankle Osteoarthritis ◽  
Surgical Fixation

Category: Trauma Introduction/Purpose: Prompt reduction and stabilization of displaced ankle fractures is important to protect soft tissues, restore potential neurovascular deficits and prevent cartilage injury. Many of these injuries do eventually require surgical fixation. The purpose of this study is to determine whether the initial quality of ankle closed reduction based on radiographic criteria would affect outcomes such as ankle osteoarthritis and complications after surgery. Furthermore, we sought to develop a classification system for the quality of closed reduction that would be easy to use and provide interrater reliability. Methods: A retrospective analysis of patients who sustained isolated, closed ankle fractures with at least 3 months follow up postoperatively at two level 1 trauma centers was performed. Patient demographics and history, ankle fracture characteristics and reduction information as well as surgical outcomes and complications were collected. A grading classification for the quality of the initial closed reduction before surgery was developed based on standard AP or mortise and lateral ankle x-rays. The factors considered for rating the reduction included the degree of talar shift on the AP/mortise view, malleoli displacement, as well the relationship of a central plumb line to the center of the talar dome on the lateral x-ray. For ankle osteoarthritis, the Takakura classification was utilized. Three reviewers (1 resident, 2 attendings) independently reviewed and rated all imaging. Results: 161 patients were analyzed. 65% female, average age 50, average 4 days between injury and surgery, mean follow up of 12 months (3-58 months), and 17% wound complications. Psychiatric history was the single comorbidity significantly associated with complications (p=0.009). There was no difference in wound or infection complication rates based on initial closed reduction quality (p=0.17). Neither number nor quality of reductions correlated with increased osteoarthritis (p=0.19, 0.39 respectively). Worst graded reductions had shorter time to surgery, mean 1.4 vs 4.7 days for best reductions (p=0.03), suggesting a protective factor that may account for no association between reduction quality and wound complications. Interclass correlation coefficients for multiple observers showed very high consistency for grading of reduction quality based on the classification system (ICC >0.85, p<0.001). Conclusion: It is often emphasized that a displaced ankle fracture should be as perfectly reduced as possible, understandably for grossly dislocated ankle fracture dislocations potentially compromising skin and neurovascular structures. At the same time, this original study demonstrated contrary to common assumption that the initial quality of ankle closed reduction does not appear to affect the severity of ankle osteoarthritis or the rate of surgical complications. This study also developed a highly reproducible ankle reduction classification system. It opens the opportunity for future prospective application and analysis of this classification’s ultimate clinical utility.

Effect of CT on Management Plan in Malleolar Ankle Fractures

2017 ◽  
Vol 39 (1) ◽  
pp. 59-66 ◽  
Author(s):  
Ashwani Kumar ◽  
Puneet Mishra ◽  
Anupama Tandon ◽  
Rajesh Arora ◽  
Manish Chadha
Keyword(s):  
Ct Scan ◽  
Case Series ◽  
Management Plan ◽  
Ankle Fractures ◽  
X Rays ◽  
Level Of Evidence ◽  
Plain Radiographs ◽  
Posterior Malleolus ◽  
Trimalleolar Fractures ◽  
Type C

Background: Conventionally ankle fractures have been classified using plain radiographs. Because of complex 3-dimensional anatomy and complexity of injuries, plain radiographs may not always be able to clearly depict the complete fracture pattern. There is a paucity of studies regarding the utility of computed tomography (CT) scanning in malleolar ankle fractures (MAFs). Hence, we conducted this study to further understand the role of the CT scan in MAFs. Methods: A prospective study of 56 consecutive malleolar ankle fractures was conducted. In the first evaluation by a team of 3 observers, a management plan was made based on plain radiographs. All patients received a CT scan evaluation with a standard protocol. The second evaluation by the same team included formulating an operative plan based on the CT. Results: In 13 (23.2%) cases, the management plan changed after CT evaluation. In most of the cases, the change in the management plan included an alteration in fixation of the posterior malleolus followed by lateral malleolus in 4 cases. Most of the changes took place in AO 44 type C followed by types B and A. Maximum change was noted in trimalleolar fractures followed by bimalleolar and unimalleolar. The most common morphological characteristic fracture identified on CT scan that was not evident on plain radiography was Chaput fracture in 17 cases. Conclusion: CT scan evaluation of MAFs changed the management plan in a significant number of cases, especially if the fractured fragment included a posterior malleolus, AO type C, and/or if 2 or more malleoli were fractured as noted on plain x rays. Level of Evidence: Level IV, case series.

Effects of Three- or Four-Cortex Syndesmotic Fixation in Ankle Fractures

2007 ◽  
Vol 97 (6) ◽  
pp. 457-459 ◽  
Author(s):  
Hasan Karapinar ◽  
Onder Kalenderer ◽  
Levent Karapinar ◽  
Taskin Altay ◽  
Metin Manisali ◽  
...  
Keyword(s):  
Clinical Results ◽  
Joint Space ◽  
Ankle Fractures ◽  
Routine Procedure ◽  
Plain Radiographs ◽  
Weber Type ◽  
Type C ◽  
Type 3

Background: There is no study comparing how Weber type C ankle fractures treated with either three- or four-cortex syndesmotic fixation affects the structure of the syndesmosis. Methods: In a retrospective study, 46 patients were separated into two groups: 22 patients with three-cortex fixation and 24 patients with four-cortex fixation. All of the patients were evaluated clinically and radiographically at least 1 year after removal of the syndesmosis screws. Results: There were three types of joint space obliteration: type 1, synostosis on plain radiographs; type 2, an incomplete bony bridge on magnetic resonance imaging with normal plain radiographs; and type 3, fibrous obliteration of the joint space. Although obliteration of the joint space was significant (P &lt; .005) after four-cortex fixation, radiologic results did not affect the clinical outcome. Conclusion: Four-cortex fixation for diastasis after an ankle fracture should not be a routine procedure. We advocate three-cortex fixation because the clinical results are no different and there is less syndesmotic space obliteration postoperatively. (J Am Podiatr Med Assoc 97(6): 457–459, 2007)

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