Removal of Internal Fixation—The Effect on Patients’ Complaints: A Study of 66 Cases of Removal of Internal Fixation after Malleolar Fractures

1994 ◽  
Vol 15 (4) ◽  
pp. 170-171 ◽  
Author(s):  
Steffen Jacobsen ◽  
Mette Honnens de Lichtenberg ◽  
Claus Munk Jensen ◽  
Carsten Tørholm
Keyword(s):  
Internal Fixation ◽  
Ankle Joint ◽  
Postoperative Period ◽  
Malleolar Fractures ◽  
Ao Mode

To estimate the effect of removal of internal fixation after treatment of malleolar fractures on postoperatively presented complaints, we retrospectively evaluated 66 patients by their records and by personal questionnaires. Of all the patients, 89.4% had one or more complaints. These were typically soreness over implant and cicatrix, reduced movement of the ankle joint, and strain-related pain. About 75% of these patients reported improvement after removal. The AO mode of fixation, i.e., typically by lateral semitubular plating and transsyndesmotic screw and a medial screw or pins, and the Wiberg-Cedell mode, i.e., typically consisting of lateral single or double cerclage and staple and medial pinning, constituted the principal groupings of the patients. The two groups were comparable. In this series, we found significantly more complaints associated with the AO mode in the postoperative period. We conclude that removal of internal fixation after malleolar fractures is indicated when common types of complaints are presented.

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.

Dental Trauma Caused by Screws in Internal Fixation of Mandibular Osteotomies in the Dog

1992 ◽  
Vol 05 (03) ◽  
pp. 104-108 ◽  
Author(s):  
A. J. Ligthelm ◽  
F. J. M. Verstraete
Keyword(s):  
Internal Fixation ◽  
Oral Mucosa ◽  
Postoperative Period ◽  
Periodontal Ligament ◽  
Dental Trauma ◽  
Mandibular Fracture ◽  
Fracture Repair ◽  
The Body ◽  
Mandibular Osteotomy

SummaryIn a canine mandibular osteotomy model, the extent and nature of dental trauma resulting from internal fixation by means of a plate and screws was investigated. The plate was positioned relatively dorsally on the buccal aspect of the body of the mandible, for maximum biomechanical advantage. After a three-month period, dental trauma was evaluated clinically and histologically. Erosion of the oral mucosa overlying the plate occurred in 10 out of 15 dogs. Dental roots were damaged by 61% of the screws. A variety of lesions involving the periodontal ligament, dentine, cementum, pulp, and periapical tissue were noted. It is concluded that this method of fixation can not be recommended for mandibular fracture repair in the dog.The effects of plating osteotomies of canine mandibles are described and evaluated following a three-month postoperative period.

Open reduction and internal fixation of posterior malleolar fractures using the posterolateral approach

2016 ◽  
Vol 98-B (6) ◽  
pp. 812-817 ◽  
Author(s):  
S. M. Verhage ◽  
F. Boot ◽  
I. B. Schipper ◽  
J. M. Hoogendoorn
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Posterolateral Approach ◽  
Malleolar Fractures

scholarly journals Distal tibial fracture treated by minimally invasive plate osteosynthesis after external fixation Retrospective clinical and radiographic assessment

2014 ◽  
Vol 20 (1) ◽  
pp. 44-49
Author(s):  
Șerban Al. ◽  
Obadă B. ◽  
Turcu R. ◽  
Anderlik St. ◽  
Botnaru V.
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
Ankle Joint ◽  
Plate Osteosynthesis ◽  
Weight Bearing ◽  
Distal Tibia ◽  
Tibial Fractures ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Surgical Trauma ◽  
Distal Tibial Fractures

ABSTRACT Fractures of the horizontal surface of the distal tibia are known commonly as pylon or plafond fractures, and represent 1-5% of lower extremity fractures, 7-10% of all tibial fractures. The protocol consisted of immediate (within eight to 24 hours) open reduction and internal fixation of the fibula, using a fibular plate or one third tubular plate and application of an external fixator spanning the ankle joint. In the second stage, the treatment of proximal and distal tibial fractures with close reduction and MIPPO technique can preserve soft tissue, simplify operative procedure and decrease wound, obtain rigid internal fixation and guarantee early function exercises of ankle joint. In this study we evaluated 22 patients treated in Clinical Emergency Hospital Constanta between April 2012 - July 2013 diagnosed with multifragmentary fractures of the distal tibia. This study evaluates the treatment of complex fractures of distal tibia with locked plate after external fixation. There were 17 males and 5 females of mean age 51,7 years (31-68). The mean follow-up period was 14 weeks. (Ranging from 9-16 weeks). All patients were fully weight bearing at 16 weeks (ranging 9-16 weeks) showing radiological union. There were no cases of failures of fixation, or rotational misalignment. No significant complication was observed in our patients. MIPO is an effective method of treatment for distal tibial fractures, reduce surgical trauma and maintain a more biologically favorable environment for fracture healing, reducing risks of infection and nonunion.

scholarly journals Distal tibial pilon fractures (AO/OTA type B, and C) treated with the external skeletal and minimal internal fixation method

2013 ◽  
Vol 70 (9) ◽  
pp. 836-841 ◽  
Author(s):  
Sasa Milenkovic ◽  
Milorad Mitkovic ◽  
Ivan Micic ◽  
Desimir Mladenovic ◽  
Stevo Najman ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Ankle Joint ◽  
Fixation Method ◽  
Universal Method ◽  
Type B ◽  
Tibial Pilon ◽  
Post Surgery ◽  
Articular Fractures ◽  
Type C ◽  
Pilon Fractures

Background/Aim. Distal tibial pilon fractures include extra-articular fractures of the tibial metaphysis and the more severe intra-articular tibial pilon fractures. There is no universal method for treating distal tibial pilon fractures. These fractures are treated by means of open reduction, internal fixation (ORIF) and external skeletal fixation. The high rate of soft-tissue complications associated with primary ORIF of pilon fractures led to the use of external skeletal fixation, with limited internal fixation as an alternative technique for definitive management. The aim of this study was to estimate efficacy of distal tibial pilon fratures treatment using the external skeletal and minimal internal fixation method. Methods. We presented a series of 31 operated patients with tibial pilon fractures. The patients were operated on using the method of external skeletal fixation with a minimal internal fixation. According to the AO/OTA classification, 17 patients had type B fracture and 14 patients type C fractures. The rigid external skeletal fixation was transformed into a dynamic external skeletal fixation 6 weeks post-surgery. Results. This retrospective study involved 31 patients with tibial pilon fractures, average age 41.81 (from 21 to 60) years. The average follow-up was 21.86 (from 12 to 48) months. The percentage of union was 90.32%, nonunion 3.22% and malunion 6.45%. The mean to fracture union was 14 (range 12-20) weeks. There were 4 (12.19%) infections around the pins of the external skeletal fixator and one (3.22%) deep infections. The ankle joint arthrosis as a late complication appeared in 4 (12.90%) patients. All arthroses appeared in patients who had type C fractures. The final functional results based on the AOFAS score were excellent in 51.61%, good in 32.25%, average in 12.90% and bad in 3.22% of the patients. Conclusion. External skeletal fixation and minimal internal fixation of distal tibial pilon fractures is a good method for treating all types of inta-articular pilon fractures. In fractures types B and C dynamic external skeletal fixation allows early mobility in the ankle joint.

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.

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