Polyglycolide Bioabsorbable Screws in the Treatment of Ankle Fractures

1997 ◽  
Vol 18 (3) ◽  
pp. 128-131 ◽  
Author(s):  
W. David Hovis ◽  
Robert W. Bucholz
Keyword(s):  
Functional Results ◽  
Sinus Tract ◽  
Ankle Fractures ◽  
Medial Malleolus ◽  
Wound Infections ◽  
Inflammatory Reactions ◽  
Malleolar Fractures ◽  
Metallic Implants ◽  
Bioabsorbable Screws

Twenty-one patients with unstable medial malleolar, bimalleolar, or trimalleolar ankle fractures underwent open reduction and internal fixation of the medial malleolus with 4.5-mm polyglycolide screws. All lateral malleolar fractures were internally fixed with standard metallic implants. Radiographic and clinical follow-up results were available on 16 of 21 patients. All fractures healed at an average of 3.4 months (range, 3–6 months), and there were no medial wound infections. Eight of 16 patients developed an inflammatory reaction to the biodegradable polyester at 3 to 4 months after implantation, including one who developed a sterile draining sinus tract. No surgical or nonsurgical treatment was required in those eight patients. We conclude that whereas polyester screws yield union rates and functional results similar to those of metallic screws in the treatment of medial malleolar fractures, the use of polyglycolide screws is associated with an unacceptable rate of inflammatory reactions.

scholarly journals Percutaneous intramedullary screw fixation in lateral malleolar ankle fractures

2020 ◽  
Author(s):  
Mohamed Ibrahim Abulsoud ◽  
Adnan Al Sebaie ◽  
Ahmed Darwish ◽  
Mohamed Moawad ◽  
Ehab Elzahed ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Functional Results ◽  
Ankle Fractures ◽  
Wound Infections ◽  
Malleolar Fracture ◽  
Deep Wound ◽  
Clinical And Radiological Results ◽  
Percutaneous Internal Fixation ◽  
Intramedullary Screw

Abstract Background: To evaluate the outcome of percutaneous fixation of lateral malleolar ankle fractures by intramedullary screw.Methods: Twenty-five patients with Weber A and Weber B displaced lateral malleolus fractures were retrospectively reviewed after they had done closed reduction and percutaneous internal fixation with an intramedullary fully threaded screw with a washer. A 3.5-mm, fully threaded, self- tapping bone screw. The length of the screw varies between 90 mm and 110 mm, depending on the fracture location and pattern.Results: All fractures united within an average time to union of 5.86 ± 1.74 weeks. There were no deep wound infections or complaints of painful hardware. At the latest follow-up, functional results were excellent in 16 patients (64%) good in 8 patients (32 %), fair in one patient (4%).Conclusion Percutaneous intramedullary screw fixation is a good easy technique in the management of lateral malleolar fracture that provides good clinical and radiological results as it is rapid, minimally invasive and without prominent hardware.

Radiographic Results of Unicortical Medial Malleolar Fracture Fixation

2018 ◽  
Vol 40 (4) ◽  
pp. 398-401
Author(s):  
Henrik C. Bäcker ◽  
Matthew Konigsberg ◽  
Christina E. Freibott ◽  
Melvin P. Rosenwasser ◽  
Justin K. Greisberg ◽  
...  
Keyword(s):  
Fracture Fixation ◽  
Bone Growth ◽  
Distal Tibia ◽  
Case Series ◽  
Clinical Results ◽  
Ankle Fractures ◽  
Medial Malleolus ◽  
Malleolar Fracture ◽  
Malleolar Fractures

Background: Medial malleolar fractures commonly occur as part of rotational ankle fractures, which often require surgery. Different fixation techniques exist, including unicortical or bicortical lag-screw fixation. Bicortical screws that engage the lateral distal tibia have been noted to be biomechanically superior to unicortical ones with a lower failure rate. The authors of this study have used unicortical screws routinely. This study was initiated to investigate the clinical results of a large series of patients with unicortical medial malleolar fixation. Methods: Patients who underwent unicortical medial malleolar fracture fixation between 2011 and 2017 were reviewed. In total, 461 ankle fractures were identified with a mean follow-up of 11.4 months (range, 3-57), of which 211 had a medial malleolar fracture. Eight patients were excluded as they did not follow up with the treating surgeons after surgery, leaving 203 patients for evaluation. The primary outcome was radiographic union. Any loss of reduction, complication, or subsequent surgery was recorded. Malunion was defined as greater than 2 mm displacement. Results: There were 2 asymptomatic nonunions (1.0%), 1 delayed union that healed using an external bone growth stimulator (0.5%), and 2 malunions of the medial malleolus (1.0%) with 1 asymptomatic. The other patient developed posttraumatic osteoarthritis but has not yet required further surgery. None of these 5 patients required revision medial malleolar surgery. Ultimately, the union rate using unicortical medial malleolar fixation was 99.0% (201/203). Conclusion: Unicortical fixation of medial malleolar fractures resulted in consistently good healing. Even though biomechanical studies have shown that bicortical screws provide stronger fixation, our clinical results indicate that the need for this stronger fixation may be questionable. Level of Evidence: Level IV, retrospective 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 <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.

scholarly journals Percutaneous intramedullary screw fixation in lateral malleolar ankle fractures

2020 ◽  
Author(s):  
Mohamed Ibrahim Abulsoud ◽  
Adnan Al Sebaie ◽  
Ahmed Darwish ◽  
Mohamed Moawad ◽  
Ehab Elzahed ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Functional Results ◽  
Ankle Fractures ◽  
Malleolar Fracture ◽  
Deep Wound ◽  
Good Technique ◽  
Clinical And Radiological Results ◽  
Percutaneous Internal Fixation ◽  
Intramedullary Screw

Abstract Objectives: To evaluate the outcome of percutaneous fixation of lateral malleolar ankle fractures by intramedullary screw.Methods: Twenty-five patients with Weber A and Weber B displaced lateral malleolus fractures were retrospectively reviewed after they had done closed reduction and percutaneous internal fixation with an intramedullary fully threaded screw with a washer. A 3.5-mm, fully threaded, self- tapping bone screw. The length of the screw varies between 90 mm and 110 mm, depending on the fracture location and pattern.Results: All fractures united within an average time to union of 5.86 ± 1.74 weeks. There were no deep wound infections or complaints of painful hardware. At the latest follow-up, functional results were excellent in 16 patients (64%) good in 8 patients (32 %), fair in one patient (4%).Conclusion Percutaneous intramedullary screw fixation is a good technique in the management of lateral malleolar fracture that provides good clinical and radiological results as it is rapid, minimally invasive, and without prominent hardware.

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.

scholarly journals Functional outcomes of unstable ankle fractures with and without syndesmotic fixation in the adolescent population

2021 ◽  
pp. 1-8
Author(s):  
Conner J. Paez ◽  
Benjamin M. Lurie ◽  
Vidyadhar V. Upasani ◽  
Andrew T. Pennock
Keyword(s):  
Functional Outcome ◽  
Functional Outcomes ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
Medial Malleolus ◽  
Syndesmotic Injury ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Male Sex

Purpose: The purpose of this study was to compare functional outcomes of adolescents with and without ankle syndesmotic injuries and identify predictors of functional outcome after operative ankle fractures. Methods: A retrospective review was conducted on operative adolescent ankle fractures treated between 2009 and 2019 with a minimum of one-year follow-up (mean 4.35 years). Patients who underwent syndesmotic fixation (SF) (n = 48) were compared with operative ankle fractures without syndesmotic injury (n = 63). Functional outcomes were assessed using standardized questionnaires, specifically the Foot and Ankle Ability Measure (FAAM) and Single Assessment Numerical Evaluation. Results: There were no differences in patient-reported outcomes, rates of return to sport or complications between groups with and without SF. The SF group had a longer tourniquet time (p = 0.04), duration of non-weight-bearing (p = 0.01), more Weber C fibula fractures (p < 0.001), fewer medial malleolus fractures (p = 0.03) and more frequently underwent implant removal (p < 0.0001). Male sex, lower body mass index (BMI) and longer duration of follow-up were significant predictors of a higher FAAM sports score using multivariable linear regression. SF was not a predictor of functional outcome. Conclusion: This study demonstrated that patients that undergo surgical fixation of syndesmotic injuries have equivalent functional outcomes compared to operative ankle fractures without intraoperative evidence of syndesmotic injury. We also identified that male sex, lower BMI and longer duration of follow-up are predictors of a good functional outcome. Level of Evidence: III

scholarly journals A lean bioabsorbable magnesium-zinc-calcium alloy ZX00 used for operative treatment of medial malleolus fractures

2020 ◽  
Vol 9 (8) ◽  
pp. 477-483
Author(s):  
Patrick Holweg ◽  
Valentin Herber ◽  
Martin Ornig ◽  
Gloria Hohenberger ◽  
Nicolas Donohue ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Clinical Investigation ◽  
Blood Analysis ◽  
Ankle Fractures ◽  
Fracture Reduction ◽  
Medial Malleolus ◽  
Aofas Score ◽  
Talocrural Joint ◽  
The Mean

Aims This study is a prospective, non-randomized trial for the treatment of fractures of the medial malleolus using lean, bioabsorbable, rare-earth element (REE)-free, magnesium (Mg)-based biodegradable screws in the adult skeleton. Methods A total of 20 patients with isolated, bimalleolar, or trimalleolar ankle fractures were recruited between July 2018 and October 2019. Fracture reduction was achieved through bioabsorbable Mg-based screws composed of pure Mg alloyed with zinc (Zn) and calcium (Ca) ( Mg-Zn0.45-Ca0.45, in wt.%; ZX00). Visual analogue scale (VAS) and the presence of complications (adverse events) during follow-up (12 weeks) were used to evaluate the clinical outcomes. The functional outcomes were analyzed through the range of motion (ROM) of the ankle joint and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Fracture reduction and gas formation were assessed using several plane radiographs. Results The follow-up was performed after at least 12 weeks. The mean difference in ROM of the talocrural joint between the treated and the non-treated sites decreased from 39° (SD 12°) after two weeks to 8° (SD 11°) after 12 weeks (p ≤ 0.05). After 12 weeks, the mean AOFAS score was 92.5 points (SD 4.1). Blood analysis revealed that Mg and Ca were within a physiologically normal range. All ankle fractures were reduced and stabilized sufficiently by two Mg screws. A complete consolidation of all fractures was achieved. No loosening or breakage of screws was observed. Conclusion This first prospective clinical investigation of fracture reduction and fixation using lean, bioabsorbable, REE-free ZX00 screws showed excellent clinical and functional outcomes. Cite this article: Bone Joint Res 2020;9(8):477–483.

scholarly journals Acute Retrograde Tibiotalocalcaneal Nailing for Osteoporotic Ankle Fractures in Fragile Patients

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0003
Author(s):  
Mario Herrera-Perez ◽  
Sergio Tejero-Garcia ◽  
Victor Valderrabano
Keyword(s):  
Soft Tissues ◽  
Weight Bearing ◽  
Functional Results ◽  
Ankle Fractures ◽  
Full Weight Bearing ◽  
Term Outcome ◽  
Poor Condition ◽  
Vascular Insufficiency ◽  
The Mean

Category: Ankle, Trauma Introduction/Purpose: With the rising aging of the population, osteoporotic ankle fractures represent a frequent scenario in daily practice. The coexistence of comorbidities such as poorly controlled diabetes mellitus, vascular insufficiency, and poor condition of the surrounded soft tissues, means that conventional open reduction and internal fixation methods often fail. On the other hand, conservative or orthopaedic treatments in such population are badly tolerated. Our study aims to study the short- term outcome of retrograde tibiotalocalcaneal (TTC) nailing in a selected series of fragile patients. Methods: This study included 15 patients who underwent primary retrograde TTC nailing from January 2016 to July 2018. The mean age of the patients was 83,5 years (range, 75 to 88), and the mean follow-up period was 11,5 months (range, 6 to 24 months) with no patient lost to follow-up. All patients but one were diabetic; 2 were non-ambulatory; and 13 walked with walking aids. The authors implemented a primary nailing without addressing tibiotalar or subtalar joint and without using a tourniquet. Complete weight bearing was allowed early as tolerated. Alignment and healing of the fracture were evaluated. American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score were recorded preoperatively and at the final follow-up. Results: One of the patients died 8 months after the treatment. Radiographic healing of the fractures were identified in 100% of the cases. In 2 cases, a complete arthrodesis of the ankle joint was achieved by simple nail reaming (Figure 1). No infection or any scarring problems was recorded. Of the 13 patients who walked with difficulty, 4 remained prostrate to a wheelchair, but the rest maintained their previous autonomy. The mean AOFAS score improved from 48 (range, 14 to 71) preoperatively to 71 (range, 44 to 81) postoperatively. Conclusion: In the view of these results, we suggest that primary retrograde TTC nailing is a valid option in selected patients with fragility ankle fractures, high comorbidity, poor condition of the soft tissues and with difficulties to walk before the fracture. This option allows an early full weight bearing, avoids complications due to joint off-loading, and achieves acceptable functional results.

scholarly journals Outcomes Following Nonoperative Treatment of Isolated Posterior Malleolar Ankle Fractures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Fred Finney ◽  
Andrew Kuhn ◽  
Shahin Sheibani-Rad ◽  
Paul Charpentier ◽  
James Holmes ◽  
...  
Keyword(s):  
General Population ◽  
Clinical Outcomes ◽  
Normative Data ◽  
Ankle Fractures ◽  
Foot And Ankle ◽  
Fracture Fragment ◽  
Malleolar Fractures ◽  
Posterior Malleolus ◽  
Clinical Series

Category: Ankle, Trauma Introduction/Purpose: Ankle fractures are common injuries, however isolated posterior malleolar fractures are rare. Axial loading of the foot in hyper-plantarflexion is thought to be the most likely mechanism of injury for this fracture pattern. Management of isolated posterior malleolar fractures presents challenges for clinicians, and controversy exists over surgical indications. The literature to-date examining isolated posterior malleolar fractures is scarce and confined to case reports and small clinical series. Recommendations for surgical treatment are based largely on biomechanical studies and not clinical evidence. The purpose of this study was to assess outcomes in a series of patients, who were consecutively treated nonoperatively for isolated posterior malleolus ankle fractures. Methods: Outcomes of patients with isolated posterior malleolus fractures who were all treated nonoperatively at two academic teaching hospitals were retrospectively reviewed. The size of the posterior malleolar fracture fragment was measured on lateral ankle radiographs, and clinical outcomes were evaluated using the American Academy of Orthopaedic Surgeons (AAOS) Foot and Ankle Survey. These scores were then compared to published normative data from the general population via independent t-tests. These same outcome measures were then correlated with the size of the posterior malleolar fragment via Spearman Rank Correlations. Results: A total of 28 patients (17 male, 11 female) were retrospectively reviewed. The average size of the posterior malleolus fragment was 16.0% (Range: 2.0-59.5%) of the tibial plafond articular surface. The average follow-up duration was 2 years and 7 months. At follow-up, the average “Foot and Ankle Core Score” and “Shoe Comfort Scale Score” were 90 (±11.2) and 80.0 (±28.9), respectively. When these scores were compared to normative data from the general population, no significant differences were found (Foot and Ankle Core Score: p=0.234, Shoe Comfort Scale: p=0.276). There was also no significant association between these scores and the size of fracture fragment. At follow-up, no patients demonstrated signs of instability, dermatological complications, malalignment of the mortise or post-traumatic arthritis. Conclusion: This is the largest study to date evaluating outcomes of isolated posterior malleolus fractures in patients treated nonoperatively. This series of 28 patients with isolated posterior malleolar fractures managed nonoperatively demonstrates short- to mid-term functional outcomes that are no different than reported normative data for the general population. These findings are consistent with previously reported clinical outcomes and suggest that nonoperative management is a viable treatment option for isolated posterior malleolar fractures.

scholarly journals Preliminary Clinical and Radiographic Evaluation of a Novel Resorbable Implant of Polylactic Acid (PLA) for Tibial Tuberosity Advancement (TTA) by Modified Maquet Technique (MMT)

Animals ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 1271
Author(s):  
Victoria Valiño-Cultelli ◽  
Óscar Varela-López ◽  
Antonio González-Cantalapiedra
Keyword(s):  
Bone Healing ◽  
Recovery Time ◽  
Functional Results ◽  
Radiographic Evaluation ◽  
3D Printer ◽  
Radiographic Study ◽  
Clinical Recovery ◽  
Metallic Implants ◽  
Healing Score

Our objectives were to determine whether PLA implants can be used in TTA with successful results; secondly, to observe whether they provide a faster bone healing; finally, to determine whether weight or age influences bone healing scores. PLA cages were created with a 3D printer. TTA by MMT with PLA implants was performed in 24 patients. Follow-ups were carried out pre-surgical, at 1, 2, and 5 months and consisted of a radiographic study and a lameness assessment. A comparison was performed in terms of weight and age. Patients data, time between follow-up examinations, healing score, and lameness score were compared between patients using commercial software for statistically significant differences p < 0.05. Eighteen dogs finished the study. The ossification degrees presented statistically significant differences between each other. PLA implants maintained the advancement in 100% of cases. Comparing weight and age did not present any statistically significant differences between groups. Lameness presented statistically significant differences between follow-up examinations. Complications were observed in 20.8%. PLA implants for TTA provide good functional results, presenting an acceptable rate of complications. They provide a faster bone healing of the osteotomy gap, which was not affected by age or body weight, and have a clinical recovery time similar to metallic implants.

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