scholarly journals Screw fixation of the posterior malleolar fracture

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0030
Author(s):  
Gi-Soo Lee ◽  
Chan Kang ◽  
Byung-Ki Cho ◽  
Yougun Won
Keyword(s):  
Clinical Outcome ◽  
Screw Fixation ◽  
Cannulated Screw ◽  
Joint Surface ◽  
Functional Score ◽  
Malleolar Fracture ◽  
Malleolar Fractures ◽  
Posterior Malleolar Fracture ◽  
Group A

Category: Trauma Introduction/Purpose: Posterior malleolar fracture is known to be an indication for surgery when the size of the fragment is greater than 25% to 30% of the joint surface. The purpose of this study was to compare the results of cannulated screw fixation and early joint motion in patients with ankle fracture with posterior malleolar fracture of less than 25%, and we do cadaver experiments. Methods: The clinical portion of the study evaluated 70 patients with fracture of the posterior malleolus that comprised less than 25% of the articular surface. After fixation for lateral and/or medial malleolar fractures, cannulated screw fixation was performed for posterior malleolar fractures in 34 cases. (A group) In other 36 cases, fixation was not performed for posterior malleolar fractures. (B group) One week after the operation, ankle range of motion exercise was performed. Cadaver studies were evaluated both cannulated screw fixed and non-fixed in less than 25% fractures of the posterior malleolar. The stability of the ankle joint was measured in 12 cases. In 6 cases, the posterior malleolar was fixed and the other 6 cases were not fixed. Results: There was no significant difference in clinical outcome between Group A and B and functional score at 2 years follow up. However, the ankle function score at 6 months and 1 year after the follow - up was significantly higher in group A than in group B. In the cadaver study, the group with screw fixation was significantly stable in external rotation. Conclusion: In case of less than 25% posterior fracture, screw fixation is considered to have a significant effect on recovery and clinical outcome in the short term due to stability.

scholarly journals Percutaneous posteroanterior screw fixation for Haraguchi type 1 posterior malleolar fracture in tri-malleolar fracture: Operative technique and randomized clinical results

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902199799
Author(s):  
Tianming Yu ◽  
Jichong Ying ◽  
Jianlei Liu ◽  
Dichao Huang ◽  
Hailin Yan ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Malleolar Fracture ◽  
Malleolar Fractures ◽  
Posterior Malleolar Fracture ◽  
Post Traumatic ◽  
Group 2 ◽  
Traumatic Arthritis ◽  
Group 1

Purpose: The study described a novel surgical treatment of Haraguchi type 1 posterior malleolar fracture in tri-malleolar fracture and patient outcomes at intermediate period follow-up. Methods: All patients from January 2015 to December 2017 with tri-malleolar fracture of which posterior malleolar fractures were Haraguchi type 1, were surgically treated in this prospective study. Lateral and medial malleolar fractures were managed by open reduction and internal fixation through dual incision approaches. 36 cases of Haraguchi type 1 posterior malleolar fractures were randomly performed by percutaneous posteroanterior screw fixation with the aid of medial exposure (group 1). And 40 cases were performed by percutaneous anteroposterior screw fixation (group 2). Clinical outcomes, radiographic outcomes and patient-reported outcomes were recorded. Results: Seventy-six patients with mean follow-up of 30 months were included. There were no significant differences in the mean operation time (81.0 ± 11.3 vs. 77.2 ± 12.4), ankle function at different periods of follow-up, range of motions and visual analog scale (VAS) at 24 months between the two groups ( p > 0.05). However, the rate of severe post-traumatic arthritis (Grade 2 and 3) and the rate of step-off rather than gap in radiological evaluation were lower in group 1 than that in group 2 ( p < 0.05). Conclusion: Using our surgical technique, more patients had good outcome with a lower rate of severe post-traumatic arthritis, compared with the group of percutaneous anteroposterior screw fixation. Percutaneous posteroanterior screw fixation can be a convenient and reliable alternative in treating Haraguchi type 1 posterior malleolar fracture.

Combined Posteromedial and Posterolateral Approaches for 2-Part Posterior Malleolar Fracture Fixation

2020 ◽  
Vol 41 (10) ◽  
pp. 1234-1239 ◽  
Author(s):  
Yunfeng Yang ◽  
Wenbao He ◽  
Haichao Zhou ◽  
Jiang Xia ◽  
Bing Li ◽  
...  
Keyword(s):  
Case Series ◽  
Good Alternative ◽  
Retrospective Case ◽  
Malleolar Fracture ◽  
Level Of Evidence ◽  
Malleolar Fractures ◽  
Posterior Malleolar Fracture ◽  
The Mean ◽  
Mean Time

Background: This study investigated the clinical efficacy of combined posteromedial and posterolateral approaches for repair of 2-part posterior malleolar fractures associated with medial and lateral malleolar fractures. Methods: This case series report included 27 Weber B with Haraguchi type II patients with medial and lateral malleolar fractures combined with 2-part posterior malleolar fractures. Patients were treated with open reduction and internal fixation through a combination of posteromedial and posterolateral approaches from January 2015 to January 2018. There were 11 males and 16 females, with an average age of 61.5 years (range, 53-67 years). The procedures were performed on prone patients under spinal anesthesia. The medial, lateral, and posterior malleolar fractures were exposed through posteromedial and posterolateral approaches performed at the same time. The lateral malleolar fracture was fixed using a plate, the medial malleolar fracture was fixed using screws, and the posterior malleolar fracture was fixed using a plate or cannulated screws according to the size of the fragments. We performed follow-up on 22 patients for an average of 30 months (range, 18-48 months). Results: Primary healing of the incisions was achieved in all cases, and no infection was found. The mean time of bone union was 12.5 weeks (range, 10-15 weeks). The mean time from the operation to full weightbearing was 13 weeks (range, 11-16 weeks). We used the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale to score patient outcomes; the mean score was 85.4 (range, 80-92) at the final follow-up. No significant pain was found at the final follow-up. Conclusion: This study showed that satisfactory outcomes were achieved with combined posteromedial and posterolateral approaches. Therefore, we believe this approach was a good alternative strategy to repair 2-part posterior malleolar fractures associated with medial and lateral malleolar fractures. Level of Evidence: Level IV, retrospective case series.

Effect of Manipulation under Anesthesia of the First Knee in Staged Bilateral Total Knee Arthroplasty on Clinical Outcome and Satisfaction

2020 ◽  
Author(s):  
Jung-Won Lim ◽  
Yong-Beom Park ◽  
Dong-Hoon Lee ◽  
Han-Jun Lee
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Functional Score ◽  
Manipulation Under Anesthesia ◽  
Total Knee

AbstractThis study aimed to evaluate whether manipulation under anesthesia (MUA) affect clinical outcome including range of motion (ROM) and patient satisfaction after total knee arthroplasty (TKA). It is hypothesized that MUA improves clinical outcomes and patient satisfaction after primary TKA. This retrospective study analyzed 97 patients who underwent staged bilateral primary TKA. MUA of knee flexion more than 120 degrees was performed a week after index surgery just before operation of the opposite site. The first knees with MUA were classified as the MUA group and the second knees without MUA as the control group. ROM, Knee Society Knee Score, Knee Society Functional Score, Western Ontario and McMaster Universities (WOMAC) score, and patient satisfaction were assessed. Postoperative flexion was significantly greater in the MUA group during 6 months follow-up (6 weeks: 111.6 vs. 99.8 degrees, p < 0.001; 3 months: 115.9 vs. 110.2 degrees, p = 0.001; 6 months: 120.2 vs. 117.0 degrees, p = 0.019). Clinical outcomes also showed similar results with knee flexion during 2 years follow-up. Patient satisfaction was significantly high in the MUA group during 12 months (3 months: 80.2 vs. 71.5, p < 0.001; 6 months: 85.8 vs. 79.8, p < 0.001; 12 months: 86.1 vs. 83.9, p < 0.001; 24 months: 86.6 vs. 85.5, p = 0.013). MUA yielded improvement of clinical outcomes including ROM, and patient satisfaction, especially in the early period after TKA. MUA in the first knee could be taken into account to obtain early recovery and to improve patient satisfaction in staged bilateral TKA.

scholarly journals Comparison Between With Kirschner-wires Only And Combined Screw Fixation in Proximal Reverse Chevron osteotomy(PCMO) For Hallux Valgus Deformity

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Hwa Jun Kang ◽  
Hong-Geun Jung ◽  
Jong-Soo Lee ◽  
Sungwook Kim ◽  
Mao Yuan Sun
Keyword(s):  
Hallux Valgus ◽  
Screw Fixation ◽  
Fixation Method ◽  
Kirschner Wires ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Severe Hallux Valgus

Category: Bunion Introduction/Purpose: Kirschner-wires fixation, sometimes we have encountered pin irritation or pull-out. This is the reason why we consider additional fixation. Moreover, there are few reports according to comparison of fixation method, and Most of them focused on comparison K-wires or screw fixation only. Purpose of study is to compare clinical and radiographic outcome between Kirschner-wires only and combined screw fixation. Methods: The study included two different groups according to fixation methods. One with Kirschner-wires fixation (KW group) included 117 feet(of 98 patients), the other with combined screw fixation (KWS group) 56 feet (of 40 patients) with moderate to severe hallux valgus. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain scores, the preoperative and final follow-up American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal (MTP)-interphalangeal (IP) scores, and patient satisfaction after the surgery were evaluated. Radiographically, the hallux valgus angle (HVA), intermetatarsal angle (IMA), medial sesamoid position (MSP), and first to fifth metatarsal width (1-5MTW) were analyzed before and after surgery. Results: The mean AOFAS score improved preoperative 65.5 to 95.3 at final follow up in group A, while preoperative 56.5 to 88.6 at final follow up. Pain VAS decreased from 5.7 to 0.5 in group A, whereas from 6.2 to 1.6 in group B. The mean HVA all improved from preoperative 38.5 to 9.3 at final follow up in group A and 34.7 to 9.1 in group B. The mean IMA and MSP also improved significantly at final follow up. In comparative analysis, the IMA did not show significant difference between postoperative and final state in group A, while showed significant increase in group B. Conclusion: We achieved favorable clinical and radiographic outcomes with minimal complications in patient with moderate to severe hallux valgus in both groups. However, this study shows no statistically significant difference in IMA during follow-up period and lower recurrence rate. Therefore we need to consider combined fixation method to provide better stability and can expect lower recurrence rate.

scholarly journals Radiological and clinical outcome of lateral ankle instability with medial compartment osteoarthritis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Sungwook Kim ◽  
Hong-Geun Jung ◽  
Jong-Soo Lee ◽  
Hwa Jun Kang ◽  
Mao Yuan Sun
Keyword(s):  
Clinical Outcome ◽  
Pain Score ◽  
Ligament Reconstruction ◽  
Ankle Instability ◽  
Degenerative Change ◽  
Medial Compartment ◽  
Functional Score ◽  
Lateral Ankle ◽  
Lateral Ankle Instability

Category: Ankle, Ankle Arthritis, osteoarthritis, ankle instability Introduction/Purpose: When lateral ankle instability (LAI) is not treated for long period, unbalanced loading on medial ankle may proceed to osteoarthritis (OA). Outcome studies about osteoarthritis with lateral ankle instability after stabilization, however, have rarely been reported. The authors have investigated the radiological and clinical outcome of ligament stabilization for LAI with medial compartment OA. Methods: The study is based on 25 ankles of LAI with medial compartment ankle OA that underwent lateral ankle ligament reconstruction from 2007 to 2014 with at least 1 year follow-up. The medial ankle OA was diagnosed with degenerative change of medial ankle on plain X-ray or MRI or arthroscopic findings. The OA was classified using Takakura stage, and arthroscopic degenerative change was classified by modified Outerbridge grading. Ligament stabilization surgery was done using either modified Broström procedure or lateral ligament reconstruction using semitendinosus tendon allograft. Arthroscopic synovectomy, debridement, and microfracture for osteochondral lesion were performed when needed. Clinical outcomes were evaluated using visual analogue scale (VAS) pain score, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Karlsson- Peterson score, and subjective patient satisfaction. Statistical analysis were done using Wilcoxon signed rank test. Results: The average instability duration was 98 (range, 12-480) months and the average follow up period was 46 (range, 13-108) months. Preoperative Takakura stage was mostly I (n=19, 76%) and II (n=4, 17%), and was same postoperatively. MRI OA findings of 18 ankles were medial cartilage denudation (17%), cartilage thinning/erosion (44%), medial osteophyte (50%), and loose bodies (30%). Modified Outerbridge grade 2 and 4 were most common (both 41%). The VAS pain score decreased from 6.1 ± 1.6 preoperatively to 1.8 ± 1.6 postoperatively (P<0.05). The AOFAS score improved from 61.8 ± 14.7 preoperatively to 90.0 ± 6.3 postoperatively, and the Karlsson-Peterson score improved from 54.5 ±14.4 to 89.4 ± 8.4 (P<0.05). There were no significant complications. All patients were satisfied. Conclusion: Ligament stabilization accompanied with arthroscopic procedure could draw good outcome, even without structural bony deformity correction. Even with no improvement in plain radiograph, functional score could be improved.

scholarly journals Closed Reduction And Cannulated Screw Fixation For Pediatric Femoral Neck Fractures: A Case Series

2021 ◽  
Author(s):  
Hakan Cici ◽  
Sabahaddin Kiliç
Keyword(s):  
Femoral Neck ◽  
Closed Reduction ◽  
Screw Fixation ◽  
Case Series ◽  
Femoral Neck Fractures ◽  
Cannulated Screw ◽  
Fixation Method ◽  
Coxa Vara

Objective: Pediatric femoral neck fractures are uncommon injuries. Accurate early reduction and fixation is recommended to avoid serious long-term complications. The aim of this study was to analyze the clinical and radiological outcomes of 12 children with femoral neck fractures who were treated with closed reduction and cannulated screw fixation. Method: Between November 2015 and December 2019, 12 children (4 males,8 females) with an average age of 9.7 were operated by closed reduction and cannulated screw fixation for femoral neck fractures. We evaluated the medical records of all patients, including age, gender, injury mechanism, fracture type, initial displacement, postoperative reduction, follow-up roentgenograms and Ratliff’s scores. Results: The mean follow-up was 22.3 months (range 12–47 months). Six Delbett type 2, five Delbett type 3 and one Delbett type 4 fractures were operated with an avarage time to surgery of 12.5 (range: 1-75 hours). Satisfactory outcomes according to Ratliff’s criteria were obtained in 10 (%83.3) children. Coxa vara occurred in 2 cases. Any avascular necrosis was not seen during the follow-up period. Conclusion: Early closed reduction and cannulated screw fixation may be effective to avoid long-term complications in pediatric femoral neck fractures. Keywords: Femoral neck fracture, Pediatric, Closed reduction

scholarly journals Screw Fixation of the Posterior Malleolus Fragment in Ankle Fracture: Cadaveric and Clinical Studies

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0026
Author(s):  
Gisoo Lee ◽  
Chan Kang ◽  
Yougun Won ◽  
Jae Hwang Song ◽  
Byungki Cho
Keyword(s):  
Clinical Outcomes ◽  
Ankle Fracture ◽  
Screw Fixation ◽  
Articular Surface ◽  
Cannulated Screw ◽  
Ankle Fractures ◽  
Neutral Position ◽  
Early Recovery ◽  
Malleolar Fracture ◽  
Posterior Malleolus

Category: Ankle, Trauma Introduction/Purpose: Previously, a posterior malleolus fragment (PMF) covering 25–30% of the articular surface was a known indication for surgical fixation for ankle fractures. This study aimed to compare the outcomes of screw fixation for PMF comprising <25% of the articular surface and to evaluate the results of cadaver experiments. Methods: The clinical study enrolled ankle fracture patients with PMFs who planned to undergo surgery between March 2014 and February 2017. Among them, 62 with type 1 PMF comprising <25% of the articular surface were included: 32 patients underwent cannulated screw fixation for PMF after fixation for lateral and/or medial malleolar fracture (A group), whereas the other 30 patients underwent internal fixation for lateral and/or medial malleolar fracture but no screw fixation (B group). Clinical outcomes were determined at the 3-, 6-, 12-, and 18-month visits. Additionally, cadaver studies were conducted to evaluate cannulated screw fixation or no fixation in cases of PMFs comprising <25% of the articular surface and >1 mm displacement. Ankle joint stability was measured under external torque on the ankle in the neutral position. The level of significance was set at P < .05. Results: Clinical outcomes at 6 and 12 months after surgery were significantly higher in group A than in group B. However, there was no significant intergroup difference in clinical outcomes at 18 months of follow-up. In the cadaver study, PMF screw fixations were significantly more stable under external rotation force. Conclusion: Screw fixation was significantly useful during early recovery and in short-term clinical outcomes owing to stabilization of ankle fractures with PMF involving <25% of the articular surface.

scholarly journals Radiologic and Clinical Outcomes of Ollier Approach with Screw Fixation for Displaced Intra-Articular Calcaneal Fractures – Comparative Study with Extensile Lateral Approach with Lateral Plating

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0004 ◽  
Author(s):  
Seunghun Woo ◽  
Su-Young Bae ◽  
Hyung Jin Chung ◽  
Tae Sik Goh
Keyword(s):  
Soft Tissue ◽  
Screw Fixation ◽  
Weight Bearing ◽  
Lateral Approach ◽  
Functional Score ◽  
Calcaneal Fractures ◽  
Pain Scores ◽  
Extensile Lateral Approach ◽  
Lateral Plating

Category: Trauma Introduction/Purpose: This study aims to assess the detailed radiologic outcomes which used uninjured side weight-bearing radiograph as a template as well as clinical results to compare the Ollier approach with screw fixation and the extensile lateral approach with lateral plating. Methods: We performed a retrospective review of intra-articular calcaneal fractures treated operatively in our hospital from January 2009 to November 2014. Radiologic outcomes were assessed using radiologic parameters such as Böhler angle, calcaneal height, and talar sagittal angles represent calcaneal deformation by the comparison of the final follow-up bilateral weight-bearing lateral radiograph. Functional outcome was assessed through the American Orthopaedic Foot and Ankle Society (AOFAS) scores and Visual Analog Scale (VAS) pain scores. Postoperative complications were investigated. Results: Ninety-seven unilateral fractures were appeared to match our inclusion criteria: forty-six fractures were treated by using the extensile lateral approach with lateral plating (the ELP group), and fifty-one fractures were treated with the Ollier approach and screw fixation (the OS group). The operation time was significantly shorter in the OA group (p<0.05). There were no significant difference of the final follow-up radiologic parameters between two groups. The mean AOFAS scores were significantly higher in the OS group (p = 0.020) and both groups showed similarity in the VAS pain scores (p = 0.175). Overall soft-tissue complications were 28.3% in the ELP group and 9.8% in the OS group (p = 0.034). Conclusion: No difference could be shown in the postoperative and final follow-up radiological outcomes between the Ollier approach and the extensile lateral approach, but the Ollier approach had better functional score and lower soft tissue complication rate with shorter operative time.

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 Risk Factors for Recurrent Syndesmotic instability after Syndesmotic Screw Fixation in Rotational Ankle Fractures

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0004
Author(s):  
Sunghyun Lee ◽  
Hoiyoung Kwon
Keyword(s):  
Risk Factors ◽  
Screw Fixation ◽  
Significant Risk ◽  
Ankle Fractures ◽  
Binary Logistic Regression Analysis ◽  
Malleolar Fracture ◽  
Syndesmotic Screw ◽  
Posterior Malleolar Fracture ◽  
The Mean ◽  
Recurrence Group

Category: Ankle Introduction/Purpose: Rotational ankle fractures often have unstable syndesmotic injuries the require reduction and stabilization. Though multiple studies have focused on methods to assess accurate syndesmotic reduction, fairly high rates of recurrent syndesmosis diastasis were reported. However, there was no study to investigate possible risk factors for syndesmosis widening after surgical fixation. The purpose of this study was to identify the risk factors for recurrent syndesmosis widening after screw fixation. We hypothesized that risk factors for recurrence syndesmosis widening could be identified from patient demographic, intraoperative variables and the extent of the pathologic condition associated with fractures. Methods: We performed a retrospective review between 2009 and 2015 of consecutive patients who had sustained rotational ankle fractures with intraoperative evidence of syndesmotic instability requiring syndesmotic reduction and stabilization. The exclusion criteria included syndesmosis screws placed for diabetic neuropathy, skeletal immaturity, tibial pilon fractures, polytrauma, open fracture. Patients were sorted into 2 groups according to the presence of recurrent syndesmosis instability which was defined as a difference in the tibiofibular distance of =2 mm between the injured and uninjured ankles on CT at postoperative 1 year and a positive external rotation test. Furthermore, the statistical analysis by binary logistic regression analysis included the significance of various risk factors including age at surgery, sex, diabetes, smoking, body mass index (BMI), dominant side, type of fracture, associated fracture, initial tibiofibular distance on CT, number and size of screws, cortices. The functional outcomes were assessed with the Foot and Ankle Outcome Score (FAOS). Results: A total 126 patients met the study inclusion criteria and underwent analysis. The overall postoperative recurrent instability rate was 25.4% (without recurrence group: 94 patients, recurrence group: 32). It was significantly affected by the BMI (p=0.018; adjusted odds ratio, OR, = 30, 6.21) and concomitant posterior malleolar fracture (p=0.040, adjusted OR 3.31). The other variables were not found to be significant risk factors. There was a significant improvement in the mean clinical scores at one years postoperatively (both p < 0.001), but the mean scores in the group with recurrence were significantly lower than those in the group without recurrence (p=0.021) Conclusion: Among the risk factors, obesity and concomitant posterior malleolar fracture were significant risk factors for the recurrent syndesmotic instability after syndesmotic screw fixation. The overall results suggest meticulous attention to concomitant posterior malleolar fracture, especially in obese patients.

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