scholarly journals Outcomes of Bridge Plating Versus Standard Fixation in Geriatric Ankle Fractures

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0022
Author(s):  
Russell E Holzgrefe ◽  
Amalie Erwood ◽  
Samuel Maidman ◽  
William Runge ◽  
Michael Gottschalk ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Lateral Malleolus ◽  
Ankle Fractures ◽  
Medial Malleolus ◽  
Lag Screw ◽  
Plate Group ◽  
Bridge Plate ◽  
Sf 36 ◽  
One Year ◽  
Bridge Plating

Category: Ankle, Trauma Introduction/Purpose: Ankle fractures represent one of the most common injuries encountered by foot and ankle specialists. Internal fixation of the lateral malleolus can be achieved by several different techniques, most commonly by lag screw and neutralization plating. However, ankle fractures in older patients often present technical challenges as osteoporotic bone is more commonly encountered which may require bridge plating techniques. This study compares outcomes in patients over age 50 years who underwent ORIF of the lateral malleolus with either a bridge plate or lag screw and neutralization plate technique. Methods: This retrospective study evaluated 56 patients with closed ankle fractures, aged over 50 years who underwent open reduction internal fixation of the lateral malleolus. These were divided into two groups: 36 patients had fixation with one or more lag screws and a neutralization plate, and 20 patients had fixation with a bridge plate technique. Fractures were stabilized with lag screw fixation when feasible, while bridge plating was utilized in patients where lag screw fixation was not possible. SF-36 scores were attained at a minimum one-year post-op. Final radiographs and complications were recorded. Results: The lag group had a mean age of 63 years, 17% men, 61% with syndesmotic screw fixation, and 56% with medial malleolus fixation. The bridge group had a mean age of 65 years, 15% men, 60% with syndesmotic screw fixation, and 70% with medial malleolus fixation. At minimum one-year, SF-36 physical component summary score was 74.2 ± 19.4 in the lag group vs 63.2 ± 24.8 in the bridge plate group (p=0.049). The SF-36 mental component summary score was 89.2 ± 12 in the lag group vs 75.5 ± 22.7 in the bridge plate group (p=0.009). One patient in each group required return to the OR for irrigation and debridement for infection. No patients experienced fixation failure and all fractures demonstrated union on final radiograph. Conclusion: In the present study of patients over age 50 years who underwent ORIF of an ankle fracture, as compared with bridge plating, lag screw and neutralization plating is associated with superior one-year SF-36 physical and mental summary scores with similar rates of complications. However, additional research is needed to determine to what degree this difference is causative or correlative with confounding variables as fixation technique was not found to be an independent predictor of SF-36 outcomes in this small cohort.

scholarly journals Dorsal bridge plating or transarticular screws for Lisfranc fracture dislocations

2018 ◽  
Vol 100-B (4) ◽  
pp. 468-474 ◽  
Author(s):  
N. Kirzner ◽  
P. Zotov ◽  
D. Goldbloom ◽  
H. Curry ◽  
H. Bedi
Keyword(s):  
Screw Fixation ◽  
Combination Group ◽  
Anatomical Reduction ◽  
Aofas Score ◽  
Combination Technique ◽  
Plate Group ◽  
Bridge Plate ◽  
Fracture Dislocations ◽  
Bridge Plating ◽  
Screw Group

AimsThe aim of this retrospective study was to compare the functional and radiological outcomes of bridge plating, screw fixation, and a combination of both methods for the treatment of Lisfranc fracture dislocations.Patients and MethodsA total of 108 patients were treated for a Lisfranc fracture dislocation over a period of nine years. Of these, 38 underwent transarticular screw fixation, 45 dorsal bridge plating, and 25 a combination technique. Injuries were assessed preoperatively according to the Myerson classification system. The outcome measures included the American Orthopaedic Foot and Ankle Society (AOFAS) score, the validated Manchester Oxford Foot Questionnaire (MOXFQ) functional tool, and the radiological Wilppula classification of anatomical reduction.ResultsSignificantly better functional outcomes were seen in the bridge plate group. These patients had a mean AOFAS score of 82.5 points, compared with 71.0 for the screw group and 63.3 for the combination group (p < 0.001). Similarly, the mean Manchester Oxford Foot Questionnaire score was 25.6 points in the bridge plate group, 38.1 in the screw group, and 45.5 in the combination group (p < 0.001). Functional outcome was dependent on the quality of reduction (p < 0.001). A trend was noted which indicated that plate fixation is associated with a better anatomical reduction (p = 0.06). Myerson types A and C2 significantly predicted a poorer functional outcome, suggesting that total incongruity in either a homolateral or divergent pattern leads to worse outcomes. The greater the number of columns fixed the worse the outcome (p < 0.001).ConclusionPatients treated with dorsal bridge plating have better functional and radiological outcomes than those treated with transarticular screws or a combination technique. Cite this article: Bone Joint J 2018;100-B:468–74.

scholarly journals Functional outcome of bimalleolar ankle fractures treated with fibular plate for lateral malleolus and C.C. screws for medial malleolus

2020 ◽  
Vol 6 (1) ◽  
pp. 1126-1132
Author(s):  
Dr. Sachin Kale ◽  
Dr. Pratik Tank ◽  
Dr. Rahul Ghodke ◽  
Dr. Pankaj Singh ◽  
Dr. Abhiraj Patel
Keyword(s):  
Functional Outcome ◽  
Lateral Malleolus ◽  
Ankle Fractures ◽  
Medial Malleolus

scholarly journals The Fibular Intramedullary Nail Versus Locking Plate and Lag Screw Fixation in the Management of Unstable Elderly Ankle Fractures: A Cadaveric Biomechanical Comparison

2020 ◽  
Vol 34 (11) ◽  
pp. e401-e406
Author(s):  
Thomas H. Carter ◽  
Robert Wallace ◽  
Samuel A. Mackenzie ◽  
William M. Oliver ◽  
Andrew D. Duckworth ◽  
...  
Keyword(s):  
Intramedullary Nail ◽  
Locking Plate ◽  
Screw Fixation ◽  
Ankle Fractures ◽  
Lag Screw ◽  
Biomechanical Comparison

scholarly journals Bridge Plate Fixation Results in Better Functional Outcomes Than Transarticular Screw Fixation for Low-Energy Lisfranc Injuries

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Joseph Bellamy ◽  
Grant Cochran
Keyword(s):  
Plate Fixation ◽  
Low Energy ◽  
Categorical Variables ◽  
Complication Rates ◽  
Transarticular Screw ◽  
Plate Group ◽  
Bridge Plate ◽  
Lisfranc Injuries ◽  
Bridge Plating ◽  
Screw Group

Category: Midfoot/Forefoot, Sports, Trauma Introduction/Purpose: Open reduction and internal fixation (ORIF) with transarticular screws or bridge plating is the standard of care for unstable Lisfranc injuries. There are no studies comparing the clinical outcomes of fixation with transarticular screws or bridge plates in young, athletic patients who sustained low-energy injuries. Methods: All low-energy Lisfranc injuries that underwent ORIF between 2010 and 2015 were reviewed. Injuries were classified as low-energy if the occurred during athletic activity, ground level twisting, or a fall from less than three feet (typically stairs or curbs). Tarsometatarsal (TMT) joint fixation with transarticular screws or bridge plating was documented. Transarticular screws were typically removed between four and six months postoperatively. Injury characteristics, complication rates, pain scores, and Foot and Ankle Ability Measure (FAAM) scores were compared. All continuous variables were compared with a two-tailed Student t-test. All categorical variables were compared using the Chi Squared test. Results: Of the fifteen patients identified, nine were fixed with transarticular screws and six with bridge plates. Average patient age was 27 years old. 12 of 15 were primarily ligamentous injuries. Implant removal was performed in the entire transarticular screw group and three out of six in the bridge plate group (p=0.018). Secondary arthrodesis for arthritis was recommended in two of the transarticular screw group and none of the bridge plate group (p=0.21). Mean FAAM scores were significantly higher in all subscales (ADL 96.2 v 76.7 p=.035, ADL SANE 92.5 v 72.6 p=.055, Sport 89.5 v 62.5 p=.027, Sport SANE 90 v 58.7 p=.024) in the bridge plate group at an average of 43 months follow up. Conclusion: In this study, ORIF with bridge plate fixation of the TMT joints had a lower rate of HWR and higher medium term FAAM scores than fixation with transarticular screws. A statistically significant difference in rates of secondary arthritis could not be established in this small cohort. Prospective studies are necessary to confirm these findings.

Complications of lateral plate fixation compared with tension band wiring and pin or lag screw fixation for calcaneoquartal arthrodesis

2013 ◽  
Vol 26 (06) ◽  
pp. 445-452 ◽  
Author(s):  
C. S. Knudsen ◽  
M. Gosling ◽  
M. McKee ◽  
R. G. Whitelock ◽  
G. I. Arthurs ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Screw Fixation ◽  
Plate Fixation ◽  
Tension Band ◽  
Complication Rates ◽  
Lateral Plate ◽  
Lag Screw ◽  
Tension Band Wire ◽  
Plate Group ◽  
Pin Fixation

SummaryObjective: To compare complication rates and the outcomes of these complications after lateral plate fixation with figure-ofeight tension-band-wire and pin or lag screw fixation for arthrodesis of the calcaneoquartal joint, following non-traumatic disruption of the plantar tarsal ligament in dogs.Methods: Data were collected retrospectively from five UK referral centres. Diplomate specialists and their residents performed all procedures. Referring veterinarians were contacted for long-term follow-up.Results: Seventy-four procedures were undertaken in 61 dogs. There were 58 arthrodeses in the lateral plate group (Plate), nine in the pin and tension-band-wire group (Pin), and seven in the lag screw and tension-band wire-group (Screw). Compared to Plate (17%), further surgical intervention was required more frequently following Pin (56%, OR = 3.2) or Screw (43%, OR = 2.5) fixation. Clinical failure of arthrodesis occurred less frequently with Plate (5%) compared with Screw (43%, OR = 8.6) and Pin fixation (22%, OR = 4.4). Cases managed with external coaptation postoperatively were more likely to suffer from postoperative complications (OR = 2.2).Clinical significance: Lateral plating was associated with fewer postoperative complications than pin and tension-band-wire fixation for arthrodesis of the calcaneoquartal joint in dogs with non-traumatic disruption of the plantar tarsal ligament.

scholarly journals Effect of Post-Operative Toradol Administration on Bone Healing After Ankle Fracture Fixation

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Elizabeth McDonald ◽  
Brian Winters ◽  
Rachel Shakked ◽  
David Pedowitz ◽  
Steven Raikin ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Tobacco Use ◽  
Bone Healing ◽  
Historical Control ◽  
Lateral Malleolus ◽  
Ankle Fractures ◽  
Medial Malleolus ◽  
Foot And Ankle ◽  
Factors Associated ◽  
Posterior Malleolus

Category: Ankle, Trauma Introduction/Purpose: Ketorolac has been reported to delay bone healing when administered after spine surgery, and there is hesitancy to use non-steroidal anti-inflammatories (NSAIDs) in the fracture setting despite its reliable ability to relieve surgical pain. The effect of ketorolac administration after foot and ankle surgery has not been well-defined in the literature to date. The purpose of this study is to report clinical and radiographic outcomes for patients treated with a perioperative ketorolac regimen after open reduction and internal fixation (ORIF) of ankle fractures. A secondary purpose is to determine whether there are other patient factors that affect radiographic healing in this population. We hypothesize that the time to radiographic healing with ketorolac use after ORIF of ankle fractures is no different than a historical control. Methods: A retrospective chart review was performed on all patients that received perioperative ketorolac at the time of lateral malleolar, bimalleolar, and trimalleolar ankle ORIF by a single surgeon between 2010 and 2016 with minimum 4 months follow-up. Patients were prescribed 5 days of 10 mg ketorolac every 6 hours. Radiographs were evaluated independently by two blinded fellowship-trained foot and ankle surgeons to assess for radiographic healing of lateral malleolus, medial malleolus, and posterior malleolus fractures at 6, 12, and 16 weeks post-operatively. Two hundred and ninety-four patients were included with an average age of 50 years with 138 males (47%). Literature review was performed to determine an appropriate historical control of time to radiographic healing after ankle ORIF for comparison. Statistical analysis consisted of a linear mixed-effects regression which was performed to estimate the effect of time and covariates, taking into account repeated measurements on the same subject. Results: Radiographic healing was demonstrated by 16 weeks in 221 of 281 (79%) lateral malleolus fractures, 105 of 132 medial malleolus fractures (80%), and 53 of 57 (93%) posterior malleolus fractures (see Figure 1). Median healing times were 12, 11, and 6 weeks for lateral, medial, and posterior malleoli fractures respectively. There was no significant difference in time to radiographic healing of lateral malleolus when compared to a historical control of 16.7 weeks to union. Active tobacco use was an independent risk factor for delayed radiographic healing (p < 0.05). Diabetes mellitus and age greater than 50 years were independent factors associated with faster healing of the lateral malleolus fractures (p < 0.05). Rheumatoid arthritis, oral steroid use, and obesity had no effect on radiographic healing. Conclusion: Perioperative ketorolac use did not affect radiographic healing of ankle fractures after ORIF. As expected, active tobacco use was associated with slower radiographic healing. There is no evidence that ketorolac use further delayed union in smokers, but this may warrant further study. We unexpectedly identified diabetes mellitus and older age as factors associated with faster healing which also warrants further study. This is the first study to date examining the effect of ketorolac on radiographic time to union of ankle fractures. Further study may help determine whether ketorolac helps reduce opioid consumption and improve pain following ORIF of ankle fractures.

Percutaneous screw fixation for painful non-union of lateral malleolus ankle fractures

Injury ◽  
2018 ◽  
Vol 49 (10) ◽  
pp. 1936-1941
Author(s):  
Timothy J. Batten ◽  
Charlotte Scott-Davies ◽  
Michael Butler ◽  
Stephen W. Parsons ◽  
Richard P. Walter
Keyword(s):  
Screw Fixation ◽  
Lateral Malleolus ◽  
Ankle Fractures ◽  
Percutaneous Screw Fixation ◽  
Non Union

Incomplete ossification of the humeral condyle as the cause of lameness in dogs

2002 ◽  
Vol 15 (03) ◽  
pp. 187-194 ◽  
Author(s):  
V. Heinen ◽  
M. Fehr ◽  
I. Nolte ◽  
A. Meyer-Lindenberg
Keyword(s):  
Computed Tomography ◽  
Screw Fixation ◽  
Osteochondrosis Dissecans ◽  
Prospective Trial ◽  
Olecranon Fracture ◽  
Lag Screw ◽  
Post Operation ◽  
One Year ◽  
Condylar Fractures ◽  
Humeral Condyle

SummaryIn a retrospective and prospective trial over six years, 17 joints from 13 dogs presented with incomplete ossification of the humeral condyle (IOHC) were included. All dogs showed lameness of the forelimb but no humeral condylar fractures. One dog showed a fracture of the olecranon. Four of the bilaterally affected dogs showed only unilateral lameness. 53.8% of the dogs (7/13) were younger than one year. With regard to breed distribution, the German Wachtel was most frequently represented with three dogs. In 12 dogs the diagnosis was made by radiography in a craniocaudal view, and seven dogs could be further investigated by computed tomography. In one dog the diagnosis was only made during arthroscopy. Two joints showed an additional fragmented medial coronoid process of the ulna and another two an osteochondrosis dissecans of the medial humeral condyle. During arthroscopy, all joints showed a clearly visible fissure line in the joint cartilage between the humeral condyles. In ten joints the I0HC was treated with a transcondylar lag screw under arthroscopic control. Three of the four bilaterally affected dogs were treated only unilaterally because of a lack of lameness on the other side. In the dog with the olecranon fracture, only the fracture was treated. The patients were rechecked clinically and radiologically (n = 10) or by means of a questionnaire (n = 1) at an average of 26 months post operation. Seven cases, six of them treated by lag screw fixation, did not show any lameness. Three joints (one dog with olecranon fracture, two unilaterally affected dogs with lag screw fixation) showed some degree of lameness after heavy strain and one dog showed a continuous slight lameness. The four bilaterally affected and only unilaterally treated dogs showed no lameness on the untreated joint. With regard to development of arthrosis, six radiographically examined joints showed no increase in arthroses. In five joints the increase was mild and in two joints moderate. In six joints with lag screw fixation, the IOHC was radiographically unified and was confirmed by computed tomography in three cases.

scholarly journals Incidence of Chondral and Osteochondral Lesions in Ankle Fracture Patients Identified with Ankle Arthroscopy Following Rotational Ankle Fracture

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0049
Author(s):  
Emilie Williamson ◽  
Kevin Rosas ◽  
John Dankert ◽  
James P. Toale ◽  
Eoghan T. Hurley ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
Ankle Arthroscopy ◽  
Chondral Lesion ◽  
Lateral Malleolus ◽  
Ankle Fractures ◽  
Medial Malleolus ◽  
Fracture Type ◽  
Malleolar Fracture ◽  
Chondral Lesions ◽  
Chondral Injury

Category: Ankle; Trauma Introduction/Purpose: It is controversial whether routine arthroscopy is beneficial at the time of ankle fracture fixation. This may be, in part, due to sparse information regarding the incidence of chondral injury in the setting of ankle fractures.The purpose of this study is to systematically review the incidence of chondral injures in patients with ankle fractures and to further characterize intra-articular chondral injuries of the talus, tibial plafond, medial malleolus, and lateral malleolus in patients who undergo ankle arthroscopy following an ankle fracture. Methods: The literature search was performed based on the PRISMA guidelines. Studies evaluating the incidence of chondral lesions at the time of arthroscopy for ankle fractures were included. The incidence of intraarticular chondral lesions was recorded, as well as location within the ankle, ankle fracture type, time of arthroscopy, characterization of chondral injury, complications, and outcome if available. All statistical analyses were carried out with statistical software package SPSS 24.0 (SPSS, Chicago, IL, USA). Multiple comparisons were used to compare incidence rates of chondral injury based on Weber classification, malleolar fracture type, and Lauge-Hansen classification, using Pearson chi-square test. For all analyses, p < 0.05 was considered statistically significant. Results: Fifteen studies with 1,355 ankle fractures were included. Of those ankles, 738 demonstrated evidence of chondral or osteochondral lesion (54.5%). Overall, 648 ankles had chondral lesions on the talus (47.8%), 207 ankles had lesions on the tibial plafond (15.3%), 165 has lesions of the lateral malleolus (12.2%), and 133 had lesions of the medial malleolus (9.8%). Weber C group had significantly higher incidence than Weber A group (p=0.015). Trimalleolar and isolated lateral malleolar fracture groups had significantly higher incidence of chondral injury than bimalleolar and isolated medial malleolar fracture groups (p<0.001). A significant difference was found in occurrence rate of chondral injury among Lauge-Hansen classification, with supination-adduction having the lowest incidence (p=0.001). Conclusion: Our study found a high incidence of intra-articular chondral lesion in the setting of ankle fractures as demonstrated by arthroscopy, with more than half of all patients having a chondral lesion. Talar lesions were most common. This study may help direct greater attention to the Talus as a source of chondral injury particularly in higher grade fracture patterns.

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