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.

scholarly journals Ankle Arthroscopy for Diagnosis and Treatment of Full Thickness Cartilage Lesions in the Setting of Ankle Fracture

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Sydney Karnovsky ◽  
Mark Drakos ◽  
William Schairer ◽  
Rachael Da Cunha
Keyword(s):  
Clinical Outcomes ◽  
Ankle Fracture ◽  
Ankle Arthroscopy ◽  
Chondral Lesion ◽  
Ankle Fractures ◽  
Full Thickness ◽  
Talar Dome ◽  
Fracture Characteristics ◽  
Chondral Lesions ◽  
Chondral Injury

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Ankle fractures treated with anatomic open reduction and internal fixation (ORIF) can still be associated with poor clinical outcomes. The presence of radiographically occult intra-articular chondral injury is a known entity, however the clinical relevance in the setting of ankle fractures is not well established. The purpose of this study aims to evaluate the prevalence of chondral lesions, in particular full thickness talar dome lesions, with concurrent arthroscopy in acute ankle fracture ORIF and determine if there is a correlation with patient and fracture characteristics. In addition, we aimed to evaluate the treatment effect on clinical outcomes to establish the role of concurrent arthroscopy in ankle fracture management. Methods: A retrospective chart review was conducted from prospectively collected registry data at the investigators’ institution from 2011 to 2016. All patients that underwent an acute ankle fracture ORIF with concurrent arthroscopy were identified. Patients with concomitant injuries were excluded. Baseline patient and fracture characteristics were recorded. Fracture type by the Lauge-Hansen classification as well as by anatomic location were determined. Charts were reviewed to determine the prevalence and grade of chondral lesions. The treatment performed for each chondral lesion was determined. Clinical outcomes with a minimum of one year follow up were assessed using the Foot and Ankle Outcome Score (FAOS). Results: One hundred and sixteen consecutive patients undergoing acute ankle fracture ORIF with concurrent arthroscopy were included. A chondral lesion was identified in 78% (90/116). Of those, a Grade IV full thickness talar dome chondral lesion was identified in 43% (39/90). Patient age was a significant predictor, with patients less than thirty being less likely to have a chondral injury compared to those greater than thirty (59% vs 85%, p=0.0077). Of the patients that sustained a dislocation at the time of injury, 100% had a chondral lesion which was statistically significant (p=0.039). Patients with complete syndesmosis disruption and instability were also more likely to have a chondral lesion (96% vs 73%, p=0.013). Patients with chondral lesions had statistically significant worse clinical outcomes than those without (Table). Conclusion: Arthroscopy performed concomitantly with ankle ORIF is useful in diagnosing chondral injuries. In particular, full thickness talar dome chondral lesions are quite common. Increased fracture severity, as indicated by the presence of a dislocation at presentation, and a syndesmotic injury may be more likely to present with a chondral lesion and thus should raise suspicion and prompt evaluation. The presence of a concurrent talar chondral injury has a negative impact on clinical outcomes. Concurrent arthroscopy allows for simultaneous diagnosis and acute treatment of full thickness talar lesions.

scholarly journals Arthroscopic Findings During Routine Ankle ORIF: What is Being Missed?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0026
Author(s):  
Shain Howard ◽  
Victor C. Hoang ◽  
Troy S. Watson ◽  
Candice L. Brady ◽  
Adam Eudy
Keyword(s):  
Fracture Fixation ◽  
Ankle Fracture ◽  
External Rotation ◽  
Ankle Arthroscopy ◽  
Ankle Fractures ◽  
Osteochondral Lesions ◽  
Fracture Type ◽  
Syndesmotic Injury ◽  
Patient Reported ◽  
Articular Pathology

Category: Ankle; Arthroscopy; Trauma Introduction/Purpose: Ankle fractures are among the most common operatively treated injuries by orthopedic surgeons. However, up to 20% of patients will have continued pain and poor patient reported outcomes despite good/excellent radiographic results. Ankle fractures typically occur with varying degrees of intra-articular and soft tissue injury which can include ligamentous injury, loose bodies, and chondral lesions. The aim of study is to document intra-articular findings with ankle arthroscopy prior to ankle open reduction internal fixation (ORIF) and to contribute to the growing body of literature that shows this to be a safe adjunct to fracture fixation. Methods: IRB approval was obtained prior to chart review. This is a retrospective review of ankle fractures that were treated with arthroscopy and ORIF by a single surgeon. Between August 2016 and July 2018 Operative reports, office notes, and images were reviewed to identify intra-articular pathology and fracture type. Analysis was performed with regard to fracture type, presence and location of osteochondral lesions, presence of loose-body, syndesmotic injury, and deltoid injury. Results: Fifty-seven ankle fractures were identified that met inclusion criteria. 84.2% of the fractures had intra-articular pathology, most commonly a syndesmotic injury followed by loose joint body and osteochondral defect. Conclusion: Arthroscopic evaluation during ankle fracture ORIF, particularly pronation external rotation and supination external rotation patterns give a more detailed examination of associated pathology. Arthroscopy at the time of ankle fracture fixation is a safe adjunct and should be considered a potential compliment to routine ORIF of ankle fractures.

scholarly journals Second-Look Arthroscopic Findings and Clinical Outcomes After Management of Intra-Articular Lesions in Acute Ankle Fractures with Arthroscopy

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Jeon-Gyo Kim ◽  
Heuichul Gwak ◽  
Sangmyung Roh
Keyword(s):  
Clinical Outcomes ◽  
Ankle Fracture ◽  
Arthroscopic Surgery ◽  
Osteochondral Lesion ◽  
Ankle Arthroscopy ◽  
Ankle Fractures ◽  
Chondral Lesions ◽  
Second Look ◽  
Initial Surgery ◽  
Arthroscopic Finding

Category: Ankle, Arthroscopy, Trauma Introduction/Purpose: Anatomically successful surgical reduction of ankle fractures does not always result in a clinically favorable outcome. The purpose of the present study was to compare initial and second look arthroscopic finding of acute ankle fracture and to evaluate clinical outcomes. Methods: A total of 39 patients (40 ankles, 20 male, 20 female) who underwent surgery for ankle fracture between March 2009 and August 2016 were retrospectively reviewed. All patients gave consent to the exploratory arthroscopic surgery for the removal of internal fixation devices placed in the initial surgery. Intra-articular lesions (osteochondral lesion, loose body, injury of ligaments and fibrosis) were evaluated via ankle arthroscopy. Arthroscopic finding of osteochondral lesion were classified using the Ferkel and Cheng staging system, and cartilage repair was assessed using the international Cartilage Repar System (ICRS). Clinicial outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and Visual Analogue Scale (VAS) Results: Chondral lesions were found in 26 ankles (65%) with initial arthroscopic finding of acute ankle fracture. Newly discovered chondral lesions in second-look arthroscopy was 15 cases. Accoding to the Ferkel and Cheng staging at second-look arthroscopy, 4 of 23 ankles with chondral lesions of talus was getting worse (more than stage D). In terms of ICRS overall repair grades, 4 ankle (15%) were abnormal (grade III). Diffuse synovitis and arthrofibrosis were found in 12 and 7 ankles respectively in second-look arthroscopy. Correlation were found between AOFAS scores, VAS and intra-articular lesions with second-look arthroscopy. Conclusion: Second-look arthroscopic examination combined with treatment of intra-articular lesion arising from ankle fracture surgery may consider to improve clinical outcomes.

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 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 Role of Arthroscopy in Ankle Fracture Surgery

2019 ◽  
Vol 7 (11_suppl6) ◽  
pp. 2325967119S0045
Author(s):  
Jae Hoon Ahn
Keyword(s):  
Internal Fixation ◽  
Ankle Fracture ◽  
Postoperative Outcome ◽  
Persistent Pain ◽  
Ankle Arthroscopy ◽  
Ankle Fractures ◽  
Definitive Treatment ◽  
Syndesmosis Injury ◽  
Poor Outcomes

The ankle arthroscopy is widely used as an essential tool for the various ankle disorders. The use of arthroscopy has also been tried for the treatment of acute ankle fractures, in the hope of improving the postoperative outcome. It was initially thought that the properly reduced ankle fractures had generally acceptable outcomes, with a reported rate of 81% good to excellent results. However further investigation and longer term follow-up has shown more mixed and less encouraging results. Some patients have persistent pain and poor outcomes following open reduction and internal fixation (ORIF), although the cause of poor outcome is not clearly understood. It may be secondary to intra-articular injuries at the time of fracture, which occur in up to 88% of fractures. Ankle arthroscopy at the time of ORIF has been proposed to address these intraarticular injuries. Arthroscopy-assisted reduction and percutaneous screw fixation for syndesmosis injury has been performed as well by some surgeons. However the effectiveness of true arthroscopic reduction and internal fixation compared with ORIF for ankle fractures has yet to be determined, in spite of the advantages such as limited exposure, preservation of blood supply, and improved visualization of the pathology. Postoperative chronic pain and arthrofibrosis after ankle fracture are another good indication for ankle arthroscopy, which can be performed at the time of implant removal. In conclusion, the ankle arthroscopy is a safe adjunctive procedure for the treatment of ankle fractures. It can be performed as well for the evaluation and management of syndesmotic injury, and for persistent pain following the definitive treatment of ankle fractures.

scholarly journals BIMALLEOLAR ANKLE FRACTURE: A SIMPLE FRACTURE?

2017 ◽  
Vol 25 (1) ◽  
pp. 48-51 ◽  
Author(s):  
JUNJI MILLER FUKUYAMA ◽  
ROBINSON ESTEVES SANTOS PIRES ◽  
PEDRO JOSÉ LABRONICI ◽  
JOSÉ OCTÁVIO SOARES HUNGRIA ◽  
RODRIGO LOPES DECUSATI
Keyword(s):  
Ankle Fracture ◽  
Fragment Size ◽  
External Rotation ◽  
Ankle Fractures ◽  
Ligament Injury ◽  
Deltoid Ligament ◽  
Medial Malleolus ◽  
Level Of Evidence ◽  
Deltoid Ligament Injury ◽  
Supination External Rotation

ABSTRACT Objective: To evaluate the frequency of deltoid ligament injury in bimalleolar supination-external rotation type fractures and whether there is a correlation between the size of the fractured medial malleolus and deltoid ligament injury . Methods: Twenty six consecutive patients underwent magnetic resonance exams after clinical and radiographic diagnosis of bimalleolar supination-external rotation type ankle fractures . Results: Thirteen patients (50%) presented deltoid ligament injury associated to bimalleolar ankle fracture. Partial injury was present in seven (26.9%) patients and total injury in six (23.1%). Regarding medial fragment size, the average was 2.88 cm in the absence of deltoid ligament injury. Partial injuries presented 1.93 cm and total 2.1 cm on average . Conclusion: Deltoid ligament injury was present in 50% of bimalleolar ankle fractures. Smaller medial malleolus fragments, especially concerning the anterior colliculus, presented greater association with partial deltoid ligament injuries. Level of Evidence IV, Cross Sectional Study.

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.

scholarly journals The Distribution Pattern of the Neurovascular Structures for Anterior Ankle Arthroscopy to Minimize Structural Injury: Anatomical Study

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Anna Jeon ◽  
Chang Min Seo ◽  
Je-Hun Lee ◽  
Seung-Ho Han
Keyword(s):  
Anatomical Study ◽  
Ankle Arthroscopy ◽  
Lateral Malleolus ◽  
Reference Line ◽  
Medial Malleolus ◽  
Entry Points ◽  
Structural Injury ◽  
Age Range ◽  
Arteries And Veins ◽  
Neurovascular Structures

Introduction. The aim of this study was to investigate entry points for anterior ankle arthroscopy that would minimize the risk of neurovascular injury. Methods. Thirty-eight specimens from 21 Korean cadavers (age range from 43 to 92 years, mean age of 62.3 years) were used for the study. For the measurements, the most prominent points of the lateral malleolus (LM) and the medial malleolus (MM) were identified before dissection. A line connecting the LM and MM, known as the intermalleolar line, was used as a reference line. We measured 14 variables passed on the reference line. Results. This study found that the nerves were located at 40.0%, 50.0%, and 82.0% of the reference line from the lateral malleolus. We also found that the arteries were located at 22.0%, 35.0%, and 60% of the reference line from the lateral malleolus. Discussion. If all the variables are combined (nerves, arteries, and veins), then there is no safety zone for anterior portal placement. Therefore, we recommend that surgeons concentrate primarily on the arteries and nerves in the clinical setting.

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