Morphological analysis of posterior malleolar fractures with intra-articular impacted fragment in computed tomography scans

Abstract Background Intraarticular impacted fragment (IAIF) of posterior malleolar fractures has been reported by a few studies. However its location, morphology, and the correlation of posterior malleolar fractures have not been described in detail. The aim of this study was to describe the morphology of IAIF in posterior malleolar fractures, to analyze the related factors between IAIF and posterior malleolar fragments, and explore the treatment of IAIF. Materials and methods Between January 2013 and December 2018, 108 consecutive patients with unilateral posterior malleolar fractures were managed in our hospital. Basic demographic and computed tomography (CT) data were collected and classified by Lauge–Hansen, OTA/AO, Haraguchi, and Mason classification. Additional radiographic data, including the length and area of posterior malleolar fragment, IAIF, and stable tibial plafond were measured. The location of IAIF was described, and involvement of the fibular notch and medial malleolus was also observed. Statistics were analyzed based on univariate analysis (Chi-square test, t-test, Mann–Whitney U test, Fisher’s test) and Spearman’s correlation test. Results Among the 108 cases of posterior malleolar fractures, 75 (69.4%) were with IAIF and 33 (30.6%) cases were without. There were 74 (68.5%) females and 34 (31.5%) males, and the average age of the patients was 49 years (18–89 years). The average LIFN/(LIFN + LSFN) [length of involving fibular notch/(length of involving fibular + length of stable notch fibular notch)] was 32.9% (11.6–64.9%). The APMF/(APMF + ASTP + AIAIF) [area of posterior malleolar fragment/(area of posterior malleolar fragment + area of IAIF + area of stable tibial plafond)] and AIAIF/APMF (area of IAIF/area of posterior malleolar fragment) were 13.1% (0.8–39.7%) and 52.6% (1.2–235.4%), respectively. Involvement of medial malleolus (fracture line extended to medial malleolus, P = 0.022), involvement of fibular notch (P = 0.021), LIFN/(LIFN + LSFN) (P = 0.037), LMPMF (P = 0.004), and APMF were significantly related to the occurrence of IAIF. Conclusion Our research indicates a high incidence of IAIF in posterior malleolar fractures. All IAIFs were found in posterior malleolar, and the most common location was within the lateral area A. Posterior malleolar fracture lines that extend to medial malleolus or fibular notch herald the incidence of IAIF. LIFN/(LIFN + LSFN), LMPMF and APMF are also associated with the incidence of IAIF. CT scans are useful for posterior malleolar fractures to determine the occurrence of IAIF and make operational plans. Operation approach selection should be based on the morphology of posterior malleolar fragments and the location of IAIF. Level of evidence Level III, retrospective case analysis.

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Posterior malleolar fractures. New classification and treatment algorithm

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2020.v14.1199 ◽

2020 ◽

Vol 14 (3) ◽

pp. 254-259

Author(s):

Diego Yearson ◽

Ignacio Melendez ◽

Federico Anain ◽

Santiago Siniscalchi ◽

Juan Drago

Keyword(s):

Posterior Approach ◽

Treatment Algorithm ◽

Case Series ◽

Fracture Pattern ◽

Joint Surface ◽

Medial Malleolus ◽

New Classification ◽

Level Of Evidence ◽

Malleolar Fractures ◽

Posterior Malleolus

Objective: This study proposes a new classification of posterolateral malleolar fractures and a treatment algorithm. Methods: We divided the posterolateral malleolus, which we considered as the posterior malleolus, from the posteromedial one, which we considered as being part of the medial malleolus fracture. The experience with 77 patients treated from February 2017 to February 2020 was assessed. All of them were assessed by frontal and profile radiographies and computed tomography (CT). Among the parameters to classify these fractures, we believe the most determining ones are fracture size, followed by presence of fracture displacement. Results: Fractures were divided into those whose posterior fragment was 25% smaller than the tibial joint surface and those that compromised more than 25% of this joint. The first group underwent syndesmotic opening and was subclassified into 1A (stable fractures), which do not require surgical treatment, and 1B (unstable), which require syndesmotic stabilization. The second group, which comprised the larger fractures, was subclassified into 2 A (non-displaced fractures, or with a displacement below 2 mm), which underwent percutaneous osteosynthesis, 2B (displaced fractures), and 2C (comminuted fractures), which underwent open reduction and internal fixation using a posterior approach. Conclusion: The classifications published so far are anatomic or descriptive, but none of them proposes a therapeutic algorithm for each type of fracture. We believe it will be helpful for its interpretation and decision-making on the need to perform a posterior approach, prioritizing the anatomical reduction of the joint fragment and resolution of syndesmotic instability linked to each fracture pattern using the most simple and effective method. Level of Evidence IV; Therapeutic Studies; Case Series.

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Single- vs 2-Screw Lag Fixation of the Medial Malleolus in Unstable Ankle Fractures

Foot & Ankle International ◽

10.1177/1071100719840995 ◽

2019 ◽

Vol 40 (7) ◽

pp. 790-796 ◽

Cited By ~ 1

Author(s):

Jessica Mandel ◽

Omar Behery ◽

Rajkishen Narayanan ◽

Sanjit R. Konda ◽

Kenneth A. Egol

Keyword(s):

Ankle Fracture ◽

Fragment Size ◽

Smoking Status ◽

Medial Malleolus ◽

Retrospective Case ◽

Level Of Evidence ◽

Initial Injury ◽

American Society ◽

Fixation Points ◽

American Society Of Anesthesiologists

Background: The purpose of this study was to determine the efficacy of medial malleolar fixation with 1 vs 2 screws. Methods: Between April 2013 and February 2017, 196 patients who presented at 2 hospitals within one academic institution with an unstable rotational ankle fracture with a medial fracture and were treated operatively by a trained orthopedic surgeon were identified. These patients’ charts were reviewed and their injury, radiographic, surgical, and follow-up data recorded. Medial malleolus fragment size was assessed on the anteroposterior (AP) and lateral views of the initial injury radiograph. Functional outcome was assessed using Maryland Foot Score (MFS). Patients were grouped based upon the number of screws utilized to fox the medial malleolar fragment. Data were assessed using Fisher exact tests and independent t tests with SPSS, version 23. Results: Out of the 196 patients who met inclusion criteria, 47 patients (24%) were fixed with 1 medial malleolar screw and 149 patients (76%) were fixed with 2 screws. There were no differences among patients who received 1 vs 2 screws with regard to age, gender, body mass index, American Society of Anesthesiologists grade, or smoking status. The average malleolar fragment size was smaller in those treated with 1 screw on both the AP and lateral radiographic views than those with 2 screws ( P = .009, P = .001, respectively). There was no difference between groups in ankle dorsiflexion or plantarflexion at 1 year postoperation ( P = .451, P = .581). Patients who received 1 screw did not differ from those who received 2 screws with respect to Maryland Foot Scores ( P = .924). There was no difference in rate of revision surgery or need for hardware removal between groups ( P = .093). Furthermore, time to healing and postoperative complication rate did not differ between groups. Conclusion: The use of a single screw for medial malleolar fixation provided stable fixation to allow ankle fracture healing, without an increase in complications. This information is especially important in situations when the fragment is too small to accommodate multiple fixation points. Level of Evidence: Level III, retrospective case-control study.

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Midfoot Arthrodesis following Multi-Joint Stabilization with a Novel Hybrid Plating System

Foot & Ankle International ◽

10.3113/fai.2012.0220 ◽

2012 ◽

Vol 33 (3) ◽

pp. 220-225 ◽

Cited By ~ 14

Author(s):

Jorge Filippi ◽

Mark S. Myerson ◽

Mark W. Scioli ◽

Bryan Dale Den Hartog ◽

David B. Kay ◽

...

Keyword(s):

Computed Tomography ◽

Body Mass Index ◽

Healing Rate ◽

Case Series ◽

The Other ◽

Joint Disease ◽

Retrospective Case ◽

Exclusion Criteria ◽

Level Of Evidence ◽

Joint Gap

Background: Several methods for fixation have been described for midfoot arthrodesis. Multi-joint arthrodesis at this level can be challenging because of bone loss and deformity, making it difficult to obtain a stable construct. We present the results of a novel hybrid plating system that incorporates locked and non-locked compression screws for multi-joint arthrodesis of the midfoot. Method: A retrospective multicenter review of patients undergoing multi-joint arthrodesis with hybrid plating of the midfoot was performed to evaluate the time to radiographic arthrodesis. Hybrid plating was defined as a construct that incorporates locked and non-locked compression screws. Neuropathy was the only exclusion criteria. Radiographic arthrodesis was defined as bridging bone on one of the three standard foot radiographs in the absence of a joint gap on the other views, or by 50% or greater bridging bone on computed tomography. Etiology of the arthritis, presurgical comorbidities, body mass index, functional level and postoperative complications were evaluated. Results: Seventy-two patients were evaluated, and arthrodesis was obtained in 67 patients at 6 weeks in 27 patients, 9 weeks in 26, 12 weeks in 11, and at 16 weeks in three. In five patients at least one of the joints were not fused at 16 weeks and were considered a nonunion. Complications were present in 12 patients (17%). Conclusions: The healing rate and time to arthrodesis compared favorably to similar published studies. Based on these results, hybrid plating was a reliable and consistent alternative for fixation in midfoot arthrodesis, especially in multi-joint disease. Level of Evidence: IV; Retrospective Case Series

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Faktor-Faktor yang Berhubungan dengan Penggunaan Metode Kontrasepsi Tradisional

JURNAL PROMOSI KESEHATAN INDONESIA ◽

10.14710/jpki.16.1.14-22 ◽

2021 ◽

Vol 16 (1) ◽

pp. 14-22

Author(s):

Urip Tri Wijayanti

Keyword(s):

Family Planning ◽

Univariate Analysis ◽

Secondary Data ◽

Married Women ◽

Bivariate Analysis ◽

Chi Square ◽

Related Factors ◽

Cross Sectional ◽

Significance Level ◽

Central Java

Background: The use of modern contraceptives in Central Java tends to decrease while traditional methods are increasing. The purpose of this study was to determine the factors associated with the use of traditional contraceptives among currently married women aged 15-49 in Central Java Province. The factors discussed include the number of children born alive, wife's age, wife's education, wife's occupation, residence, and access/utilization of family planning information sources.Method: The research design was cross-sectional, used secondary data from the Central Java SKAP 2019. The total number of respondents was 2.088 married women aged 15-49 years and not currently pregnant. Data collected by interview using a structured questionnaire. Data analysis with univariate analysis and bivariate analysis using the chi-square statistical test with a significance level of 5%.Results: The research found that most respondents were ≥ 35 years old, having ≥ 2 children, having high education level (senior high school to higher education), not working, living in the cities, and able to use some media to find information about family planning. The related factors to the use of traditional contraceptive methods were education and residences. The number of live birth children, ages, jobs, and the use of media did not influence the use of the traditional contraceptive method.

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Arthroscopic Treatment of Osteochondral Lesions of the Tibial Plafond

Foot & Ankle International ◽

10.3113/fai.2012.0662 ◽

2012 ◽

Vol 33 (8) ◽

pp. 662-668 ◽

Cited By ~ 22

Author(s):

Daniel J. Cuttica ◽

W. Bret Smith ◽

Christopher F. Hyer ◽

Terrence M. Philbin ◽

Gregory C. Berlet

Keyword(s):

Case Series ◽

Retrospective Chart Review ◽

Arthroscopic Treatment ◽

Osteochondral Lesions ◽

Retrospective Case ◽

Aofas Score ◽

Level Of Evidence ◽

Tibial Plafond ◽

Average Patient ◽

Poor Outcomes

Background: Osteochondral lesions of the distal tibial plafond (OLTPs) are an uncommon problem. The purpose of this study was to evaluate clinical outcomes following arthroscopic treatment of OLTPs. Methods: Retrospective chart review was performed on all patients treated arthroscopically for OLTPs. Treatment consisted of generalized synovectomy followed by curettage of the lesion and microfracture. If a cartilage cap was intact, antegrade drilling was performed. Cystic defects were treated with curettage of the cyst and filling of any defect with bone graft. Results: A total of 13 patients were included. Nine patients had isolated lesions, while four had lesions of the distal tibial plafond and talar dome. Average followup was 156 (range, 38 to 402 ± 117.9) weeks and average patient age was 32.9 (range, 14 to 50 ± 11.8) years. Eleven of 13 patients were available for followup modified AOFAS score. The average preoperative score was 35.2 (range, 24 to 49 ± 7.1). The average postoperative modified AOFAS score was 50.4 (range, 33 to 56 ± 7.6). There were four patients (30.8%) with a poor outcome. Conclusion: OLTPs can be challenging to treat. Arthroscopic treatment can lead to improved outcomes. However, the higher incidence of poor outcomes in our series may indicate less predictability in the treatment of OLTPs and that outcomes may not be equivalent to previous reported studies on OLTPs or osteochondral lesions of the talus. Level of Evidence: IV, Retrospective Case Series

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The predictive factors that are associated with the number of sutures used during meniscal repair

10.21203/rs.3.rs-70748/v1 ◽

2020 ◽

Author(s):

Xiaoxiao Song ◽

Dongyang Chen ◽

Qi Xinsheng ◽

Qing Jiang ◽

Caiwei Xia

Keyword(s):

Cruciate Ligament ◽

Demographic Data ◽

Meniscal Tear ◽

Univariate Analysis ◽

Meniscal Repair ◽

Meniscus Repair ◽

Meniscus Tear ◽

Chi Square ◽

Level Of Evidence ◽

Surgical Data

Abstract PurposeTo investigate factors associated with the consumption of a large number of sutures during arthroscopic meniscus repair procedures.MethodsAll patients who received meniscal repair, with or without concomitant anterior cruciate ligament (ACL) reconstruction, in our hospital from January 2015 to December 2019 were included in the current study. Demographic data (sex, age, body mass index (BMI), and injury-to-surgery interval) and surgical data (the site of the tear, side of the meniscus, presence of an ACL rupture or not and the number of sutures) were retrospectively collected from our medical records. The number of sutures was divided into two groups (1–2 sutures versus > 2 sutures). The stitching process was implemented through an all-inside technique using a meniscal repair device (Fast-Fix; Smith & Nephew). According to the length and stability of the meniscal tear, one to seven sutures were used. Univariate analysis consisted of chi-square tests. Multivariate logistic regression was then performed to adjust for confounding factors.ResultsA total of 242 patients, including 168 males and 57 females, was finally included. In the univariate analysis, we found that those patients who underwent meniscus repair within one month after meniscus tear were more likely to need fewer sutures than those who underwent surgery more than one month after injury (70/110 versus 59/115, p = 0.062). In total, 75/109 (68.8%) lateral meniscal tears were repaired with fewer sutures than medial (34/72, 47.2%) and bilateral meniscus injuries (20/44, 45.4%; p = 0.003). In the multivariate analysis, we found that the duration of injury (OR, 2.06; 95% CI, 1.16–3.64, p = 0.013), presence of an ACL injury (OR, 3.76; 95% CI, 1.97–7.21, p < 0.001) and the side of the meniscus (OR, 0.31; 95% CI, 0.14–0.65, p = 0.002) were associated with the number of sutures used during meniscal repair procedures.ConclusionsPatients who underwent meniscal repair within one month after meniscus tear, especially lateral menisci tears, were more likely to need fewer sutures.Study DesignCase-control study; level of evidence, 3.

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Hallux valgus measurements using weight-bearing computed tomography: what changes?

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2021.v15.1600 ◽

2021 ◽

Vol 15 (3) ◽

pp. 259-264

Author(s):

Samuel Braza ◽

Nacime Salomão Barbachan Mansur ◽

Vineel Mallavarapu ◽

Kepler Alencar Mendes de Carvalho ◽

Kevin Dibbern ◽

...

Keyword(s):

Computed Tomography ◽

Hallux Valgus ◽

Case Control Study ◽

Weight Bearing ◽

Metatarsal Head ◽

Case Control ◽

Retrospective Case ◽

Level Of Evidence ◽

Mean Values ◽

Control Study

Objective: To assess whether traditional hallux valgus (HV) measurements obtained with conventional radiography (CR) correspond to those obtained with weight-bearing computed tomography (WBCT). Methods: In this retrospective case-control study, 26 HV feet and 20 control feet were analyzed with CR and WBCT. Hallux valgus angle (HVA), intermetatarsal angle (IMA), interphalangeal angle (IPA), distal metatarsal articular angle (DMAA), sesamoid station (SS), and first metatarsal head shape were measured. Chi-square tests were used to compare hallux valgus and control patients. T-tests were used to compare CR and WBCT. P-values less than 0.05 were considered significant. Results: WBCT was capable of discriminating patients with HV from controls, showing higher mean values for HV patients than controls in HVA (35.29 and 9.02, p < 0.001), IMA (16.01 and 10.01, p < 0.001), and DMAA (18.90 and 4.10, p < 0.001). When comparing the two methods, differences were not significant between CR and WBCT measurements in HVA (-0.84, p = 0.79), IMA (-0.93, p = 0.39), IPA (1.53, p = 0.09), or SS (p = 0.40), but were significant for DMAA (13.43, p < .0001). CR analysis yielded varied metatarsal head shapes, while all WBCT shape classifications were round. Conclusion: Unidimensional HV measurements were similar between WBCT and CR, while more three-dimensional findings were not. CR may be used to assess the axial aspects of HV, but multidimensional aspects of the deformity may not be accurately assessed with plain radiographs. Level of Evidence III; Therapeutic Studies; Retrospective Case-Control Study.

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Variations in Mortise Anatomy

The American Journal of Sports Medicine ◽

10.1177/0363546504271207 ◽

2005 ◽

Vol 33 (6) ◽

pp. 852-855 ◽

Cited By ~ 18

Author(s):

Christopher T. LeBrun ◽

John O. Krause

Keyword(s):

Computed Tomography ◽

Ankle Instability ◽

Articular Surface ◽

New Method ◽

Medial Malleolus ◽

Level Of Evidence ◽

Predisposing Factor ◽

Index Method ◽

Significant Difference ◽

Computed Tomography Scans

Background Variations in ankle mortise anatomy may be a predisposing factor to ankle instability. Hypothesis A posteriorly positioned fibula associated with ankle instability may not be a true pathologic entity but rather the result of measuring off an internally rotated talus. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods The authors reviewed 60 ankle computed tomography scans performed on patients from their institution for reasons unrelated to ankle instability. They also reviewed ankle computed tomography scans on 21 patients surgically treated for clinical ankle instability. The position of the fibula in relation to the talar articular surface was calculated and expressed as the axial malleolar index, as described by Scranton et al. They also calculated the intermalleolar index, a new method that references the medial malleolus, not the talus. Results Using the method of Scranton et al, the axial malleolar index in the control and instability patients was similar to values previously described, and there was a significant difference between control and instability patients (P <. 01). However, using the intermalleolar index method referencing the medial malleolus, there was not a significant difference between control and instability patients (P =. 43). Conclusion The new method of referencing the medial malleolus assesses fibular position independent of talar rotation. The data, when referencing the medial malleolus, do not show significant variation in fibular position in patients with and without ankle instability.

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Comparison of Computed Tomography, Traction, and Inverted Grayscale Radiographs for Understanding Pilon Fracture Morphology

Foot & Ankle International ◽

10.1177/10711007211049247 ◽

2021 ◽

pp. 107110072110492

Author(s):

Gokay Eken ◽

Abdulhamit Misir

Keyword(s):

Computed Tomography ◽

Interobserver Reliability ◽

Case Series ◽

Fracture Morphology ◽

Correct Identification ◽

Retrospective Case ◽

Level Of Evidence ◽

Fracture Fragment ◽

Plain Radiographs ◽

Pilon Fractures

Background: There have been no studies evaluating the usefulness of grayscale radiographs in extremity fractures. We aimed to compare the ability and reliability of traction radiographs vs traction grayscale inversion radiographs to detect fracture fragment and comminution zones in comminuted tibia pilon fractures. Methods: Plain radiographs and grayscale inversion images of 60 patients with Orthopaedic Trauma Association/AO Foundation type C3 fracture were evaluated by 20 observers (15 orthopedic surgeons and 5 radiologists) after traction had been applied. The anterolateral, posterolateral, and medial malleolar fragments, as well as the lateral, central, and medial column comminution zones, were identified by all physicians. Computed tomography scan images were used as the “gold standard” against which plain radiographs and grayscale inversion image interpretation were measured. Intra- and interobserver reliability and correct identification of fracture fragments and comminution zones were evaluated. Results: The interobserver reliability for 3 of the fracture fragments and comminution zones on the traction plain radiographs was moderate, whereas it was substantial on traction grayscale inversion radiographs. The lateral comminution zones ( P = .001) and presence or absence of posterolateral fragments ( P < .001) were significantly better identified in grayscale inversion radiographs compared to standard radiographs. Conclusion: After traction was applied, we found grayscale inversion radiographs are superior to plain radiographs in the identification of posterolateral fragment and lateral zone of comminution in comminuted intraarticular pilon fractures. Level of Evidence: III, Retrospective Case Series.

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Physical violence inside female prisons in Brazil: prevalence and related factors

Ciência & Saúde Coletiva ◽

10.1590/1413-81232020252.10842018 ◽

2020 ◽

Vol 25 (2) ◽

pp. 623-632

Author(s):

Isabelle Silva Gama-Araujo ◽

José Gomes Bezerra Filho ◽

Ligia Kerr ◽

Carl Kendall ◽

Raimunda Hermelinda Maia Macena ◽

...

Keyword(s):

Goodness Of Fit ◽

Physical Violence ◽

Univariate Analysis ◽

Chi Square ◽

Related Factors ◽

Cross Sectional ◽

Female Prisoners ◽

Lemeshow Test ◽

Chi Square Test ◽

Stratified Analysis

Abstract The present study aims to identify the prevalence of physical violence against female prisoners in Brazil, as well as related factors. This is a cross-sectional national survey conducted in 15 female prisons in five regions of Brazil selected in multiple stages. The following types of analysis were performed: univariate analysis; stratified analysis relating the outcome (suffer physical violence inside prison) to predictor variables, using the Pearson chi-square test; calculation of the Odds Ratio (O.R.); and multiple logistic regression. The Hosmer-Lemeshow test was used for analysis of goodness of fit and adequacy of the model. The prevalence of physical violence inside female prisons was 37.4%. There was a correlation between physical violence victimization in prison and the following variables: physical victimization prior to arrest (p = 0.013), solitary confinement (p = 0.000), mental suffering (p = 0.003), current or previous abusive intake of alcohol (p = 0.011), current or previous injection of cocaine (p = 0.002) and not performing prison labor (p = 0.003). Physical violence has become inherent in the Brazilian female prison system. Continued studies are needed to monitor the situation and to develop interventions to prevent physical violence inside the facilities.

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