scholarly journals Therapeutic effects of internal fixation with support plates and cannulated screws via the posterolateral approach on supination external rotation stage IV ankle fracture

2020 ◽  
Vol 36 (3) ◽  
Author(s):  
Zhongbing Liu ◽  
Genling Tang ◽  
Shuguang Guo ◽  
Bin Cai ◽  
Qingsong Li
Keyword(s):  
Ankle Fracture ◽  
External Rotation ◽  
Stage Iv ◽  
Cannulated Screw ◽  
Posterolateral Approach ◽  
Therapeutic Effects ◽  
Cannulated Screws ◽  
Support Plate ◽  
Rotation Stage ◽  
Supination External Rotation

Objective: To evaluate the therapeutic effects of internal fixation with support plates and cannulated screws via the posterolateral approach on supination external rotation stage IV ankle fracture. Methods: Eighty-five patients with SER-IV°ankle fracture and large posterior malleolar fracture treated from June 2016 to June 2018 in our hospital, were randomly divided into a support plate group (n=47) and a cannulated screw group (n=38). The treatment outcomes were compared regarding surgical time, amount of bleeding, time of fracture healing, postoperative complications, as well as the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and excellent rate one year later. Results: The surgical time and intraoperative blood loss of cannulated screw group were significantly lower than those of support plate group (P<0.05). There were four cases of posterior lateral incision redness complicated with obvious bloody exudation in support plate group on the postoperative 2nd day. One case developed into superficial incision infection subsequently, and one case suffered from deep infection. After dressing and treatment with sensitive antibiotics, stitch removal was delayed, and primary healing was obtained. In cannulated screw group, there were two cases of posterior lateral incision redness complicated with obvious bloody exudation on the postoperative 3rd day, without skin incision infection. One case had cannulated screw loosening two months after surgery, and the posterior malleolar fracture block was slightly displaced. The incidence of surgical complications in support plate and cannulated screw groups were 8.51% and 7.89%, respectively (P>0.05). The AOFAS scores of cannulated screw ((81.71 ± 12.39) points) and support plate groups ((86.62 ± 10.12) points) were significantly different (P<0.05). Conclusion: For patients with posterior malleolar fracture or osteoporosis, fixation using support plate is recommended. Cannulated screw fixation is suitable for for patients with poor conditions of skin soft tissues or basic diseases such as diabetes intolerant to long surgery. doi: https://doi.org/10.12669/pjms.36.3.1671 How to cite this:Liu Z, Tang G, Guo S, Cai B, Li Q. Therapeutic effects of internal fixation with support plates and cannulated screws via the posterolateral approach on supination external rotation stage IV ankle fracture. Pak J Med Sci. 2020;36(3):---------.  doi: https://doi.org/10.12669/pjms.36.3.1671 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Health Related Quality of Life in Patients with Supination-External Rotation Stage IV Ankle Fractures

2005 ◽  
Vol 26 (12) ◽  
pp. 1038-1041 ◽  
Author(s):  
Ryan Finnan ◽  
Luke Funk ◽  
Michael S. Pinzur ◽  
Steven Rabin ◽  
Laurie Lomasney ◽  
...  
Keyword(s):  
Quality Of Life ◽  
External Rotation ◽  
Stage Iv ◽  
Ankle Fractures ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Rotation Stage ◽  
Supination External Rotation

Background: While open reduction of displaced ankle fractures generally is accepted as the standard of care, relatively little is known about the health related quality of life after treatment. It is generally accepted that clinical results of treatment for supination-external rotation stage IV ankle fractures are favorable. The goal of this investigation was to determine the relationship between clinical results and health-related quality of life outcome measures in a consecutive series of patients treated for closed supination-external rotation stage IV ankle fractures. Methods: Twenty-six of 156 patients who had operative treatment for closed, displaced supination-external rotation stage IV ankle fractures during a 9-year period, completed the Short Musculoskeletal Function Assessment (SMFA) outcome questionnaire. Radiographs and clinical records were reviewed to determine quality of operative repair, postoperative morbidity, and the development of post-traumatic arthritis. Results: There were no postoperative complications. Of the 26 patients who returned the SMFA questionnaires, 19 had “good,” and seven had “fair” reduction of their fractures. Six showed radiographic evidence of arthritis at followup. Study participants reported scores that were similar to the general population in five of the six domains of the SMFA. Their scores in the mobility index were statistically less favorable (23.72 vs. 13.61, p = 0.016) when compared to the general population. Participants with “good” operative reductions and no evidence of arthritis at followup showed no significant difference to the general population. Participants with either a “fair” operative reduction or evidence of postoperative arthritis at followup had less favorable scores in the daily activities (mean 13.45 vs. 11.82, p = 0.004), mobility (43.43 vs. 13.61, p = 0.001), dysfunction (32.89 vs. 12.70, p = 0.014), and bother (35.80 vs. 13.77, p = 0.020) domains, when compared to the general population. Conclusions: The results of this investigation suggest that patients with excellent radiographic operative reductions and no arthritis as early as 6 months after surgery sustain no lasting unfavorable effect on health related quality of life. Patients with “fair” radiographic reduction, or presence of arthritis or both at followup, are likely to have a negative effect on their quality of life.

Osseous Talofibular Impingement after Supination–External Rotation Stage II Ankle Fracture: Case Report

2012 ◽  
Vol 33 (11) ◽  
pp. 1006-1010
Author(s):  
Michael Q. Potter ◽  
Brad D. Blankenhorn ◽  
Frank R. Avilucea ◽  
Timothy C. Beals ◽  
Florian Nickisch
Keyword(s):  
Case Report ◽  
Ankle Fracture ◽  
External Rotation ◽  
Stage Ii ◽  
Rotation Stage ◽  
Supination External Rotation

scholarly journals Comparison of below knee cast and elasticated support bandage treatment foe an isolated fracture of the lateral malleolus

2017 ◽  
Vol 17 (2) ◽  
pp. 12-17
Author(s):  
Rajram Maharjan
Keyword(s):  
Ankle Fracture ◽  
External Rotation ◽  
Lateral Malleolus ◽  
Stage Ii ◽  
Group A ◽  
The Difference ◽  
Group B ◽  
Rotation Stage ◽  
Supination External Rotation

Introduction: Ankle fractures are the most common type of fractures treated in orthopaedics with isolated malleolar fractures, accounting for two-thirds of fractures. The most common injury mechanism is supination external rotation, which accounts for the majority of all ankle fracture patterns. Supination external rotation stage II is the classic short oblique fracture of the distal fibula without a medial side injury, which responds well to non-operative treatment as it is a stable fracture. The purpose of this study is to compare efficacy of elasticated support bandage versus plaster cast in the patient with isolated lateral malleolus fracture (Lauge-Hansen supination- eversion external stage II.)Method: A prospective comparative study was carried out in the Department of Orthopaedics in Bir Hospital from February 2007 to January 2009. Patients with ankle fracture were initially treated by below knee posterior slab for seven days to allow the swelling to subside and on seventh day follow-up they were grouped in two groups. Group A were patients with below knee cast and Group B were elasticated support bandage. Both groups were followed-up in the 5th week for cast or elasticated bandage removal and were evaluated after a week, thereafter, every monthly for 3 months and finally at 6 month.Result: Of the 48 cases enrolled, the mean age of the patients was 38.85 years. The common mode of injury was fall from height followed by road traffic accident. The modified subjective ankle score of Olerud and Molander (1984) was found more in group B in comparison to group A in all follow ups. In initial three successive follow ups at 6 week, 12 week and at 3 month subjective score was found statistically significant (p> 0.05) however, it was not significant at 6 month follow up. The range of motion was significantly improved in group B in all follow ups but the difference between the two groups at 6 weeks and 10 weeks follow ups was statistically significant. Immobilized group required less analgesic but the difference was not significant statistically.Conclusion: Both below knee cast and elasticated support bandage treatment methods are safe, satisfactory and equally effective with a better early result in elasticated support bandage. Supination External Rotation stage II type fracture can be treated conservatively, if there is no medial tenderness.Journal of Society of Surgeons of NepalVol. 17, No. 2, 2014, Page: 7-11

scholarly journals The Importance of the Deep Deltoid Ligament Repair in Treating Supination-External Rotation Stage IV Ankle Fracture: A Comparative Retrospective Cohort Study

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Hongfeng Chen ◽  
Dongsong Yang ◽  
Zhen Li ◽  
Junke Niu ◽  
Pengru Wang ◽  
...  
Keyword(s):  
Functional Performance ◽  
External Rotation ◽  
Stage Iv ◽  
Deltoid Ligament ◽  
Ligament Repair ◽  
Ligament Rupture ◽  
Clear Space ◽  
Rotation Stage ◽  
Supination External Rotation

Background. The necessity of the deep deltoid ligament repair in the treatment of supination-external rotation (SER) ankle stage IV fracture with deltoid ligament rupture is highly debated. We conducted this retrospective research aimed at exploring the curative effect of the deep deltoid ligament repair in treating SER fracture. Methods. Sixty-three patients with closed SER stage IV fractures received open reduction and internal fixation (ORIF), using either deep deltoid ligament repair (the DDLR group, 31 patients) or nondeep deltoid ligament repair (the NDDLR group, 32 patients). The radiographic parameters examined include the talocrural angle (TA), fibular length (FL), tibiomedial malleolar angle (TMMA), medial clear space (MCS), and tibiofibular clear space (TFCS). The functional performance parameters examined in the study were visual analog scale (VAS) pain score, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scales, and range of motion of bilateral ankles (RMBA). Complications, including bone nonunion, infection, and fragment displacement, were also recorded and compared. Results. Similar basic characteristics were found in both cohorts. All patients completed follow-up ranging from 12 to 22 months (mean time: 12.41 ± 4.21 months). The DDLR group had significantly reduced VAS score ( p < 0.05 ), with markedly increased RMBA ( p < 0.05 ) compared to the NDDLR group. The two cohorts showed similar follow-up performance at 3 months ( p > 0.05 ), 6 months ( p > 0.05 ), and 12 months ( p > 0.05 ), in terms of parameters including TA, FL, TMMA, MCS, TCS, and AOFAS ankle-hindfoot scales. Conclusion. Although similar radiographic performances were achieved in both cohorts, the DDLR group displayed enhanced functional outcome postsurgery, indicating that DDLR may be a better potential for the treatment of SER stage IV fracture with deltoid ligament rupture.

Weight-Bearing Cone-Beam CT Scan Assessment of Stability of Supination External Rotation Ankle Fractures in a Cadaver Model

2018 ◽  
Vol 39 (7) ◽  
pp. 850-857 ◽  
Author(s):  
Mark C. Lawlor ◽  
Melissa A. Kluczynski ◽  
John M. Marzo
Keyword(s):  
Ct Scan ◽  
Ankle Fracture ◽  
External Rotation ◽  
Imaging Modality ◽  
Cone Beam Ct ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
Cone Beam ◽  
Clear Space ◽  
Supination External Rotation

Background: The utility of computed tomography (CT) for measuring medial clear space (MCS) for determination of the stability of supination external rotation (SER) ankle fractures and in comparison to standard radiographs is unknown. We compared MCS on gravity stress (GS) radiographs to GS and weight bearing (WB) cone-beam CT (CBCT). Methods: An AO SER 44B3.1 ankle fracture was simulated in 10 human cadavers, also serving as controls. MCS was measured on GS radiographs, GS CBCT, and a simulated WB CBCT scan. Specimens were stable if MCS was <5 mm and unstable if MCS was ≥5 mm. Paired t tests were used to compare MCS from each imaging modality for controls versus SER injuries and stable versus unstable specimens. Results: Compared with controls assessed by GS radiographs, MCS was greater for an SER injury when assessed by GS radiograph and GS CBCT scan within the stable group. Compared with controls assessed by GS radiographs, MCS was greater for SER injuries when assessed by GS radiograph, GS CBCT scan, and WB CBCT within the unstable group. MCS was reduced for stable versus unstable SER injuries assessed by WB CBCT. Conclusion: In a cadaveric model of SER ankle fracture, the medial clear space was statistically significantly greater for the experimental condition when assessed by gravity stress radiograph and gravity stress CBCT scan. Under weight-bearing conditions, the cone-beam CT scanner distinguished between stable and unstable ankles in the experimental condition. Clinical Relevance: This study suggests that a WB cone-beam CT scan may be able to distinguish between stable and unstable SER ankle fractures and influence operative decision making.

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