Clinico-Radiological Outcome after Surgical Interventions in Ankle Fractures at a Tertiary Care Centre in Moradabad, Uttar Pradesh

2021 ◽  
Vol 8 (26) ◽  
pp. 2265-2270
Author(s):  
Amit Saraf ◽  
Manish Singhal ◽  
Najmul Huda
Keyword(s):  
Internal Fixation ◽  
Ankle Joint ◽  
Scoring System ◽  
Ankle Fracture ◽  
Cartilage Damage ◽  
Ankle Fractures ◽  
Joint Surface ◽  
Radiological Outcome ◽  
Surgical Fixation

BACKGROUND Ankle fractures are among the most common injuries encountered by orthopaedic surgeons. An ankle is considered unstable when the loss of normal constraints around the ankle permits the talus to move in a non-physiologic pattern. Under such circumstances, the dynamic joint surface contact area within the ankle is diminished, which predisposes to articular cartilage damage and premature degeneration. In today’s time, many modalities are available for surgical fixation of bimalleolar fractures. Such interventions restore anatomy and biomechanics of the ankle joint. Even though there are plethora of foreign studies on similar matter, deficiency of such analysis has been depicted in literature from developing countries, particularly from South-East Asian region. In this study, we wanted to assess various methods of internal fixation in ankle fracture & evaluate their clinical and radiological outcome post-operatively. METHODS 26 ankle fracture patients in the age group of 18 - 60 years were included in this study. Fractures were classified pre-operatively based on Lauge-Hansen classification. Patients were followed up at regular intervals of 1st, 2nd, 3rd, 6th & 12 month after surgery and assessed by Baird and Jackson scoring system based on subjective, objective and radiographic criteria. Complications like infection, arthritis, stiffness & implant failure were assessed on regular follow-up. RESULTS Variety of methods (including k-wires, plates & screws) were used for surgical fixation. Majority of fractures resulted from road traffic accident (RTA). Patients were evaluated using Baird & Jackson scoring system during follow-up at 1st, 2nd , 3 rd, 6th & 12 month. All patients had poor scores for initial 3 months. Patients showed good to excellent result on final follow-up at 9 to 12 months after surgery. Complications were observed in 19 % cases with arthritis being most common. CONCLUSIONS Open reduction and internal fixation restores the articular congruity of the ankle joint. The operative result was satisfactory with good clinical outcome. KEYWORDS Ankle, Fracture, Anatomy, Modalities

scholarly journals Does the quality of preoperative closed reduction of displaced ankle fractures affect wound complications after surgical fixation?

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0018
Author(s):  
Bonnie Chien ◽  
Kristen Stupay ◽  
Christopher Miller ◽  
Jeremy Smith ◽  
Jorge Briceno ◽  
...  
Keyword(s):  
Classification System ◽  
Closed Reduction ◽  
Ankle Fracture ◽  
Ankle Fractures ◽  
Wound Complications ◽  
Complication Rates ◽  
Ankle Osteoarthritis ◽  
Surgical Fixation

Category: Trauma Introduction/Purpose: Prompt reduction and stabilization of displaced ankle fractures is important to protect soft tissues, restore potential neurovascular deficits and prevent cartilage injury. Many of these injuries do eventually require surgical fixation. The purpose of this study is to determine whether the initial quality of ankle closed reduction based on radiographic criteria would affect outcomes such as ankle osteoarthritis and complications after surgery. Furthermore, we sought to develop a classification system for the quality of closed reduction that would be easy to use and provide interrater reliability. Methods: A retrospective analysis of patients who sustained isolated, closed ankle fractures with at least 3 months follow up postoperatively at two level 1 trauma centers was performed. Patient demographics and history, ankle fracture characteristics and reduction information as well as surgical outcomes and complications were collected. A grading classification for the quality of the initial closed reduction before surgery was developed based on standard AP or mortise and lateral ankle x-rays. The factors considered for rating the reduction included the degree of talar shift on the AP/mortise view, malleoli displacement, as well the relationship of a central plumb line to the center of the talar dome on the lateral x-ray. For ankle osteoarthritis, the Takakura classification was utilized. Three reviewers (1 resident, 2 attendings) independently reviewed and rated all imaging. Results: 161 patients were analyzed. 65% female, average age 50, average 4 days between injury and surgery, mean follow up of 12 months (3-58 months), and 17% wound complications. Psychiatric history was the single comorbidity significantly associated with complications (p=0.009). There was no difference in wound or infection complication rates based on initial closed reduction quality (p=0.17). Neither number nor quality of reductions correlated with increased osteoarthritis (p=0.19, 0.39 respectively). Worst graded reductions had shorter time to surgery, mean 1.4 vs 4.7 days for best reductions (p=0.03), suggesting a protective factor that may account for no association between reduction quality and wound complications. Interclass correlation coefficients for multiple observers showed very high consistency for grading of reduction quality based on the classification system (ICC >0.85, p<0.001). Conclusion: It is often emphasized that a displaced ankle fracture should be as perfectly reduced as possible, understandably for grossly dislocated ankle fracture dislocations potentially compromising skin and neurovascular structures. At the same time, this original study demonstrated contrary to common assumption that the initial quality of ankle closed reduction does not appear to affect the severity of ankle osteoarthritis or the rate of surgical complications. This study also developed a highly reproducible ankle reduction classification system. It opens the opportunity for future prospective application and analysis of this classification’s ultimate clinical utility.

scholarly journals Early weight bearing compared with non-weight bearing functional mobilization after operative treatment of an ankle fracture

2012 ◽  
Vol 7 (1) ◽  
pp. 40-46
Author(s):  
KP Paudel
Keyword(s):  
Internal Fixation ◽  
Operative Treatment ◽  
Ankle Fracture ◽  
Subjective Evaluation ◽  
Weight Bearing ◽  
Randomized Study ◽  
T Test ◽  
Ankle Fractures ◽  
Early Weight Bearing

Ankle fractures are the most common types of fractures treated in orthopaedics. When to begin ankle movement and weight bearing and the type of immobilizing devices to use post-operatively have had more intense clinical study than most other aspects of ankle fracture treatment. Aim of this study is to compare the results of two functional methods of post-operative treatment in internally fixed ankle fractures, i.e. one after early weight bearing using walking plaster and the other after non-weight bearing functional mobilization in the first six weeks following stable internal fixation. This is a prospective, non-randomized study. Between March 2004 and February 2006, thirty- five patients with displaced ankle fractures treated by internal fixation were assigned in a way that every alternate patient fell in different groups. Group A patients, 17, were managed with a below-knee walking plaster and group B patients, 18 with non-weight bearing mobilization with crutches. Five patients were lost in follow up and 30 were followed regularly as in the protocol. There was a temporary benefit in subjective evaluation (63 v 48 points, student t test. P=0.262), return to work (53.8 v 72.9 days, student t test, p=0.079) for those with a below-knee walking plaster at six week. There were minimal differences between the groups in the loss of dorsal range of movement (14.7 v 13.1 degree) or in the overall clinical results at the first follow up. But the differences disappeared in any evaluation after three months. Both treatments were considered to be satisfactory and the treatment choice depends on the ability to mobilize or weight bearing, the type of work and personal preference. DOI: http://dx.doi.org/10.3126/jcmsn.v7i1.5972 JCMSN 2011; 7(1): 40-46

scholarly journals Timing of Open Reduction and Internal Fixation of Ankle Fractures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Direk Tantigate ◽  
J. Turner Vosseller ◽  
Justin Greisberg ◽  
Benjamin Ascherman ◽  
Christina Freibott ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Functional Outcomes ◽  
Ankle Fracture ◽  
Open Reduction ◽  
Demographic Variables ◽  
Ankle Fractures ◽  
Significant Difference ◽  
The Mean

Category: Ankle, Trauma Introduction/Purpose: Unstable ankle fractures are typically treated with open reduction and internal fixation (ORIF) for stabilization in an effort to ultimately prevent post-traumatic arthritis. It is not uncommon for operative treatment to be performed as an outpatient in the ambulatory surgery setting several days to a couple weeks after the injury to facilitate things from a scheduling perspective. It is unclear what effect this delay has on functional outcome. The purpose of this study is to assess the impact of delayed operative treatment by comparing the functional outcomes for groups of patients based on the amount of time between the injury and surgery. Methods: A retrospective chart review of 122 ankle fracture patients who were surgically treated by ORIF over a three year period was performed. All ankle fracture patients older than 18 years with a minimum of 24 months of follow-up were included. A total of 61 patients were included for this study. Three patients were excluded; 2 patients had an open injury and 1 patient presented with a delayed union. Demographic data, comorbidities, injury characteristics, duration from injury to surgery, operative time, length of postoperative stay, complications and functional outcomes were recorded. Functional outcome was determined by Foot and Ankle Outcome Score (FAOS) at the latest follow-up visit. Comparison of demographic variables and the subcategory of FAOS including symptoms, pain, activities of daily living (ADL), sport activity and quality of life (QOL) was performed between patient underwent ORIF less than 14 days after injury and 14 days or greater. Results: A total of 58 patients were included in this study. Thirty-six patients (62.1%) were female. The mean age of patients was 48.14 ± 16.84 years (19-84 years). The mean follow-up time was 41.48 ± 12.25 months (24-76 months). The duration between injury and operative fixation in the two groups was 7 ± 3 days (<14 days) and 18 ± 3 days (>14 days), respectively. There was no statistically significant difference in demographic variables, comorbidities, injury characteristics, or length of operation. Each subcategory of FAOS demonstrated no statistically significant difference between these two groups. (Table 1) Additionally, further analysis for the delayed fixation more than 7 days and 10 days also revealed no significant difference of FAOS. Conclusion: Open reduction and internal fixation of ankle fracture more than 14 days does not significantly diminish functional outcome according to FAOS. Delay of ORIF for ankle fractures does not play a significant role in the long-term functional outcome.

Functional Outcomes After Fracture-Dislocation of the Ankle

2019 ◽  
Vol 13 (1) ◽  
pp. 18-26 ◽  
Author(s):  
Direk Tantigate ◽  
Gavin Ho ◽  
Joshua Kirschenbaum ◽  
Henrik C. Bäcker ◽  
Benjamin Asherman ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Functional Outcomes ◽  
Ankle Fracture ◽  
Statistical Significance ◽  
Ankle Fractures ◽  
Fracture Dislocation ◽  
Wound Complications ◽  
Pain Subscale ◽  
Fracture Dislocations

Background. Fracture dislocation of the ankle represents a substantial injury to the bony and soft tissue structures of the ankle. There has been only limited reporting of functional outcome of ankle fracture-dislocations. This study aimed to compare functional outcome after open reduction internal fixation in ankle fractures with and without dislocation. Methods. A retrospective chart review of surgically treated ankle fractures over a 3- year period was performed. Demographic data, type of fracture, operative time and complications were recorded. Of 118 patients eligible for analysis, 33 (28%) sustained a fracture-dislocation. Mean patient age was 46.6 years; 62 patients, who had follow-up of at least 12 months, were analyzed for functional outcome assessed by the Foot and Ankle Outcome Score (FAOS). The median follow-up time was 37 months. Demographic variables and FAOS were compared between ankle fractures with and without dislocation. Results. The average age of patients sustaining fracture-dislocation was greater (53 vs 44 years, P = .017); a greater percentage were female (72.7% vs 51.8%, P = .039) and diabetic (24.2% vs 7.1%, P = .010). Wound complications were similar between both groups. FAOS was generally poorer in the fracture-dislocation group, although only the pain subscale demonstrated statistical significance (76 vs 92, P = .012). Conclusion. Ankle fracture-dislocation occurred more frequently in patients who were older, female, and diabetic. At a median of just > 3-year follow-up, functional outcomes in fracture-dislocations were generally poorer; the pain subscale of FAOS was worse in a statistically significant fashion. Levels of Evidence: Therapeutic, Level III

scholarly journals The Development of Heterotopic Ossification Following Ankle Fracture Syndesmotic Screw Fixation

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0044
Author(s):  
Benjamin R. Williams ◽  
Paul M. Lafferty
Keyword(s):  
Risk Factors ◽  
Heterotopic Ossification ◽  
Ankle Fracture ◽  
Screw Fixation ◽  
Low Energy ◽  
Ankle Fractures ◽  
Factors Associated ◽  
Syndesmotic Screw ◽  
The Mean

Category: Ankle, Trauma Introduction/Purpose: Syndesmotic fixation with screws is commonly used for ankle fractures with syndesmotic disruption. Few studies have reported the development of heterotopic ossification (HO) within the syndesmosis following ankle injuries, which may lead to abnormal joint kinematics and even joint synostosis. However, there is little data on the prevalence and on the risk factors associated with the development of HO. The purpose of this study is to determine the (1) prevalence and (2) risk factors associated with the development of HO within the distal tibiofibular syndesmosis following ankle fractures requiring syndesmotic fixation. We hypothesized that screws within the syndesmosis articulation and broken screws would be associated with a higher incidence of HO than extraarticular and intact screws, respectively. Methods: A retrospective review was conducted for patients who sustained an ankle fracture with syndesmotic disruption. Inclusion criteria: age between 18 and 65 years old, a closed ankle fracture treated operatively with syndesmotic screw fixation. Exclusion criteria: additional lower extremity injury, history of prior ankle fracture, lack of radiographic follow-up and fixation other than 1 or 2 syndesmosis screws. Medical records were reviewed for: age, sex, high or low energy injury mechanism, smoking status, diabetes, BMI, perioperative complications, and further procedures. Fractures were classified by Lauge-Hansen and Weber systems. Immediate postoperative radiographs were reviewed for the number of syndesmotic screws, whether screws were intraarticular or extraarticular and the number of cortices each screw crossed. Final postoperative radiographs were reviewed for retention or screw removal and the presence of HO. The presence of HO was defined as new or increased bone formation within the syndesmosis compared to immediate postoperative radiographs. Results: Included were 264 patients, mean radiographic follow-up of 10.5+/-10.2 months. The mean age was 39.2+/-12.6 years (38.7% female) with a mean BMI of 32.1+/-7.8. Current smokers made up 39.4% of patients and 10.6% were diabetic. The mean time to fracture fixation was 12.6+/-3.2 days and 198 patients (75%) had a low energy injury. There was no significant difference in HO formation for demographics, injury mechanism or time to fixation. Overall, HO developed in 160 patients (60.6%). There was no difference, additionally for fracture pattern, number screws or fixation construct (Table 1). HO developed in 92% of broken, 75% of loose and 44% of intact screws (P<0.001). Screws were removed in 107 patients (40.5%) with no difference in HO formation compared to patients with intact screws. Conclusion: Heterotopic ossification is commonplace following screw fixation for syndesmotic injuries with a prevalence of 60.6%. Broken screws and loosened screws are a significant risk factor for the development of HO. However, no other risk factors in this study were found to be associated with the development of HO, including intraarticular syndesmotic screw placement. Patients should be counseled on the prevalence although further research is needed to determine the effect on ankle motion and progression of post-traumatic osteoarthritis.

scholarly journals A prospective study of 50 cases of patella fractures treated with different modalities

2018 ◽  
Vol 4 (5) ◽  
pp. 783
Author(s):  
Rajesh V. Chawda ◽  
Parag M. Tank ◽  
Vijay J. Patel ◽  
Yash S. Shah
Keyword(s):  
Prospective Study ◽  
Internal Fixation ◽  
Optimal Operation ◽  
Joint Surface ◽  
Patella Fractures ◽  
Surgical Options ◽  
A Prospective Study ◽  
Partial Patellectomy ◽  
Patellar Fractures

<p class="abstract"><strong>Background:</strong> Fractures of patella account for 1% of all skeletal injuries. There is no universal accepted treatment for patellar fractures. After a fracture of the patella, the best results are obtained by accurate reduction and stable internal fixation. Partial or total patellectomy is generally indicated when the patella is so severely comminuted that an accurate reduction and reconstruction of the retropatellar joint surface cannot be achieved.</p><p class="abstract"><strong>Methods:</strong> The prospective study of 50 cases of patellar fractures was carried out at the department of orthopaedics for the period from May 2015 to December 2017. The maximum period of follow up was 18 months with a minimum period of follow up of 5 months (average 11.68 months). Operative treatment was done in patella fractures for more than 2 mm of articular displacement or 3 mm of fragment separation. Surgical options includes internal fixation with tension band wiring with k wire and partial patellectomy with extensor mechanism repair.<strong></strong></p><p class="abstract"><strong>Results:</strong> We have studied 50 patients where 7 cases were treated conservatively. In the present series 22 patients were treated with internal fixation out of which 13 patients had excellent results. 6 patients had good results. 21 patients were treated with partial patellectomy where 6 patients had excellent results, 11 patients had good and 4 patients had fair results.</p><p class="abstract"><strong>Conclusions:</strong> Patella should be preserved and Osteosynthesis whenever possible has better chance for excellent results. A good surgical technique, optimal operation room environment and judicious use of antibiotics will reduce the possibility of infection.</p>

scholarly journals Correlation between functional and radiological outcome after surgical stabilization of volar Barton fracture with plating: a comparative study

2020 ◽  
Vol 6 (4) ◽  
pp. 666
Author(s):  
Vikram Goud ◽  
Manoj Kanamarlapudi
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Functional Result ◽  
Dash Score ◽  
Statistical Relationship ◽  
Radiological Outcome ◽  
Distal Extremity ◽  
The Mean ◽  
Barton Fracture

<p class="abstract"><strong>Background:</strong> The objective of the study was to evaluate the functional and radiological outcomes after open reduction with internal fixation of volar Barton’s fracture of the wrist and compare their outcomes.</p><p class="abstract"><strong>Methods:</strong> Total of 30 cases of volar Barton fractures were operated by open reduction and internal fixation with plating. Mean follow up period was 6 months. Patients were assessed both radiological and functional outcome and compare between the two outcomes.<strong></strong></p><p class="abstract"><strong>Results:</strong> All fractures were healed in a mean period of 7 weeks (range 6-9 weeks). The mean disabilities of the arm, shoulder and hand (DASH) score was 13.21 points (range: 10.3 to 30), thus confirming the patient’s good functional capacity. The higher the DASH score was (i.e. the worse the functional result), the smaller were the flexion (p=0.01), pronation (p=0.03), supination (p&lt;0.0001) and radial deviation (p=0.005) of the wrist that underwent the surgical procedure after the fracture of the distal extremity of the radius. The radiological results were evaluated by modified Lidstrom criteria.</p><p class="abstract"><strong>Conclusions:</strong> The radiographic results did not influence the DASH score. There was no statistical relationship between the DASH score and the radial height or the volar tilt or the radial tilt of the distal extremity of the operated radius.</p>

scholarly journals Immediate Weight Bearing and Range of Motion After Internal Fixation of Unstable Ankle Fractures: A Retrospective Controlled Study

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0021
Author(s):  
Brianna R. Fram ◽  
Ryan G. Rogero ◽  
Daniel Corr ◽  
Gerard Chang ◽  
James Krieg ◽  
...  
Keyword(s):  
Risk Factors ◽  
Internal Fixation ◽  
Range Of Motion ◽  
Ankle Fracture ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
Controlled Study ◽  
Posterior Malleolus ◽  
Significant Difference ◽  
Operative Complications

Category: Ankle; Trauma Introduction/Purpose: Ankle fractures are the third most common adult fractures. Further, they are the second most common fracture type to require inpatient admission, behind only hip fractures, despite occurring in a population on average nearly 30 years younger. There is evidence that early or immediate weight bearing and range of motion may be safe following ankle fracture fixation, but existing studies are small and largely exclude patients with syndesmotic or posterior malleolar fixation. We therefore studied the safety of immediate weight bearing as tolerated (IWBAT) and immediate range of motion (IROM) following open reduction internal fixation (ORIF) of unstable ankle fractures in a diverse cohort and attempted to identify risk factors for complications. Methods: We performed a retrospective case-control study. Out of 268 patients who underwent primary ORIF of an unstable ankle fracture from 2013-18, we identified 133 (49.6%) who were IWBAT and IROM. The treating surgeon excluded patients from IWBAT if they had an ipsilateral leg injury requiring non-weight bearing, a large displaced posterior malleolus fragment, or Maisonneuve injury with fracture of the proximal fibula. We used propensity-score matching to identify 172 controls who were non-weight bearing (NWB) and no range of motion for 6 weeks post-op. We reviewed medical records and radiographs for demographic, injury and treatment characteristics. Our primary outcome was complications. We compared demographics, injury characteristics, treatment episode, and complications between the IWBAT and NWB groups and performed within group analysis to identify risk factors for complications. A p-value <0.05 was considered significant. Results: The groups did not differ significantly in age, BMI, Charleston Comorbidity Index (CCI), smoking status, diabetes status, malleoli involved, percentages undergoing medial malleolus (60.9% IWBAT vs. 51.7% NWB, p=0.11), posterior malleolus (24.1% IWBAT, 26.7% NWB, p=0.59), or syndesmosis fixation (41.4% IWBAT, 42.4% NWB, p=0.85). There was no significant difference in total complications (9.8% IWBAT vs. 12.8% NWB, p=0.41), nonoperative complications (6.8% IWBAT vs. 8.7% NWB, p=0.53), or operative complications (3.8% IWBAT vs. 4.1% NWB, p=0.89). We did not identify any factors associated with increased complication risk, including posterior malleolus or syndesmosis fixation, diabetes, age, CCI or pre-injury assisted ambulation. Conclusion: IWBAT and IROM may be safe following ankle fracture ORIF in a broader patient population than previously believed. We did not identify specific risk factors for post-operative complications. Further study on patient selection may allow for more extensive use of this protocol to reduce the morbidity associated with unstable ankle fractures. [Table: see text]

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.

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