Intra-Articular Block Compared with Conscious Sedation for Closed Reduction of Ankle Fracture-Dislocations

Background: Closed reduction and splinting followed by outpatient management is standard of care for temporizing most ankle fractures. However, ankle fracture-dislocation potentially warrants a different approach based on the propensity for loss of reduction. The purpose of this study was to determine the rate of complications associated with closed reduction and splinting of unstable ankle fracture-dislocations. Further, we sought to determine the efficacy of immediate external fixation as an alternative to splinting in cases too swollen for acute operation. Methods: This retrospective chart review analyzed all ankle-fracture dislocations that came through a large health care system from 2008 to 2018. Patients managed with acute open reduction internal fixation (ORIF) and open fractures were excluded. In patients managed late, the cohorts were divided into those temporized with closed reduction/splinting vs external fixation. Reduction quality and splint technique were additionally assessed in splinted patients. A total of 354 closed ankle fracture-dislocations were identified: 298 patients (84%) underwent ORIF within 48 hours and were excluded; 28 (15 female/13 male, average age 46.8 years) were placed in an external fixator and 28 (22 female/6 male, average age 57.2 years) were reduced, splinted, and discharged. Results: At follow-up, 14 of the patients (50%) in the splint group developed loss of reduction and 5 of these patients (17.6%) developed anteromedial skin necrosis from skin tenting. None of the patients in the ex-fix group developed loss of reduction or skin necrosis. The rate of redislocation and the rate of development of skin necrosis was statistically higher in cases temporized with a splint versus an external fixator ( P < .01 and P = .05, respectively). Conclusion: We found that in ankle fracture-dislocations not treated with acute ORIF, splint immobilization was associated with an increased risk of complications, including redislocation and skin necrosis, when compared to a temporizing external fixator. Level of Evidence: Level III, retrospective comparative study.

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The Hematoma Block: A Simple, Effective Technique for Closed Reduction of Ankle Fracture Dislocations

The Journal of Foot & Ankle Surgery ◽

10.1053/j.jfas.2011.04.037 ◽

2011 ◽

Vol 50 (4) ◽

pp. 507-509 ◽

Cited By ~ 9

Author(s):

Adrianne Ross ◽

Alan R. Catanzariti ◽

Robert W. Mendicino

Keyword(s):

Closed Reduction ◽

Ankle Fracture ◽

Effective Technique ◽

Fracture Dislocations

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Stability of Ankle Fracture–dislocations following Successful Closed Reduction

The Duke Orthopaedic Journal ◽

10.5005/jp-journals-10017-1084 ◽

2017 ◽

Vol 7 (1) ◽

pp. 58-63

Author(s):

Robert D Zura ◽

Andrew P Matson ◽

Cynthia L Green ◽

Shepard R Hurwitz

Keyword(s):

Closed Reduction ◽

Ankle Fracture ◽

Fragment Size ◽

Articular Surface ◽

Case Series ◽

Operative Intervention ◽

Fracture Fragment ◽

Posterior Malleolus ◽

Loss Of Reduction ◽

Fracture Dislocations

ABSTRACT Introduction Following successful closed reduction, the ideal timing of operative fixation for ankle fracture–dislocations is not well understood. We sought to describe the rate at which initial reduction is lost between the Emergency Department (ED) and clinic visits, and to identify factors associated with loss of reduction. Materials and methods We identified 30 patients with isolated, closed ankle fracture–dislocations that were successfully reduced and splinted in the ED prior to operative intervention. The maintenance of reduction at follow-up clinic visit was defined as a success, and loss of reduction was defined as a failure. Results There were 17 (57%) successes and 13 (43%) failures. When the ratio of posterior malleolus (PM) fracture fragment size to complete articular surface was >0.1, rate of failure was 65% compared with 18% when the ratio was ≤0.1 (p = 0.016). Conclusion Ankle fracture–dislocations with a larger PM fracture fragment size may warrant consideration of earlier operative intervention. Level of evidence IV, Case Series. Matson AP, Green CL, Hurwitz SR, Zura RD. Stability of Ankle Fracture–dislocations following Successful Closed Reduction. The Duke Orthop J 2017;7(1):58-63.

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Splinting vs temporary external fixation in the initial treatment of ankle fracture-dislocations

Foot and Ankle Surgery ◽

10.1016/j.fas.2021.03.018 ◽

2021 ◽

Author(s):

Mehmet Ozbey Buyukkuscu ◽

Seckin Basilgan ◽

Ali Mollaomeroglu ◽

Abdulhamit Misir ◽

Hakan Basar

Keyword(s):

External Fixation ◽

Initial Treatment ◽

Ankle Fracture ◽

Fracture Dislocations

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Translunate, Transmetacarpal, Scapho-Radial Fracture with Perilunate Dislocation A Case Report

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681_85_80068-1 ◽

1985 ◽

Vol 10 (3) ◽

pp. 382-384

Author(s):

P. TOFT ◽

K. BERTHEUSSEN ◽

S. OTKJAER

Keyword(s):

Case Report ◽

Avascular Necrosis ◽

Closed Reduction ◽

Open Reduction ◽

X Rays ◽

Radial Fracture ◽

Perilunate Dislocation ◽

Carpal Fracture ◽

Fracture Dislocations

A case translunate, transmetacarpal, scapho-radial fracture with perilunate dislocation occurred as a young man drove his motorcycle into the side of a car. Closed reduction was performed initially. Open reduction was performed with a screw in the lunate. Eighteen months later the screw was removed and after two and a half years x-rays revealed no signs of avascular necrosis or arthrosis. The patient fully recovered. This case stresses the necessity of open reduction in cases of complicated carpal fracture dislocations.

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Functional Outcomes After Fracture-Dislocation of the Ankle

Foot & Ankle Specialist ◽

10.1177/1938640019826701 ◽

2019 ◽

Vol 13 (1) ◽

pp. 18-26 ◽

Cited By ~ 1

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

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