scholarly journals PO 18198 - Treatment of distal tibiofibular syndesmosis injury in ankle fractures with suture button

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 43S
Author(s):  
Guilherme Honda Saito ◽  
Marcelo Pires Prado ◽  
Alberto Abussamra Moreira Mendes ◽  
Danilo Ryuko Nishikawa ◽  
Beatriz Devito ◽  
...  
Keyword(s):  
Hardware Removal ◽  
Ankle Fractures ◽  
Tibiofibular Syndesmosis ◽  
Aofas Score ◽  
Patient Functioning ◽  
Suture Button ◽  
Distal Tibiofibular Syndesmosis ◽  
Tibiofibular Joint ◽  
The Mean

Introduction: Distal tibiofibular syndesmosis (DTFS) injuries in ankle fractures are conventionally treated by DTFS fixation with stabilizing screws. However, screws may cause problems due to their inherent rigidity. Therefore, the popularity of fixation devices that allow DTFS mobility has increased. The objective of the present study is to describe the outcomes of the surgical treatment of ankle fractures with DTFS injury using suture button syndesmosis fixation. Methods: Forty-four patients surgically treated with a suture button for ankle fractures associated with DTFS injury were retrospectively analyzed. The mean follow-up time was 14.7 months. Patient functioning was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score, the visual analog scale (VAS), the rate of complications and the need for reoperation. Results: The mean AOFAS score at the last follow-up visit was 92 (35-100). The mean VAS was 0.8 (0-7). Eight patients (18%) developed complications, the most common of which were posttraumatic osteoarthrosis and peroneal tendinopathy. Reoperations were performed in 6 patients (13.5%) and included orthopedic hardware removal, peroneal tenoplasty, neurolysis or distal tibiofibular arthrodesis. Only one patient was unable to resume previous activities. Conclusion: Suture button is a reliable alternative for DTFS fixation in ankle fractures, providing excellent functional outcomes with a low rate of complications. This device has the theoretical advantage of allowing physiological mobility of the distal tibiofibular joint and generally requires no subsequent orthopedic hardware removal.

scholarly journals Early Weight Bearing on Weber C Fractures with Retained Syndesmotic Screws

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Cristian Ortiz ◽  
Andres Keller Díaz ◽  
Pablo Mococain ◽  
Pablo Wagner ◽  
Ruben Radkievich ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
X Rays ◽  
Aofas Score ◽  
Early Weight Bearing ◽  
Clear Space ◽  
Screw Breakage ◽  
The Mean

Category: Ankle, Sports, Trauma Introduction/Purpose: There is no consensus about when to allow weight bearing in ankle fractures treated with syndesmotic screw fixation. There has been no evaluation of the radiographic fate of the syndesmosis when syndesmotic screws are retained and early weight bearing is encouraged, or the clinical result depending on the screw status, which can be intact, broken or loose. Our objective was to evaluate the radiographic and clinical parameters of patients who had a screw fixation of the syndesmosis and early weight bearing was allowed. Our hypothesis was that no difference would be observed on syndesmotic reduction or clinical function depending on the screw status. Methods: We analyzed 42 patients with ankle fractures treated with syndesmotic screws in which early weight bearing was allowed (3 weeks postoperatively). Weight bearing radiographs were obtained at 2 weeks, 2 months and at final follow up (41.2 months). Radiologically we measured medial clear space (MCS), tibiofibular overlap (OL), tibiofibular clear space (CS), talar shift (TS) and screw condition (intact, broken, loose). Clinical function was measured with the AOFAS score and stratified by the screw condition. Statistical analysis was performed with the SPSS software and a non-inferiority confidence interval for the mean was calculated. Results: At final follow up, 66,6% of the screws were broken, 30,9% showed significant loosening and only 1 patient (4,7%) had a screw that remained solid with no signs of osteolysis. MCS at 2 weeks, 2 months and at final follow up was 2,94 mm; 3,03 mm; 3,02, respectively. OL was 6,76 mm; 6,78 mm; 6,83 and CS was 4,26 mm; 4,66 mm; 4,6 mm. No TS was detected. There was no difference in measurements along time (p>0,05). Relative to clinical function, the mean AOFAS score was 95 points. No difference was found between the clinical scores of patients stratified by the screw condition (p>0,05). Conclusion: Early weight bearing on a fixed syndesmosis appears to be safe, with no measurable radiographic or clinical consequences regarding ankle joint function. Despite screw breakage or loosening on x-rays, loss of reduction is seldom observed. We suggest that routine removal of syndesmotic screws is not necessary in these group of patients.

scholarly journals A lean bioabsorbable magnesium-zinc-calcium alloy ZX00 used for operative treatment of medial malleolus fractures

2020 ◽  
Vol 9 (8) ◽  
pp. 477-483
Author(s):  
Patrick Holweg ◽  
Valentin Herber ◽  
Martin Ornig ◽  
Gloria Hohenberger ◽  
Nicolas Donohue ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Clinical Investigation ◽  
Blood Analysis ◽  
Ankle Fractures ◽  
Fracture Reduction ◽  
Medial Malleolus ◽  
Aofas Score ◽  
Talocrural Joint ◽  
The Mean

Aims This study is a prospective, non-randomized trial for the treatment of fractures of the medial malleolus using lean, bioabsorbable, rare-earth element (REE)-free, magnesium (Mg)-based biodegradable screws in the adult skeleton. Methods A total of 20 patients with isolated, bimalleolar, or trimalleolar ankle fractures were recruited between July 2018 and October 2019. Fracture reduction was achieved through bioabsorbable Mg-based screws composed of pure Mg alloyed with zinc (Zn) and calcium (Ca) ( Mg-Zn0.45-Ca0.45, in wt.%; ZX00). Visual analogue scale (VAS) and the presence of complications (adverse events) during follow-up (12 weeks) were used to evaluate the clinical outcomes. The functional outcomes were analyzed through the range of motion (ROM) of the ankle joint and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Fracture reduction and gas formation were assessed using several plane radiographs. Results The follow-up was performed after at least 12 weeks. The mean difference in ROM of the talocrural joint between the treated and the non-treated sites decreased from 39° (SD 12°) after two weeks to 8° (SD 11°) after 12 weeks (p ≤ 0.05). After 12 weeks, the mean AOFAS score was 92.5 points (SD 4.1). Blood analysis revealed that Mg and Ca were within a physiologically normal range. All ankle fractures were reduced and stabilized sufficiently by two Mg screws. A complete consolidation of all fractures was achieved. No loosening or breakage of screws was observed. Conclusion This first prospective clinical investigation of fracture reduction and fixation using lean, bioabsorbable, REE-free ZX00 screws showed excellent clinical and functional outcomes. Cite this article: Bone Joint Res 2020;9(8):477–483.

scholarly journals Clinical Analysis of Posterolateral Approach for the Treatment of Posterior Malleolus Fracture with Cannulated Screw or Buttress Plate

2021 ◽  
Author(s):  
Yang Lei ◽  
liu zhiyuan ◽  
Yin Gang
Keyword(s):  
Internal Fixation ◽  
Pain Score ◽  
Cannulated Screw ◽  
Ankle Fractures ◽  
Posterolateral Approach ◽  
Aofas Score ◽  
Posterior Malleolus ◽  
The Mean ◽  
Buttress Plate

Abstract Background:Posterior malleolus (PM) fractures account for 7%-44% of all ankle fractures. however, the management of PM fractures remains controversial. Studies have shown that the posterolateral approach is one of the most commonly used surgical approaches. The aim of this study was to evaluate the clinical effect of the posterolateral approach with cannulated screw or buttress plate for the treatment of posterior malleolus fracture.Method:We retrospectively analyzed the clinical data of 66 patients with ankle fractures involving posterior malleolus from January 2016 to March 2018. All patients were treated with a posterolateral approach. Fixation of the posterior malleolus was made with anterior to posterior (AP) lag screws in 7 patients, posterior to anterior (PA) lag screws in 38 patients, buttress plates in 9 patients, and buttress plates combined with PA lag screws in 12 patients. We used the AOFAS ankle and posterior foot function scoring system, VAS pain score, and radiographic evaluations as the primary outcome measures. The mean follow-up was 10.8 ± 4.4 (range, 6-20) months.Results:Radiological evaluation showed that 64 patients (97.0%) achieved a good or excellent reduction and the primary bone union was achieved in all the 66 patients without internal fixation failure or occurrence of post-traumatic ankle arthritis. At the final follow-up, the mean AOFAS score of the patients was 92.39 ± 3.84, with an excellent/good rate of 100%. The VAS pain score was 6.62±1.03 before surgery, changed to 3.06 ± 0.72 one week after surgery, and 1.20 ± 0.92 at the final follow-up. There was no statistical difference in the AOFAS score (p=0.01) or VAS pain score (p=0.01) between the different internal fixation methods.Conclusion:The posterolateral approach using lag screws and/or buttress plates can achieve good clinical outcomes in the treatment of posterior malleolus fracture with reduced incidence of postoperative complications, fracture reduction failure, and ankle osteoarthritis.

scholarly journals Short-Term Results of Lisfranc Injuries Treated with the Suture Button Technique

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0037
Author(s):  
Guilherme H. Saito ◽  
Alberto A. M. Mendes ◽  
Danilo R. C. Nishikawa ◽  
Beatriz Devito ◽  
Cesar de Cesar Netto ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Articular Surface ◽  
Insertion Site ◽  
Hardware Removal ◽  
Short Term ◽  
Suture Button ◽  
Loss Of Reduction ◽  
The Mean ◽  
Lisfranc Injuries

Category: Midfoot/Forefoot, Sports, Trauma Introduction/Purpose: Primary fixation with screws or plates or primary arthrodesis are considered the gold-standard surgical treatment options for Lisfranc injuries. However, drawbacks of these procedures include loss of joint motion, need for later hardware removal, injury of the articular surface by screws and nonunion. Interosseous suture buttons can be used as an alternative technique for fixation of Lisfranc lesions. Theoretically, it may overcome the disadvantages of the rigid construct provided by plates and screws and minimize the harm to the joint cartilage. The aim of the present study was to provide the short-term results of Lisfranc injuries treated with the suture button technique. Methods: Sixteen consecutive patients with Lisfranc injuries requiring an operation were treated with the use of the Mini Tight Rope (Arthrex, Naples, FL) between April 2014 and November 2017. Medical records and radiographic images were retrospectively analyzed by independent observers with respect to functional outcomes, complications, need for reoperation and radiographic outcomes. The mean follow-up was 32 (range, 6-49) months. Functional outcomes were measured by the AOFAS midfoot score and the Visual Analogue Scale (VAS) at the latest follow-up. Results: At a mean follow-up of 32 months, the average AOFAS score was 95.8 (range, 82-100) and the mean VAS was 0.6 (range, 0-2). All patients but one were able to return to their previous activities. Twelve patients were very satisfied with the outcomes and four were satisfied or partially satisfied. A total of 9 complications were observed in 6 patients, with discomfort on the button insertion site being the most common (4 cases). Other complications included evidence of radiographic arthritis (3 cases), loss of reduction (1 case) and extensor hallucis longus tendinopathy (1 case). Only 1 patient required a reoperation for removal of the suture button. Conclusion: The use of the suture button for fixation of Lisfranc injuries showed excellent results in the short-term. This technique is potentially less harmful to the articular cartilage and generally does not require hardware removal. However, arthritis and/or loss of reduction were noted in 3 patients during follow-up, which could have been caused by the severity of the primary injury itself or by a lack of stability provided by the construct. Further studies are required to evaluate whether the suture button technique provides enough fixation to maintain reduction and prevent the development of arthritis in the long-term.

scholarly journals The Surgical Outcomes of Unstable Ankle Fractures in Patients Aged >65 Years

2021 ◽  
Vol 12 ◽  
pp. 215145932199776
Author(s):  
Adem Sahin ◽  
Anıl Agar ◽  
Deniz Gulabi ◽  
Cemil Erturk
Keyword(s):  
Surgical Outcomes ◽  
External Rotation ◽  
High Energy ◽  
Ankle Fractures ◽  
Medial Malleolus ◽  
Aofas Score ◽  
Non Union ◽  
The Mean ◽  
Medial Malleolus Fracture ◽  
Mechanism Of Trauma

Aim: To evaluate the surgical outcomes and complications of patients over 65 years of age, with unstable ankle fractures. Material and Method: The study included 111 patients (73F/38 M) operated on between January 2015 and February 2019 and followed up for a mean of 21.2 months (range, 6-62 months).Demographic characteristics, comorbidities, fracture type, and mechanisms of injury were evaluated. Relationships between postoperative complications and comorbidities were examined. In the postoperative functional evaluations, the AOFAS score was used and pre and postoperative mobilization (eg, use of assistive devices) was assessed. Results: The mean age of the patients was 70.5 ± 6.1 years (range, 65-90 years). The mechanism of trauma was low-energy trauma in 90.1% of the fractures and high-energy trauma in 9.9%. The fractures were formed with a SER injury (supination external rotation) in 83.7% of cases and bimalleolar fractures were seen most frequently (85/111, 76%).Complications developed in 16 (14.4%) patients and a second operation was performed in 11 (9.9%) patients with complications. Plate was removed and debridement was performed in 5 of 6 patients due to wound problems. Nonunion was developed in the medial malleolus in 4 patients. Revision surgery was performed because of implant irritation in 2 patients and early fixation loss in the medial malleolus fracture in one patient. Calcaneotibial arthrodesis was performed in 3 patients because of implant failure and ankle luxation associated with non-union. A correlation was determined between ASA score and DM and complications, but not with osteoporosis. The mean follow-up AOFAS score was 86.7 ± 12.5 (range, 36-100).A total of 94 (84.7%) patients could walk without assistance postoperatively and 92 (82.9%) were able to regain the preoperative level of mobilization. Conclusion: Although surgery can be considered an appropriate treatment option for ankle fractures in patients aged >65 years, care must be taken to prevent potential complications and the necessary precautions must be taken against correctable comorbidities.

scholarly journals Treatment of Hallux Valgus Deformity Using a Suture Button Device: A Preliminary Report

2018 ◽  
Vol 3 (4) ◽  
pp. 247301141880695
Author(s):  
Tyler A. Gonzalez ◽  
Jeremy T. Smith ◽  
Eric M. Bluman ◽  
Lauren V. Ready ◽  
William Ciurylo ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Normal Position ◽  
Suture Button ◽  
Soft Tissue Procedure ◽  
Sf 36 ◽  
Second Metatarsal ◽  
Average Change ◽  
The Mean

Background: Hallux valgus (HV) is commonly treated with proximal or distal first metatarsal osteotomy. Despite good correction, these procedures have inherent risks such as malunion, nonunion, metatarsal shortening, loss of fixation, and avascular necrosis. Suture button fixation has been used for HV treatment. It avoids the risks of corrective osteotomies while maintaining reduction of the intermetatarsal angle (IMA). The goal of this study was to assess the radiographic and functional outcomes of patients undergoing HV correction with a distal soft tissue procedure and proximal suture button fixation. Methods: The authors retrospectively reviewed the charts and radiographs of 22 patients who had undergone HV correction using a distal soft tissue correction and proximal fixation with a miniature suture button device (Mini TightRope; Arthrex, Inc, Naples, FL). Mean follow-up was 27.7 months. The IMA, hallux valgus angle (HVA), and sesamoid station were measured on radiographs obtained preoperatively as well as in the immediate postoperative period and at final follow-up. Preoperative and postoperative Short Form-36 (SF-36) and Foot and Ankle Ability Measure (FAAM) scores were collected. Postoperative complications, and any additional operative procedures performed were also recorded. Results: The mean preoperative IMA and HVA were 16.9 and 32.6 degrees, respectively. The mean immediate postoperative IMA was 5.2 degrees ( P < .0001) and the mean HVA was 9.8 degrees ( P < .0001). At final follow-up, the mean IMA was 8.2 degrees ( P < .0001) and the mean HVA was 16.7 degrees ( P < .0001). The average change in HVA from preoperative to final follow-up was 16.0 degrees and the average change in IMA from preoperative to final follow-up was 8.6 degrees ( P < .0001). Sesamoid station assessment at the 2-week follow-up showed that 22 patients (100%) were in the normal position group; at final follow-up, 17 patients (77%) had normal position and 5 patients (23%) had displaced position. Although there were no clinically symptomatic recurrences, asymptomatic radiographic recurrence was noted in 5 patients (23%) who had a final HVA >20 degrees. All components of the FAAM and the SF-36 showed improvement from preoperative to final follow-up, although these changes were not statistically significant. Three patients experienced complications, including an intraoperative second metatarsal fracture, a postoperative second metatarsal stress fracture, and a postoperative deep vein thrombosis. Conclusion: The use of a distal soft tissue procedure in conjunction with proximal suture button fixation is a safe and effective procedure for treating symptomatic HV deformity. Our results show that this technique can correct the IMA, HVA, and sesamoid station without the need for osteotomy. Level of evidence: Level IV.

scholarly journals Haglund’s disease: surgical outcome of calcaneal osteotomy

2017 ◽  
Vol 3 (2) ◽  
pp. 278 ◽  
Author(s):  
Veerabhadra Javali ◽  
Virupaksha N. Reddy
Keyword(s):  
Conservative Treatment ◽  
Surgical Outcome ◽  
Surgical Intervention ◽  
Lateral Approach ◽  
Lateral View ◽  
Aofas Score ◽  
Postoperative Score ◽  
Calcaneal Osteotomy ◽  
The Mean

<p class="abstract"><strong>Background:</strong> The aim of the present study was to assess the surgical outcome of Haglund’s disease by calcaneal osteotomy<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> 23 cases of Haglund’s disease who failed to respond to conservative treatment were considered for surgery. Parallel pitch lines were drawn in the lateral view radiograph of the calcaneum and the bursal projection to be resected was assessed. All cases were surgically treated with calcaneal osteotomy through lateral approach and followed.<strong></strong></p><p class="abstract"><strong>Results:</strong> 23 cases of Haglund’s disease were treated with this procedure and 21 were available for follow up. The mean follow-up was 15 months. <span>The mean preoperative AOFAS score of 60.57 points (SD= 3.23) and postoperative score of 88.71 points (SD= 3.92) was obtained. </span>Three minor complications were noted<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> The results of the current study suggest that calcaneal ostectomy produces outcomes that justify surgical intervention in cases of Haglund’s disease<span lang="EN-IN">.</span></p>

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.

Sign in / Sign up

Export Citation Format

Share Document