MALLEOLAR ANKLE FRACTURES IN ADULTS: FUNCTIONAL OUTCOME AND COMPLICATIONS AFTER OPEN DECREASE AND INTERNAL FIXATION

2020 ◽  
Vol 4 (3) ◽  
Author(s):  
Chetan Laljibhai Rathod
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Open Reduction ◽  
External Rotation ◽  
Ankle Fractures ◽  
Ankle Injuries ◽  
Excellent Outcome ◽  
Malleolar Fractures ◽  
Supination External Rotation ◽  
Type Of Injury

Background: Ankle injuries may result from high energy as well as low energy rotational forces sustained during sports or a misstep during routine daily activities.3 Young and middle aged are more prone for this type of injury. Population-based studies suggest that the incidence of the ankle fractures has increased dramatically since the early 1960s. Objective: To evaluate the functional outcome and complications following open reduction and internal fixation of malleolar fractures of ankle in adults. Methodology: The study was a descriptive observational study conducted involving all the adult patients of malleolar fractures. Total of 35 subjects of malleolar fractures undergoing open reduction and internal fixation and fulfilling the eligibility criteria were selected for the study. Results: 31.4% subjects each were from 31-40 and 41-50 years age group with mean age of 39.32 +/- 4.16 years. 37.1% patients had Supination External Rotation and 34.3% patients had Pronation External Rotation type of injury. 82.9% patients had Bi-malleolar fracture. 11(31.4%) patients had excellent outcome. Post-operative complications included superficial skin infections in 17.1% and Ankle stiffness in 5.7% cases. Conclusion: At the end of 6 months, 11(31.4%) patients had excellent outcome, 19(54.3%) had good results, 3 (8.6%) patients had fair outcome while 2 (5.7%) had poor results according to Baird and Jackson score. Weber type B was the commonest type of fracture while supination external rotation injury was the most common mechanism of injury. Keywords: Malleolar fractures, ankle, adults, functional outcome, complications, open reduction and internal fixation.

scholarly journals Demographic profile and functional outcome following fixation of malleolar fractures in adults

2020 ◽  
Vol 6 (2) ◽  
pp. 313
Author(s):  
Rejo V. Jacob ◽  
Sanjeev Kumar ◽  
Naveen K. Singh ◽  
Prateek Girotra
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Scoring System ◽  
Open Reduction ◽  
External Rotation ◽  
Early Mobilization ◽  
Common Mechanism ◽  
Demographic Profile ◽  
Malleolar Fractures ◽  
Male Preponderance

<p class="abstract"><strong>Background:</strong> Malleolus are important structures which forms part of ankle mortise and provide stability to it. This article underlines the current demographic profile of patients sustaining malleolar fractures in adults. It also discusses the modalities of treatment and functional outcomes following open reduction and internal fixation of these fractures as well as the improvement in functional outcome following early mobilization.</p><p class="abstract"><strong>Methods:</strong> 30 patients sustaining malleolar fractures who attended the Department of Orthopedics were included in the study. The patients were operated as and when the soft tissue condition permitted and were followed up in outpatient department at 6 weeks, 3 months and 6 months where functional outcome based on Baird and Jackson scoring system was assessed.<strong></strong></p><p class="abstract"><strong>Results:</strong> In this study, the average age of patients was 43.8 years with a male preponderance. Supination-external rotation was the most common mechanism of injury following a slip or twisting injury. According to Baird and Jackson scoring system 20% patients had excellent, 50% patients had good results, 20% patients had fair results and 10% patients had poor results.</p><p class="abstract"><strong>Conclusions:</strong> 70% patients had excellent to good results following fixation of malleolar fractures. Early mobilization was started in 5 patients with 80% patients showing excellent results. Open reduction and Internal fixation proved to be an excellent procedure leading to union in all cases, less complication and early resumption of routine activities.</p><p> </p>

scholarly journals Study on functional outcome of bimalleolar ankle fractures treated by open reduction and internal fixation

2021 ◽  
Vol 7 (3) ◽  
pp. 518
Author(s):  
Nithin Gangadhran ◽  
Manju G. Pillai
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Open Reduction ◽  
External Rotation ◽  
Outcome Measurement ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
Cortical Screw ◽  
Articular Fractures ◽  
Prospective Longitudinal

<p class="abstract"><strong>Background:</strong> Ankle injury is the most common weight bearing orthopaedic musculoskeletal trauma encountered in emergency medicine and practice. Ankle joint is highly congruous and any disturbance of normal articular relationship may result in some progressive arthrosis of biomechanical dysfunction. As with all intra-articular fractures it necessitates accurate reduction and stable internal fixation. The objectives were to study the functional outcome of surgical treatment of bimalleolar ankle fractures and to know the complications of open reduction internal fixation of bimalleolar fractures.</p><p class="abstract"><strong>Methods:</strong> 45 patients with malleolar fractures were included in this prospective longitudinal interventional study. Patients who underwent operative treatment were followed up regularly for 6 months with OPD visits and X-ray imaging at each stage. Patient parameters were recorded at immediate post op period, 6 weeks, 12 weeks and 24 weeks. Baird and Jackson scoring system for ankle were used for the functional outcome measurement.<strong></strong></p><p class="abstract"><strong>Results:</strong> Most common type of injury pattern was supination-external rotation with 21 cases (47% of cases). The results are excellent to good in 65% of patients, 27% of patients had fair and 8% had poor result. Syndesmotic screw fixation was done with 4.5 mm cortical screw in 7 cases. Most common complication was surgical site infection in 3 cases (6.67%). 2 patients underwent implant removal due to unresolved infection at 3 months.</p><p class="abstract"><strong>Conclusions:</strong> The results of operative fixation were satisfactory in 90% of patients. Most of the complications were minor and resolved within three weeks.</p><p class="abstract"> </p>

scholarly journals Are Orthopaedic Surgeons Being Adequately Compensated for Ankle Fractures? An Analysis of Relative Value Units (RVUs)

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0005
Author(s):  
Azeem Tariq Malik ◽  
Safdar N. Khan ◽  
Laura Phieffer ◽  
Thuan V. Ly ◽  
Carmen E. Quatman
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Operative Time ◽  
Open Reduction Internal Fixation ◽  
Ankle Fractures ◽  
Reimbursement Rate ◽  
Total Operative Time ◽  
Orthopaedic Surgeons ◽  
Malleolar Fractures ◽  
The Mean

Category: Ankle, Trauma Introduction/Purpose: Tri-malleolar fractures, as compared to simple uni-malleolar fractures, are technically more challenging cases, have longer operative times and require a higher effort. The current RVU-based system is built to reflect the varying presentation of ankle fractures (uni-malleolar vs. bi-malleolar vs. tri-malleolar) by assigning individual RVUs to different fracture complexities. However, no study has evaluated whether the current RVUs reflect an appropriate compensation per unit time following open reduction internal fixation (ORIF) for uni-malleolar vs. bi-malleolar vs. tri-malleolar ankle fractures. Methods: The 2012-2017 American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) files were queried using CPT codes for patients undergoing open reduction internal fixation (ORIF) for uni-malleolar (CPT-27766, CPT- 27769, CPT-27792), bi-malleolar (CPT-27814) and tri-malleolar (CPT-27822, CPT-27823) ankle fractures. A total of 7,830 (37.2%) uni-malleolar, 7,826 (37.2%) bi-malleolar and 5,391 (25.6%) tri-malleolar ankle fractures were retrieved. Total RVUs were calculated for each case. Mean RVU/minute was derived by dividing the total RVU of each case by the total operative time. Reimbursement rate ($/min) was calculated by multiplying the mean RVU/min of each procedure by a preset CMS-defined rate of $35.8887/RVU. Mean Reimbursement/case was calculated by multiplying the reimbursement rate by the operative time of each procedure. Kruskal-Wallis tests were used to compare RVUs, operative time and reimbursements between the three fracture groups. Results: The mean total RVU for each fracture type was as follows:- 1) Uni-malleolar: 9.99, 2) Bi-malleolar=11.71 and 3) Tri- malleolar=12.87 (p<0.001). A statistically significant difference was noted in mean operative time (uni-malleolar=63.2 vs. bi- malleolar=78.6 vs. tri-malleolar=95.5; p<0.001) between the two groups. Reimbursement rates ($/min) decreased significantly as fracture complexity increased (uni-malleolar=$7.21/min vs. bi-malleolar=$6.75/min vs. tri-malleolar=$6.10; p<0.001). The average reimbursement/case was $358, $420 and $462 for uni-malleolar, bi-malleolar and tri-malleolar fractures respectively. Based on a hypothetical scenario, an orthopaedic surgeon spent 190 minutes fixing two tri-malleolar fractures and earning $924 in the process. Within a total operative time of 190 minutes, three uni-malleolar ankle fractures and two bi-malleolar ankle fractures could be managed completely with an associated earning of $1,074 and $840 respectively. Conclusion: Orthopaedic surgeons are reimbursed at a higher rate ($/min) for treating a simple uni-malleolar fracture as compared to bi-malleolar and tri-malleolar fractures, despite the higher complexity and longer operative times seen in the latter. The study highlights the need of a change in the RVUs for bi-malleolar and tri-malleolar ankle fractures to ensure that surgeons are adequately reimbursed per unit time for treating a more complex fracture case.

scholarly journals Functional outcome of elbow joint in AO type 13C fractures treated with open reduction and internal fixation using dual plates

2019 ◽  
Vol 5 (3) ◽  
pp. 509
Author(s):  
Uyyalawada Sreedhar Reddy ◽  
Bheemsingh Samorekar ◽  
Vinay J. Mathew ◽  
Anil Kumar Mettu
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Open Reduction ◽  
Distal Humerus ◽  
Range Of Movement ◽  
Excellent Outcome ◽  
Significant Difference ◽  
Dual Plating ◽  
Type C ◽  
A Prospective Study

<p class="abstract"><strong>Background:</strong> Distal end of the humerus, with its unique orientation of articular surfaces supported by a meagre amount of cancellous bone, makes its fracture a constant challenge to orthopaedic surgeons. Aim of the study is to evaluate the functional outcome of surgical management of intercondylar AO type C fractures of distal end of humerus using dual plating.</p><p class="abstract"><strong>Methods:</strong> A prospective study was conducted at our hospital between January 2015 to December 2016. Thirty five consecutive patients with intercondylar (AO Type C) fracture of distal humerus, included in study as per inclusion criteria. All patients were treated surgically using triceps reflecting approach and posterior trans-olecranon approach with ulnar nerve exploration and fixation using dual plating and tension band wiring for olecranon osteotomy wherever done.<strong></strong></p><p class="abstract"><strong>Results:</strong> In 35 patients, final results using MEPS scoring system excellent outcome is noticed in 15 patients (42.86%), good results is noticed in 13 patients (37.14%), fair result is noticed in 5 patients (14.29%) and poor result is noticed in 2 patients (5.71%). There was statistical significant difference in flexion range of movement arc at 2 and 6 months in our study.</p><p class="abstract"><strong>Conclusions:</strong> Open reduction and internal fixation of AO type 13C fractures is challenge to surgeon, preoperative planning and mastering the technique over a period of time gives good to excellent functional outcomes.</p><p class="abstract"> </p>

A Medial Malleolar “Fleck Sign” May Predict Ankle Instability in Ligamentous Supination External Rotation Ankle Fractures

2017 ◽  
Vol 11 (3) ◽  
pp. 246-251 ◽  
Author(s):  
Kenneth Nwosu ◽  
Brian Andrew Schneiderman ◽  
Stephen Joseph Shymon ◽  
Thomas Harris
Keyword(s):  
Ankle Instability ◽  
External Rotation ◽  
Treatment Protocol ◽  
Operative Management ◽  
Ankle Fractures ◽  
Ankle Injuries ◽  
Medial Malleolus ◽  
Joint Stability ◽  
Clear Space ◽  
Supination External Rotation

Background. Ankle joint stability dictates treatment in ligamentous supination external rotation ankle injuries (LSERAI). Investigation of the medial structures that support the ankle mortise is critical, and a small avulsion fracture, or “fleck”, of the medial malleolus is occasionally encountered. This study aimed to assess the utility of this medial malleolus fleck sign (MMFS) in diagnosing instability requiring surgery in LSERAI. Methods. This retrospective observational study examined 166 LSERAI at a single level I trauma center. A standardized diagnostic and treatment protocol for ankle fractures was followed. LSERAI at presentation were reported as having a normal, dynamically wide, or statically wide medial clear space. Patient demographics, MMFS characteristics, and the use of operative management were recorded. Results. MMFS incidence in the cohort was 16 (10%) of 166 and was present in 25% of patients with unstable LSERAI. Fifteen (94%) of 16 patients with a MMFS were deemed to have an unstable LSERAI (P < .005). MMFS had a 25% sensitivity and 99% specificity in diagnosing an unstable LSERAI. For the subgroup of patients without a statically wide medial clear space, MMFS had a 50% sensitivity and 99% specificity in determining instability. Conclusion. A MMFS may be indicative of an unstable LSERAI. With previous MRI studies demonstrating complete deltoid disruption in unstable LSERAI, we deduce the MMFS may be associated with extensive deltoid incompetence. The MMFS may help to diagnose a complete deltoid injury in LSERAI with a normal medial clear space, which could influence treatment and reduce patient morbidity, radiation exposure, and healthcare costs. Levels of Evidence: Level III: Retrospective Cohort Study

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.

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