The frequency of proximal tibiofibular joint types in patients with malleolar fractures

Background: Due to the prevalence of ankle malleolar fractures and by considering the influence of proximal tibiofibular joint(PTFJ) on fibula movement during ankle motion and subsequently on ankle injuries, this research was conducted to determine distributed frequency of the PTFJ in adult patients with malleolar fractures.Methods: This survey was conducted on a prospective cross-sectional basis. adult patients with malleolar fractures in two year period enrolled . Information, such as gender, age, mechanisms of fractures, reason of fractures, location of fractures was Collected, classified and reported along with descriptive statistics. Frequency of PTFJ in normal population determined and used for comparison with study group.Results: In the 79 patients could match our criteria in this study. The age of patients was 37±15 with range of 18-80 years. The highest number of ankle fractures were seen in third decade of age and these fractures were more prevalent in men. The most common cause of ankle fractures was traffic accidents (54/43%).the most common injury was lateral malleolar fracture (68/74%) and the most common mechanism of injury was Lauge-Hansen supination – external rotation, Danis-Weber type B . Frequency of PTFJ transverse and oblique types in normal population (80.6/19.4%)and study(71/29%) groups was statistically different (P < 0/05). According to mechanism of injury and location of fibular fracture, there was no significant difference between PTFJ types (P > 0/05).Conclusions: Frequency of oblique PTFJ in patients with malleolar fracture was more than normal population. There was no correlation between PTFJ type and mechanism of malleolar fracture or location of fibular fracture.Bangladesh Journal of Medical Science Vol.17(4) 2018 p.625-630

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Prospective Evaluation of the Ottawa Ankle Rules in a University Sports Medicine Center

The American Journal of Sports Medicine ◽

10.1177/03635465980260020201 ◽

1998 ◽

Vol 26 (2) ◽

pp. 158-165 ◽

Cited By ~ 59

Author(s):

John J. Leddy ◽

Robert J. Smolinski ◽

James Lawrence ◽

Jody L. Snyder ◽

Roger L. Priore

Keyword(s):

Sports Medicine ◽

Ankle Injuries ◽

Fracture Rate ◽

Malleolar Fracture ◽

Potential Reduction ◽

Malleolar Fractures ◽

Ottawa Ankle Rules ◽

Clinically Significant ◽

Sensitivity Specificity ◽

Fracture Identification

In a sports medicine center, we prospectively evaluated the Ottawa Ankle Rules over 1 year for their ability to identify clinically significant ankle and midfoot fractures and to reduce the need for radiography. We also developed a modification to improve specificity for malleolar fracture identification. Patients with acute ankle injuries ( 10 days old) had the rules applied and then had radiographs taken. Sensitivity, specificity, and the potential reduction in the use of radiography were calculated for the Ottawa Ankle Rules in 132 patients and for the new “Buffalo” rule in 78 of these patients. There were 11 clinically significant fractures (fracture rate, 8.3% per year). In these 132 patients, the Ottawa Ankle Rules would have reduced the need for radiography by 34%, without any fractures being missed (sensitivity 100%, specificity 37%). In 78 patients, the specificity for malleolar fracture for the new rule was significantly greater than that of the Ottawa Ankle Rules malleolar rule (59% versus 42%), sensitivity remained 100%, and the potential reduction in the need for radiography (54%) was significantly greater. The Ottawa Ankle Rules could significantly reduce the need for radiography in patients with acute ankle and midfoot injuries in this setting without missing clinically significant fractures. The Buffalo modification could improve specificity for malleolar fractures without sacrificing sensitivity and could significantly reduce the need for radiography.

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Comparison of ultrasonography and X-ray test for lateral malleolar fracture in ankle sprain

Biomedical Research and Therapy ◽

10.15419/bmrat.v7i8.624 ◽

2020 ◽

Vol 7 (8) ◽

pp. 3939-3943

Author(s):

Hamideh FeizDisfani ◽

Ehsan Bolvardi ◽

Mohadeseh Shourabi ◽

Mohammad Davood Sharifi ◽

Seyed Mohammad Mousavi ◽

...

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Likelihood Ratio ◽

Ankle Sprain ◽

Diagnostic Value ◽

Ankle Injuries ◽

Malleolar Fracture ◽

X Ray ◽

Malleolar Fractures ◽

Bedside Ultrasonography

Introduction: The use of ultrasonography for diagnosing musculoskeletal injuries, especially fractures, in the emergency department is on the rise because of its good diagnostic value. This study aimed to evaluate the diagnostic value of bedside ultrasonography in detecting the patients suffering from lateral malleolar fractures with an ankle sprain mechanism. Methods: This prospective study was conducted on patients having acute ankle injuries with ankle sprain mechanism and diagnosed with lateral malleolar tenderness. All patients underwent bedside ultrasonography with a 7.5 - 10 MHz probe by an emergency medicine specialist who was assisted by a radiologist. Next, they underwent lateral ankle and anteroposterior (AP) X-rays by another emergency medicine specialist who was blinded from the ultrasonography results. The ultrasonography and X-Ray results were then compared. Results: A total of 244 patients participated in this study, of whom 92 (37.70%) were diagnosed with lateral malleolar fracture through bedside ultrasonography and X-Ray tests. The results showed that ultrasonography had a sensitivity of 96.84% and a specificity of 97.31%. The positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 36.07 and 0.0325, respectively, and the positive and negative predictive values of bedside ultrasonography were 95.83% and 97.98%, respectively. Finally, the results indicated a percent agreement (accuracy) of 97.13% between the two tests with Kappa coefficient of 0.94 (z = 14.68, P value < 0.01). Conclusion: The results of this study showed that bedside ultrasonography has a high sensitivity and specificity in the diagnosis of lateral malleolar fractures with an ankle sprain mechanism. Conducting further studies will lead to the use of this diagnostic test in the emergency department.

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

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i3.1443 ◽

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.

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Ankle Trauma

Musculoskeletal Imaging Volume 1 ◽

10.1093/med/9780190938161.003.0023 ◽

2019 ◽

pp. 108-112

Author(s):

Pavan Parasu ◽

Winnie A. Mar

Keyword(s):

Treatment Options ◽

Ankle Fractures ◽

Ankle Injuries ◽

Mechanism Of Injury ◽

Tibial Pilon ◽

Imaging Characteristics ◽

Fibular Fracture ◽

Ankle Trauma ◽

Imaging Strategy

Chapter 23 reviews the mechanism of injury and clinical features, imaging strategy, imaging characteristics and classification and treatment options of ankle fractures. The Lauge-Hansen and Weber classifications for malleolar fractures are described. The Lauge-Hansen classification of ankle fractures is based on the mechanism of injury. Weber classification of ankle fractures is based on the fibular fracture location relative to the ankle mortise. Pilon, Maisonneuve, and osteochondral fractures are also discussed. Ankle injuries are first evaluated with radiographs. CT examination is helpful in preoperative planning for distal tibial Pilon fractures, which are generally underestimated radiographically. MRI may be useful in determining associated ligamentous injury.

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Radiographic Results of Unicortical Medial Malleolar Fracture Fixation

Foot & Ankle International ◽

10.1177/1071100718816692 ◽

2018 ◽

Vol 40 (4) ◽

pp. 398-401

Author(s):

Henrik C. Bäcker ◽

Matthew Konigsberg ◽

Christina E. Freibott ◽

Melvin P. Rosenwasser ◽

Justin K. Greisberg ◽

...

Keyword(s):

Fracture Fixation ◽

Bone Growth ◽

Distal Tibia ◽

Case Series ◽

Clinical Results ◽

Ankle Fractures ◽

Medial Malleolus ◽

Malleolar Fracture ◽

Malleolar Fractures

Background: Medial malleolar fractures commonly occur as part of rotational ankle fractures, which often require surgery. Different fixation techniques exist, including unicortical or bicortical lag-screw fixation. Bicortical screws that engage the lateral distal tibia have been noted to be biomechanically superior to unicortical ones with a lower failure rate. The authors of this study have used unicortical screws routinely. This study was initiated to investigate the clinical results of a large series of patients with unicortical medial malleolar fixation. Methods: Patients who underwent unicortical medial malleolar fracture fixation between 2011 and 2017 were reviewed. In total, 461 ankle fractures were identified with a mean follow-up of 11.4 months (range, 3-57), of which 211 had a medial malleolar fracture. Eight patients were excluded as they did not follow up with the treating surgeons after surgery, leaving 203 patients for evaluation. The primary outcome was radiographic union. Any loss of reduction, complication, or subsequent surgery was recorded. Malunion was defined as greater than 2 mm displacement. Results: There were 2 asymptomatic nonunions (1.0%), 1 delayed union that healed using an external bone growth stimulator (0.5%), and 2 malunions of the medial malleolus (1.0%) with 1 asymptomatic. The other patient developed posttraumatic osteoarthritis but has not yet required further surgery. None of these 5 patients required revision medial malleolar surgery. Ultimately, the union rate using unicortical medial malleolar fixation was 99.0% (201/203). Conclusion: Unicortical fixation of medial malleolar fractures resulted in consistently good healing. Even though biomechanical studies have shown that bicortical screws provide stronger fixation, our clinical results indicate that the need for this stronger fixation may be questionable. Level of Evidence: Level IV, retrospective case series.

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Functional outcome and complications of surgically managed malleolar fractures at ankle

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20172871 ◽

2017 ◽

Vol 3 (4) ◽

pp. 770

Author(s):

K. Nageswara Rao ◽

Asif Hussain K.S ◽

P. Chandra Sekhar ◽

C. Vijay Krishna

Keyword(s):

Functional Outcome ◽

Fracture Fixation ◽

Ankle Injuries ◽

Medical Sciences ◽

Malleolar Fracture ◽

Exclusion Criteria ◽

Degenerative Arthritis ◽

Radiological Criteria ◽

Malleolar Fractures

Background: If not treated properly the ankle injuries are a source of disability in the form of pain, instability and early degenerative arthritis of ankle. The aim and objectives of the study were to assess functional outcome of surgically managed malleolar fractures at ankle and to assess the results of complication.Methods: This study was undertaken from January 2012 to August 2015. In-patients who were admitted in Nizams institute of medical sciences Hyderabad, for surgical management of ankle fracture were taken for the present study. 61 patients were admitted during this period. Among them, 4 patients died, 5 patients were lost from follow up due to various reasons and 4 patients were not fulfilling the inclusion/exclusion criteria. The remaining 48 patients were included in the study.Results: Pronation abduction injury was more common, seen in 45% of patients. In terms of functional outcome 62% patients achieved excellent to good results as per subjective criteria. 75% good results as per objective criteria and 83% good results as per radiological criteria. Patients with unimalleolar fractures had the best outcome with mean Olerud Molander ankle score (OMA) Score of 94 With regards to lateral malleolar fracture fixation modality, patients with rush nail fixation had mean OMA Score of 86. With regards to medial malleolar fracture fixation modality, patients with Tension band wiring had mean OMA SCORE of 93. The patients with complications has poorer outcome with mean OMA Score of 76. Conclusions: There was a significant improvement in the functional outcome of the patients as assessed by radiological, subjective and objective parameters compared to preoperative condition.

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Percutaneous posteroanterior screw fixation for Haraguchi type 1 posterior malleolar fracture in tri-malleolar fracture: Operative technique and randomized clinical results

Journal of Orthopaedic Surgery ◽

10.1177/2309499021997996 ◽

2021 ◽

Vol 29 (1) ◽

pp. 230949902199799

Author(s):

Tianming Yu ◽

Jichong Ying ◽

Jianlei Liu ◽

Dichao Huang ◽

Hailin Yan ◽

...

Keyword(s):

Screw Fixation ◽

Malleolar Fracture ◽

Malleolar Fractures ◽

Posterior Malleolar Fracture ◽

Post Traumatic ◽

Group 2 ◽

Traumatic Arthritis ◽

Group 1

Purpose: The study described a novel surgical treatment of Haraguchi type 1 posterior malleolar fracture in tri-malleolar fracture and patient outcomes at intermediate period follow-up. Methods: All patients from January 2015 to December 2017 with tri-malleolar fracture of which posterior malleolar fractures were Haraguchi type 1, were surgically treated in this prospective study. Lateral and medial malleolar fractures were managed by open reduction and internal fixation through dual incision approaches. 36 cases of Haraguchi type 1 posterior malleolar fractures were randomly performed by percutaneous posteroanterior screw fixation with the aid of medial exposure (group 1). And 40 cases were performed by percutaneous anteroposterior screw fixation (group 2). Clinical outcomes, radiographic outcomes and patient-reported outcomes were recorded. Results: Seventy-six patients with mean follow-up of 30 months were included. There were no significant differences in the mean operation time (81.0 ± 11.3 vs. 77.2 ± 12.4), ankle function at different periods of follow-up, range of motions and visual analog scale (VAS) at 24 months between the two groups ( p > 0.05). However, the rate of severe post-traumatic arthritis (Grade 2 and 3) and the rate of step-off rather than gap in radiological evaluation were lower in group 1 than that in group 2 ( p < 0.05). Conclusion: Using our surgical technique, more patients had good outcome with a lower rate of severe post-traumatic arthritis, compared with the group of percutaneous anteroposterior screw fixation. Percutaneous posteroanterior screw fixation can be a convenient and reliable alternative in treating Haraguchi type 1 posterior malleolar fracture.

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