FUNCTIONAL OUTCOMES FOLLOWING SYNDESMOTIC SCREW FIXATION- A COMPARISON OF SCREW REMOVAL VERSUS RETENTION.

BACKGROUND: - The incidence of distal tibiofibular syndesmotic injury in ankle fractures is about 13%. The integrity of syndesmosis is a critical factor which stabilizes ankle mortise during weight-bearing besides load transmission. The primary purpose of the study was to assess the functional outcome in patients with Weber B and C fractures and to decide whether the syndesmotic screws are to be removed or not before weight-bearing. MATERIALS AND METHODS: - This was a prospective observational study involving patients (>18 years of age) who had undergone open reduction and internal fixation of an ankle fracture belonging to Weber B or C classification who had screw stabilization of a disrupted syndesmosis. The study period was three years commencing from August 2014. They were divided into two groups based on the syndesmotic screw retention or removal before weight-bearing. The patients were then regularly followed up with American Orthopaedic Foot and Ankle Society (AOFAS) ankle/hindfoot score and Visual Analogue Score-Foot and Ankle (VAS-FA) score were used to assess the functional outcome. Clinical and radiographic evaluations were done with each follow-up at 4,6,9,12 months. RESULTS: - We identified 32 fractures in 32 patients. Treatment undertaken was open reduction and internal fixation for the malleolli and syndesmotic screw fixation in all patients, and syndesmotic screws were removed in 17 and retained in 15. None of the patients were managed conservatively. We lost a patient to long-term follow-up. The AOFAS score was seen to be progressively increasing (92.3 – 96.75) and higher in the removed group as compared to retained. The VAS-FA score was also seen to be increasing besides being higher in the removed group (160.17 to 187). None of the patients failed the operative stabilization. Also, none of the patients had long-term complications like non-union, mal-union or screw back out excepting one patient who had persistent pain in the retained group. CONCLUSION: It is safe and better to remove the syndesmotic screw prior to weight bearing, when compared to retaining them insitu. Level of evidence IV-prognostic

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Limited Open Reduction and Internal Fixation of Calcaneal Fractures

Foot & Ankle International ◽

10.1177/1071100719873273 ◽

2019 ◽

Vol 41 (1) ◽

pp. 57-62 ◽

Cited By ~ 3

Author(s):

Anne K. Bremer ◽

Lukas Kraler ◽

Lars Frauchiger ◽

Fabian G. Krause ◽

Martin Weber

Keyword(s):

Wound Healing ◽

Internal Fixation ◽

Open Reduction ◽

Case Series ◽

Functional Results ◽

High Rate ◽

Calcaneal Fractures ◽

Retrospective Case ◽

Level Of Evidence

Background: The treatment of displaced intra-articular calcaneal fractures remains a challenge and the optimal approach is still controversial. The main reason to avoid the extended lateral approach is the high complication rate due to wound healing problems. We report on 16 years of experience with a standardized limited open reduction and internal fixation technique. Methods: Between 2001 and 2017, we prospectively followed 240 consecutive patients operatively treated for a displaced intra-articular calcaneal fracture. Patients with open, multiple, bilateral, extra-articular, and Sanders IV fractures and those lost to follow-up were excluded. A lateral subtalar approach was used, with a cast for 8 weeks and full weightbearing allowed after 12 weeks. Follow-up examinations were scheduled until 24 months. Subjective and clinical assessment included gait abnormality, subtalar and ankle range of motion, and stability and alignment. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score was calculated. Alignment was analyzed on standard radiographs. In total, 131 patients were excluded. The remaining 109 patients were followed for a minimum of 24 months (34.4 ± 14.2 [range, 24-102] months). Results: The mean AOFAS score was 87 ± 13 (range, 32-100). “Excellent” and “good” results, as well as hindfoot motion with “normal/mild” and “moderate” restrictions, were seen in 80% of patients. Early reoperations were performed for insufficient reduction (2 patients), delayed wound healing (debridement, 3 patients), and hematoma (1 patient). Late revisions were arthrodesis (3 patients), medializing calcaneal osteotomy (1 patient), and implant removal (53 patients; 49%). Conclusion: The presented approach has remained unmodified for 16 years and resulted in consistently good functional results. The main disadvantage was the high rate of heel screw removal. Level of Evidence: Level IV, retrospective case series.

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Cross-Sectional Study to Assess the Functional Outcome of Neglected Bimalleolar Fracture

Foot & Ankle Specialist ◽

10.1177/1938640016685149 ◽

2016 ◽

Vol 10 (6) ◽

pp. 509-512

Author(s):

Rajeev Shukla ◽

Ravi Kant Jain ◽

Shravan Patidar ◽

Nikhil Jain ◽

Pranav Mahajan

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Rating Scale ◽

Weight Bearing ◽

Functional Results ◽

Cross Sectional Study ◽

Cross Sectional ◽

Results Of Treatment ◽

Trimalleolar Fractures

Introduction. Ankle fracture is the most common intra-articular fracture of a weight-bearing joint and accounts for 9% of all fractures. Ankle fractures are classified into 3 subgroups: unimalleolar, bimalleolar, and trimalleolar fractures. Accurate reduction and stable internal fixation is necessary in bimalleolar fractures; otherwise, it may lead to posttraumatic painful restriction of movements or osteoarthritis. The purpose of this study is to assess the functional outcome and results of treatment of neglected bimalleolar fracture. Materials and Methods. Seventeen neglected bimalleolar fracture patients were treated with open reduction and internal fixation. Patients were followed-up at 1, 2, and 5 years and functional ability was assessed by using the modified Weber Rating Scale. Results. The mean age of patients was 41.4 ± 13.28 years. After 2 year of surgery, 13 out of 17 patients showed excellent results and 4 patients had fair results. Conclusion. Good to excellent functional results were observed after long-term follow-up in neglected bimalleolar fracture treated with open reduction and internal fixation, and we advise surgical intervention in all such patients. Levels of Evidence: Therapeutic, Level III: Retrospective Cohort study

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Long-Term Functional Outcome of Bilateral Spontaneous and Simultaneous Achilles Tendon Ruptures

Foot & Ankle Specialist ◽

10.1177/1938640012444728 ◽

2012 ◽

Vol 5 (5) ◽

pp. 318-320

Author(s):

Prasad Ellanti ◽

Nikos Davarinos ◽

Thomas E. Burke ◽

Lester G. D’Souza

Keyword(s):

Risk Factors ◽

Achilles Tendon ◽

Functional Outcome ◽

Chronic Diseases ◽

Therapeutic Level ◽

Level Of Evidence ◽

Good Functional Outcome ◽

Tendon Ruptures

Bilateral simultaneous ruptures are rare comprising less than 1% of all Achilles tendon ruptures. Risk factors for bilateral ruptures include chronic diseases and medications such as corticosteroids and fluoroquinolones. There is little in the literature on the long-term functional outcome of bilateral Achilles tendon ruptures. This article present a series of 3 cases of simultaneous and spontaneous bilateral Achilles tendon ruptures with a minimum of 5-year follow up suggesting a good functional outcome. Level of Evidence: Therapeutic Level IV

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Open Reduction and Rigid Internal Fixation of Mandibular Condylar Fractures by an Intraoral Approach: A Long-Term Follow-Up Study of 15 Patients

Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.joms.2005.12.069 ◽

2006 ◽

Vol 64 (12) ◽

pp. 1771-1779 ◽

Cited By ~ 36

Author(s):

Thomas Jensen ◽

John Jensen ◽

Sven Erik Nørholt ◽

Martin Dahl ◽

Lone Lenk-Hansen ◽

...

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Rigid Internal Fixation ◽

Follow Up Study ◽

Intraoral Approach ◽

Long Term Follow Up ◽

Condylar Fractures

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Surgical Treatment of Severe Idiopathic Flexible Flatfoot by Evans–Mosca Technique in Adolescent Patients: A Long-Term Follow-Up Study

Advances in Orthopedics ◽

10.1155/2021/8843091 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Vincenzo De Luna ◽

Fernando De Maio ◽

Alessandro Caterini ◽

Martina Marsiolo ◽

Lidio Petrungaro ◽

...

Keyword(s):

Surgical Treatment ◽

Weight Bearing ◽

Radiographic Examination ◽

Radiographic Evaluation ◽

Foot And Ankle ◽

Flexible Flatfoot ◽

Adolescent Patients ◽

The Mean

Flexible idiopathic flatfoot is very common in growing age and rarely causes pain or disability. Surgery is indicated only in severe symptomatic cases that are resistant to conservative treatment, and numerous surgical procedures have been proposed. Lateral column calcaneal lengthening as described by Evans and modified by Mosca is a widely used surgical technique for the correction of severe symptomatic flexible flatfoot. In the present study, we report the long-term clinical and radiographic results in 14 adolescent patients (mean age: 12.8 years) affected by severe symptomatic flexible flatfoot, surgically treated by Evans–Mosca procedure, for a total of 26 treated feet (12 cases bilateral and 2 unilateral). In all cases, surgery was indicated for the presence of significant symptoms resistant to nonsurgical management. Clinical evaluation was made according to the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, the Foot and Ankle Disability Index (FADI) Score, and Yoo et al.’s criteria. Radiographic evaluation was made using anteroposterior and lateral weight-bearing radiographs of the feet to evaluate Meary’s angle and Costa–Bertani’s angle and to evaluate possible osteoarthritic changes in the midtarsal joints. At follow-up (mean: 7 years and 7 months), we observed a satisfactory result in all patients. The mean average score of the AOFAS Ankle-Hindfoot Scale improved from 60.03 points to 95.26; the mean FADI score improved from 71.41 to 97.44; and according to Yoo et al.’s criteria, the average clinical outcome score was 10.96. At radiographic examination, nonunion of the calcaneal osteotomy was never observed. Meary’s angle improved from an average preoperative value of 25° to 1.38° at follow-up; Costa–Bertani’s angle improved from an average preoperative value of 154.2° to 130.9° at follow-up. In no case, significant radiographic signs of midtarsal joint arthritis were observed. According to our results, we believe that Evans–Mosca technique is a valid option of surgical treatment for severe idiopathic flexible flatfoot and allows a satisfactory correction of the deformity with a low rate of complications.

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Functional outcome after open reduction and internal fixation for traumatic diastasis of the pubic symphysis a one year follow-up study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20163548 ◽

2016 ◽

Vol 2 (4) ◽

pp. 256

Author(s):

B. L. S. Kumar Babu ◽

Biju Ravindran

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

High Energy ◽

Walking Distance ◽

Early Weight Bearing ◽

Dual Plating ◽

Pubic Diastasis ◽

One Year

Background: Pubic diastasis often results in anteroposterior compression (APC) injuries based on Young and Burgess classification. It is caused due to high-energy trauma and of much clinical importance is given when coexists with urogenital and neurological complications with hemodynamic instability. Open reduction and internal fixation with plating facilitates early mobilisation with better results and is the preferable mode of stabilisation. We evaluated the clinical and functional outcome of such patients in a one-year follow-up period.Methods: In our study, we included 20 patients with APC II injuries who underwent an open reduction by single or dual plating technique by the Pfannenstiel approach, were followed for one year.Results: Among 20 patients, 14 patients (70%) were operated with single superior plating, six patients (30%) were performed with dual plating, i.e., both superior and anterior plating. Among 20 patients, two patients (10%) were operated for primary arthrodesis with double plating. Only one among 20 (5%) had implant failure due to early weight bearing and were re-operated with primary arthrodesis with plating. Results were analysed based on a scoring system which includes five criteria such as anterior pelvic pain, dyspareunia and sexual dysfunction, ability to sit, gait abnormalities and walking distance. Among 20 patients ten patients (50%) had excellent results, six patients (30%) had good results, two patients (10%) had fair results, two patients (10%) had poor results.Conclusions: Open reduction and internal fixation of traumatic pubic diastasis in type II APC injuries with single or dual plating had given better results and early functional recovery.

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Treatment of Tibial Avulsion Fracture of Posterior Cruciate Ligament by Open Reduction and Internal Fixation

Journal of Nobel Medical College ◽

10.3126/jonmc.v9i1.29419 ◽

2020 ◽

Vol 9 (1) ◽

pp. 17-21

Author(s):

Ranjib Kumar Jha ◽

Santosh Thapa

Keyword(s):

Clinical Outcome ◽

Internal Fixation ◽

Functional Outcome ◽

Posterior Cruciate Ligament ◽

Open Reduction ◽

Avulsion Fracture ◽

Cruciate Ligament ◽

Avulsion Injury ◽

The Mean

Background: An avulsion fracture of posterior cruciate ligament from tibial attachment is more common in younger age group. It should be fixed otherwise it may lead to secondary changes in knee. Various techniques and approaches are available to fix posterior cruciate ligament avulsion. Different biomechanical studies have shown that, results both open and arthroscopic methods of fixation of posterior cruciate ligament avulsion by screws are comparable. The purpose of study is to evaluate functional and clinical outcome of open reduction and fixation of posterior cruciate ligament avulsion injury through posteromedial approach. Materials and Methods: The study enrolled 19 cases of isolated posterior cruciate ligament avulsion injury with mean age of 33.21±9.07 year. All cases were treated by open reduction and internal fixation through modified posterior approach. The patients having duration of injury more than 12 weeks were excluded. The minimum follow up duration was 12 months. Results were assessed clinically and radiologically. Final functional outcome was assessed using the Lysholm scoring for knee. Results: The mean duration of follow up was 14±1.85 months. All patients achieved union at 3months. At final follow up the mean range of motion was 125.42±6.37 degree (range 110 to 135 degree) without any extensor lag. The functional outcome assessed by Lysholm scoring system was excellent in 15 cases and good in 4 cases. Conclusion: Open reduction and internal fixation with early range of motion exercises provides good clinical outcome and stable knee.

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Bilateral Sander IV calcaneus fractures: Primary fusion or fixation?

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00066 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0006

Author(s):

Rajiv Shah

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Standard Of Care ◽

Calcaneus Fracture ◽

Subtalar Fusion ◽

Fall From Height ◽

Long Term Follow Up ◽

Calcaneus Fractures

Category: Trauma Introduction/Purpose: Primary subtalar fusion for Sander IV calcaneus fractures was considered to be the standard of care till recent past. Presently debate is on whether to manage Sander IV calcaneus fracture cases with primary subtalar fusion or with open reduction and internal fixation. Bilateral Sander IV calcaneus fractures are seen in cases with fall from height. No study has ever been conducted till date to compare the results of primary fusion of a Sander IV calcaneus fracture on one side and open reduction and internal fixation on another side in cases with bilateral Sander IV calcaneus fractures. We present a study comparing the results of primary fusion versus open reduction and internal fixation for bilateral sander IV calcaneus fracture cases. Methods: Twelve cases with bilateral closed Sander IV calcaneus fractures where included in the present study. Cases were operated between four to six weeks by a single surgeon after the appearance of wrinkles. All right sided fractures underwent open reduction and internal fixation with proximal tibia grafting. While all left-sided fractures underwent subtalar fusion with the use of ipsilateral anterior iliac crest grafts. Cases were followed up for 24 months. Results: Though operative time was more in the fusion group wound problems were equal in both the groups. Four months of average time to union was the same in both the groups and so was time to return to work. At two years, the AOFAS score was slightly better in the fusion group but it was not statistically significant. Conclusion: Primary subtalar fusion is with almost similar results as those with open reduction and internal fixation in bilateral Sander IV at 24 months. Long term follow up with more number of cases is required to prove the benefit of one over other.

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