Follow-up Evaluation of Medial Clear Space and Talar Tilt After Bimalleolar Equivalent Fracture Fixation Without Primary Deltoid Repair

2021 ◽  
Vol 111 (4) ◽  
Author(s):  
Dalton Ryba ◽  
Jordan Ernst ◽  
Somer Blair ◽  
Travis A. Motley
Keyword(s):  
Ankle Fractures ◽  
Fixation Method ◽  
Foot And Ankle ◽  
Lateral Ankle ◽  
Clear Space ◽  
Outcome Score ◽  
Study Results ◽  
Perceived Outcomes ◽  
Subjective Outcomes

Background We sought first to determine the efficacy of lateral ankle fixation alone in maintenance of medial clear space and talar valgus in bimalleolar equivalent ankle fractures not receiving primary deltoid repair, and second to assess perceived outcomes via the Foot and Ankle Outcome Score. To our knowledge, no study has quantified the reduction of medial clear space and talar valgus in bimalleolar equivalent ankle fractures receiving lateral ankle fixation alone. Methods We compared preoperative, initial postoperative, and greater than 1-year follow-up radiographs of medial clear space and talar valgus in individuals who received lateral ankle fixation alone in bimalleolar equivalent ankle fractures. Subjective outcomes were measured via the Foot and Ankle Outcome Score. Results Thirty-seven patients participated in the study and showed a statistically significant reduction of medial clear space and restoration of talar position, and maintenance with this fixation method during follow-up in patients with bimalleolar equivalent ankle fractures. Adjunctively, patients perceived their outcomes to be satisfactory, as demonstrated by the results of the Foot and Ankle Outcome Score. Conclusions We aimed to assess the efficacy of lateral ankle fixation in the maintenance of medial clear space and talar valgus reduction at midterm follow-up. Although some authors contend that primary deltoid repair in bimalleolar equivalent ankle fractures is warranted, these midterm study results suggest that isolated lateral ankle fixation is adequate for medial ankle stabilization in bimalleolar equivalent fractures, and thus primary deltoid repair is not indicated.

scholarly journals Obesity as a Risk Factor for Failure following a Modified Brostrom Procedure

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0003
Author(s):  
Daniel Corr ◽  
Ryan G. Rogero ◽  
Justin E. Palm ◽  
Joseph N. Daniel ◽  
Steven M. Raikin ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Postoperative Period ◽  
Ankle Instability ◽  
Clinical Success ◽  
Treatment Success ◽  
Foot And Ankle ◽  
Lateral Ankle ◽  
Lateral Ankle Instability ◽  
Modified Broström Procedure

Category: Ankle; Hindfoot Introduction/Purpose: The modified Brostrom procedure has been widely accepted as the operative treatment of choice for treating lateral ankle instability in patients that have failed nonoperative management. However, the predisposing risk factors for failure of operative treatment, which has important implications for patient selection, is unknown. Foot and ankle surgeons often raise body mass index (BMI) as a particular concern due to the increased pressure and strain that is applied to the repair with standing and walking in the setting of an elevated BMI. The purpose of this study was to investigate the effect of patient BMI at the time of surgical intervention on preoperative and long-term postoperative functional outcomes, as well as complication and reoperation rates. Methods: A retrospective single institutional study of 160 modified Brostrom procedures, average age 43.8 years, was performed with a minimum of 2-year follow-up. An electronic query based on Current Procedural Terminology codes was initially performed followed by a manual review of the operative report. Patients with any concurrent osteotomy, arthrodesis, or arthroplasty procedures were excluded. Pre- and postoperative Foot and Ankle Ability Measure (FAAM) ADL and Sports survey responses along with Visual Analog Scale for Pain (0-100) patient reports were recorded. Comorbidities and relevant demographic information were manually obtained. Patients were split into two groups based on their preoperative BMI: those patients with BMI <30 and those >=30 (considered obese). Treatment success was defined as achieving the previously established minimal clinically important difference (MCID) FAAM-ADL increase of >=8 and/or FAAM-Sport increase of >=9 from the preoperative to postoperative period. Results: Of 97 patients with BMI <30, 22 (22.7%) did not demonstrate a self-reported MCID in the FAAM-ADL score, and 20 (20.6%) did not demonstrate positive MCID in the FAAM-Sport score. For the 63 patients with BMI >=30, 13 (20.6%) failed to reach FAAM-ADL MCID, while 12 (19%) failed to reach FAAM-Sport MCID. BMI was not shown to be significant in terms of clinical improvement following surgery, as both groups improved significantly on average from preoperative period to follow-up with 125/160 (78.1%) achieving MCID in FAAM-ADL and 128/160 (80%) achieving MCID in FAAM-Sport. However, patients with BMI <30 had significantly higher average preoperative FAAM-ADL scores than those >=30 (66.7 vs 51.2; p=0.003) and higher average postoperative ADL scores that approached significance (92.9 vs 84.5; p=0.075). Conclusion: The modified Brostrom procedure has been previously shown to effectively improve stability and function of the ankle with relatively high rates of success, and such findings are supported by this study. In addition, this study demonstrates that patient BMI is not a prohibitive factor in limiting clinical success in the postoperative period. The procedure was generally effective for both groups of patients. However, data suggests that the condition of lateral ankle instability may simply be more debilitating for those patients with obese BMI, and that these patients should have lower expectations in terms of their absolute recovery of function. [Table: see text]

scholarly journals Functional outcomes and return-to-sports rate after modified Brostrom repair for lateral ankle instability with absorbable sutures and immediate postoperative weightbearing

2017 ◽  
Vol 2 (2) ◽  
pp. 2473011416S0000 ◽  
Author(s):  
Somen Agrawal ◽  
Greg Keene ◽  
James Clayton
Keyword(s):  
Functional Outcomes ◽  
Ankle Instability ◽  
Weight Bearing ◽  
Return To Sport ◽  
Cost Effective ◽  
Foot And Ankle ◽  
Lateral Ankle ◽  
Absorbable Sutures ◽  
Lateral Ankle Instability

Category: Sports Introduction/Purpose: The ankle is commonly injured in sporting activities occurring in up to 1 in 10,000 people a day. About 80% of ankle sprains recover with nonoperative management, with the remaining 20% of patients developing symptomatic instability requiring surgery. There are various surgical options being used, including anatomic repair (Brostrom technique and modifications), anatomic recon- struction with autograft or allograft, and nonanatomic reconstructions such as the Watson-Jones, Evans, and Chrisman-Snook procedures. The outcome of the direct anatomic repair is likely dependent on tissue quality, ability to tension the ligaments, and the security of the fixation. Secure fixation is critical to enable an early rehabilitation without compromising clinical outcome. We hypothesized that using absorbable suture for anatomic reconstruction is not only cost effective but also allows early rehabilitation with immediate postoperative weightbearing with good functional outcomes. Methods: The study included 71 patients presenting with chronic lateral ankle instability (who failed non-operative management) who underwent modified Brostrom repair by a single surgeon between Jan 2012 and Feb 2014.The anterior talofibular ligament and calcaneo- fibular ligament were anatomically repaired , and the repair was augmented with inferior extensor retinaculum proximal advancement, both with 1 vicryl suture. Full weight bearing in normal shoe was allowed from the day of surgery. Physiotherapy commenced prior to discharge from day surgery with gentle active range of motion, calf strength, and static peroneii exercises. From 3 to 4 weeks proprioceptive, theraband, and dynamic peroneal exercises were started. No boots, braces, or casts were used at any stage in the post-operative period. Patients were assessed preoperatively and at a minimum 2-year follow-up using the Foot and Ankle Outcome Score (FAOS). Complication, failure (recurrent instability), and return-to-sport rates were also recorded. Results: There were 41 were males and 30 females with mean age at surgery of 27 years (range 16 - 47 years), mean duration of symptoms of 2 years (range, 6 months to 8 years)and a mean follow-up duration of 34 months (range 24- 49 months). Significant improvement was seen in the FAOS from preoperatively to postoperatively (from 37 to 79): the pain subscale , the symptom subscale, the function subscale, the function in sports and recreation subscale, and the foot and ankle–related quality of life subscale improved from 38 to 79, 42 to 81, 43 to 82 , 31 to 79 and 32 to 77 respectively. All these findings were statistically significant. The failure rate was 4%, with 3 patients reporting instability after subsequent traumatic re-rupture. Two case of temporary neuropraxia of the superficial peroneal nerve was observed. Fifty four out of 71 patients were involved in sports prior to injury and forty seven (87%) returned to sport after reconstruction. Conclusion: This study demonstrates that lateral ligament reconstruction using absorbable sutures is an effective procedure for the treatment of chronic lateral ankle instability and allows immediate weight bearing. This allows a cost-effective approach to management with minimal impact on a patient’s activities of daily living in the post-operative period. The procedure also has high return-to-sport rate.

scholarly journals Outcome of primary deltoid ligament repair in acute ankle fractures: a meta-analysis of comparative studies

2019 ◽  
Vol 44 (2) ◽  
pp. 341-347 ◽  
Author(s):  
Motasem Salameh ◽  
Abduljabbar Alhammoud ◽  
Nedal Alkhatib ◽  
Ahmed K. Attia ◽  
Mohamed M. Mekhaimar ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Comparative Studies ◽  
Meta Analysis ◽  
Ankle Fractures ◽  
Deltoid Ligament ◽  
Ligament Repair ◽  
Pain Scores ◽  
Clear Space ◽  
Repair Group

Abstract Purpose The indications of deltoid ligament repair in ankle injuries with widened medial clear space in the absence of medial malleolus fracture remain controversial. Many authors reported no difference in long-term functional outcomes, while others stated that persistent medial clear space widening and malreduction are higher when deltoid ligaments went without repair. This meta-analysis aims to report the current published evidence about the outcomes of deltoid ligament repair in ankle fractures. Methods Several databases were searched through May 2018 for comparative studies. The primary outcome was the medial clear space correction, while secondary outcomes included maintenance of medial clear space reduction, pain scores, functional outcome, and total complications if any. Three comparative studies met the inclusion criteria for the meta-analysis. The analysis included a total of 192 patients, 81 in the deltoid ligament repair group and 111 in the non-repair group. Results The medial clear space correction and maintenance of the said correction on final follow-up radiographs were superior in the deltoid ligament repair group. Although the pain scores were better in the repair group at the final follow-up, this did not result in a better functional outcome, with similar total complication rates. Conclusion In conclusion, those who had their deltoid ligament repaired had superior early and late radiological correction of the medial clear space, an indicator of the quality of ankle reduction with better pain scores. However, no differences in the functional outcome and complications rate were reported.

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 Effects of microsurgical repair treatment on the clinical efficacy, complications, and flap follow-up scores of patients with exposed steel plates after surgery for foot and ankle fractures

2020 ◽  
Vol 9 (6) ◽  
pp. 4089-4096
Author(s):  
Xianxue Xia ◽  
Zhiqiang Yang ◽  
Changgong Deng ◽  
Chaoming Song ◽  
Lu Chen ◽  
...  
Keyword(s):  
Clinical Efficacy ◽  
Steel Plates ◽  
Ankle Fractures ◽  
Foot And Ankle

scholarly journals Evaluation of foot and ankle injuries in professional soccer

2020 ◽  
Vol 14 (2) ◽  
pp. 158-162
Author(s):  
Danilo Pizzo Kitagaki ◽  
Eduardo Souza Maciel ◽  
Nacime Salomão Barbachan Mansur ◽  
Eduardo Ramalho De Moraes ◽  
Gustavo Gonçalves Arliani
Keyword(s):  
Triceps Surae ◽  
Physical Contact ◽  
Ankle Injuries ◽  
Ankle Sprains ◽  
X Rays ◽  
Foot And Ankle ◽  
Time Loss ◽  
Lateral Ankle ◽  
Professional Soccer

Objective: To evaluate the profile of foot and ankle injuries in professional soccer. Methods: Data were collected prospectively during the 2016 São Paulo Soccer Championship using two electronic forms: an initial form (10 variables) and a follow-up form (6 variables). The results were standardized and evaluated in SPSS 23.0. Results: A total of 259 injuries were reported: 106 to the thigh (40.9%), 42 to the foot and ankle (16.2%), 39 to the knee (15.1%), 39 to the head or face (15.1%) and 33 in other locations (12.7%). Of the 42 foot and ankle injuries, 20 were lateral ankle sprains (47.6%), 5 were medial ankle sprains (11.9%), 3 were to the triceps surae (7.1%), 3 were leg contusions (7.1%), 3 were foot contusions (7.1%), 2 were myalgias (4.8%), in addition to 5 other types (11.9%). There was physical contact in 73.8% of the injuries (p <0.001), and six injuries (14.3%) were considered severe, i.e., involving a time loss of at least one month. Of the severe injuries, four were treated surgically (three by osteosynthesis and one by tenorrhaphy). The mean time loss due to injury was 19.7 days, and the overall incidence rate was 3.5 injuries per 1000 hours of exposure, with 2.1 ligament injuries per 1000 hours. X-rays and magnetic resonance imaging were the most requested tests in the follow-up of these patients. Conclusion: Foot and ankle injuries were the second most frequent injury in Brazilian professional soccer, 73.8% of which resulted from physical contact (p<0.001). Lateral ankle sprains accounted for 47.6% of these injuries, which reaffirms their high prevalence and importance for sports medicine. Level of Evidence III; Prognostic Studies; Prospective Study.

scholarly journals A long term functional and radiological outcome assessment study of management of high grade acromioclavicular joint injury

2020 ◽  
Vol 6 (6) ◽  
pp. 1199
Author(s):  
Rajesh Goel ◽  
Anand Bhushan ◽  
Sandeep Kumar ◽  
Mohit Kumar
Keyword(s):  
Acromioclavicular Joint ◽  
Constant Score ◽  
Fixation Method ◽  
Acromioclavicular Joint Dislocation ◽  
Joint Injury ◽  
Prospective Longitudinal Study ◽  
Study Results ◽  
Significant Difference ◽  
Prospective Longitudinal

<p><strong>Background:</strong> Acromioclavicular joint dislocation (ACD) of Rockwood types III and above require surgical intervention. We used a unique technique for CC interval fixation using endobutton with two separate small incisions, which did not need dissection through the joint at all. It replaces the anatomical course of conoid and trapezoid part of the CC ligament. The purpose of the present study was to describe an innovative method of fixation and evaluate its functional outcome using subjective as well as objective measures. We aimed to determine whether this fixation method could be an optimal alternative to address this injury.</p><p><strong>Methods:</strong> A total of 24 patients were enrolled for this prospective longitudinal study. Coraco-clavicular distance was calculated radiologically preoperatively and at the final follow up.  Clinically, the final outcome was assessed using the Shoulder Constant score and visual analogue scale (VAS) for residual pain at the final follow up.</p><p><strong>Results:</strong> There was no statistically significant difference between the two shoulders and results were considered as an excellent in terms of constant shoulder score. The VAS was 0.42 (0-1) at final follow-up. The coraco-clavicular distance (CC) reduced significantly postoperatively and was comparable to the contralateral side.</p><p><strong>Conclusions:</strong> Our study results suggested that this is a simple, safe and effective technique which needed minimal dissection.</p>

Immediate Unrestricted Weightbearing With Simple Stirrup Brace Following Single Anchor Lateral Ankle Ligament Stabilization

2020 ◽  
pp. 193864002097282
Author(s):  
Gregory A. Lundeen ◽  
Christopher Diefenbach ◽  
Laura Hemker Moles ◽  
Larissa Lee White ◽  
Patrick Barousse
Keyword(s):  
Ligament Reconstruction ◽  
Short Form ◽  
Case Series ◽  
Lateral Ligament ◽  
Foot And Ankle ◽  
Balance Test ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament

Objective To report on a series of patients treated with immediate unrestricted weightbearing with limited protection following single anchor lateral ligament stabilization. Methods Patients with chronic lateral ankle ligament instability who underwent modified Broström-Gould lateral ligament reconstruction with a single double-loaded anchor were identified. Immediate unrestricted full weightbearing in a stirrup brace was allowed the first postoperative day and accelerated physical therapy was initiated from 2 weeks. Subsequent assessment was performed at a minimum of 1-year follow-up. Results Thirteen patients with a mean age at final follow-up of 49 years (range 21-70 years). Average follow-up was 21 months (16 to 26). American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and visual analogue scale (VAS) score improved significantly (P < .05) from preoperative to postoperative, respectively (57 to 91, 5.7 to 1.5). Average postoperative Foot and Ankle Outcome Score (FAOS) was 82 (range 52-100). Short Form–12 (SF-12) scores averaged 55 and 49 on mental component and physical components, respectively, consistent with US age-matched averages. No measurable differences in range of motion, ligamentous stability, or Star Excursion Balance Test in the anterior, posterolateral, or posteromedial planes compared to the contralateral side (P > .05) were observed. No recurrence was reported. Conclusion Immediate unrestricted weightbearing in a stirrup brace following single anchor lateral ligament reconstruction is a successful protocol for the treatment of chronic lateral ankle instability. Levels of Evidence Therapeutic, Level IV: Case series

Impact of anti-gravity treadmill rehabilitation therapy on the clinical outcomes after fixation of lower limb fractures: A randomized clinical trial

2020 ◽  
pp. 026921552096685
Author(s):  
Ralf Henkelmann ◽  
Lisa Palke ◽  
Sebastian Schneider ◽  
Daniel Müller ◽  
Bernhard Karich ◽  
...  
Keyword(s):  
Knee Injury ◽  
Tibial Plateau ◽  
Tibial Plateau Fractures ◽  
Ankle Fractures ◽  
Thigh Muscle ◽  
Foot And Ankle ◽  
Outcome Score ◽  
Significant Difference ◽  
Patient Reported ◽  
Partial Weight

Objective: To compare the effects of anti-gravity treadmill rehabilitation with those of standard rehabilitation on surgically treated ankle and tibial plateau fractures. Design: Open-label prospective randomized multicenter study. Setting: Three level 1 trauma centers. Subjects: Patients with tibial plateau or ankle fractures who underwent postoperative partial weight-bearing were randomized into the intervention (anti-gravity treadmill use) or control (standard rehabilitation protocol) groups. Main measures: The primary endpoint was the change in the Foot and Ankle Outcome Score for ankle fractures and total Knee injury and Osteoarthritis Outcome Score for tibial plateau fractures (0–100 points) from baseline (T1) to six weeks after operation (T4) in both groups. Leg circumference of both legs was measured to assess thigh muscle atrophy in the operated leg. Results: Thirty-seven patients constituted the intervention and 36 the control group, respectively; 14 patients dropped out during the follow-up period. Among the 59 remaining patients (mean age 42 [range, 19–65] years), no difference was noted in the Foot and Ankle Outcome Score (54.2 ± 16.1 vs. 56.0 ± 16.6) or Knee injury and Osteoarthritis Outcome Score (52.8 ± 18.3 vs 47.6 ± 17.7) between the intervention and control groups 6 weeks after operation. The change in the leg circumference from T1 to T4 was greater by 4.6 cm in the intervention group (95% confidence interval: 1.2–8.0, P = 0.005). No adverse event associated with anti-gravity treadmill rehabilitation was observed. Conclusion: No significant difference was noted in patient-reported outcomes between the two groups. Significant differences in muscular atrophy of the thigh were observed six weeks after operation.

Validation of the Indonesian Version of the Foot and Ankle Outcome Score in Patients with Chronic Lateral Ankle Instability

2021 ◽  
Author(s):  
I Putu Gde Surya Adhitya ◽  
Wen-Yu Yu ◽  
Putu Ayu Sita Saraswati ◽  
I Made Niko Winaya ◽  
Mau-Roung Lin
Keyword(s):  
Rating Scale ◽  
Ankle Instability ◽  
Short Form ◽  
Principal Component ◽  
Foot And Ankle ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Outcome Score ◽  
Sf 36 ◽  
Lateral Ankle Instability

Abstract Background: This study aimed to examine the psychometric performance of the Foot and Ankle Outcome Score (FAOS) used in Indonesian patients with chronic lateral ankle instability (CLAI).Methods: The FAOS was translated into Indonesian through standardized procedures. Among 224 patients with unilateral CLAI recruited from 14 physical therapy clinics during a 1-year period, reliabilities, construct validities, and responsiveness levels of the FAOS were examined. Active and passive range of motion of ankle dorsiflexion or plantiflexion, figure-of-eight, numeric pain rating scale (NPRS), and Short Form (SF)-36 were used to test the construct validities.Results: The five subscales indicated adequate internal consistency (Cronbach’s alpha, 0.74~0.96) and interrater test-retest reliabilities (interclass correlation coefficients, 0.80~0.94). Subscales of the FAOS moderately converged with those selected measures with similar constructs (r values, 0.32~0.53), with the exception of the correlation of pain with the NPRS (r, -0.06). Results of the principal component analysis showed that the five-factor structure of the FAOS was appropriate for the Indonesian data, although six items (four in the pain and two in the other symptoms (OSs) subscales) did not perfectly fit their original subscales. Guyatt’s responsiveness index for the FAOS’s subscales changed in the SF-36’s physical function over a 1-month period and ranged 0.37 to 1.27.Conclusions: The Indonesian version of the FAOS demonstrated acceptable reliabilities and responsiveness, and fair construct validities among CLAI patients, although certain items in the pain and OSs subscales may need to be further explored and improved.

Sign in / Sign up

Export Citation Format

Share Document