Postoperative Outcomes for Plate-Screw Fixation in Adolescent Patients with Ankle Fracture

2020 ◽  
Vol 110 (6) ◽  
Author(s):  
Mehmet Ali Talmaç ◽  
Mehmet Akif Görgel ◽  
Yusuf Yahşi ◽  
Muharrem Kanar ◽  
Ali Seker ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Ankle Fracture ◽  
Screw Fixation ◽  
High Energy ◽  
Low Energy ◽  
Ankle Fractures ◽  
Postoperative Outcomes ◽  
Trauma Patients ◽  
High Energy Trauma ◽  
Adolescent Patients

Backround We compared postoperative outcomes in adolescent patients who did and did not undergo plate-screw fixation of at least one of the lateral, medial, or posterior malleoli in ankle fractures. It was hypothesized that using plate-screw fixation would not negatively affect postoperative outcomes. Methods All of the preoperative data and postoperative outcomes for 56 patients with ankle fractures aged 12 to 15 years who underwent surgical treatment between January 1, 2007, and December 31, 2017, were reviewed retrospectively. Patients were grouped into plate-screw fixation (n = 15) and non–plate-screw fixation (n = 41) groups and as high- and low-energy trauma patients. Results There were no significant differences in postoperative outcomes between the plate-screw fixation and non–plate-screw fixation groups. The mean American Orthopaedic Foot & Ankle Society score of high-energy trauma patients was significantly lower than that of low-energy trauma patients (P < .001), and the rate of degenerative change in high-energy trauma patients was significantly higher than that in low-energy trauma patients (P = .008). There were no significant differences between high- and low-energy trauma patients with respect to other postoperative outcomes. Conclusions If anatomical reduction is performed without damaging the growth plate, postoperative clinical outcomes may be near perfect regardless of screw-plate fixation use. Postoperative outcomes of adolescent ankle fracture after high-energy trauma, independent of Salter-Harris classification and surgical treatment methods, were negative.

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.

scholarly journals Functional outcome of traumatic spinopelvic instabilities treated with lumbopelvic fixation

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Emre Yilmaz ◽  
Martin F. Hoffmann ◽  
Alexander von Glinski ◽  
Christiane Kruppa ◽  
Uwe Hamsen ◽  
...  
Keyword(s):  
Functional Outcome ◽  
High Energy ◽  
Low Energy ◽  
Trauma Patients ◽  
Concomitant Injuries ◽  
High Energy Trauma ◽  
Lumbopelvic Fixation ◽  
Energy Group ◽  
And Function

Abstract The aim of this study was to assess the functional outcome after lumbopelvic fixation (LPF) using the SMFA (short musculoskeletal functional assessment) score and discuss the results in the context of the existing literature. The last consecutive 50 patients who underwent a LPF from January 1st 2011 to December 31st 2014 were identified and administered the SMFA-questionnaire. Inclusion criteria were: (1) patient underwent LPF at our institution, (2) complete medical records, (3) minimum follow-up of 12 months. Out of the 50 recipients, 22 questionnaires were returned. Five questionnaires were incomplete and therefore seventeen were included for analysis. The mean age was 60.3 years (32–86 years; 9m/8f) and the follow-up averaged 26.9 months (14–48 months). Six patients (35.3%) suffered from a low-energy trauma and 11 patients (64.7%) suffered a high-energy trauma. Patients in the low-energy group were significantly older compared to patients in the high-energy group (72.2 vs. 53.8 years; p = 0.030). Five patients (29.4%) suffered from multiple injuries. Compared to patients with low-energy trauma, patients suffering from high-energy trauma showed significantly lower scores in “daily activities” (89.6 vs. 57.1; p = 0.031), “mobility” (84.7 vs. 45.5; p = 0.015) and “function” (74.9 vs. 43.4; p = 0.020). Our results suggest that patients with older age and those with concomitant injuries show a greater impairment according to the SMFA score. Even though mostly favorable functional outcomes were reported throughout the literature, patients still show some level of impairment and do not reach normative data at final follow-up.

Differences in Classification Between Mono- and Polytrauma and Low- and High-Energy Trauma Patients With an Ankle Fracture: A Retrospective Cohort Study

2017 ◽  
Vol 56 (4) ◽  
pp. 793-796 ◽  
Author(s):  
Jan Paul Briet ◽  
Roderick Marijn Houwert ◽  
Diederik P.J. Smeeing ◽  
Marcel G.W. Dijkgraaf ◽  
Egbert Jan Verleisdonk ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Ankle Fracture ◽  
Retrospective Cohort ◽  
High Energy ◽  
Trauma Patients ◽  
High Energy Trauma

Clinical and economic effects of selective radiological evaluation of high-energy trauma patients: a prospective experience of a level 1 busy trauma centre

2014 ◽  
Vol 32 (7) ◽  
pp. 535-538 ◽  
Author(s):  
Shahram Paydar ◽  
Armin Ahmadi ◽  
Behnam Dalfardi ◽  
Alireza Shakibafard ◽  
Hamidreza Abbasi ◽  
...  
Keyword(s):  
High Energy ◽  
Trauma Centre ◽  
Economic Effects ◽  
Trauma Patients ◽  
Radiological Evaluation ◽  
High Energy Trauma ◽  
Level 1

scholarly journals Changing presentation of knee dislocation and vascular injury from high-energy trauma to low-energy falls in the morbidly obese

2013 ◽  
Vol 57 (5) ◽  
pp. 1196-1203 ◽  
Author(s):  
Andrew G. Georgiadis ◽  
Farah H. Mohammad ◽  
Kristin T. Mizerik ◽  
Timothy J. Nypaver ◽  
Alexander D. Shepard
Keyword(s):  
Vascular Injury ◽  
Knee Dislocation ◽  
High Energy ◽  
Low Energy ◽  
Morbidly Obese ◽  
High Energy Trauma

scholarly journals Screw Fixation of the Posterior Malleolus Fragment in Ankle Fracture: Cadaveric and Clinical Studies

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0026
Author(s):  
Gisoo Lee ◽  
Chan Kang ◽  
Yougun Won ◽  
Jae Hwang Song ◽  
Byungki Cho
Keyword(s):  
Clinical Outcomes ◽  
Ankle Fracture ◽  
Screw Fixation ◽  
Articular Surface ◽  
Cannulated Screw ◽  
Ankle Fractures ◽  
Neutral Position ◽  
Early Recovery ◽  
Malleolar Fracture ◽  
Posterior Malleolus

Category: Ankle, Trauma Introduction/Purpose: Previously, a posterior malleolus fragment (PMF) covering 25–30% of the articular surface was a known indication for surgical fixation for ankle fractures. This study aimed to compare the outcomes of screw fixation for PMF comprising <25% of the articular surface and to evaluate the results of cadaver experiments. Methods: The clinical study enrolled ankle fracture patients with PMFs who planned to undergo surgery between March 2014 and February 2017. Among them, 62 with type 1 PMF comprising <25% of the articular surface were included: 32 patients underwent cannulated screw fixation for PMF after fixation for lateral and/or medial malleolar fracture (A group), whereas the other 30 patients underwent internal fixation for lateral and/or medial malleolar fracture but no screw fixation (B group). Clinical outcomes were determined at the 3-, 6-, 12-, and 18-month visits. Additionally, cadaver studies were conducted to evaluate cannulated screw fixation or no fixation in cases of PMFs comprising <25% of the articular surface and >1 mm displacement. Ankle joint stability was measured under external torque on the ankle in the neutral position. The level of significance was set at P < .05. Results: Clinical outcomes at 6 and 12 months after surgery were significantly higher in group A than in group B. However, there was no significant intergroup difference in clinical outcomes at 18 months of follow-up. In the cadaver study, PMF screw fixations were significantly more stable under external rotation force. Conclusion: Screw fixation was significantly useful during early recovery and in short-term clinical outcomes owing to stabilization of ankle fractures with PMF involving <25% of the articular surface.

scholarly journals Initial Evaluation by a Nonoperative Provider Does Not Delay the Surgical Care of Operative Ankle Fractures in a Walk-in Orthopaedic Clinic

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0017
Author(s):  
Matthew N Fournier ◽  
Joseph T Cline ◽  
Adam Seal ◽  
Richard A Smith ◽  
Clayton C Bettin ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Ankle Fracture ◽  
Initial Evaluation ◽  
Orthopaedic Surgeon ◽  
Ankle Fractures ◽  
Definitive Treatment ◽  
Foot And Ankle ◽  
Orthopaedic Clinic ◽  
Orthopaedic Surgeons ◽  
Clinic Visits

Category: Ankle, Trauma Introduction/Purpose: Walk-in and “afterhours” clinics are a common setting in which patients may seek care for musculoskeletal complaints. These clinics may be staffed by orthopaedic surgeons, nonsurgical physicians, advanced practice nurses, or physician assistants. If orthopaedic surgeons are more efficient than nonoperative providers at facilitating the care of operative injuries in this setting is unknown. This study assesses whether evaluation by a nonoperative provider delays the care of patients with operative ankle fractures compared to those seen by an orthopaedic surgeon in an orthopaedic walk-in clinic. Methods: Following IRB approval, a cohort of patients who were seen in a walk-in setting and who subsequently underwent surgical treatment for an isolated ankle fracture were retrospectively identified. The cohort was divided based on whether the initial clinic visit had been conducted by an operative or nonoperative provider. A second cohort of patients who were evaluated and subsequently treated by a fellowship-trained foot and ankle surgeon in their private practice was used as a control group. Outcome measures included total number of clinic visits before surgery, total number of providers seen, days until evaluation by treating surgeon, and days until definitive surgical management. Results: 138 patients were seen in a walk-in setting and subsequently underwent fixation of an ankle fracture. 61 were seen by an orthopaedic surgeon, and 77 were seen by a nonoperative provider. No significant differences were found between the operative and nonoperative groups when comparing days to evaluation by treating surgeon (4.1 vs 4.5, p=.31), or days until definitive surgical treatment (8.4 vs 8.8, p=.58). 62 patients who were seen and treated solely in a single surgeon’s practice had significantly fewer clinic visits (1.11 vs 2.03 and 2.09, p<.05), as well as days between evaluation and surgery compared to the walk-in groups (5.44 vs 8.44 and 8.78, p<.05). Conclusion: Initial evaluation in a walk-in orthopaedic clinic setting is associated with a longer duration between initial evaluation and treatment compared to a conventional foot and ankle surgeon’s clinic, but this difference may not be clinically significant. Evaluation by a nonoperative provider is not associated with an increased duration to definitive treatment compared to an operative provider.

scholarly journals Traumatic infra-renal aortic dissection after a high-energy trauma: a case report of a primary missed diagnosis

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Holger Godry ◽  
Guido Rölleke ◽  
Achim Mumme ◽  
Thomas A. Schildhauer ◽  
Martin Gothner
Keyword(s):  
Aortic Dissection ◽  
Ct Scan ◽  
High Energy ◽  
The Body ◽  
Trauma Patients ◽  
Traumatic Injuries ◽  
High Energy Trauma ◽  
Missed Injuries ◽  
Lumbar Vertebral Body ◽  
Life Threatening

A traumatic infra-renal aortic dissection is a rare but life-threatening injury that follows deceleration injuries. The mechanism of blunt abdominal aortic injury involves both direct and indirect forces. The successful management of patients with traumatic injuries depends on a prompt suspicion of the injury and early diagnosis and therapy. Missed injuries in trauma patients are well-described phenomena and implementation of the ATLS® trauma schedule led to a decrease in the number of missed injuries, but trauma computed tomography (CT) scans in injured patients are still not standard. We report on a 54-year old Caucasian female patient who was involved in a car accident. The fellow passenger of the car was seriously injured. The patient had been previously treated at two different hospitals, and a dislocated acetabular fracture had been diagnosed. Because of this injury, the patient was transferred to our institution, a level 1 trauma-center where, according to the nature of the accident as a high-energy trauma, a complete polytrauma management was performed at the time of admission. During the body check, a moderate tension of the lower parts of the abdomen was detected. During the CT scan, an aneurysm of the infra-renal aorta with a dissection from the height of the second lumbar vertebral body to the iliac artery was observed. The patient required an operation on the day of admission. After 19 days post-trauma care the patient was able to leave our hospital in good general condition. Therefore, missed injuries in multiple injury patients could be fatal, and it is essential that the orthopedic surgeon leaves room for suspicion of injuries based on the nature of the trauma. Traumatic injuries of the abdominal aorta are rare. According to the ATLS® trauma schedule, all of the patients who have experienced high-energy trauma and associated fractures should undergo routine screening using a trauma CT scan with contrast agents to detect potential life-threatening injuries. In case of abdominal trauma, an aortic dissection, which can easily be overlooked, has to be considered.

scholarly journals Predictors of early complications following surgical treatment of geriatric ankle fracture

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Seung-Myung Choi ◽  
Byung-Ki Cho
Keyword(s):  
Surgical Treatment ◽  
Glycemic Control ◽  
Wound Infection ◽  
Ankle Fracture ◽  
Chronic Renal Disease ◽  
Multiple Logistic Regression Analysis ◽  
Serum Glucose ◽  
Ankle Fractures ◽  
Major Complications ◽  
Geriatric Ankle Fracture

Category: Ankle, Diabetes, Trauma Introduction/Purpose: Factors predicting complications after surgical treatment of geriatric ankle fractures include presence of various comorbidities such as diabetes, chronic renal disease. However, beyond the binary definition of presence or absence, further speci? c information of these comorbidities such as their chronicity, severity and/or perioperative laboratories have not been studied as risk factors for postoperative complications. The purpose of this study is to investigate the association between the measurements of comorbidities and complications within the? rst 30 days following surgical treatment of geriatric ankle fracture. Methods: A retrospective cohort study. From 2000 to 2015, we collected patient demographics, comorbidities-related data including laboratory values and complications within 30 days following open reduction and internal fixation of low energy ankle fractures in patients older than 65 years. Multiple logistic regression analysis was performed to determine factors affecting minor (super? cial wound infection, delayed wound healing, urinary tract infection, pneumonia), major complications (deep wound infection, loss of? xation, deep venous thrombosis, organ/space failure). Results: In total, 1,358 patients were included for analysis. The average age was 70.54 years (SD, 7.40). There were 895 (66%) females and 463 (34%) males. Baseline glucose concentrations >200 mg/dL (p < 0.001) and the mean 48 hour postoperative serum glucose concentrations >150 mg/dL (p < 0.001), history of taking wound compromising medications (p = 0.003) were signi? cantly associated with minor complications. Preoperative glycated hemoglobin (HbA1c) >6.5% (p < 0.001), estimated glomerular? ltration rate (eGFR) <45 mL/min/1.73 m2 (p < 0.001), dependent functional status and presence of two or comorbidities (p < 0.001) were statistically associated with major complications. Conclusion: poor glycemic control in the perioperative period, wound-compromising medications were associated with increased rates of minor complications, whereas poor chronic glycemic control (HbA1c), decreased renal function and vulnerability with multiple comorbid conditions were associated with major complications. Perioperative blood glucose management may prevent minor complications, whereas and mean serum glucose concentrations of 150 mg/dL and higher during this time period

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