ankle fracture
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2022 ◽  
pp. 193864002110659
Author(s):  
Matthew S. Broggi ◽  
Syed Tahmid ◽  
John Hurt ◽  
Rishin J. Kadakia ◽  
Jason T. Bariteau ◽  
...  

Background The effects of preoperative depression following ankle fracture surgery remains unknown. The purpose of this study is to investigate the relationship between preoperative depression and outcomes following ankle fracture surgery. Methods This retrospective study used the Truven MarketScan database to identify patients who underwent ankle fracture surgery from January 2009 to December 2018. Patients with and without a diagnosis of preoperative depression were identified based on International Classification of Diseases (ICD) codes. Chi-squared and multivariate analyses were performed to determine the association between preoperative depression and postoperative complications following ankle fracture surgery. Results In total, 107,897 patients were identified for analysis, 13,981 of whom were diagnosed with depression (13%). Preoperative depression was associated with the increased odds for postoperative infection (odds ratio [OR]: 1.33, confidence interval [CI]: 1.20-1.46), wound complications (OR: 1.13, CI: 1.00-1.28), pain-related postoperative emergency department visits (OR: 1.58, CI: 1.30-19.1), 30-day and 90-day readmissions (OR: 1.08, CI: 1.03-1.21 and OR: 1.13, CI: 1.07-1.18), sepsis (OR: 1.39, CI: 1.12-1.72), and postoperative development of complex regional pain syndrome (OR: 1.46, CI: 1.18-1.81). Conclusion Preoperative depression is associated with increased complications following ankle fracture surgery. Further studies are warranted to investigate the degree to which depression is a modifiable risk factor. Level of Evidence: 3


Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 199
Author(s):  
Marta Mirando ◽  
Corrado Conti ◽  
Federica Zeni ◽  
Fabio Pedicini ◽  
Antonio Nardone ◽  
...  

(1) Background: Ankle fracture results in pain, swelling, stiffness and strength reduction, leading to an altered biomechanical behavior of the joint during the gait cycle. Nevertheless, a common pattern of kinematic alterations has still not been defined. To this end, we analyzed the literature on instrumental gait assessment after ankle fracture, and its correlation with evaluator-based and patient-reported outcome measures. (2) Methods: We conducted a systematic search, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, of articles published from January 2000 to June 2021 in PubMed, Embase and PEDro on instrumental gait assessment after ankle fracture. (3) Results: Several changes in gait occur after ankle fracture, including a reduction in step length, swing time, single support time, stride length, cadence, speed and an earlier foot-off time in the affected side. Additionally, trunk movement symmetry (especially vertical) is significantly reduced after ankle fracture. The instrumental assessments correlate with different clinical outcome measures. (4) Conclusions: Instrumental gait assessment can provide an objective characterization of the gait alterations after ankle fracture. Such assessment is important not only in clinical practice to assess patients’ performance but also in clinical research as a reference point to evaluate existing or new rehabilitative interventions.


2022 ◽  
Author(s):  
Mohammad Yonso
Keyword(s):  

2022 ◽  
Vol 10 (1) ◽  
pp. 232596712110668
Author(s):  
Nathaniel B. Hinckley ◽  
Jeffrey D. Hassebrock ◽  
Phillip J. Karsen ◽  
David G. Deckey ◽  
Andrea Fernandez ◽  
...  

Background: Despite appropriate care, a subset of patients with ankle fractures has persistent pain. This condition may be associated with intra-articular pathology, which is present up to 65% of the time. Purpose: To quantify how much of the talus is visible through an open approach to a standard supination external rotation bimalleolar ankle fracture as a percentage of the entire weightbearing surface of the talus. Study Design: Descriptive laboratory study. Methods: Standard ankle approaches to lateral and medial malleolar fractures were performed in 4 cadaveric ankles from 2 cadavers. Osteotomies were made to simulate a supination external rotation bimalleolar ankle fracture based on the Lauge-Hansen classification. The visible segments of talar cartilage were removed. The tali were then exhumed, and the entire weightbearing superior portion of the talus was assessed and compared with the amount of cartilage removed by an open approach. The mean of the data points as well as the 95% confidence interval were calculated. Results: Four ankle specimens from 2 cadavers were used for these measurements. The mean surface area of the talus was 14.0 cm2 (95% CI, 13.3-14.7 cm2), while the mean area visible via an open approach was 2.1 cm2 (95% CI, 0.5-3.6 cm2). The mean proportion of the talus visualized via an open approach was 14.8% (95% CI, 3.6-26.1%). Conclusion: These findings indicate that the true area of weightbearing talar surface visible during an open exposure may be less than what many surgeons postulate. Clinical Relevance: Only a small fracture of the talus is visible via an open approach to the talus during fracture fixation. This could warrant arthroscopic evaluation of these injuries to evaluate and treat osteocondral lesions resulting from ankle fractures.


PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0262115
Author(s):  
Michael R. Mercier ◽  
Anoop R. Galivanche ◽  
Jordan P. Brand ◽  
Neil Pathak ◽  
Michael J. Medvecky ◽  
...  

Introduction Ankle fractures have continued to occur through the COVID pandemic and, regardless of patient COVID status, often need operative intervention for optimizing long-term outcomes. For healthcare optimization, patient counseling, and care planning, understanding if COVID-positive patients undergoing ankle fracture surgery are at increased risk for perioperative adverse outcomes is of interest. Methods The COVID-19 Research Database contains recent United States aggregated insurance claims. Patients who underwent ankle fracture surgery from April 1st, 2020 to June 15th, 2020 were identified. COVID status was identified by ICD coding. Demographics, comorbidities, and postoperative complications were extracted based on administrative data. COVID-positive versus negative patients were compared with univariate analyses. Propensity-score matching was done on the basis of age, sex, and comorbidities. Multivariate regression was then performed to identify risk factors independently associated with the occurrence of 30-day postoperative adverse events. Results In total, 9,835 patients undergoing ankle fracture surgery were identified, of which 57 (0.58%) were COVID-positive. COVID-positive ankle fracture patients demonstrated a higher prevalence of comorbidities, including: chronic kidney disease, diabetes, hypertension, and obesity (p<0.05 for each). After propensity matching and controlling for all preoperative variables, multivariate analysis found that COVID-positive patients were at increased risk of any adverse event (odds ratio [OR] = 3.89, p = 0.002), a serious adverse event (OR = 5.48, p = 0.002), and a minor adverse event (OR = 3.10, p = 0.021). Discussion COVID-positive patients will continue to present with ankle fractures requiring operative intervention. Even after propensity matching and controlling for patient factors, COVID-positive patients were found to be at increased risk of 30-day perioperative adverse events. Not only do treatment teams need to be protected from the transmission of COVID in such situations, but the increased incidence of perioperative adverse events needs to be considered.


Author(s):  
Abdulmalik B. Albaker

Introduction: Ankle fractures are claimed to affect 70-185 patients out of 100,000 people each year. There is currently no unanimity among surgeons throughout the world on early versus restricted weight bearing in surgically treated trauma patients with fractures. The aim of this study was to systematically review the effectiveness and outcome of early weight bearing in ankle fracture as well as quality of life and pain. Methods: An electronic search was conducted of the databases EMBASE, PubMed, and The Cochrane Library, as well as Medline, Google Scholar to identify all articles related to the topic that have been published after 2006. Results: Initially, 2434 records were identified. Due to similarity and duplication, 1308 records were eliminated, and 1126 records were kept. Following the screening of the records and their subjects, 921 further unconnected records were eliminated. Then, 205 qualified full-text articles were selected, and 10 articles were included in qualitative analysis. Conclusion: According to the findings of this study, surgical therapy, both aggressive and minimal, appears to be a safe alternative for the elderly. Short-term advantages of early weight-bearing include a decreased incidence of thromboembolic disease. Active movement reduces joint stiffness while maintaining muscle mass. Post-operative mobility, quality of life, and post-operative early weight bearing status are considered as significant outcome indicators. Unsafe weight as tolerated after ankle surgery might be a safe and encouraging option. As a result, future research should include this possibilities.


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