A talar body fracture combined with bimalleolar ankle fracture

The incidence of talar fractures is relatively low affecting usually young patients, while recent epidemiological studies have shown that talar body fractures represent a significant proportion of the total number of talar fractures. Talar body fractures are usually high-energy injuries and often a combined talar neck and body fracture is noted. An association between talar body fractures and ankle fractures has also been recorded involving the medial or lateral malleolus. The only report of a talar fracture combined with a bimalleolar ankle fracture that was found in the literature is referred to a talar neck fracture. In this report, a combination of a talar body fracture and bimalleolar ankle fracture in a polytraumatised young patient is presented. This combined injury pattern seems to be very rare, since a similar case was not found in the literature. An open reduction and internal fixation of the talar body fracture as well as the bimalleolar fracture, followed by a prolonged non-weight bearing, led to a fracture healing with no evidence of osteonecrosis. Minimal osteoarthritic changes of the tibiotalar joint were noted at 3 years follow-up with satisfactory functional results.

The purpose of this study was to identify the incidence and risk factors associated with surgical site infection (SSI) after open reduction and internal fixation of bimalleolar ankle fractures. Bimalleolar ankle fractures are one of the most common subtypes of ankle fractures, accounting for 15% to 20% of all ankle fractures. Recent studies have shown that 4.37% of patients undergoing ORIF of ankle fractures develop an SSI postoperatively. The literature detailing the risk factors for the development of SSI after open reduction and internal fixation (ORIF) of bimalleolar ankle fractures is sparse. Therefore, the purpose of this study was to determine the risk factors that predispose patients to SSI after the index procedure. Patients who underwent bimalleolar ankle fracture repair between January 1, 2010, and December 31, 2021, were identified using the PearlDiver Mariner Database. Demographics and comorbidities between SSI and non-SSI cohorts were compared through chi-square analysis. Multivariate logistic regression was used to analyze risk factors for SSIs. A P value less than 0.001 was determined to be statistically significant. The incidence of SSI after ORIF of bimalleolar ankle fractures was 3.1%. Age, sex, and a higher total Elixhauser Comorbidity Index were associated with an increased incidence of SSI (P < 0.0001). Risk factors for the development of SSI included male sex (OR = 1.17; P < 0.0001), chronic kidney disease (odds ratio [OR] = 1.233; P < 0.001), diabetes (OR = 1.27; P < 0.0001), drug abuse (OR = 1.22; P < 0.0001), fluid and electrolyte disorders (OR = 1.42; P < 0.0001), hypertension (OR = 1.29; P < 0.0001), peripheral vascular disease (OR = 1.62; P < 0.0001), tobacco use (OR = 1.25; P < 0.0001), and weight loss (OR = 1.25; P < 0.0001). Peripheral vascular disease was the most highly correlated risk factor for the development of SSIs in this study. These findings underscore the importance of preoperative risk stratification and optimization to minimize SSIs in this population. This is the first study to delineate the risk factors for the development of SSI in patients undergoing ORIF for bimalleolar ankle fractures. Physicians can use these results to counsel patients before undergoing the index procedure to minimize postoperative infections. IV.

Talar fractures are uncommon and talar body fracture dislocations are still rare. We present the case of patient who sustained a simultaneous fracture dislocation of talar body and avulsion of lateral process with fracture of medial malleolus and tibial pilon. No similar cases are reported in the literature to the best of our knowledge. The patient was treated with open reduction and internal fixation of talus through the malleolar fracture. The prognosis after this fracture dislocation is poor because of the very high risk of avascular necrosis. INTRODUCTION Fracture dislocations of the talar body are rare and a source of serious injuries. Simultaneous fracture of the talus and the ankle are exceptional. These fractures result from high injury. The prognosis after talar body fracture dislocation is determined by the severity of the injury and the quality of reduction and internal fixation. The case reported is unusual combination of multiple articular fractures of the distal tibial with a fracture dislocation of the body of talus. CASE REPORT A 26-year-old man, admitted to our Emergency Department, had sustained a close injury to his right ankle after an axial compression injury with inversion. The physical examination revealed an obvious deformity of the ankle with his foot lying supinated and adducted, intact skin with no neuro-vascular deficit. Radiograph revealed a displaced oblique fracture of the medial malleolus and tibial pilon with an associated posterior dislocation of the talar body and minor avulsion of lateral process (fig.1). Figure 1 Figure 1: Pre operative radiographs Open reduction and internal fixation was performed through a medial approach. The talar body was found completely rotated behind the tibia. After gross reduction of the talar body, fine reduction of the fracture is achieved and fixed with two cancellous screws from medial side. The medial malleolus and tibial pilon fracture were reduced and fixed with two cancellous screws and k-wires. The stability of the construct was assessed and found to be satisfactory requiring no further fixation. Post-operative radiographs were satisfactory (fig.2). A below knee cast applied for six weeks and the patient was kept nonweight bearing for another 6 weeks. Unusual fracture dislocation of the ankle 2 of 4 Figure 2 Figure 2: Post operative anteroposterior and lateral view He was allowed to partially weight bear at three months and full weight bearing was commenced at four months. At 12 months follow up, the patient had dorsi flexion of 15°, planter flexion of 20° and full range of subtalar joint mouvements. He had a stable ankle and minimal pain on walking uneven ground. The radiographs taken at this time showed no evidence of avascular necrosis (fig.3). Figure 3 Figure 3: Anteroposterior and lateral radiographs at 12 months follow up DISCUSSION Fractures of the talus have a relatively low incidence accounting for 0.3 % of all bone fractures and 3-6 % of all foot fractures (1, 2, 3, 4) These injuries affect the neck of the talus more than the head or the body. Talar body fractures of the talus are uncommon accounting for 7-38 % of all talus fractures (4, 5, 6). A combined talar body fracture and medial malleolus fracture is exceptional. We identified only 3 cases of this combination (5,7, 8) without any dislocation of the talar body fragment or pilon fracture. We could not find any reports in literature mentioning this combination of talar body fracture dislocation and medial malleolus with pilon fracture. The mechanism of injury of these fractures is not clear but is thought to be similar to the one of talar neck and pilon fractures, dorsi flexion but with added axial compression. The axial force is transmitted through the sagittal axis of the dome of talus and usually produces comminution of the talar body or tibial pilon. Supination may have contributed to this injury in view of the medial malleolus fracture. In our case, there is a significant displacement of the talar body fragment with concurrent sub dislocation of the ankle. Peterson (9) proposed in this displacement fracture, that the talus acts as a cantilever between the distal tibia and the strong sustentaculum tali of the calcaneus. If the energy is not exhausted, the talar body is extruded posterioly with deltoid ligament. This mechanism is facilitated by the displaced fracture of the medial malleolus. Sneppen (6) classified talar body fractures into five groups: Compression injuries ; Shear fracture(Coronal, sagittal or horizontal) ; Fracture of the posterior process ; Fracture of the lateral process ;

Background: The movement around ankle joint is very important because of the cultural practices, which involve squatting and sitting cross-legged. Bimalleolar Pott’s fractures are very common in ankle joint injuries because of increased incidence of road traffic accidents and industrial trauma. Accurate reduction of fractures around ankle joint is important for a painless ankle joint. Objective: To study the functional outcome of surgically managed closed bimalleolar fractures of ankle in adults; to evaluate restoration of the anatomy of malleoli and ankle perfectly by operative treatment with internal fixation; to assess the union of fractures after surgical management; and to achieve stable fixation and early mobilization of the ankle. Materials and Methods: We have evaluated clinical, radiographic, and functional outcomes of 40 patients treated with a combination of different treatment modalities, which involve the combination of tension band wiring (TBW), Kirschner (K)-wire, Rush pin, cortical and cancellous screws, and one-third tubular plates for lateral and medial malleolus fixation. Results: In this prospective study, 40 cases of bimalleolar fractures of ankle were treated by surgical methods. Road traffic accident was the most common mode of injury. Majority [16 (40%)] of the cases showed supination–external rotation injury, followed by 11 (27.5%) cases with pronation–external rotation injury. Majority [29 (72.5%)] of the medial malleolus fractures were fixed with TBW. In the remaining cases, cancellous screws and K-wire were used. Most [20 (50%)] of the lateral malleolar fractures were fixed with K-wire. In the rest of the cases, one-third tubular plate and Rush pin were used. In our study, the average time taken for union was 10.4 weeks. Excellent results were achieved in 23 cases (57.5%), good in 10 cases (25%), fair in five cases (12.5%), and poor in two cases (5%). Excellent results were observed in most bimalleolar fractures. Of the two cases with poor results, one developed superficial infection and the other showed delayed union. Conclusion: Unstable bimalleolar ankle fractures are common because of road traffic accidents. Understanding the mechanism of injury is essential for anatomical reduction and fixation. Fibular alignment (length and rotation) has to be maintained for lateral stability of the ankle. Anatomical reduction with restoration of the articular congruence is essential in all intra-articular fractures, more so, if a weight-bearing joint such as ankle is involved. Open reduction and internal fixation restores the articular congruity of the ankle joint. Excellent results are obtained with stable fixation of fracture. TBW is better in internal fixation of medial malleolus compared with K-wire fixation, and lateral plating was the best for fibular fractures. Hence, we conclude that surgical management of bimalleolar ankle fractures provides good functional outcome. By stable surgical fixation of fracture, early mobilization can be done with good functional outcome.

Background: Ankle fracture ranks second among lower limb fractures, accounting for about 10% of all fractures. It occurs in about 137 per 1 lakh people each year. Bimalleolar fractures are the most common fracture in outpatient as well as in emergency department which accounts for 1/4th of all ankle fractures. Treatment of this fracture is complicated and challenging as the outcome will influence the locomotive power. Improper and inadequate fixation will cause long term disability as the body weight is transmitted through the ankle joint. This study was conducted to evaluate the functional outcome of bimalleolar ankle fractures treated with various surgical modalities. We also try to delineate the types of fractures occurred and its outcome after surgical fixation and also to understand the advantages and disadvantages of various implants used along with its complications. Aims and Objectives: To determine the functional outcome of surgical management of bimalleolar ankle fractures and to know the risks and complications associated with surgical fixation of bimalleolar ankle fractures. Subjects and Methods: A prospective study is conducted among 40 patients who came to the Emergency Department and to Orthopaedics Outpatient Department in Sree Mookambika Institute of Medical Sciences between April 2021 and September 2022 were analyzed. We have included bimalleolar ankle fractures with Lauge–Hansen classification (SER4, SAD 2, PER 3, PAB 3), Danis–Weber Type (A2, B2, C2, C3) in this study and we have excluded patients with Lauge–Hansen classification (SER1,2,3, SAD1, PER1,2,4, PAB1,2), Danis-Weber Type (A1, A3, B1, B3, C1), Systemic infections, open injury, fracture with dislocation, skin diseases over the incision site Trimalleolar ankle fracture, previous arthrodesis at target level. Based on the fracture pattern, the patients were planned for surgical fixation with appropriate implants. Results: In our present study of 40 patients, we assessed the functional outcome based on Baird and Jackson’s scoring system. Based on which 21 patients (52.5%) had excellent outcome, 14 patients (35%) had good outcome, 3 patients (7.5%) had fair outcome, and 2 patients (5%) had poor outcome. Out of total population, 35 patients (87.5%) had no complications followed by 3 patients (7.5%) had superficial infection and 2 patient (5%) who had ankle stiffness. Conclusion: Medial malleolus fracture can be effectively treated by various modalities such as Screw fixation, tension band wiring (TBW) and K-wire fixation, giving excellent to good results. Among which TBW and Screw fixation are relatively better than K-wire fixation for medial malleolus fracture. Similarly, lateral malleolus fracture can be treated with plate fixation, screw fixation and K-wire fixation which gives excellent to good results. Among which plate fixation (locking compression plate) is better than K-wire and screw fixation for lateral malleolus fracture. Superficial skin infection is the most common complication we encountered in our study.

Résultats radiologiques des fractures bimalléolaires : importance du délai de la chirurgie et du type de reconstruction

Radiological outcomes of bimalleolar fractures: Are timing of surgery and type of reconstruction important?

Background: Malleolar injuries are the most common significant lower extremity fractures. These injuries gain importance, because the whole body weight is transmitted through the ankle, and locomotion depends on the stability of the ankle. Open reduction and internal fixation have become the mainstay of treatment for most of the unstable bimalleolar fractures, as these operative methods restores the anatomy, biomechanics and contact loading characteristics of the ankle.Objectives:1.To study the functional outcome of surgically managed bimalleolar fractures of ankle in adults.2.To restore the anatomy of malleoli and ankle perfectly by operative treatment with internal fixation Methods: A prospective study of 50 cases of bimalleolar fractures of ankle in adults, managed surgically by screw for medial malleolus and plate for lateral malleolus during the period from june 2018-feb 2020 at Dr. D.Y. Patil hospital, Navi Mumbai.Inclusion Criteria•All closed fractures.•Open type 1, 2, 3a (Gustillo-Anderson).•Above 18 years.Exclusion Criteria•With associated Pilon fracture.•Patients unfit for surgery.•Patients with minimally displaced mono-malleolar fractures, avulsion fractures and stable fracturesFollow-up was taken at 1month, 3 months, and 6 months post-operatively. At every visit check radiographs were taken to assess the radiological union.Results: In our study we achieved 86% excellent to good results, 8% fair results, 6% poor results. The results were comparable to other studies.Conclusions: The operative results were satisfactory in 86% cases, with good to excellent functional outcome.•Excellent results are obtained with stable fixation of fracture. Cancellous screws or malleolar screws are better in internal fixation of medial malleolus and lateral plating was the best for fibular fractures.•Good functional results are obtained by surgical management of bimalleolar ankle fractures. Early weight bearing and mobilisation is achieved in these patients.Anatomical reduction with restoration of the articular congruence is essential in all intra articular fractures, more so, if a weight bearing joint like ankle is involved. Open reduction and internal fixation restores the articular congruity of the ankle joint.

Sleep Apnea (SA) is a common sleep disorder that increases postoperative morbidity. There is limited research on how SA influences outcomes following operative fixation of ankle fractures. Therefore, the aim of this study was to determine whether patients who undergo surgical fixation for bimalleolar ankle fractures have higher rates of medical complications and health care expenditures. A retrospective review from January 1, 2005 to March 31, 2014 was conducted using the parts A and B Medicare Data from PearlDiver database. Patients with and without SA on the day of the primary open reduction and internal fixation (ORIF) of their bimalleolar ankle fractures were queried using the International Classification of Diseases, Ninth Revision codes. Welch'st-tests were used to compare costs of care. A multivariate binomial logistic regression model was used to calculate the odds ratio (OR) of adverse events. A P-value <.001 was considered statistically significant. There were 20 560 patients (SA = 3150; comparison cohort = 17 410) who underwent ORIF for bimalleolar ankle fractures during the study period. Sleep apnea patients were found to have significantly higher rates and odds of 90-day medical complications (21.42% vs 7.47%, OR: 3.11, P < .0001) and 90-day costs of care ($7213.12 vs $5415.79, P < .0001). This research demonstrates an increased risk of postoperative medical complications and health care costs among patients with SA undergoing ORIF for bimalleolar ankle fractures. Therapeutic, Level IV: Retrospective.

Introduction: Of all the lower limb fractures ankle fractures are one of the most common accounting for almost 9% with the annual incidence being 107-187 per 1 lakh population. Treatment of this fracture is complicated and challenging as the outcome will influence the locomotive power. Improper and inadequate fixation can cause long term disability as body weight is transmitted through it. Aim of study: To assess the functional and radiological outcome of displaced bimalleolar ankle fractures and to assess the rate of complications.Materials and Methods: This prospective study was done at the Department of orthopaedics in K.R. Hospital, Mysuru after obtaining informed consent from patients. A total of 50 patients between the age of 18-50 years were treated with Open Reduction and Internal Fixation with various methods for bimalleolar fracture between August 2017- January 2018; These patients were followed for 12 months and evaluated based on union rate, complications (Infections, Nonunion) and functionally by Baird and Jackson ankle scoring system. Results: In our study of 50 patients, bimalleolar ankle fractures treated by ORIF by various methods were followed up for 12 months. In our study, majority were males (72%). Mean age group included in the study was 33 years. In majority of patients, the mode of injury was RTA (72%) and most common fracture type being AO Type 44 A (56%). As per Baird and Jackson scoring system excellent to good functional outcome was seen in 78.3% individuals with fair outcome in 17.9% and poor outcome in 5.6%. Complications were seen in 9 patients and only two underwent re surgery for non-union.Conclusion: We found that ORIF yielded good results in terms of anatomical reduction, stability and post-operative functional outcome. Hence as per our study we can safely conclude that open reduction and internal fixation should be the treatment of choice for all unstable ankle fractures.

Bimalleolar injuries are the most common significant lower extremity fractures. Open reduction of fracture and internal fixation methods have become the good option of treatment for bimalleolar fractures. The aim of the study is to assess the outcome following surgical management of ankle fracture. Classifications used is Danis-Weber. The outcome is assessed using olerud and molander scoring system. We performed a narrative review to assess the functional outcome of surgically managed bimalleolar ankle fractures. Extensive search of articles was done electronically using databases like PUBMED, Google scholar, reference checking. We concluded that internal fixation for bimalleolar ankle fractures gives better reduction, and functional outcome showing significant improvement in function of the ankle joint.

The stability of the ankle joint is provided by the medial and lateral malleoli and ligaments. Recent studies of cadaveric ankles have demonstrated that injury to the medial structures of the ankle is necessary to allow lateral subluxation of the talus after fracture. However, cadaveric models are limited by the fracture pattern chosen for the model. We sought to investigate the competency of the deltoid ligament in vivo in patients with an operatively treated bimalleolar ankle fracture. Twenty-seven patients with a bimalleolar ankle fracture were evaluated. In each patient, the medial malleolus was anatomically reduced and fixed. A radiograph of the ankle was then made with application of an external rotation load to the joint. All lateral malleolar injuries were then reduced and fixed. The radiographs were evaluated for restoration of the competence of the deltoid ligament according to established criteria. Seven (26 percent) of the twenty-seven patients had radiographically evident incompetence of the deltoid ligament after medial malleolar fixation. This finding was associated with a small medial malleolar fragment. In bimalleolar fractures, the medial injury may be an osseous avulsion, leaving the deltoid intact on the displaced fragment, or it may be a combination of ligamentous and osseous injury with disruption of the deep portion of the deltoid ligament.

Predictors of Adverse Events for Ankle Fractures: An Analysis of 6800 Patients

Talar fractures are relatively uncommon, with an incidence of 0.1% to 0.85% of all fractures and 3% to 6% of all foot fractures. Among these, talar neck fractures are more common than those of the talar body, typically occurring in the coronal plane. Restoration of joint congruency is necessary to reduce the incidence of osteonecrosis and post-traumatic osteoarthritis. Most fractures occur in the talar neck or body in the coronal plane. In the present case report, authors present a sagittal plane fracture of the talar body in combination with a bimalleolar fracture in a 45-year-old female, managed with open reduction and internal fixation using screws. In the present case, the dual approach, which is ideal, could not be performed due to the condition of the wound over the lateral aspect of the ankle. Proper planning regarding the timing of surgery, considering the swelling and soft tissue status, alongside proper anatomic reduction and rigid fixation with good surgical technique and postoperative rehabilitation, are key to achieving favourable clinical outcomes.

Background: Malleolar injuries are the most common significant lower extremity fractures. These injuries gain importance, because the whole body weight is transmitted through the ankle, and locomotion depends on the stability of the ankle. Open reduction and internal fixation have become the mainstay of treatment for most of the unstable bimalleolar fractures, as these operative methods restores the anatomy, biomechanics and contact loading characteristics of the ankle. Objectives: To study the functional outcome of surgically managed bimalleolar fractures of ankle in adults. Methods: A prospective study of 30 cases of bimalleolar fractures of ankle in adults, managed surgically by various techniques in During the period from December 2014 to May 2016 were studied, satisfying the inclusion and exclusion criteria were studied. The functional outcome was evaluated using the Biard and Jackson’s ankle scoring system. Results: In our study we achieved 86.6% excellent to good results, 6.6% fair results, 6.6% poor results. The results were comparable to other studies. Interpretation & Conclusion: The operative results were satisfactory in 86.6% cases, with good to excellent functional outcome. Excellent results are obtained with stable fixation of fracture. Cancellous screws or malleolar screws are far better in internal fixation of medial malleolus compared to Kirschner -wire fixation and lateral plating was the best for fibular fractures. Good functional results are obtained by surgical management of bimalleolar ankle fractures. Early weight bearing and mobilisation is achieved in these patients. Anatomical reduction with restoration of the articular congruence is essential in all intra articular fractures, more so, if a weight bearing joint like ankle is involved. Open reduction and internal fixation restores the articular congruity of the ankle joint. TBW done for many PER and PA injuries showed promising results comparable to that with screw fixation and also lesser reports of skin irritation at the wound site. It is the method preferred for small transverse fragments and osteoporotic bones of both malleoli especially in the elderly.