Surgical Treatment Of Ankle Fractures Research Articles

Complications following surgical treatment of ankle fractures in the elderly: can they be avoided?

Background Following surgical treatment of ankle fractures, geriatric patients face high complication rates (CR) in literature. Commonly used diagnostic and treatment algorithms fail to consider requirements of ageing patients which increases the risk of postoperative complications. Objective Present study critically evaluated surgical management of ankle fractures in patients over 65 years old, with focus on identifying modifiable risk factors and effective comorbidity management strategies. Methods We conducted a retrospective single-center study on patients who underwent surgical treatment of an ankle fracture. Based on their age, participants were divided into non-geriatric patients (NGP<65y) and geriatric patients (GP≥65y). We analyzed overall CR and number of minor and major complications in relation to timing of surgery, biological sex, injury pattern, osteosynthesis, pre-existing medical conditions, and postoperative care. Results 402 patients were included. GP encountered significantly higher overall (p<0.001), minor (p<0.001) and major (p=0.003) complications. They presented more complex, displaced and open fractures. Predominant factor contributing to higher CR in NGP and markedly in GP was concomitant diseases, presenting a strong OR of 19,290 (p<0.001) and 17,022 (p<0.001). Delaying surgery and managing comorbidities preoperatively had a favorable impact. Conclusion We revealed a high significant correlation between pre-existing medical conditions and postoperative results. To ascertain viability of delayed surgery in facilitating additional diagnostics and treatment of comorbidities, further comparative trials with a larger cohort are imperative.

Early Weight-bearing Following Surgical Treatment of Ankle Fractures Without Trans-syndesmotic Fixation Is Safe and Improves Short-term Outcomes.

The objective of this study was to ascertain outcome differences after fixation of unstable rotational ankle fractures allowed to weight-bear 2 weeks postoperatively compared with 6 weeks. Prospective case-control study. Academic medical center; Level 1 trauma center. Patients with unstable ankle fractures (OTA/AO:44A-C) undergoing open reduction internal fixation (ORIF) were enrolled. Patients requiring trans-syndesmotic fixation were excluded. Two surgeons allowed weight-bearing at 2 weeks postoperatively (early weight-bearing [EWB] cohort). Two other surgeons instructed standard non-weight-bearing until 6 weeks postoperatively (non-weight-bearing cohort). The main outcome measures included the Olerud-Molander questionnaire, the SF-36 questionnaire, and visual analog scale at 6 weeks, 3 months, 6 months, and 12 months postoperatively and complications, return to work, range of ankle motion, and reoperations at 12 months were compared between the 2 cohorts. One hundred seven patients were included. The 2 cohorts did not differ in demographics or preinjury scores ( P > 0.05). Six weeks postoperatively, EWB patients had improved functional outcomes as measured by the Olerud-Molander and SF-36 questionnaires. Early weight-bearing patients also had better visual analog scale scores (standardized mean difference -0.98, 95% confidence interval [CI] -1.27 to -0.70, P < 0.05) and a greater proportion returning to full capacity work at 6 weeks (odds ratio = 3.42, 95% CI, 1.08-13.07, P < 0.05). One year postoperatively, EWB patients had improved pain measured by SF-36 (standardized mean difference 6.25, 95% CI, 5.59-6.92, P < 0.01) and visual analog scale scores (standardized mean difference -0.05, 95% CI, -0.32 to 0.23, P < 0.01). There were no differences in complications or reoperation at 12 months ( P > 0.05). EWB patients had improved early function, final pain scores, and earlier return to work, without an increased complication rate compared with those kept non-weight-bearing for 6 weeks. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Effectiveness of Concurrent Ankle Arthroscopy During Open Reduction and Internal Fixation of Malleolar Fractures in Prevention of Common Short-Term Complications

Rotational malleolar fractures result in a high prevalence of intra-articular pathologies; therefore, routine arthroscopic assessment may be beneficial in the surgical treatment of ankle fractures. However, the clinical studies regarding the effectiveness of arthroscopy thus far have mixed results. We investigated the efficacy of concurrent arthroscopy during the treatment of malleolar fractures using a large U.S. healthcare data set. Those who had arthroscopy were compared with those who did not, during the surgical treatment of malleolar fractures, while adjusting for covariates of clinical relevance. The analysis showed that concurrent arthroscopy is protective against postoperative repeat surgery (OR = 0.13, 95CI = 0.02-0.41) and wound dehiscence (OR = 0.18, 95CI = 0.03-0.56). The number of added arthroscopy cases needed to avoid one repeat surgery was 74, while that of wound dehiscence was 52. Further studies are needed to determine if routine use of arthroscopy is justifiable in the surgical treatment of malleolar fractures, given the additional costs and time to the healthcare system.

Standardized analysis of syndesmosis stability in ankle trauma with an innovative syndesmosis-test-tool: a biomechanical study.

When treating ankle fractures, the question of syndesmosis complex involvement often arises. So far, there is no standardized method to reliably detect syndesmosis injuries in the surgical treatment of ankle fractures. For this reason, an intraoperative syndesmosis-test-tool (STT) was developed and compared to the recommended and established hook-test (HT). Tests were performed on cadaveric lower legs (n = 20) and the diastasis was visualized by 3D camera. Tests were performed at 50, 80, and 100N in native conditions and four instability levels. Instability was induced from anterior to posterior and the reverse on the opposite side. The impact on diastasis regarding the direction, the force level, the instability level, and the device used was checked using a general linear model for repeated measurement. The direction of the induced instability showed no influence on the diastasis during the stability tests. The diastasis measured with the STT increased from 0.5 to 3.0mm depending on the instability, while the range was lower with the HT (1.1 to 2.3mm). The results showed that the differentiation between the instability levels was statistically significantly better for the developed STT. The last level of maximum instability was significantly better differentiable with the STT compared to the HT. An average visualizable diastasis of more than 2mm could only be achieved at maximum instability. In conclusion, the newly developed STT was superior to the commonly used HT to detect instability.

Ankle arthroscopy does not elevate complication rates in ankle fractures

IntroductionAnkle fractures rank as the second most common lower limb fractures, and surgical intervention is essential for unstable ankle fractures. The use of ankle arthroscopy in such cases offers several advantages. This study aim is to assess whether arthroscopy influenced on complication rates in 171 ankle fractures treated with arthroscopic assistance. MethodsThis retrospective epidemiological analysis encompassed adult ankle fractures between December 2018 and December 2021. Initially, 173 patients were considered, but two were excluded, leaving a final sample of 171 patients. Postoperative complications were categorized as major or minor. ResultsThe study included 171 patients with surgically treated ankle fractures assisted by arthroscopy, comprising 76 females and 95 males, with an average age of 41.9 years. Syndesmosis injuries were treated in all diagnosed cases (55.0%), and deltoid ligament injuries received attention when identified (33.7%). Arthroscopic techniques were preferred over open techniques (47.4%). Ten patients experienced complications, consisting of 2 major and 8 minor complications (5.8%). DiscussionOur study's epidemiological findings align with prior literature, demonstrating that intra-articular injuries accompany 63% to 79% of ankle fractures. Arthroscopy allows for both diagnosis and treatment within the same procedure, including joint lavage to reduce inflammation. We diagnosed 57 deltoid injuries and identified a statistical relationship between chondral, syndesmotic, and deltoid ligament injuries. Infection is a common complication in ankle fracture surgery, with rates ranging from 1.44% to 16%. Our study yielded a 5.8% complication rate, comprising 1.2% major and 4.6% minor complications. Patients undergoing ORIF with arthroscopic assistance had a lower prevalence of infection. ConclusionThe use of arthroscopic assistance in the surgical treatment of ankle fractures does not increase the overall complication rate. Level of evidenceIV

Arthroscopic-assisted Tibiotalocalcaneal Arthrodesis Using a Hindfoot Nail for Treatment of Ankle Fractures in Medically Complex Patients: A Technique Guide and Retrospective Case Series

Treatment of ankle fractures in patients with severe medical comorbidities poses a significant challenge, as these patients are at high risk for major complications, including infection and amputation. Tibiotalocalcaneal arthrodesis (TTCA) is gaining popularity for the surgical treatment of ankle fractures in these medically complex patients. This is traditionally performed with open joint preparation or no joint preparation, both of which have associated postoperative complications. We present our technique for arthroscopic-assisted TTCA and provide a retrospective case series of 4 patients undergoing this technique and their outcomes. Our study showed that arthroscopically-assisted joint preparation for TTCA for ankle fractures in patients with severe medical comorbidities shows promise considering 100% limb salvage rate, successful fusion, and restoration of ambulatory status. Complications were minimal requiring only one return to the operating room for symptomatic aseptic loosening of an interlocking screw. Because this is done in a minimally invasive approach, it may be the preferred technique more widely used in the future to decrease the rate of infection and increase the rate of fusion, especially in medically complex patients. Level of Evidence: Level IV, retrospective case series.

Risk factors for fracture-related infection after ankle fracture surgery

IntroductionAnkle fracture surgery comes with a risk of fracture-related infection (FRI). Identifying risk factors are important in preoperative planning, in management of patients, and for information to the individual patient about their risk of complications. In addition, modifiable factors can be addressed prior to surgery. The aim of the current paper was to identify risk factors for FRI in patients operated for ankle fractures. MethodsA cohort of 1004 patients surgically treated for ankle fractures at Haukeland University Hospital in the period of 2015–2019 was studied retrospectively. Patient charts and radiographs were assessed for the diagnosis of FRI. Binary logistic regression was used in analyses of risk factors. Regression coefficients were used to calculate the probability for FRI based on the patients’ age and presence of one or more risk factors. ResultsFRI was confirmed in 87 (9%) of 1004 patients. Higher age at operation (p < .001), congestive heart failure (CHF), p = 0.006), peripheral artery disease (PAD, p = 0.001), and current smoking (p = .006) were identified as risk factors for FRI. PAD and CHF were the risk factors displaying the strongest association with FRI with an adjusted odds ratio of 4.2 (95% CI 1.8–10.1) and 4.7 (95% CI 1.6–14.1) respectively. ConclusionThe prevalence of FRI was 9% after surgical treatment of ankle fractures. The combination of risk factors found in this study demonstrate the need for a thorough, multidisciplinary, and careful approach when faced with an elderly or frail patient with an ankle fracture. The results of this study help the treating surgeons to inform their patients of the risk of FRI prior to ankle fracture surgery. Level of evidenceLevel III retrospective case-control study

Trends and Risk Factors for Surgical Site Infection after Treatment of the Ankle Fracture: National Cohort Study.

Surgical site infection (SSI) is a major complication after the surgical treatment of ankle fractures that can result in catastrophic consequences. This study aimed to determine the incidence of SSI in several cohorts from national insurance databases over the past 12 years and identify its predictors. The claimed data for patients (n = 1,449,692) with ankle fractures between 2007 and 2019 were investigated, and a total of 41,071 patients were included in the final analysis. The covariates included were age, sex, season, fracture type (closed vs. open), type of surgical fixation procedure, and comorbidities of each patient. All subjects were divided into two groups according to the SSI after the surgical fixation of the ankle fracture (no infection group vs. infection group). The number of SSIs after the surgical treatment of ankle fractures was 874 (2.13%). Open fractures [odds ratio, (OR) = 4.220] showed the highest risk for SSI, followed by the male sex (OR = 1.841), an increasing number of comorbidities (3-5, OR = 1.484; ≥6, OR = 1.730), a history of dementia (OR = 1.720) or of myocardial infarction (OR = 1.628), and increasing age (OR = 1.010). The summer season (OR = 1.349) showed the highest risk among the four seasons for SSI after ankle fracture surgery.

Fracture-related infection: Prevalence and application of the new consensus definition in a cohort of 1004 surgically treated ankle fractures

Surgical treatment of ankle fractures comes with a substantial risk of complications, including infection. An unambiguously definition of fracture-related infections (FRI) has been missing. Recently, FRI has been defined by a consensus group with a diagnostic algorithm containing suggestive and confirmatory criteria. The aim of the current study was to report the prevalence of FRI in patients operated for ankle fractures and to assess the applicability of the diagnostic algorithm from the consensus group. Records of all patients with surgically treated ankle fractures from 2015 to 2019 were retrospectively reviewed for signs of postoperative infections. Patients with suspected infection were stratified according to confirmatory or suggestive criteria of FRI. Rate of FRI among patients with confirmatory and suggestive criteria were calculated. Suspected infection was found in 104 (10%) out of 1004 patients. Among those patients, confirmatory criteria were met in 76/104 (73%) patients and suggestive criteria were met in 28/104 (27%) at first evaluation. Patients with clinical confirmatory criteria (N=76) were diagnosed with FRI. Patients with suggestive criteria were further examined with either bacterial sampling at the outpatient clinic, revision surgery including bacterial sampling, or a wait-and-see approach. Eleven (39%) of the 28 patients had positive cultures and were therefore diagnosed as having FRI at second evaluation. In total 87 (9%) patients were diagnosed with FRI according to the consensus definition. Only 73 (70%) of the 104 patients with suspected FRI had adequate bacterial sampling. The prevalence of FRI, applying the FRI-consensus criteria, for patients with surgically treated ankle fractures was 9%. Twenty-two percent of patients who met the confirmatory criteria had negative bacterial cultures. The current study shows that we did not have a systematic approach to patients with suspected FRI as recommended by the consensus group. A systematic approach to adequate bacterial sampling when FRI is suspected is paramount. The consensus definition of FRI and its diagnostic algorithm facilitates such an approach. Level III - retrospective cohort study.

Difference in Joint Stability Between Small Posterior Malleolar Fragments With Fixation and Those Without Fixation: A Biomechanical Cadaver Study

The indication for the surgical treatment of ankle fractures that involve a posterior malleolar fragment remains controversial. This cadaver study assessed the biomechanical results of rotation stiffness of Haraguchi type 1 posterior malleolar fragments with or without cannulated screw fixation. Twelve anatomic lower-extremity specimens from 6 cadavers were tested. Six right legs were subjected to posterior malleolus osteotomy (Haraguchi type I) followed with (group A; n=3) or without (group B; n=3) fixation using a cannulated screw. Ankle joint stability was measured under both external rotation force and axial loading, and the passive resistive torque was measured in both groups. The mean torque value in group A was 0.1093 Nm/º, while that in group B was 0.0537 Nm/º. There was a significant intergroup difference (p=.004). In group B, the torque value was further increased in the latter rotation period (about 40-60 degrees). Group A proved more stable under experimental conditions than group B. Fixation in type I posterior malleolar fragments produced improved stability in ankle rotation, even for posterior malleolar fragments involving <25% of the articular surface, and has been considered an effective aid in treatment.

Association of Chronic Kidney Disease and Complications Following Acute Torsional Ankle Fracture.

Although chronic kidney disease (CKD) has been associated with poor outcomes following traumatic fractures, there is a scarcity of literature describing the effect on outcomes of ankle fractures. We will examine the impact of CKD on clinical outcomes following torsional ankle fracture, including complications and unplanned surgical procedures. A retrospective review of 1981 adult patients with torsional ankle fractures treated at a level 1 trauma center was performed to identify patients with CKD based on glomerular filtration rate. Demographic, injury, and treatment-related characteristics were collected. Outcomes included any unplanned procedure: implant removal, debridement, revision, arthrodesis, and amputation; in addition to complications of superficial infection, deep infection, and implant irritation. Patients with CKD were matched with patients without CKD by propensity score matching. Univariate comparisons between groups were conducted using chi-square and Mann-Whitney U tests. 136 patients (68 with CKD and 68 without CKD) were analyzed. Of the 68 patients with CKD, the mean stage of disease was 3.7 with 24% on dialysis for a mean length of 4.1 years. Patients without CKD were more likely to undergo primary ORIF (100% vs 54%, P < .001). Thirty-five percent of patients with CKD had surgical complications vs 19% in the cohort without (P = .07). Patients with open fractures, dislocation, and chronic kidney disease were, respectively, 5.19, 3.77, and 3.91 times more likely to have any complication (P = .02, P = .05, P = .05). Patients with CKD were more likely to undergo unplanned arthrodesis (P = .01). Only dislocation was an independent predictor for unplanned procedure (odds ratio = 5.08, P = .026). Following torsional ankle fracture, CKD is associated with increased likelihood of having a complication or an unplanned arthrodesis. Open fractures and dislocation at time of injury are also associated with complications. Our findings encourage caution about surgical treatment of ankle fractures in patients with CKD. Level III, retrospective, comparative, prognostic.

Screw-only fibular construct for Weber B ankle fractures: A retrospective clinical and cost comparison to assess feasibility for resource-limited settings

IntroductionAnkle fractures are one of the most common injuries sustained worldwide, with the majority being isolated lateral malleolus fractures. The majority of the world's population live in Low and Middle Income Countries (LMIC), where implant cost may limit surgical treatment of ankle fractures. We investigate if Weber B ankle fractures could be effectively treated with a lower-cost technique using two screws between the fibula and the tibia to neutralize an interfragmentary lag screw. MethodsAfter IRB approval, consecutive patients from January 1, 2020 to December 31, 2020 with Weber-B ankle fractures were treated using AO technique (AOT) with plate osteosynthesis neutralizing an interfragmentary screw. Syndesmotic injuries, as well as injuries to the medial malleolus or foot were treated according to the surgeon's preferences. From January 1, 2021 to December 31, 2021 these injuries were treated with a screw-only technique (SOT) with two fibula pro tibia screws to neutralize an interfragmentary screw. Patient demographics including age, sex, BMI, smoking status, associated rheumatoid arthritis, and associated diabetes mellitus were recorded. The primary outcome variable was a stable radiographic mortise at six weeks post-surgery, secondary outcome variables included clinical union, infection, hardware removal, and implant cost for lateral malleolar fixation charged to the hospital. ResultsSeventeen AOT and 10 SOT constructs were included. Demographic characteristics were similar between groups. All fractures maintained a stable mortise with clinical union at 6 weeks without infection. There was a statistically significant difference in hardware removal (17.6% AOT, 50% SOT, p = 0.012). The average implant cost to the hospital of the lateral malleolar fixation was significantly less in the SOT group ($592 (SD $229)), compared to the AOT group ($1,949.97 (SD $562)), (p < 0.0001). ConclusionWe introduce proof of concept of a novel lower-cost fixation strategy for Weber B ankle fractures that maintained a stable mortise with clinical union at six weeks post-surgery. However, there was a significantly higher rate of hardware removal following fixation with a screw-only construct.

Transcutaneous electrical nerve stimulation reduces acute pain, and the use of analgesics after ankle fracture surgery

Objective: To evaluate the applicability of transcutaneous electrical nerve stimulation (TENS) as a complementary treatment method to non-opioid analgesics for acute postoperative pain in patients undergoing surgical treatment due to ankle fractures. Methods: A prospective, randomized, analytical, cross-sectional study performed after ankle fracture surgery. Two groups were randomized as follows: group 1 (Intervention) received TENS and non-opioid analgesic (dipyrone), and group 2 (Control) received non-opioid analgesic (dipyrone). Results: This study demonstrated that TENS in patients undergoing surgical treatment of ankle fractures reduces the use of rescue opioids significantly to control postoperative pain. Conclusion: TENS devices may be another safe option to control postoperative pain and reduce the use of opioids, avoiding adverse effects from this class of analgesic. Level of Evidence II; Therapeutic Studies; Prospective Comparative Study.

Comparing the 30-Day Complications Between Smokers and Nonsmokers Undergoing Surgical Fixation of Ankle Fractures.

Background:There have been conflicting reports regarding the effect of smoking on complications after surgical treatment of ankle fractures. This study aimed at identifying the complications for which smokers and subgroups of smokers are at a higher risk compared to nonsmokers when undergoing surgery for fixation of rotational ankle fractures.Methods:The American College of Surgeons National Surgical Quality Improvement Program data set from 2008 to 2019 was used to compare the 30-day wound, cardiac, renal, and infectious complications, related readmissions, and return to the operating room between the 2 cohorts.Results:Of 33 741 patients included, 25 642 (76.0%) were nonsmokers and 8099 (24.0%) were smokers. Multivariate analysis showed that smokers were at a higher risk for deep wound infection (OR 2.34, 95% CI 1.48-3.69, P < .001), wound dehiscence (OR 2.43, 95% CI 1.56-3.77, P < .001), related return to the operating room (OR 1.69, 95% CI 1.36-2.11, P < .001), and related readmissions (OR 1.67, 95% CI 1.32-2.09, P < .001). Smokers at an increased risk for deep infection included patients between 50 and 59 years (OR 5.75, 95% CI 1.78-18.5, P = .003), who were Black (OR 4.24, 95% CI 1.04-17.23, P = .044), who had body mass index (BMI) 35 to 39.9 (OR 3.73, 95% CI 1.46-9.50, P = .006), or operative times between 60 and 90 minutes (OR 3.64, 95% CI 1.79-7.39, P < .001). Smoker subgroups at a higher risk for wound dehiscence included patients between 50 and 59 years (OR 9.86, 95% CI 3.29-29.53, P < .001), with operative times between 90 and 120 minutes (OR 4.88, 95% CI 1.89-12.58, P < .001), with BMI 30 to 34.9 (OR 3.06, 95% CI 1.45-6.45, P = .003) and who underwent spinal/epidural anesthesia (OR 9.31, 95% CI 2.31-37.58, P = .002).Conclusion:Smokers were at an increased risk for deep wound infection, wound dehiscence, related reoperations, and related readmissions after ankle fracture surgery. Certain subgroups were at an even higher risk for these complications.Level of Evidence:Level III, retrospective cohort study.

Assessing the functional outcomes of ankle fracture and its predictive factors following surgical treatment at Addis Ababa burn, emergency, and trauma (AaBET) hospital, Addis Ababa, Ethiopia, 2021: A 5-year retrospective cross-sectional study.

Ankle fracture is a common injury that is treated at Addis Ababa Burn, Emergency, and Trauma Hospital. Previous studies show that there are mixed functional outcomes after surgically treated ankle fractures. After Ethical clearance was obtained from the ethical review committee of St. Paul Millennium Medical College, a retrospective cross-sectional study was conducted on 122 patients from Septemberto October 2021. Patients fulfilling the inclusion criteria were called through phone and verbal consent was obtained, and the patients' responses were recorded with Olerud and Molander ankle outcome score (OMAS). For those study subjects who were unansweredto phone calls or non-functioning cell phones were repeated at least two times per week during the data collection period. The collected data were coded, entered, checked for its completeness, cleaned, and analyzed using SPSS Version 22. Descriptive statistics were presented with frequency, percentage, text, and graphs. Finally, the strength of association between functional outcome of ankle fracture and independent variables wereevaluated using the Chi-square test, and a P-value < 0.05 was declared to be statistically significant. Out of the total 122 patients, 72.1% of study subjects were males, and the mean OMAS for males and females was 76.79, and 75.65, respectively. Among all ankle fractures, nearly two-thirds (63.1%) of them were closed fractures, which are initially stabilized with splinting, open reduction, and internal fixation (ORIF), and external fixation were 77%, 13.9%, and 9%, respectively, whereas 83.3% definitive management of operatively treated ankle fracture was open reduction and internal fixation. In this study, the score of Olerud and Molander was 82.9% patients 'good' or 'excellent,' whereas 10.5% and 4.5% were fair and poor, respectively. In the present study patients with 40years and younger (p-value, 0.022) and early surgical treatment (p-value 0.02) were strongly associated with the positive functional outcome of ankle surgery. Even though the surgical treatment of ankle fracture results in good postoperative functional outcomes, restores ankle function, and allows good mobility of the ankle joint, still some patients experience few restrictions in functional activities of 2-5-year post-surgical treatment.

The resorption status of magnesium screws for surgical treatment of ankle fractures assessed by HRpQCT - 2.5 years follow-up data of a first-in-human study

The resorption status of magnesium screws for surgical treatment of ankle fractures assessed by HRpQCT - 2.5 years follow-up data of a first-in-human study

Posterior to anterior malleolar extended lateral approach to the ankle (PAMELA): early results of a novel approach

IntroductionIn a previous cadaveric study, we described the Posterior to Anterior Malleolar Extended Lateral Approach (PAMELA) to address complex ankle fractures. It was demonstrated to provide optimal exposure of the posterior and lateral malleoli, and of the anterolateral portion of the ankle through a single incision. The aim of this study is to report the clinical results of this novel approach.MethodsBetween January 2019 and January 2021, all patients presenting with a complex ankle fracture in our institution were assessed by CT scan. Indication to use the PAMELA was determined by the fracture pattern, according to our previous guidelines, including combination of complex lateral and displaced posterior malleolar fractures, associated in most cases with anterolateral fracture avulsion. The approach was performed according to the steps previously described. Intraoperative evaluation included quality of exposure, ease of performing the osteosynthesis, and any complication encountered. The postoperative course was assessed for wound healing, quality of reduction, and the occurrence of any complication.ResultsThe PAMELA was performed in 20 patients (aged 17–73). The most common combination of fractures was a comminuted lateral malleolus fracture associated with a displaced fracture of the posterior malleolus and a Wagstaffe-Le Fort or Chaput avulsion. We encountered no intraoperative complication. X-rays showed anatomical reduction in all cases. Postoperative complications included three delayed wound healing resolved with local treatment and one sural nerve traction injury.ConclusionsThe main potential concern regarding this novel approach was the healing of the flap. Our results reject this concern and are in line with wound healing complications reported following surgical treatment of ankle fractures. This study confirms the safe in vivo feasibility of the PAMELA and opens a new perspective in the optimal management of complex fractures of the ankle. A larger prospective clinical study is ongoing in our institution.

Early Unprotected Weight Bearing and Pre-Scheduled Supervised Rehabilitation Program after Surgical Treatment of Ankle Fractures.

Ankle fractures represent one of the most common orthopedic injuries in the lower extremity. Weight-bearing and rehabilitation protocols after surgical treatment of ankle fracture have recently evolved from traditional methods to full weight-bearing protocols. However, more evidence is needed on unprotected immediate weight-bearing along with a standardized rehabilitation program. The purpose of this study was to evaluate effects of unprotected immediate weight-bearing as tolerated and an eight-week prescheduled supervised rehabilitation program on the mid-term clinical and functional outcomes of surgically treated ankle fractures, and to compare functional results with the unaffected side. Eighty patients (24F and 56M) who underwent rigid fixation of bimalleolar ankle fractures were included (mean age 41.57±13.22 years). Preoperative radiographs and computed tomography scans were used to evaluate and classify the fractures. The fractures were classified using Lauge-Hansen classification system. Ankle ROMs, Pain Disability Index (PDI), American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scores, and Short Form-36 scores were evaluated. Patients were allowed unprotected weight-bearing on the immediate postoperative period and a standardized supervised prescheduled rehabilitation program was undertaken following surgery. The mean follow-up period was 30.32±6.91 months. Based on Lauge-Hansen classification, supination-external rotation injuries were found in 32(40%) patients, supination adduction injuries in 14(17.4%) patients, pronation-external rotation injuries in 28(35%) patients, and pronation-abduction fractures in 6(7.6%) patients. The solid union was achieved in all patients at the final follow-up. The mean PDI score was 12.78±14.78, and the AOFAS score was 80.93±17.24. Although patients' health-related quality of life was at a good level, the injured-side ankle ROM was lower than the healthy side (p ≤ 0.05). Satisfactory clinical and functional outcome can be achieved at mid-term with unprotected weight-bearing as tolerated and pre-scheduled supervised eight-week rehabilitation program following rigid internal fixation of ankle fractures. However, this protocol is not studied in patients with associated comorbidities.

The use of the combined stable-elastic fixation for unstable injuries of the ankle joint in trans-syndesmotic fractures of the tibia

The problem of complications and the frequency of poor outcomes in the surgical treatment of ankle fractures with ti-biofibular syndesmosis (TFS) rupture (4.8–36.8 % of cases) remains significant. It was interesting from a scientific and practical point of view to conduct a clinical study to determine the effectiveness of the newly developed method of metal osteosynthesis for tibial fractures with TFS rupture, which would combine stability of tibial fixation and not limit the elastic qualities of TFS. The aim of the study: to determine the effectiveness of combined stable-elastic fixation for unstable injuries of the ankle joint in trans-syndesmotic fractures of the tibia. Materials and methods. On the basis of own clinical researches and data of literature sources, the method of the combined stable-elastic fixation for unstable injuries of the ankle joint in trans-syndesmotic fractures of the tibia is developed. The effectiveness of the proposed technique was evaluated 6 months after surgery on the Kitaoka scale. We have examined 12 patients with tibial fractures type 44 B1, B2 and B3 according to the AO classification, who underwent surgery using our methods. Results. The high efficiency of using the technique of combined stable-elastic fixation for unstable injuries of the ankle joint due to trans-syndesmotic fractures of the tibia has been determined. Good and excellent treatment results 6 months after surgery were observed in all 12 people (100 %), with excellent outcomes observed in 75 % of cases. There were no satisfactory and unsatisfactory treatment results. Conclusions. The study proves the high efficiency of the proposed method for combined stable-elastic fixation of ankle injuries in unstable trans-syndesmotic fractures of the tibia with TFS damage. There were 75 % excellent and 25 % good results within 6 months after surgery. A wider introduction of this technique into the practice of traumatologists of Ukraine is proposed.

An Evaluation of Patient Characteristics Associated With Medical Disposition in the Surgical Treatment of Ankle Fractures

The objective of this investigation was to evaluate patient characteristics associated with medical disposition in treatment of ankle fractures. The 2018 American College of Surgeons National Surgical Quality Improvement Program database was interrogated with data extracted related to the 6 current procedural terminology (CPT) codes available pertaining to ankle fractures: 27766, 27769, 27792, 27814, 27822, and 27823. The primary outcome analysis involved a comparison of patient characteristics and short-term adverse outcomes between those fractures repaired on an inpatient basis versus outpatient basis. A secondary analysis was then performed on patient characteristics and adverse short-term outcomes between those fractures treated on an inpatient basis who were discharged home versus elsewhere. Age (p < .001), race (p < .001), ethnicity (p < .001), body mass index (BMI) (p < .001), estimated probability of mortality (p < .001), estimated probability of morbidity (p < .001), CPT code of fracture designation (p < .001), functional status (p < .001), elective surgery designation (p < .001), American Society of Anesthesiologists class (p < .001), diabetes (p < .001), smoking status (p < .001), dyspnea (p < .001), COPD (p < .001), congestive heart failure (p < .001), hypertension (p < .001), dialysis (p < .001), cancer (p < .001), steroid use (p < .001), blood transfusion history (p < .001), and sepsis/systemic inflammatory response syndrome history (p < .001) were all independently associated with the ankle fracture repair being performed on an inpatient basis on regression analysis. Age (p < .001), race (p = .025), ethnicity (p < .001), BMI (p = .001), CPT code of fracture designation (p < .001), preoperative functional status (p < .001), and American Society of Anesthesiologists class (p < .001) were all independently associated with inpatient ankle fracture repairs being discharged to home following the procedure on regression analysis. The results of this investigation demonstrate that differences in patient demographic characteristics might contribute to medical decision-making as it relates to patient management and discharge disposition in the treatment of ankle fractures.