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trimalleolar fracture

Kamran S Hamid, Travis J Dekker, Peter W White, Samuel B Adams
: Prone positioning affords significant benefits for the fixation of trimalleolar ankle fractures and has been the long-time standard for treatment of these injuries. However, 2 primary disadvantages hamper its utility. First, access to the medial ankle is impeded by the contralateral limb and inability to rotate the operative leg to the extent that is possible in other positions. Second, lateral fluoroscopic imaging of the ankle can be cumbersome and often necessitates physically elevating the ankle for a radiograph then placing it back on the operative table...
October 25, 2016: Foot & Ankle Specialist
Eren Cansü, Mehmet B Unal, Serkan Gurcan, Fatih Parmaksizoglu
Background Lateral malleolar fractures (Weber type B or OTA 44-B) account for 60% of all ankle fractures. To achieve anatomic restoration, surgical stabilization provides better results than conservative treatment. Various fixation methods are available to treat these fractures; however, the best method is still unknown. Our objectives were to present a new, useful, and efficient surgical technique for stabilizing lateral malleolar fractures and to analyze the outcomes of patients treated with the compression cerclage system...
September 2, 2016: Journal of the American Podiatric Medical Association
Long Yang, Xian-Wen Shang, Jian-Nan Fan, Zhi-Xu He, Jian-Ji Wang, Miao Liu, Yong Zhuang, Chuan Ye
To evaluate the effect of 3D printing in treating trimalleolar fractures and its roles in physician-patient communication, thirty patients with trimalleolar fractures were randomly divided into the 3D printing assisted-design operation group (Group A) and the no-3D printing assisted-design group (Group B). In Group A, 3D printing was used by the surgeons to produce a prototype of the actual fracture to guide the surgical treatment. All patients underwent open reduction and internal fixation. A questionnaire was designed for doctors and patients to verify the verisimilitude and effectiveness of the 3D-printed prototype...
2016: BioMed Research International
Jike Lu, Masumi Maruo Holledge, Jac Trappel, Mehul Mayank
BACKGROUND: The irreducible trimalleolar fracture case we describe is different from the Bosworth fracture, defined as a fixed posterior fracture-dislocation of the distal part of the fibula, in which the proximal fibular shaft fragment locks behind posterior tibial tubercle. This fracture is frequently irreducible by closed means as well. METHODS: We describe a rare case of trimalleolar fracture/dislocation that cannot be reduced by closed means, and review the relevant literature...
June 2016: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
S M Verhage, F Boot, I B Schipper, J M Hoogendoorn
AIMS: Involvement of the posterior malleolus in fractures of the ankle probably adversely affects the functional outcome and may be associated with the development of post-traumatic osteoarthritis. Anatomical reduction is a predictor of a successful outcome. The purpose of this study was to describe the technique and short-term outcome of patients with trimalleolar fractures, who were treated surgically using a posterolateral approach in our hospital between 2010 and 2014. PATIENTS AND METHODS: The study involved 52 patients...
June 2016: Bone & Joint Journal
Thomas J An, Rachel V Thakore, Sarah E Greenberg, Vasanth Sathiyakumar, Harrison F Kay, Michael Gerasimopoulos, William T Obremskey, Manish K Sethi
The purpose of this study was to investigate operative costs and postoperative complication rates in relation to utilization of locking versus nonlocking implants in isolated, lower limb fractures. Seventy-seven patients underwent plate fixation of isolated bicondylar tibial plateau, bimalleolar ankle, and trimalleolar ankle fractures at a large tertiary care center. Fixation with locking versus nonlocking implants was compared to incidence of postsurgical complications. Costs of these implants were directly compared...
2016: Journal of Surgical Orthopaedic Advances
Shengli Xia, Xiuhui Wang, Beigang Fu, Yaogang Lu, Minghui Wang
OBJECTIVE: To explore the clinical value of computer-assisted surgical planning in the treatment of ankle fractures. METHODS: Between January 2012 and January 2014, open reduction and internal fixation were performed on 42 patients with ankle fractures. There were 22 males and 20 females with an average age of 52 years (range, 19-72 years). The causes were spraining injury (20 cases), traffic accident injury (14 cases), and falling from height injury (8 cases). The time from injury to operation was 5 hours to 12 days (mean, 2...
December 2015: Chinese Journal of Reparative and Reconstructive Surgery
Ezequiel Palmanovich, Yaron S Brin, Benny Kish, Meir Nyska, Iftach Hetsroni
Previous investigators have questioned the reliability of plain radiographs in assessing the accuracy of ankle fracture reduction when these were compared with the computed tomography (CT) evaluation in the preoperative setting, in particular, in fractures with syndesmosis injuries or trimalleolar fragments. The role of CT assessment, however, has not been investigated in the early postoperative setting. In the early postoperative setting, reduction still relies most commonly on fluoroscopy and plain radiographs alone...
May 2016: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Eric W Tan, Norachart Sirisreetreerux, Adrian G Paez, Brent G Parks, Lew C Schon, Erik A Hasenboehler
BACKGROUND: No consensus exists regarding the timing of weightbearing after surgical fixation of unstable traumatic ankle fractures. We evaluated fracture displacement and timing of displacement with simulated early weightbearing in a cadaveric model. METHODS: Twenty-four fresh-frozen lower extremities were assigned to Group 1, bimalleolar ankle fracture (n=6); Group 2, trimalleolar ankle fracture with unfixed small posterior malleolar fracture (n=9); or Group 3, trimalleolar ankle fracture with fixed large posterior malleolar fracture (n=9) and tested with axial compressive load at 3 Hz from 0 to 1000 N for 250 000 cycles to simulate 5 weeks of full weightbearing...
June 2016: Foot & Ankle International
Marc Regier, Jan Philipp Petersen, Ahmet Hamurcu, Eik Vettorazzi, Cyrus Behzadi, Michael Hoffmann, Lars G Großterlinden, Florian Fensky, Till Orla Klatte, Lukas Weiser, Johannes M Rueger, Alexander S Spiro
BACKGROUND: The incidence of osteochondral lesions (OCLs) in association with displaced ankle fractures has only been examined in two previous studies. In both studies magnetic resonance imaging (MRI) was performed prior to open reduction and internal fixation (ORIF). Because MRI may overdiagnose or overestimate the extent of OCLs in an acute trauma setting the aim of this study was to determine the incidence of OCLs after ORIF of displaced ankle fractures using MRI at medium-term follow-up, and to analyse if the severity of fracture or the clinical outcome correlates with the incidence of OCLs...
March 2016: Injury
Femke M A P Claessen, Diederik T Meijer, Michel P J van den Bekerom, Barend D J Gevers Deynoot, Wouter H Mallee, Job N Doornberg, C Niek van Dijk
PURPOSE: The purpose of this study was to identify the most reliable classification system for clinical outcome studies to categorize post-traumatic-fracture-osteoarthritis. METHODS: A total of 118 orthopaedic surgeons and residents-gathered in the Ankle Platform Study Collaborative Science of Variation Group-evaluated 128 anteroposterior and lateral radiographs of patients after a bi- or trimalleolar ankle fracture on a Web-based platform in order to rate post-traumatic osteoarthritis according to the classification systems coined by (1) van Dijk, (2) Kellgren, and (3) Takakura...
April 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Julia Evers, Linda Barz, Dirk Wähnert, Niklas Grüneweller, Michael J Raschke, Sabine Ochman
INTRODUCTION: Ankle fractures are increasing in incidence. The more complicated the lesion is, the higher the risk of developing posttraumatic arthrosis. Severe posttraumatic arthrosis results in a reduced quality of life. Therefore, the treatment of a trimalleolar fractures is crucial. However, the treatment guidelines for posterior malleolar fractures (PMF) are still based on recommendations from 1940. Only a few retrospective studies have been conducted, which analysed patient outcomes based on lateral X-rays of the ankle...
October 2015: Injury
Radosław Górski, Sławomir Żarek, Piotr Modzelewski, Paweł Małdyk, Rafał Wiśniewski, Ryszard Górski
BACKGROUND: Open trimalleolar fractures are some of the most severe fractures of the ankle joint region and some of the most difficult in trauma surgery. Repositioning with internal fixation is the most common surgical treatment method. There is little published data on primary repositioning and external fixation. MATERIAL AND METHODS: Five patients with open trimalleolar were fitted with Ilizarov external fixators in single-stage procedures. RESULTS: Full weight bearing was possible following surgical treatment in all five patients...
July 2015: Ortopedia, Traumatologia, Rehabilitacja
S M Verhage, I B Schipper, J M Hoogendoorn
BACKGROUND: Large comparative studies that have evaluated long-term functional outcome of operatively treated ankle fractures are lacking. This study was performed to analyse the influence of several combinations of malleolar fractures on long-term functional outcome and development of osteoarthritis. METHODS: Retrospective cohort-study on operated (1995-2007) malleolar fractures. Results were assessed with use of the AAOS- and AOFAS-questionnaires, VAS-pain score, dorsiflexion restriction (range of motion) and osteoarthritis...
2015: Journal of Foot and Ankle Research
Sean Blake, George Yakubek, James Shaer
Vertical shear fractures of the medial malleolus are less common than transverse fractures. These fractures are often treated with lag screws, posteromedial buttress plating, antiglide plates, and neutralization plates with screws. We report on a 37-year-old male who had fractured his ankle after tripping and falling into a ditch. Initially, the patient was treated with closed reduction and a splint for a trimalleolar fracture with a laterally subluxed talus. However, on review of his preoperative radiographs and computed tomography studies, we confirmed a medial malleolus fracture with a vertical shear pattern and communition...
November 2015: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
D T Meijer, J N Doornberg, I N Sierevelt, W H Mallee, C N van Dijk, G M Kerkhoffs, S A Stufkens
BACKGROUND: Accurate assessment of articular involvement of the posterior malleolar fracture fragments in ankle fractures is essential, as this is the leading argument for internal fixation. The purpose of this study is to assess diagnostic accuracy of measurements on plain lateral radiographs. METHODS: Quantification of three-dimensional computed tomography (Q-3D-CT) was used as a reference standard for true articular involvement (mm(2)) of posterior malleolar fractures...
October 2015: Injury
Eui Dong Yeo, Hak Jun Kim, Woo In Cho, Young Koo Lee
We evaluated the outcomes and complications of a specialized fibular locking plate in the treatment of lateral malleolar fractures. The study included 27 patients (13 males and 14 females; mean age 46, range 16 to 73 years) with a minimum 1-year follow-up period. The study included 9 (33%) isolated lateral malleolar, 6 (23%) bimalleolar, 10 (37%) trimalleolar fractures, and 2 (7%) pilon fractures, all of which were treated using a specialized fibular locking plate for internal fixation. Bony union was monitored, and the patients' objective satisfaction was evaluated using the EQ-5D questionnaire (EuroQol Group)...
November 2015: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Graham Ross Hastie, Sabeen Akhtar, Usman Butt, Andreas Baumann, James L Barrie
The most important determinant in the treatment of malleolar fractures is stability. Stable fractures have an intact deep deltoid ligament and do not displace with functional treatment. If the deep deltoid/medial malleolar complex is disrupted, the talus is at risk of displacement. Weber (2010) showed that weightbearing radiographs predicted stability in patients with undisplaced ankle fractures. We developed clinical criteria for potential instability and applied them to a prospective series of patients. The criteria included a medial clear space of <4 mm; medial tenderness, bruising or swelling; a fibular fracture above the syndesmosis; a bimalleolar or trimalleolar fracture; an open fracture; and a high-energy fracture mechanism...
November 2015: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Matthew J Cavo, Justin P Fox, Ronald Markert, Richard T Laughlin
BACKGROUND: Although obesity is widely accepted as a risk factor for surgical complications following orthopaedic surgery, the literature is unclear with regard to the effect of obesity on outcomes of ankle fracture surgery, particularly in the setting of competing risks from diabetes. We hypothesized that obesity would be independently associated with more frequent complications, longer hospital length of stay, and higher costs of care among patients with and without diabetes. METHODS: With use of data from 2001 to 2010 from the Nationwide Inpatient Sample, we identified all adult patients who underwent surgical treatment for a primary diagnosis of an isolated ankle fracture or dislocation...
June 17, 2015: Journal of Bone and Joint Surgery. American Volume
S M Verhage, S J Rhemrev, S B Keizer, H M E Quarles van Ufford, J M Hoogendoorn
OBJECTIVE: Classification of malleolar fractures is a matter of debate. In the ideal situation, a classification system is easy to use, shows good inter- and intraobserver agreement, and has implications for treatment or research. MATERIAL AND METHODS: Interobserver study. Four observers distributed 100 X-rays to the Weber, AO and Lauge-Hansen classification. In case of a trimalleolar fracture, the size of the posterior fragment was measured. Interobserver agreement was calculated with Cohen's kappa...
October 2015: Skeletal Radiology
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