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trimalleolar ankle fracture with displacement

D Ntalos, M Rupprecht, L G Grossterlinden, A Hamurcu, M Regier, T O Klatte, J M Rueger, A S Spiro
PURPOSE: To compare tibiofibular reduction quality in different types of operatively treated ankle fractures and the impact on clinical and functional outcome at mid-term follow-up. PATIENTS AND METHODS: One hundred patients with an acute ankle fracture who had undergone open reduction and internal fixation were included. Eighty-eight patients who suffered from ligamentous ankle injury with neither fracture nor syndesmotic lesions served as a control group. Tibiofibular alignment was measured on MR images in all 188 patients...
April 23, 2018: Injury
Dinko Vidović, Esmat Elabjer, I V A Muškardin, Milan Milosevic, Marijo Bekic, Bore Bakota
INTRODUCTION: The aim of this study was to compare reduction quality and functional outcome of posterior malleolus fractures treated with indirect reduction and anteroposterior (AP) fixation or with direct reduction via a posterolateral approach and posteroanterior (PA) fixation. METHODS: Forty-eight patients with trimalleolar fracture were enrolled in the study. Patients were randomised in two groups: indirect reduction and AP fixation (AP group) and direct reduction and PA fixation (PA group)...
November 2017: Injury
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
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
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
Greg A J Robertson, Alexander M Wood, Stuart A Aitken, Charles Court Brown
BACKGROUND: The literature on the outcome of sport-related ankle fractures has focused on operatively managed fractures, despite a large proportion being treated nonoperatively. We describe the epidemiology, management, and outcome of acute sport-related ankle fractures in a UK population. METHODS: All sport-related ankle fractures sustained during 2007 to 2008 in the Lothian Population were prospectively collected when patients attended the only adult orthopaedic service in Lothian...
November 2014: Foot & Ankle International
G R Fogel, F H Sim
Nine patients had reconstructive surgery for ankle malalignment with tibiotalar incongruity. The clinical result was correlated with the roentgenographic appearance at last followup. Fracture malunions involved supination-external rotation in five patients, pronationabduction in two, pronation-extemal rotation in one, and supination-adduction in one. Osteotomy or osteotomy and bone grafting with soft tissue releases was performed in each case, and tibiofibular syndesmosis fixation was used in three. Two patients had good reductions, three fair, and four poor...
November 1, 1982: Orthopedics
I Oh, S H Nahigian, A S Salas, F B Zahrawi
When open reduction is indicated the lateral malleolus fracture should be reduced as accurately as the medial or posterior malleolar fragments. The cerclage for displaced oblique or spiral fractures of the lateral malleolus is a simple, effective way of internal fixation with a minimal amount of metal implanted. Under direct vision an anatomical reduction is achieved and maintained. The proper use of a 20- or 18 -gauge wire with a mechanical wire tightner-twister is mandatory. A below-the-knee plaster cast is necessary for support for an average of eight weeks...
September 1978: Orthopedics
Y Asloum, B Bedin, T Roger, J-L Charissoux, J-P Arnaud, C Mabit
AIM: Open reduction and internal plate fixation of the fibula is the gold standard treatment for ankle fractures. The aim of this study was to perform a prospective randomized study to compare bone union, complications and functional results of two types of internal fixation of the fibula (plating and the Epifisa FH intramedullary nail). MATERIALS AND METHODS: Inclusion criteria were: closed fractures, isolated displaced fractures of the lateral malleolus, inter- and supra-tubercular bimalleolar fractures, and trimalleolar fractures...
June 2014: Orthopaedics & Traumatology, Surgery & Research: OTSR
S Rammelt, H Zwipp, T Mittlmeier
OBJECTIVE: Early reduction of the dislocation and anatomic reconstruction of axial alignment, ankle mortise and articular congruity with special focus on syndesmotic stability. INDICATIONS: Fracture-dislocations resulting from pronation injuries to the ankle with a highly incongruent and unstable mortise and either considerable internal pressure on the soft tissues by the displaced fragments or open soft tissue damage. CONTRAINDICATIONS: General contraindications to surgery: closed reduction and cast immobilization or external fixation...
June 2013: Operative Orthopädie und Traumatologie
J Mingo-Robinet, J M Abril Larrainzar, J A Valle Cruz
INTRODUCTION: Ankle fractures involving a posterior malleolar fragment are associated with worse clinical outcomes. The standard indication for its fixation is a displaced fragment that involves more than 25% of the distal articular tibia. The method of reduction and fixation of these fractures has not received much attention. The purpose of this paper is to describe the surgical technique and clinical results. MATERIAL AND METHODS: Over a 6 year period 10 patients with an ankle fracture involving more than 25% posterior malleolus were admitted for surgery, which was performed by the first author...
July 2012: Revista Española de Cirugía Ortopédica y Traumatología
Sigurd Erik Hoelsbrekken, Kjersti Kaul-Jensen, Thale Mørch, Håvard Vika, Torkil Clementsen, Øyvind Paulsrud, Gunnar Petursson, Morten Stiris, Knut Strømsøe
OBJECTIVES: To compare internal fixation with no fixation of the medial malleolus after open reduction and internal fixation of the lateral malleolus and if needed, the posterior malleolus. DESIGN: Randomized prospective trial. SETTING: Level III trauma center in a metropolitan area. PATIENTS: One hundred patients with bimalleolar or trimalleolar Orthopaedic Trauma Association type 44 ankle fractures and displacement of the medial malleolus less than 2 mm after open reduction and internal fixation of the lateral component...
November 2013: Journal of Orthopaedic Trauma
Paul B McKenna, Kieran O'shea, Tom Burke
Displaced fractures of the lateral malleolus are typically treated with plate osteosynthesis with or without the use of lag screws, and immobilisation in a plaster cast for up to 6 weeks. Fixation through a smaller incision with less metal, such as lag screw only fixation, would theoretically lead to decreased infection rates and less irritation caused by hardware. The purpose of this study was to evaluate the benefits and success of lag screw only fixation of the lateral malleolus in non-comminuted oblique fractures of the lateral malleolus...
August 2007: International Orthopaedics
Martin Weber, Reinhold Ganz
Malunion after a malleolar fracture can include a displaced posterior malleolus with associated posterolateral subluxation of the talus. Corrective osteotomy including the posterior malleolus was performed in four patients. Joint congruity was obtained in every case. The patients were followed for 46 to 80 months postoperatively. They all experienced an improvement in pain and three of four patients were unlimited in their walking capacity. Mild to moderate residual symptoms were frequent. The symptoms were attributed to the damage of the cartilage and soft-tissues both from the initial injury and from weightbearing on the incongruous joint...
April 2003: Foot & Ankle International
F C Wilson
From the foregoing, one may reduce the following principles for the management of ankle injuries: The mechanism of injury and the diagnosis, including ligamentous injury, can be made from initial radiographs. A displaced fracture of only one malleolus must be accompanied by ligamentous injury of either the deltoid or syndesmotic ligaments, or both. When there is only one break in the ring of the ankle mortise, there is no potential for significant displacement; thus, ORIF is rarely necessary. With two breaks in the ring, the potential for displacement exists, even after successful manipulation, which usually makes operative treatment a more attractive option...
2000: Journal of the Southern Orthopaedic Association
D M Mandracchia, V J Mandracchia, D E Buddecke
Ankle injuries and associated malleolar fractures are common. The outcome of treatment depends on the treating physician's ability to properly identify the mechanism of injury and subsequently restore ankle function by accurate realignment of the normal ankle articulations. Particular attention must be paid to restoring the length and alignment of the fibula because it plays a major role in stabilizing the talar ankle component. The medial aspect of the ankle also is important. The vital role of the deltoid has been proved in many studies, and although controversy exists in the proper treatment of this complex, there is agreement regarding the importance of at least identification of medial injury...
October 1999: Clinics in Podiatric Medicine and Surgery
S Y Wei, E Okereke, R Winiarsky, P A Lotke
This study evaluates the long-term results of displaced bi- and trimalleolar fractures treated closed. Few reports exist in the literature regarding the long-term outcomes of ankle fractures, and none of these specifically addresses displaced bi- and trimalleolar fractures treated nonoperatively. This study analyzed the results of bi- and trimalleolar fractures treated by a single surgeon from 1973 to 1981. As was the standard of care at that time, these fractures were treated nonoperatively if a stable reduction was achieved and maintained...
July 1999: Foot & Ankle International
J G Kennedy, S M Johnson, A L Collins, P DalloVedova, W F McManus, D M Hynes, M G Walsh, M M Stephens
This retrospective study over a 3 year follow-up was designed to establish the significance of the Weber classification of ankle fractures with regards to functional and radiographic outcome. One hundred and seven patients were available for follow-up, of which 88 ankles could be classified with the Weber system. Medial malleolar fractures alone and pilon fractures could not be classified with this system. A correlation was found between the type of Weber fracture and the overall ankle score. This held true for unimalleolar fractures alone...
October 1998: Injury
I Sinisaari, H Pätiälä, O Böstman, E A Mäkelä, E Hirvensalo, E K Partio, P Törmälä, P Rokkanen
Absorbable fracture fixation has been in clinical use since 1984. Our study compares the infection rates and some infection parameters between metallic (2073 patients) and absorbable fracture fixation devices (1012 patients) in displaced ankle fractures. The infection rate associated with metallic fixation was 4.1%, compared with 3.2% absorbable fixation (p 0.3). The patients who had a wound infection were older when metallic fixation was used (p 0.01). They also had a bi- or trimalleolar fracture more often than did patients treated with absorbable fracture fixation, but this difference did not have a significant effect on the wound infection rate (p 0...
February 1996: Acta Orthopaedica Scandinavica
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