Malleolar

Livedoid vasculopathy (LV) is a thrombotic skin disease characterized by episodic painful ulcerations of the distal aspects of the legs. Its healing process typically leaves small porcelain-white scars called atrophie blanche as a result of the occlusion of cutaneous microcirculation. The main goals of the treatment are pain management and the prevention of ulceration and of progressive scarring in the malleolar area. The therapeutic management is still a challenge, however, and most treatments were based on anecdotal off-label protocols...

The disadvantages of the one-third-tubular plate construct to stabilize lateral malleolar fractures include; difficulty achieving adequate cancellous screw thread purchase in the bone of the distal fragment, with subsequent risk of the screws backing out. This can cause irritation and pain, and may require further surgery to remove the screw. We describe a variation of the standard technique that eliminates the risk of the distal lateral malleolar screws backing out and provides a lower profile construct. This has the potential advantages of reduced wound related problems and less postoperative pain and irritation...

BACKGROUND: Treatment of osteochondral talar defects (OCDs) after failed previous surgery is challenging. Promising short-term results have been reported with use of a metal resurfacing inlay implant. PURPOSE: To evaluate the midterm clinical effectiveness of the metal implant for OCDs of the medial talar dome after failed previous surgery. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: We prospectively studied all patients who met the inclusion criteria and received a metal resurfacing inlay implant between 2007 and 2014...

BACKGROUND: Horizontal medial malleolus fractures are caused by the application of rotational force through the ankle joint in several orientations. Multiple techniques are available for the fixation of medial malleolar fractures. METHODS: Horizontal medial malleolus osteotomies were performed in eighteen synthetic distal tibiae and randomized into two fixation groups: 1) two parallel unicortical cancellous screws or 2) two Acutrak 2 headless compression screws...

OBJECTIVE: Lower extremity injuries are the most frequent Abbreviated Injury Scale (AIS) 2 injury for drivers in frontal crashes. The objective was to reconstruct 11 real-world motor vehicle crashes (2 with AIS 2+ distal lower extremity injury and 9 without lower extremity injury) and to analyze the vehicle parameters and driver attributes that affect injury risk. METHODS: Eleven frontal crashes were reconstructed with a finite element simplified vehicle model (SVM) using a semi-automated optimization method...

BACKGROUND: A concomitant tibial shaft and posterior malleolar fracture is a type of regular compound fracture. The associated posterior malleolar fractures are mostly occult fractures, which often do not show a fracture line on ordinary films, and thus lead to a high rate of misdiagnosis. The aim of the present study was to investigate factors helpful for the pre-operative detection of concomitant posterior ankle fractures using the ipsilateral radiographic tibia and fibula shaft fracture characteristics...

The aim of the present study was to evaluate the clinical and radiologic results of surgically treated isolated medial malleolar fractures and compare the clinical and radiologic results of the fixation methods of headless cannulated fully threaded compression screws and cancellous lag screws and tension band wiring. We included 32 patients who attended the final follow-up examination. Group 1 consisted of 11 patients (34.4%) treated with headless cannulated fully threaded compression screws. Group 2 consisted of 10 patients (31...

INTRODUCTION: Little is known about injuries in canyoning. It was the purpose of this study to determine injury rates, patterns, causes and risk factors in canyoning; and to identify targets for future injury prevention strategies. METHODS: From May to October 2015, 109 participants from 17 different countries were prospectively followed via a monthly e-mail-based questionnaire. RESULTS: During 13,690 h of canyoning, 57 injury-events occurred...

BACKGROUND: Clinically there are different fixation methods used for fixation of the posterior malleolar fractures (PMF), but the best treatment modality is still not clear. Few studies have concentrated on this issue, least of all using a biomechanical comparison. The purpose of this study was to carry out a computational comparative biomechanics of three different commonly used fixation constructs for the fixation of PMF by finite element analysis (FEA). METHODS: Computed tomography (CT) images were used to reconstruct three dimensional (3D) model of the tibia...

Displaced osteochondral fractures of the body of talus quite often require a malleolar osteotomy to gain access to the fracture fragment during internal fixation. We describe a case report in which access to a displaced osteochondral fracture of the lateral talar dome was achieved using an arthroscopy-assisted fibular tunnel approach. This technique resulted in satisfactory fracture healing and a satisfactory clinical outcome.

The study presents an overview of the most common radiography and CT-based classifications of posterior malleolar fractures in ankle fracture-dislocations. Their analysis has shown that posterior malleolar fractures largely vary in size and shape. Evaluation of fractures by plain radiographs is inadequate. A detailed assessment of the fragment shape and course of fracture lines requires CT examination in all three projections, followed by 3D CT reconstructions.Key words: ankle fracture - dislocations trimalleolar fractures posterior malleolar fractures classification...

BACKGROUND: The posterior malleolar fragment (PMF) of an ankle fracture can have various shapes depending on the injury mechanism. The purpose of this study was to evaluate the morphological characteristics of the PMF according to the ankle fracture pattern described in the Lauge-Hansen classification by using computed tomography (CT) images. METHODS: We retrospectively analyzed CT data of 107 patients (107 ankles) who underwent surgery for trimalleolar fracture from January 2012 to December 2014...

OBJECTIVE: To compare clinical outcomes of external and posterior malleolar fractures associated with compressive articular surface through posteriorlateral incision and posteriormedial incision. METHODS: From January 2012 to January 2015, 52 patients with external and posterior malleolar fractures associated with compressive articular surface were treated by interfix. Among them, 24 patients were treated through posteriourlateral incision, including 16 males and 8 females, aged from 20 to 65 years old with an average of(35...

Maisonneuve fractures are relatively well known in the sports medicine, and orthopedic communities, however, can be commonly missed among primary care providers. The following case outlines an active duty 35-yr-old female patient who presented with acute pain on the left ankle and lower leg after she misjudged a step. The injury is a combination of high fibular and medial malleolar fractures with a disruption of the tibiofibular syndesmosis ligaments. This is a result of extreme external rotation and pronation of a fixed foot...

BACKGROUND: This study analyzes position of the peroneal tendons and status of the superior peroneal retinaculum (SPR) whenever a lateral malleolar bony flake fracture occurs. METHODS: Twenty-four patients had a lateral malleolar bony fleck on anteroposterior ankle radiographs, either in isolation or associated with other hindfoot injuries. We studied size of the bony flecks, presence or absence of peroneal tendon dislocation and pathoanatomy on CT scans. RESULTS: In 11 patients, a small bony fleck lies within the superior peroneal retinaculum and contiguous periosteum, which are stripped off the lateral fibula (Class II lesions)...

OBJECTIVES: To evaluate the effect of posterior bony versus ligamentous injury pattern on functional outcomes in operatively treated rotational ankle fractures. DESIGN: Retrospective cohort analysis of prospective registry. SETTING: Academic Level I trauma center. PATIENTS/PARTICIPANTS: Operatively treated supination external rotation IV and pronation external rotation IV ankle fractures. INTERVENTION: Lateral malleolus plate fixation with either posterior malleolus (PM) plate fixation or posterior inferior tibiofibular ligament (PITFL) repair...

BACKGROUND: Tightrope fixation is an emerging technique for syndesmotic fixation with promising results. However, our case series highlights the slippage of Tightrope buttons as a complication of suture button syndesmotic fixation of Weber C malleolar fractures using limited contact dynamic compression (LCDCP) plates. METHODS: We report a series of cases from our database in which slippage of the Tightrope button through the LCDCP holes in Weber C malleolar fractures was noted...

OBJECTIVE: The determination of soft signs can be a conducive practice to understand the differential etiology between depression and anxiety. This study aims at examining malleolar hypoesthesia role in distinguishing between patients with generalised anxiety disorder (GAD) and major depression disorder (MDD). METHODS: This study examines the presence of malleolar hypoesthesia in patients with GAD (n = 47) compared to patients with MDD (n = 48) and healthy individuals (controls; n = 99)...

AIMS: The aim of this study was to investigate the effect of a posterior malleolar fragment (PMF), with < 25% ankle joint surface, on pressure distribution and joint-stability. There is still little scientific evidence available to advise on the size of PMF, which is essential to provide treatment. To date, studies show inconsistent results and recommendations for surgical treatment date from 1940. MATERIALS AND METHODS: A total of 12 cadaveric ankles were assigned to two study groups...

BACKGROUND: Intra-articular Pilon fractures remain therapeutically challenging due to osteochondral fracturing and comminution, marginal impaction, and insult to the soft tissue envelope. The purpose of this study was to compare the efficacy of anterolateral distal tibial locking plates in capturing main fracture fragments in tibial plafond fractures. METHODS: From May 2011 to Dec 2015, 169 OTA C-type pilon fractures met inclusion and exclusion criteria with computed tomographic (CT) scans performed prior to definitive fixation...