Advertisement for orthosearch.org.uk
Results 1 - 3 of 3
Results per page:
Applied filters
Content I can access

Include Proceedings
Dates
Year From

Year To
Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 528 - 528
1 Sep 2012
Ahrberg A Höde N Josten C
Full Access

Objective

Ankle fractures are frequent and seem to be easy to handle in most cases. Of course, also these easy fractures can cause infections that must be carefully managed. What risk factors do we find? What options do we have in treating these complications? What are the consequences and what will the result for the patient be like, compared to non-infected cases?

In a retrospective study we included 82 patients treated with an osteosynthesis in ankle fractures (AO 44 B or C fractures). Average age was 52.4 years (range 20–84 years, median 51.0).

Results

In 9 (10.9%) patients there were septic complications. Concerning risk factors, we found 4 (44.4%) patients with nicotine abuse, 2 (22.2%) with additional alcohol abuse. Average stay in hospital was 39.6 days (range 9–95 days). In 4 (44.4%) cases local infection was treated with antibiotics and rest alone. 5 (55.5%) of the patients had additional operations due to infection, in average 5.4 per patient (range 1–10). Early implant removal was done in 3 (33.3%) cases, in average after 3 months. We found 2 (22.2%) infections due to Staphylococcus aureus, 1 (11.1%) due to MRSA and one infection with MRSA and Proteus mirabilis. In one case vacuum dressing had been applied for 44 days. In another case infection could only be healed with an intramedullary vancomycin augmented spacer and finally a screw arthodesis of the ankle, this was a patient with proven arteriosclerosis of the lower extremities. All other fractures finally showed bony healing in xrays. No plastic surgery (e.g. flaps) was needed to close a wound definitely.

In follow up (in average after 33 months, range 17–42), the average AOFAS of these patients was 76.5 (range 35–100, median 81.5), compared to an average AOFAS of 89.4 (range 35–100, median 98.0) of all patients.

No patient developed a septic syndrom, no ICU stay occurred because of the infection.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_II | Pages 348 - 348
1 May 2010
Ahrberg A Engel T Josten C
Full Access

Objective: 36 patients (male:female= 26:10, mean age 40.6 years) with ankle fractures treated with osteosynthesis including a syndesmotic screw were enrolled in this prospective study. Instability of the distal syndesmosis was proven intraoperatively and then a quadricortical syndesmotic screw was placed.

Patients were mobilized with an AirCast® ankle brace and cranes for six weeks, then the syndesmotic screw was removed and patients started full weight bearing.

Using the x-rays of the ankle before and after and the CT of both ankles before removal of the syndesmotic screw we evaluated the radiologic results: the syndesmotic interval in the axial cuts, the Espace claire de Chaput (total clear space, TCS) und the medial clear space (MCS). Ventralization of the fibula as a measurement for the position of the fibula in the incisura was defined as the difference between the vertical reference lines of tibia and fibula in the CT. The functional results were evaluated by the scores of Phillips, Olerud/Molander and Weber.

Results: The mean axial interval difference was 0.83 mm (range -2.6 – 4.5), in seven case (19.4%) the interval had been over corrected. There was one case of subluxation of the talus (2.8%). In 3 patients (8.3%) the syndesmotic screw had been corrected in a second operation after the first CT, in 2 cases (5.6%) the syndesmotic screw had been placed after there was suspection of syndesmotic insufficiency in the x-rays which had been verified by CT. Mean ventralization of the fibula was 2.3mm (range 0–6.4). Average TCS was 5.3 mm (range 3.0 – 8.8), mean MCS was 3.3 mm (range 1.0 – 8.2).

The functional scores showed good to very good results in most patients.

Conclusions: Only with CT, the correct placement of the syndesmotic screw can be verified, the syndesmotic interval in the axial cuts can be evaluated and the position of the fibula in the Incisura fibularis can be assesed, therefore CT should be postoperative standard after syndesmotic screw placement. If an ankle fracture has not been treated with a syndesmotic screw, postoperative CT of both ankles should be done in any radiological or clinical suspicion of syndesmotic insufficiency.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_I | Pages 115 - 115
1 Mar 2009
Ahrberg A Engel T Josten C
Full Access

Objective: 15 patients (male:female= 9:6, mean age 39,5 years) with ankle fractures treated with osteosynthesis including a syndesmotic screw were enrolled in this prospective study. Instability of the distal syndesmosis was proven intraoperatively and then a tricortical syndesmotic screw was placed.

Patients were mobilized with an AirCast®e brace and cranes for six weeks, then the syndesmotic screw was removed and patients started full weight bearing. Follow-Up was 21.7 weeks mean after removal of the syndesmotic screw.

Using the x-rays of the ankle after and the CT of both ankles before removal of the syndesmotic screw we evaluated the radiologic results: the syndesmotic interval in the fontal and axial cuts, the Espace claire de Chaput (total clear space, TCS) und the medial clear space (MCS). The functional results were evaluated by the scores of Phillips, Olerud/Molander and Weber.

Results: The mean frontal interval difference was 0,3 mm und the mean axial interval difference was 0,5 mm, in one case Fall (6,7%) there was a axial interval difference of 2 mm and in one case the interval had been over corrected. There was no subluxation of the talus in any patient. In 3 patients (20%) the syndesmotic screw had been placed in a second operation, after there was suspection of syndesmotic insufficiency in the x-rays which had been verified by CT. After implantation of the screw the CT scan showed regular syndesmotic intervals. Average TCS was 5.3 (range 3.40 – 7,40), mean MCS was 2.2 (range 1.0 – 4.5).

Average functional scores were: Phillips 118.53 (range 53 – 135), Olerud/Molander 93 (range 60 – 100) and Weber 2.33 (range 0 – 12).

Conclusions: Only with CT, the correct placement of the syndesmotic screw can be verified, the syndesmotic interval in the axial cuts can be evaluated and the position of the fibula in the Incisura fibularis can be assesed, therefore CT should be postoperative standard after syndesmotic screw placment. If an ankle fracture has not been treated with a syndesmotic screw, postoperative CT of both ankles should be done in any radiological or clinical suspicion of syndesmotic insufficiency.