The August 2024 Trauma Roundup. 360. looks at: Does topical vancomycin prevent fracture-related infections in closed fractures undergoing open reduction and internal fixation? A randomized controlled trial; Is postoperative splinting advantageous after upper limb fracture surgery?; Does suprapatellar nailing resolve knee pain?; Locking versus non-locking plate fixation in comminuted
Introduction. Anatomic reduction of
The April 2024 Foot & Ankle Roundup. 360. looks at: Safety of arthroscopy combined with radial extracorporeal shockwave therapy for osteochondritis of the talus; Bipolar allograft transplantation of the ankle; Identifying risk factors for osteonecrosis after
The February 2024 Trauma Roundup360 looks at: Posterior malleolus fractures: what about medium-sized fragments?; Acute or delayed total hip arthroplasty after acetabular fracture fixation?; Intrawound antibiotics reduce the risk of deep infections in fracture fixation; Does the VANCO trial represent real world patients?; Can a restrictive transfusion protocol be effective beyond initial resuscitation?; What risk factors result in avascular necrosis of the talus?; Pre-existing anxiety and mood disorders have a role to play in complex regional pain syndrome; Three- and four-part proximal humeral fractures at ten years.
Treatment of posterior malleolar (PM) ankle fractures remain controversial. Despite increasing recommendation for small PM fragment fixation, high quality evidence demonstrating improved clinical outcomes over the unfixated PM is limited. We describe the medium-to-long term clinical and radiographical outcomes in younger adult patients with PM ankle fractures managed without PM fragment fixation. A retrospective cohort study of patients aged 18–55 years old admitted under our orthopaedic unit between 1st of April 2009 and 31st of October 2013 with PM ankle fractures was performed. Inclusion criteria were that all patients must mobilise independently pre-trauma, have no pre-existing ankle pathologies, and had satisfactory bimalleolar and syndesmotic stabilisation. Open
Aims. Arthroscopically controlled fracture reduction in combination
with percutaneous screw fixation may be an alternative approach
to open surgery to treat
The purposes of this study were to clarify first, the incidence
of peroneal tendon dislocation in patients with a fracture of the
talus and second the factors associated with peroneal tendon dislocation. We retrospectively examined 30 patients (30 ankles) with a mean
age of 37.5 years, who had undergone internal fixation for a fracture
of the talus. Independent examiners assessed for peroneal tendon
dislocation using the pre-operative CT images. The medical records
were also reviewed for the presence of peroneal tendon dislocation.
The associations between the presence of dislocation with the patient
characteristics or radiological findings, including age, mechanism
of injury, severity of fracture, and fleck sign, were assessed using Fisher’s
exact tests.Aims
Patients and Methods
Fracture clinics are often characterised by the referral of large
numbers of unselected patients with minor injuries not requiring
investigation or intervention, long waiting times and recurrent
unnecessary reviews. Our experience had been of an unsustainable
system and we implemented a ‘Trauma Triage Clinic’ (TTC) in order
to rationalise and regulate access to our fracture service. The
British Orthopaedic Association’s guidelines have required a prospective evaluation
of this change of practice, and we report our experience and results. We review the management of all 12 069 patients referred to our
service in the calendar year 2014, with a minimum of one year follow-up
during the calendar year 2015. Aims
Patients and Methods
Background. Current literature of definition, classification and outcomes of
The February 2015 Foot &
Ankle Roundup360 looks at: Syndesmosis screw removal in randomised controlled trial; Diagnostic value of Hawkins sign; Chevron rules supreme?; Diabetes and ankle replacement; Fixed-bearing ankle replacement; Fusion for osteomyelitis of the ankle; ‘Reformed’ fallers.
The main object of this study was to use a geometric morphometric
approach to quantify the left-right symmetry of talus bones. Analysis was carried out using CT scan images of 11 pairs of
intact tali. Two important geometric parameters, volume and surface
area, were quantified for left and right talus bones. The geometric
shape variations between the right and left talus bones were also
measured using deviation analysis. Furthermore, location of asymmetry
in the geometric shapes were identified. Numerical results showed that talus bones are bilaterally symmetrical
in nature, and the difference between the surface area of the left
and right talus bones was less than 7.5%. Similarly, the difference
in the volume of both bones was less than 7.5%. Results of the three-dimensional
(3D) deviation analyses demonstrated the mean deviation between
left and right talus bones were in the range of -0.74 mm to 0.62
mm. It was observed that in eight of 11 subjects, the deviation
in symmetry occurred in regions that are clinically less important
during talus surgery. Objective
Methods
Results
The April 2014 Foot &
Ankle Roundup360 looks at: Hawkins fractures revisited; arthrodesis compared with ankle replacement in osteoarthritis; mobile bearing ankle replacement successful in the longer-term; osteolysis is an increasing worry in ankle replacement; ankle synostosis post-fracture is not important; radiofrequency ablation for plantar fasciitis; and the right approach for tibiotalocalcaneal fusion.
The April 2014 Trauma Roundup. 360 . looks at: is it safe to primarily close dog bite wounds?; conservative transfusion evidence based in hip fracture surgery; tibial nonunion is devastating to quality of life; sexual dysfunction after traumatic pelvic fracture; hemiarthroplasty versus fixation in displaced femoral neck fractures; silver VAC dressings “Gold Standard” in massive wounds; dual plating for
Background.
Introduction: We present the results of the Ankle Evolution System (AES) total ankle replacements with a minimum follow up of four years. Methods: Forty-five consecutive patients who had AES ankle replacement were included in the study. The mean age at operation was 64.6 (50–77). Pain and function were assessed using the AOFAS score. Patients had standardised AP and lateral weight bearing radiographs and were assessed for loosening and alignment. Patients’ satisfaction and complications were recorded. The survival of the implant was constructed using the Kaplan-Meier survival curve. Results: The mean follow up for our patients who were alive and available for follow up at the final clinical review (40 patients) was 57.8 months (48–80). A total of 2 patients were revised (One patient sustained
To analyze the results in proportion to the type of
Tarsal fractures are rare in children. Clinical and radiographic evaluation of these injuries can be difficult. We present a retrospective study documenting all tarsal fractures presenting to an inner-city children’s hospital in the UK over a fifteen year period. Of 70 case notes retrieved from the hospital database, 7 patients were excluded due to inadequate data. This resulted in 69 tarsal injuries in 63 patients being included. Mean age at presentation was 9.3 years (2.5 – 13.9). 80% were male. 72% were calcaneal fractures, 12% cuboid, 9% navicular, 4% talus and 2% medial cuneiform. The main method of diagnosis was plain x-rays. Cause of injury was predominantly fall from height, crush or road traffic accident. 25% had another associated lower extremity injury. Three patients had bilateral tarsal injuries. Only 3% had upper limb injuries and there were no injuries with spinal involvement. Calcaneal fractures were treated with a short leg cast for a mean time of 4.1 weeks (2–6). Mean time to recovery was 5.7 weeks (2–20). Mean time to discharge from clinic was 7 weeks (2–40). There were two patients with open fractures requiring surgical debridement. One patient with a