The morphology of medial malleolar fracture is highly variable and difficult to characterize without 3D reconstruction. There is also no universally accepeted classification system. Thus, we aimed to characterize fracture patterns of the medial malleolus and propose a classification scheme based on 3D CT reconstruction. We retrospectively reviewed 537 consecutive cases of ankle fractures involving the medial malleolus treated in our institution. 3D fracture maps were produced by superimposing all the fracture lines onto a standard template. We sliced fracture fragments and the standard template based on selected sagittal and coronal planes to create 2D fracture maps, where angles α and β were measured. Angles α and β were defined as the acute angles formed by the fracture line and the horizontal line on the selected planes.Aims
Methods
In this retrospective cohort study, we analysed
the incidence and functional outcome of a distal tibiofibular synostosis.
Patients with an isolated AO type 44-B or C fracture of the ankle
who underwent surgical treatment between 1995 and 2007 were invited
for clinical and radiological review. The American Orthopaedic Foot
and Ankle Society score, the American Academy of Orthopaedic Surgeons
score and a visual analogue score for pain were used to assess outcome. A total of 274 patients were available; the mean follow-up was
9.7 years (8 to 18). The extent of any calcification or synostosis
at the level of the distal interosseous membrane or syndesmosis
on the contemporary radiographs was defined as: no or minor calcifications
(group 1), severe calcification (group 2), or complete synostosis
(group 3). A total of 222 (81%) patients were in group 1, 37 (14%) in group
2 and 15 (5%) in group 3. There was no significant difference in
incidence between AO type 44-B and type 44-C fractures (p = 0.89).
Severe calcification or synostosis occurred in 21 patients (19%)
in whom a syndesmotic screw was used and in 31 (19%) in whom a syndesmotic screw
was not used.(p = 0.70). No significant differences were found between
the groups except for a greater reduction in mean dorsiflexion in
group 2 (p = 0.004). This is the largest study on distal tibiofibular synostosis,
and we found that a synostosis is a frequent complication of surgery
for a fracture of the ankle. Although it theoretically impairs the
range of movement of the ankle, it did not affect the outcome. Our findings suggest that synostosis of the distal tibiofibular
syndesmosis in general does not warrant treatment. Cite this article:
We report the outcomes of 20 patients (12 men,
8 women, 21 feet) with Charcot neuro-arthropathy who underwent correction
of deformities of the ankle and hindfoot using retrograde intramedullary
nail arthrodesis. The mean age of the patients was 62.6 years (46
to 83); their mean BMI was 32.7 (15 to 47) and their median American
Society of Anaesthetists score was 3 (2 to 4). All presented with
severe deformities and 15 had chronic ulceration. All were treated
with reconstructive surgery and seven underwent simultaneous midfoot
fusion using a bolt, locking plate or a combination of both. At
a mean follow-up of 26 months (8 to 54), limb salvage was achieved
in all patients and 12 patients (80%) with ulceration achieved healing
and all but one patient regained independent mobilisation. There was
failure of fixation with a broken nail requiring revision surgery
in one patient. Migration of distal locking screws occurred only
when standard screws had been used but not with hydroxyapatite-coated
screws. The mean American Academy of Orthopaedic Surgeons Foot and
Ankle (AAOS-FAO) score improved from 50.7 (17 to 88) to 65.2 (22
to 88), (p = 0.015). The mean Short Form (SF)-36 Health Survey Physical
Component Score improved from 25.2 (16.4 to 42.8) to 29.8 (17.7
to 44.2), (p = 0.003) and the mean Euroqol EQ‑5D‑5L score improved
from 0.63 (0.51 to 0.78) to 0.67 (0.57 to 0.84), (p = 0.012). Single-stage correction of deformity using an intramedullary
hindfoot arthrodesis nail is a good form of treatment for patients
with severe Charcot hindfoot deformity, ulceration and instability
provided a multidisciplinary care plan is delivered. Cite this article:
