Aims. Posterior malleolar (PM) fractures are commonly associated with
Aims. The aim of this study was to compare the functional and radiological outcomes and the complication rate after nail and plate fixation of unstable
Aims. Lifestyle risk factors are thought to increase the risk of infection
after acute orthopaedic surgery but the evidence is scarce. We aimed
to investigate whether smoking, obesity and alcohol overuse are
risk factors for the development of infections after surgery for
a
In this randomised controlled trial, we evaluated
the role of elastic compression using ankle injury stockings (AIS)
in the management of
The incidence of periprosthetic
Fragility
In this retrospective study, using the prospectively collected database of the AO-Documentation Centre, we analysed the outcome of 57 malunited
We randomised prospectively 60 consecutive patients who were undergoing internal fixation of similar
Supination-external rotation (SER)
We have evaluated prospectively the arthroscopic findings in acute
Our aim was to compare the one-year post-operative
outcomes following retention or removal of syndesmotic screws in
adult patients with a
Conventional methods of treating ankle fractures
in the elderly are associated with high rates of complication. We describe
the results of treating these injuries in 48 frail elderly patients
with a long calcaneotalotibial nail. The mean age of the group was 82 years (61 to 96) and 41 (85%)
were women. All were frail, with multiple medical comorbidities
and their mean American Society of Anaesthesiologists score was
3 (3 to 4). None could walk independently before their operation.
All the fractures were displaced and unstable; the majority (94%,
45 of 48) were low-energy injuries and 40% (19 of 48) were open. . The overall mortality at six months was 35%. Of the surviving
patients, 90% returned to their pre-injury level of function. The
mean pre- and post-operative Olerud and Molander questionnaire scores
were 62 and 57 respectively. Complications included superficial
infection (4%, two of 48); deep infection (2%, one of 48); a broken
or loose distal locking screw (6%, three of 48); valgus malunion
(4%, two of 48); and one below-knee amputation following an unsuccessful
vascular operation. There were no cases of nonunion, nail breakage
or peri-prosthetic fracture. . A calcaneotalotibial nail is an excellent device for treating
an unstable
Stable
The February 2024 Foot & Ankle Roundup. 360. looks at: Survival of revision ankle arthroplasty; Tibiotalocalcaneal nail for the management of open
We have compared the results at a mean follow-up of 13 years (11 to 14) of two groups of supination-external rotation type-4
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
We undertook a prospective study to analyse the
outcome of 48 malunited pronation-external rotation fractures of the
ankle in 48 patients (25 females and 23 males) with a mean age of
45 years (21 to 69), treated by realignment osteotomies. The interval
between the injury and reconstruction was a mean of 20.2 months
(3 to 98). In all patients, valgus malalignment of the distal tibia and
malunion of the fibula were corrected. In some patients, additional
osteotomies were performed. Patients were reviewed regularly, and
the mean follow-up was 7.1 years (2 to 15). Good or excellent results were obtained in 42 patients (87.5%)
with the benefit being maintained over time. Congruent ankles without
a tilted talus (Takakura stage 0 and 1) were obtained in all but
five cases. One patient required total ankle replacement.
We assessed the long-term (20 years) outcome
of closed reduction and immobilisation in 19 patients with an isolated
fracture of the posterior malleolus of the ankle treated at a single
hospital between 1985 and 1990. The assessments used were an Olerud
functional questionnaire score, physical examination using a loaded
dorsal and plantar range of movement measurement, radiological analysis
of medial joint space widening, the Cedell score for anatomical
alignment of all three malleoli, and the radiological presence of
osteoarthritic change. There were excellent or good results in 14 patients (74%) according
to the Olerud score, in 18 patients (95%) according to loaded dorsal
and plantar range of movement assessment, in 16 patients (84%) as
judged by the Cedell score, and for osteoarthritis 18 patients (95%)
had an excellent or good score. There were no poor outcomes. There was
no correlation between the size of the fracture gap and the proportion
of the tibiotalar contact area when compared with the clinical results
(gap size: rho values -0.16 to 0.04, p ≥ 0.51; tibiotalar contact
area: rho values -0.20 to -0.03, p ≥ 0.4). Conservative treatment
of ‘isolated’ posterior malleolar fractures resulted in good clinical
and radiological outcome in this series at long-term follow-up.
It has previously been suggested that among unstable
ankle fractures, the presence of a malleolar fracture is associated
with a worse outcome than a corresponding ligamentous injury. However,
previous studies have included heterogeneous groups of injury. The
purpose of this study was to determine whether any specific pattern of
bony and/or ligamentous injury among a series of supination-external
rotation type IV (SER IV)
There has been an evolution recently in the management of unstable
fractures of the ankle with a trend towards direct fixation of a
posterior malleolar fragment. Within these fractures, Haraguchi
type 2 fractures extend medially and often cannot be fixed using
a standard posterolateral approach. Our aim was to describe the
posteromedial approach to address these fractures and to assess
its efficacy and safety. We performed a review of 15 patients with a Haraguchi type 2
posterior malleolar fracture which was fixed using a posteromedial
approach. Five patients underwent initial temporary spanning external
fixation. The outcome was assessed at a median follow-up of 29 months (interquartile
range (IQR) 17 to 36) using the Olerud and Molander score and radiographs were
assessed for the quality of the reduction.Aims
Patients and Methods
Most of the literature on surgical site infections
following the surgical treatment of
Aims. Paediatric triplane
Stable
Our aim was to assess the reproducibility and the reliability of the Weber classification system for
Aims.
Aims.
The December 2023 Trauma Roundup. 360. looks at: Distal femoral arthroplasty: medical risks under the spotlight; Quads repair: tunnels or anchors?; Complex trade-offs in treating severe tibial fractures: limb salvage versus primary amputation; Middle-sized posterior malleolus fractures – to fix?; Bone transport through induced membrane: a randomized controlled trial; Displaced geriatric femoral neck fractures; Risk factors for reoperation to promote union in 1,111 distal femur fractures; New versus old – reliability of the OTA/AO classification for trochanteric hip fractures; Risk factors for fracture-related infection after
The October 2023 Foot & Ankle Roundup. 360. looks at: Risk factors for failure of total ankle arthroplasties; Effects of synovial fluid fracture haematoma to tissue-engineered cartilage; Coronal plane deformity in CMT-cavovarus feet using automated 3D measurements; Immediate weightbearing 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.
Aims. A pilon
Aims.
The February 2024 Children’s orthopaedics Roundup. 360. looks at: Hip impingement after in situ pinning causes decreased flexion and forced external rotation in flexion on 3D-CT; Triplane
Aims. Pneumatic tourniquets are often used during the surgical treatment of unstable traumatic
Aims. Treatment of Weber B
To report the outcomes of patients with a fracture of the distal tibia who were treated with intramedullary nail versus locking plate in the five years after participating in the Fixation of Distal Tibia fracture (FixDT) trial. The FixDT trial reported the results for 321 patients randomized to nail or locking plate fixation in the first 12 months after their injury. In this follow-up study, we report the results of 170 of the original participants who agreed to be followed up until five years. Participants reported their Disability Rating Index (DRI) and health-related quality of life (EuroQol five-dimension three-level questionnaire) annually by self-reported questionnaire. Further surgical interventions related to the fracture were also recorded.Aims
Methods
Aims. To systematically review qualitative studies of patients with distal tibia or
Aims. To compare the cost-utility of removable brace compared with cast in the management of adult patients with
Diabetes mellitus is considered an indicator of poor prognosis for acute
Osteoporosis and fragility fractures in men constitute a considerable burden in healthcare. We have reviewed 2035 men aged over 50 years with 2142 fractures to clarify the epidemiology of these injuries and their underlying risk factors. The prevalence of osteoporosis ranged between 17.5% in
Many orthopaedic surgeons believe that obese patients have a higher rate of peri-operative complications and a worse functional outcome than non-obese patients. There is, however, inconsistency in the literature supporting this notion. This study was performed to evaluate the effect of body mass index (BMI) on injury characteristics, the incidence of complications, and the functional outcome after the operative management of unstable
Osteochondral lesions (OCLs) occur in up to 70%
of sprains and
Aims. Complex joint fractures of the lower extremity are often accompanied by soft-tissue swelling and are associated with prolonged hospitalization and soft-tissue complications. The aim of the study was to evaluate the effect of vascular impulse technology (VIT) on soft-tissue conditioning in comparison with conventional elevation. Methods. A total of 100 patients were included in this prospective, randomized, controlled monocentre study allocated to the three subgroups of dislocated
The management of symptomatic osteochondral lesions of the talus (OLTs) can be challenging. The number of ways of treating these lesions has increased considerably during the last decade, with published studies often providing conflicting, low-level evidence. This paper aims to present an up-to-date concise overview of the best evidence for the surgical treatment of OLTs. Management options are reviewed based on the size of the lesion and include bone marrow stimulation, bone grafting options, drilling techniques, biological preparations, and resurfacing. Although many of these techniques have shown promising results, there remains little high level evidence, and further large scale prospective studies and systematic reviews will be required to identify the optimal form of treatment for these lesions. Cite this article:
We describe a technique of lengthening osteotomy of the fibula for the late treatment of symptomatic malaligned or malunited
A review is presented of the results of treatment in 126 patients over 50 years of age who had suffered a displaced
Aims. This study is a prospective, non-randomized trial for the treatment of fractures of the medial malleolus using lean, bioabsorbable, rare-earth element (REE)-free, magnesium (Mg)-based biodegradable screws in the adult skeleton. Methods. A total of 20 patients with isolated, bimalleolar, or trimalleolar
1. Twenty-three patients were treated by cross screwing for diastasis of the tibia and fibula in