Characteristics and Outcomes of Ankle Injuries in Winter and Summer Seasons

The diagnostics and treatment of ankle trauma remain challenging as they enable the patients' return to work and ability to perform daily activities. The aim of the study was to evaluate characteristics and outcomes of ankle injuries, focusing on the trauma mechanisms in winter and summer seasons. A retrospective study was conducted of 182 patients with ankle injuries, admitted to the Hospital of Traumatology and Orthopaedics in 2014, 2015, and 2016 from the months December to February, and from June to August. Patients with supination-external rotation (SER) type ankle injuries were included in the functional outcome evaluation. Our results suggested that most of the injuries were SER type, stage IV in both seasons, and that more than 2 3 of the SER type ankle injuries that needed surgery were in the winter season. In patients with tibiofibular syndesmosis (TFS) rupture the functional results were worse than in those without TFS rupture, but in winter and summer seasons they seemed to be without statistical difference.publishersversionPeer reviewe

Management of trimalleolar fracture in Sanglah hospital: a case series

Trimalleolar fractures are one of the most complex fracture around ankle. This study aims to assess the functional outcome and result of the surgical treatment for trimalleolar fracture. Case 1: A 49-years-old male experience closed fracture left ankle Lauge-Hansen PER type IV caused by traffic accident. Patient present with swollen and painful around ankle with an inability to bear weight on the affected extremity. Case 2: A 36-years-old female sustained closed fracture at right trimalleolar ankle, closed fracture at right talus nondisplace Hawkins I, and closed fracture at second, third, and fourth metatarsal. Case 3: A 57-years-old female came with history the left ankle twisted after got slipped and fell down at the yard. Patient was diagnosed by closed fracture left ankle Lauge Hansen SER type IV. Ankle fracture mostly happen in young men and older women during sporting activities or even bicycle or car accidents. The Lauge-Hansen system classify the fracture based on the postion and the direction of the ankle when trauma happen. The AOFAS was use for evaluation patient-relevant outcomes in patients operated on with anatomical ankle injury. In or present study of 3 patients with ankle fractures that were unstable, displaced or both treated surgically by open reduction with internal fixation in accordance with Lauge-Hansen classification. The result in our series confirm that all of 3 patients have a good result based on AOFAS scoring for evaluation the treatment and it means the management approve the good functional outcomes for the patients with ankle fractures

Functional outcome and complications of surgically managed malleolar fractures at ankle

Background: If not treated properly the ankle injuries are a source of disability in the form of pain, instability and early degenerative arthritis of ankle. The aim and objectives of the study were to assess functional outcome of surgically managed malleolar fractures at ankle and to assess the results of complication.Methods: This study was undertaken from January 2012 to August 2015. In-patients who were admitted in Nizams institute of medical sciences Hyderabad, for surgical management of ankle fracture were taken for the present study. 61 patients were admitted during this period. Among them, 4 patients died, 5 patients were lost from follow up due to various reasons and 4 patients were not fulfilling the inclusion/exclusion criteria. The remaining 48 patients were included in the study.Results: Pronation abduction injury was more common, seen in 45% of patients. In terms of functional outcome 62% patients achieved excellent to good results as per subjective criteria. 75% good results as per objective criteria and 83% good results as per radiological criteria. Patients with unimalleolar fractures had the best outcome with mean Olerud Molander ankle score (OMA) Score of 94 With regards to lateral malleolar fracture fixation modality, patients with rush nail fixation had mean OMA Score of 86. With regards to medial malleolar fracture fixation modality, patients with Tension band wiring had mean OMA SCORE of 93. The patients with complications has poorer outcome with mean OMA Score of 76. Conclusions: There was a significant improvement in the functional outcome of the patients as assessed by radiological, subjective and objective parameters compared to preoperative condition

Functional and radiological outcome of open reduction and internal fixation in bimalleolar fractures of ankle: a prospective study

Background: Bimalleolar fractures are commonly encountered fractures in the orthopaedic emergency. The goals in the treatment of these fractures are aimed at perfect anatomical reduction which could be obtained by open reduction and internal fixation.Methods: A prospective study conducted in the department of orthopedics, Government Medical College, Jammu, Jammu and Kashmir from June 2019 to December 2020 in patients with bimalleolar fracture. Clinical history, socio-demographic profile, and Lauge Hansen classification was noted for all patients. Functional outcome was evaluated 6 months postoperatively using the Baird and Jackson criteria.Results: Mean time for radiological union was 18 weeks. Baired and Jackson scoring was used with excellent results in 21 patients (43.75%), good results in 19 patients (39.58%), fair results in 8 patients (16.66) while no patients had poor outcome.Conclusions: In our study we concluded that open reduction and internal fixation (ORIF) in bimalleolar fractures with plating for lateral malleolus and cannulated cancellous screw (CCS) for medial malleolus is an effective treatment modality with very good results in experienced hands

Advantages of the Ilizarov external fixation in the management of intra-articular fractures of the distal tibia

<p>Abstract</p> <p>Background</p> <p>Treatment of distal tibial intra-articular fractures is challenging due to the difficulties in achieving anatomical reduction of the articular surface and the instability which may occur due to ligamentous and soft tissue injury. The purpose of this study is to present an algorithm in the application of external fixation in the management of intra-articular fractures of the distal tibia either from axial compression or from torsional forces.</p> <p>Materials and methods</p> <p>Thirty two patients with intra-articular fractures of the distal tibia have been studied. Based on the mechanism of injury they were divided into two groups. Group I includes 17 fractures due to axial compression and group II 15 fractures due to torsional force. An Ilizarov external fixation was used in 15 patients (11 of group I and 4 of group II). In 17 cases (6 of group I and 11 of group II) a unilateral hinged external fixator was used. In 7 out of 17 fractures of group I an additional fixation of the fibula was performed.</p> <p>Results</p> <p>All fractures were healed. The mean time of removal of the external fixator was 11 weeks for group I and 10 weeks for group II. In group I, 5 patients had radiological osteoarthritic lesions (grade III and IV) but only 2 were symptomatic. Delayed union occurred in 3 patients of group I with fixed fibula. Other complications included one patient of group II with subluxation of the ankle joint after removal of the hinged external fixator, in 2 patients reduction found to be insufficient during the postoperative follow up and were revised and 6 patients had a residual pain. The range of ankle joint motion was larger in group II.</p> <p>Conclusion</p> <p>Intra-articular fractures of the distal tibia due to axial compression are usually complicated with cartilaginous problems and are requiring anatomical reduction of the articular surface. Fractures due to torsional forces are complicated with ankle instability and reduction should be augmented with ligament repair, in order to restore normal movement of talus against the mortise. Both Ilizarov and hinged external fixators are unable to restore ligamentous stability. External fixation is recommended only for fractures of the ankle joint caused by axial compression because it is biomechanically superior and has a lower complication rate.</p

Bilateral simultaneous rotational ankle fractures: case series and literature review

Bilateral Simultaneous rotational ankle injuries are rare entities with little number of cases reported in literature. Unlike axial type ankle fractures, they tend to happen as a result of pivoting trauma on the supportive limb. We conducted a case series and literature review of patients who presented with simultaneous bilateral ankle injuries and discussed their presentation and imaging. A total of Four cases in our institute and 6 separate cases reported in literature were found who sustained bilateral simultaneous rotational ankle fractures. There were 10 cases, nine of which were simultaneous and symmetrical ankle injuries. Injuries found were; Maisonneuve fracture, Tillaux fracture, Syndesmotic injury, Lauge-Hansen’s supination external rotation (SER), pronation external rotation (PER), supination adduction (SAD), and pronation abduction (PA). Four cases were presented in our institute over the last 10 years. A single case was asymmetrical in nature given the presence of an associated distal tibial metaphyseal fracture. Bilateral rotational ankle injuries are rare entity presenting simultaneously unlike axial type ankle fractures. When they present, they are likely caused by higher mechanism of injury than typical unilateral rotational ankle fractures. SER injuries are the most commonly found mechanism in both unilateral and bilateral ankle injuries.

Outcome Analysis of Open Fractures of the Ankle Joint

INTRODUCTION: Fractures of the ankle joint are the second most common lower limb fractures after the hip fractures and they represent 10% of all fractures with an incidence of around 137 per 1,00,000 persons per year. Around 2% of ankle fractures are open fractures. Open injuries around the ankle joint cause destruction of not only the bony architecture but also often the ligamentous and soft tissue components including skin. AIM OF THE STUDY: To study the functional and radiological outcome of open ankle fractures treated by various treatment modalities. MATERIALS AND METHODS: This is a prospective and retrospective study of open ankle fractures conducted at Institute of Orthopedics and Traumatology, RGGGH, Madras Medical College, Chennai -3 between March 2016 to August 2016. Outcome of 23 open ankle fractures analysed functionally and radiologically. RESULTS: The most common cause in our study is road traffic accidents (69%), Majority of the patients presents as Gr III A open fractures (gustilo – Anderson) 43.5 % followed by Gr III B open fractures (30.4%) and bi malleolar fractures are common (60.9%) Based on the observations of the Lauge – Hansen and AO/OTA classifications, supination external rotation type 4 (SER 4) and type 44B2 (AO) are more prevalent. CONCLUSION: Open reduction and internal fixation in Gr I and Gr II open ankle fractures results in excellent patient outcome. Post traumatic osteoarthritis of the ankle (PTOA), the most common indication for ankle arthrodesis occurs in significant number in our study (around 39.1%), contribute significantly to the poor outcome

Demographic profile and functional outcome following fixation of malleolar fractures in adults

Background: Malleolus are important structures which forms part of ankle mortise and provide stability to it. This article underlines the current demographic profile of patients sustaining malleolar fractures in adults. It also discusses the modalities of treatment and functional outcomes following open reduction and internal fixation of these fractures as well as the improvement in functional outcome following early mobilization.Methods: 30 patients sustaining malleolar fractures who attended the Department of Orthopedics were included in the study. The patients were operated as and when the soft tissue condition permitted and were followed up in outpatient department at 6 weeks, 3 months and 6 months where functional outcome based on Baird and Jackson scoring system was assessed.Results: In this study, the average age of patients was 43.8 years with a male preponderance. Supination-external rotation was the most common mechanism of injury following a slip or twisting injury. According to Baird and Jackson scoring system 20% patients had excellent, 50% patients had good results, 20% patients had fair results and 10% patients had poor results.Conclusions: 70% patients had excellent to good results following fixation of malleolar fractures. Early mobilization was started in 5 patients with 80% patients showing excellent results. Open reduction and Internal fixation proved to be an excellent procedure leading to union in all cases, less complication and early resumption of routine activities.

Correlation between radiological assessment of acute ankle fractures and syndesmotic injury on MRI

Item does not contain fulltextOBJECTIVE: Owing to the shortcomings of clinical examination and radiographs, injury to the syndesmotic ligaments is often misdiagnosed. When there is no indication requiring that the fractured ankle be operated on, the syndesmosis is not tested intra-operatively, and rupture of this ligamentous complex may be missed. Subsequently the patient is not treated properly leading to chronic complaints such as instability, pain, and swelling. We evaluated three fracture classification methods and radiographic measurements with respect to syndesmotic injury. MATERIALS AND METHODS: Prospectively the radiographs of 51 consecutive ankle fractures were classified according to Weber, AO-M�ller, and Lauge-Hansen. Both the fracture type and additional measurements of the tibiofibular clear space (TFCS), tibiofibular overlap (TFO), medial clear space (MCS), and superior clear space (SCS) were used to assess syndesmotic injury. MRI, as standard of reference, was performed to evaluate the integrity of the distal tibiofibular syndesmosis. The sensitivity and specificity for detection of syndesmotic injury with radiography were compared to MRI. RESULTS: The Weber and AO-M�ller fracture classification system, in combination with additional measurements, detected syndesmotic injury with a sensitivity of 47\% and a specificity of 100\%, and Lauge-Hansen with both a sensitivity and a specificity of 92\%. TFCS and TFO did not correlate with syndesmotic injury, and a widened MCS did not correlate with deltoid ligament injury. CONCLUSION: Syndesmotic injury as predicted by the Lauge-Hansen fracture classification correlated well with MRI findings. With MRI the extent of syndesmotic injury and therefore fracture stage can be assessed more accurately compared to radiographs