Background: The aim of this study was to investigate the relationship between the radiographic
bone morphology of the ankle and the observed fracture type.
Methods: We retrospectively reviewed the patients who had visited our emergency department with ankle injuries between June 2012 and July 2018. All patients were treated with open reduction and internal fixation. Patients were categorized in two groups based on the fracture patterns (groups 1 and 2). Group 1 consisted of isolated lateral malleolar fractures, while group 2 comprised bimalleolar fractures. Group 1 was further divided into two groups; namely group A and B based on their classification into Weber type B and C fractures, respectively. Four radiographic parameters were measured postoperatively by standing whole-leg anteroposterior view of the ankle; talocrural angle (TCA), medial malleolar relative length (MMRL), lateral malleolar relative length (LMRL), and the distance between the talar dome and distal fibula.
Results: One hundred and seventeen patients were included in group 1-A, 89 patients in group 1-B, and 168 patients in group 2. The values of TCA and MMRL were significantly higher in group 2 than in group 1. Lateral malleolar length/medial malleolar length ratio was also significantly different between the two groups. However, there were no significant differences between the groups in terms of LMRL and the distance between the tip of the distal fibula and talar process. LMLR and MMRL values between groups A and B were not significantly different (p=0.402 and p=0.592, respectively). However, there was a significant difference between the two groups in terms of TCA and the distance between the tip of the distal fibula and talar process.
Conclusions: The talocrural angle, medial malleolar relative length, and lateral malleolar length/medial malleolar length were significantly higher in patients with bimalleolar fracture than in patients with isolated lateral malleolar fractures.
The Lauge-Hansen classification does not cover all types of ankle injuries. The present report details three cases of exceptional fragment of the medial tibia that differed from the traditional Lauge-Hansen supination–external rotation and pronation–external rotation fracture patterns. The information obtained from this study will be helpful for conducting basic research of this condition and determining appropriate surgical approaches.
Most complications of calcaneal fractures are due to the combination of the dynamic nature and the mechanism of the injury itself. Complications are usually secondary to three integral parts of this complex fracture pattern: 1) fracture and depression of the subtalar joint, 2) loss of the height of the calcaneal body with varus rotation, and 3) expansion of the lateral wall of the calcaneus. Other complications occur with less frequency. This article describes the complications and sequelae of old, malunited intra-articular calcaneal fractures in relation to the nature and the components of these unique fractures. (J Am Podiatr Med Assoc 94(4): 382–388, 2004)
The literature is scanty regarding the biomechanical effects of different thread configurations on the initial stability of ankle arthrodesis. This study aims to compare the initial stability of tibiotalar fusion site in ankle arthrodesis using cannulated screws with different thread designs.
We biomechanically tested under cyclic loading the effects of different screw combinations on the initial stability of ankle arthrodesis. A total of 28 synthetic ankle models were divided into four groups: two partially threaded cancellous screws (group A), partially and fully threaded cancellous screws (group B), a partially threaded cancellous screw with a headless compression screw (group C), and a fully threaded cancellous screw and a headless compression screw (group D). Biomechanical variables including ultimate failure load, initial stiffness, ultimate stiffness, and failure angulation were analyzed.
There were no differences in any of the biomechanical variables among the four groups (P = .41 for ultimate failure load, P = .079 for initial stiffness, P = .084 for ultimate stiffness, and P = .937 for failure angulation).
Combinations of different cannulated screws showed similar results in terms of the stability and stiffness of the tibiotalar fusion site.
We present a case of tibial pilon fracture where only the lateral part of the distal tibia was affected. The transfibular approach to the ankle was used for the surgical treatment of the fracture. After an initial nonweightbearing period of 3 weeks, full weightbearing was allowed 8 weeks after surgery. The second-year follow-up showed no evidence of degenerative signs, with full ankle range of motion.
This study was performed to determine the factors that influence the clinical outcomes of surgically treated ankle fractures associated with the posterior malleolus (PM).
We evaluated 42 fractures of 42 patients. Posterior malleolus fracture size was calculated using computed tomography. Posterior malleolar fractures with a size less than 10% were left nonfixated. The decision for larger fragments was performed using fluoroscopy following the fixation of other components. If the joint was found to be congruent, the PM was left nonfixated. Otherwise, the PM was reduced and fixated. Clinical outcomes were evaluated based on Weber, Freiburg, and American Orthopaedic Foot and Ankle Society scores. Ankle osteoarthritis was determined according to the Canadian Orthopaedic Foot and Ankle Society classification. The effect of PM fixation, age, PM fragment size, waiting period before surgery, presence of ankle dislocation, and number of injured malleoli on clinical outcomes were assessed. Statistical significance was set at a value of P < .05.
The mean patients age was 48.5 ± 14.9 years (range, 20–84 years) and the mean follow-up was 23.7 ± 8.6 months (range, 12–56 months). Fixation of the PM was performed solely in 12 patients. Postoperative displacement of the PM and articular step were less than 2 mm in all fractures. Statistically significant worse outcomes were demonstrated based on functional scores in the patients with a PM size greater than or equal to 25% (P = .042, P = .038, and P = .048, respectively) and in patients aged 60 years or older (P = .005, P = .007, and P = .018, respectively). However, there was no significant difference between functional scores and the other factors. Ankle osteoarthritis was observed at a higher rate in patients with PM size greater than or equal to 25% and in patients aged 60 years or older.
Clinical outcomes of the patients are mainly influenced by the patient's age and PM fragment size. However, if the tibiotalar joint is congruent, comparable results can be obtained in PM fixated or nonfixated patients.
Talar injuries that are associated with pilon fractures include talar body fractures, osteochondral defects, and posterior process talar fractures. Pilon fractures, in combination with talar dome fractures, have not yet been reported in the scientific literature. We report the case of a 15-year-old boy who sustained a pilon fracture with a lateral talar dome fracture. The pilon fracture was initially fixed using a temporary external fixator for soft-tissue care. After the swelling subsided, definitive internal fixation was performed. First, the lateral talar dome fracture was directly reduced and fixed using a small anterolateral approach of the ankle. Then, the intra-articular portion of the pilon fracture was directly reduced using the same anterolateral approach and an additional small anteromedial approach, and the extra-articular metaphyseal portion of the pilon fracture was indirectly reduced. The pilon fracture was finally fixed with an anterolateral distal tibia plate, using a submuscular plating technique through the anterolateral approach and a separate proximal skin incision. A medial distal tibia plate was later added using a subcutaneous plating technique through the anteromedial approach and another proximal skin incision. Both the pilon fracture and the lateral talar dome fracture were addressed simultaneously through a combination of the small anterolateral and anteromedial approaches.
Spiral fractures of the tibia are often the result of torsion trauma. In clinical practice, this type of fracture is frequently complicated by posterior malleolus fractures. This study aimed to observe the effectiveness of diagnosis and treatment of these fractures in a single hospital in China. Posterior malleolus fractures are sometimes occult, occurring alongside spiral fractures of the distal third of the tibia; posttraumatic arthritis can result if they are missed.
This study includes 128 consecutive patients with tibia fractures between May 1, 2008, and April 30, 2012. Patients in the early study period underwent radiography only, and subsequent patients underwent both radiography and computed tomography (CT). The causes of the fractures were evaluated. Intramedullar nailing was performed for the tibia fractures. Percutaneous cannulated screw fixation was used for the posterior malleolus fractures. Patients were followed up for a minimum of 3 months.
Twenty-eight patients had spiral fractures of the mid-distal third of the tibia. Ten of the 28 patients were complicated by posterior malleolus fractures. Diagnosis was initially missed in one early patient who underwent radiography only. Three cases of posterior malleolus fractures were identified by radiography. A CT was performed in all ten patients and showed that approximately 25% to 50% of the ankle joint surface of posterior malleolus fractures was involved. One early diagnosis was missed that had a displaced posterior malleolus fracture after intramedullary nailing. Using CT as the gold standard, radiography had sensitivity of 33.3%, specificity of 100.0%, positive predictive value of 100%, and negative predictive value of 73.9%. All correctly diagnosed patients healed well, without ankle pain.
Computed tomography helped identify most posterior malleolus fractures, and radiography alone might miss it. Intramedullary nailing and posterior malleolus screw fixation were straightforward and effective treatments.
Bilateral stress fractures of the fibula are very rare. We present an unusual case report of a 54-year-old osteoporotic woman with bilateral stress fractures involving the distal fibula. After conservative treatment, she made a good recovery with full motion and was free of pain. (J Am Podiatr Med Assoc 99(1): 61–64, 2009)
Open fracture-dislocation of the lower extremity poses a serious risk, has a high incidence of complications, and necessitates prompt surgical intervention. Patients need to be evaluated on presentation to the emergency department for neurovascular injury, soft-tissue insult, stability of the fracture, concomitant injuries, and overall medical/nutritional status. Implementation of a specific treatment protocol will decrease time to operative management and increase the overall success rate. Success after treatment of lower-extremity trauma should be defined as a noninfected, functional limb with optimal tissue preservation allowing ambulation. We present a case of open fracture-dislocation of the first ray treated with prompt debridement, skeletal stabilization, and immediate soft-tissue reconstruction. (J Am Podiatr Med Assoc 103(1): 76–80, 2013)