Dataset Information

In Vivo Syndesmotic Overcompression After Fixation of Ankle Fractures With a Syndesmotic Injury.

ABSTRACT:

Objectives

The goals of this study were to assess syndesmotic reductions using computerized tomography and to determine whether malreductions are associated with certain injury types or reduction forceps.

Design

Prospective cohort.

Setting

Urban level 1 trauma center.

Patients

Twenty-seven patients with operatively treated syndesmotic injuries were recruited prospectively.

Intervention

Patients underwent postoperative bilateral computerized tomography of the ankle and hindfoot to assess syndesmotic reduction. The uninjured extremity was used as a control.

Main outcome measurement

Side-to-side differences of the fibular position within the tibial incisura were measured at several anatomic points and analyzed based on injury type, the presence of posterior malleolar injury, level of fracture, and type of reduction forceps used.

Results

On average, operatively treated syndesmotic injuries were overcompressed (fibular medialization) by 1 mm (P < 0.001) and externally rotated by 5° (P = 0.002) when compared with the uninjured extremity. The absence of a posterior malleolar injury and Weber B (OTA 44-B) fractures seemed to have a protective effect against malrotation, but not against overcompression. There was no difference in malreduction based on the type of the clamp used.

Conclusions

It is possible, and highly likely based on these data, to overcompress the syndesmosis when using reduction forceps. Care should be taken to avoid overcompression, as this may affect the ankle motion and functional outcomes. To our knowledge, this is the first in vivo series of syndesmotic overcompression.

Level of evidence

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

SUBMITTER: Cherney SM

PROVIDER: S-EPMC4547473 | biostudies-literature | 2015 Sep

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

In Vivo Syndesmotic Overcompression After Fixation of Ankle Fractures With a Syndesmotic Injury.

Cherney Steven M SM Haynes Jacob A JA Spraggs-Hughes Amanda G AG McAndrew Christopher M CM Ricci William M WM Gardner Michael J MJ

Journal of orthopaedic trauma 20150901 9

<h4>Objectives</h4>The goals of this study were to assess syndesmotic reductions using computerized tomography and to determine whether malreductions are associated with certain injury types or reduction forceps.<h4>Design</h4>Prospective cohort.<h4>Setting</h4>Urban level 1 trauma center.<h4>Patients</h4>Twenty-seven patients with operatively treated syndesmotic injuries were recruited prospectively.<h4>Intervention</h4>Patients underwent postoperative bilateral computerized tomography of the a ...[more]

PMID: 26295735

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Project description:BackgroundSyndesmotic ankle fractures occur when there is damage to the syndesmosis complex, resulting in severe pain and instability. Treatment methods include static fixation, dynamic fixation, and fibular nailing. This systematic review and meta-analysis aims to compare the outcomes of these surgical interventions for syndesmotic ankle fractures.MethodsPubMed and Embase were searched up until April 2024 for comparison studies that included at least two of the treatment methods and relevant functional outcomes and complication metrics. Review Manager 5.4 was used for statistical analyses, and a P value ≤0.05 was considered statistically significant. Risk of bias was assessed with Review Manager 5.4. and the Newcastle-Ottawa scale.ResultsNineteen studies with a total of 1,182 patients met the inclusion criteria. Compared to static fixation, dynamic fixation had a significantly higher Olerud-Molander Ankle Score (OMAS) at both 1-year [standardized mean difference (SMD) =0.43; 95% confidence interval (CI): 0.22 to 0.65; P<0.05] and 2-year post-operation (SMD =0.76; 95% CI: 0.33 to 1.20; P<0.05). Dynamic fixation had a significantly lower reoperation rate than static fixation [risk ratio (RR) =0.55; 95% CI: 0.36 to 0.83; P=0.004]. Compared to static fixation, fibular nail had a significantly higher OMAS at 1-year post-operation (SMD =0.28; 95% CI: 0.03 to 0.53; P=0.03). Fibular nails had significantly lower infection (RR =0.12; 95% CI: 0.04 to 0.37; P<0.05) and reoperation rates (RR =0.22; 95% CI: 0.06 to 0.86; P=0.03) than static fixation. Compared to fibular nail, dynamic fixation had a significantly higher OMAS at both 1-year (SMD =1.07; 95% CI: 0.83 to 1.31; P<0.05) and 2-year post-operation (SMD =1.03; 95% CI: 0.60 to 1.47; P<0.05). Dynamic fixation had a significantly higher reoperation rate compared to fibular nail (RR =20.41; 95% CI: 2.81 to 148.21; P=0.003).ConclusionsDynamic fixation seems to be the superior treatment method, displaying better outcomes than static fixation and fibular nailing, with the fibular nail proving to be a viable alternative. Dynamic fixation should be the first choice of treatment for those with syndesmotic ankle fractures due to its clinical advantages compared to static fixation and fibular nailing.Level of evidence3.

Project description:Context:Ankle syndesmotic injuries present a significant challenge for athletes due to prolonged disability and recovery periods. The optimal management of these injuries and rates of return to sport in athletes remains unclear.Objective:The purpose of this study was to evaluate return to sport for athletes after ankle syndesmotic injuries.Data source:The electronic databases MEDLINE, EMBASE, and PubMed were searched for relevant studies from database inception to January 15, 2017, and pertinent data were abstracted.Study selection:Only studies reporting return-to-sport rates after ankle syndesmotic injuries were included.Study design:Systematic review.Level of evidence:Level 4.Data extraction:Two reviewers extracted data from the included studies, which were stored in a standardized collection form (Microsoft Excel). Recorded data included demographics (eg, author, year of publication, study design), descriptive statistics (eg, patient age, percentage male, number of athletes, sample size), and outcomes (eg, time to return to sport, proportion of those who returned to sport, the self-reported questionnaire the Olerud-Molander Ankle Score).Results:A total of 10 studies and 312 patients with ankle syndesmotic injuries were included in this systematic review. The rate of return to preinjury or any injury level of sport after ankle syndesmotic injuries was 93.8% ± 1.2% and 97.6% ± 1.5%, respectively, for the corresponding 7 and 3 studies that reported this characteristic. The mean time to return to sport was 46.4 days (range, 15.4-70 days), with 55.2 ± 15.8 and 41.7 ± 9.8 days for operative and nonoperative management, respectively.Conclusion:This systematic review found a high rate of return to any as well as preinjury level of sport after ankle syndesmotic injury in both operative and nonoperative treatment groups. However, further high-level studies are required to compare operative and nonoperative treatment groups associated with return to sport after ankle syndesmotic injury.

Project description:BackgroundPatients undergoing fixation for foot and ankle fractures may experience poor outcomes despite achieving apparent anatomic reduction. Adjunct arthroscopy to identify missed concomitant injuries and subtle displacements has been proposed as a vehicle to enhance functional results for these patients. The purpose of this review is to provide an overview of the literature regarding arthroscopically assisted open reduction and internal fixation (AAORIF) methods for commonly encountered foot and ankle injuries including pilon, ankle, and calcaneus fractures published to date.MethodsA systematic review of the literature was performed using the PubMed database to access all studies reporting on arthroscopically assisted internal fixation methods for pilon, ankle, and calcaneus fractures. Relevant publications were analyzed for details on their respective study designs, the operative technique used, clinical outcomes, outcome instruments used, and reported complications.ResultsA total of 32 studies were included in this review. Two studies on pilon fractures, a randomized controlled trial (RCT) and case series with a total of 243 patients, met inclusion criteria. Postoperative articular reductions, bone union, and Mazur scores were found to be significantly better for those using adjunct arthroscopy when compared to those with no arthroscopy use. Patient-reported outcomes were overall reported as excellent for most patients, with no difference in patient-reported outcomes reported in the RCT. For ankle fractures, a total of 17 studies comprising of 2 systematic reviews, 1 meta-analysis, 2 RCTs, 5 retrospective comparative studies, 6 case series, and 1 case-control study met inclusion criteria for this review. Results were mixed, though the overall consensus was that arthroscopy use may help to better visualize concomitant intra-articular injuries and is generally considered safe with at least comparable outcomes to conventional methods. For the calcaneus, 13 studies met the criteria. Two studies were review papers, 8 were case series, and 3 were retrospective comparative studies. A total of 308 patients with 316 fractures formed the basis of analysis. In general, the studies found comparable functional outcomes between with or without arthroscopy use, but found that anatomical reductions were significantly improved with the use of arthroscopy.ConclusionsArthroscopy shows promise as a valuable adjunct tool for internal fixation of foot and ankle fractures, though definitive conclusions as to its clinical significance have yet to be drawn because of limited evidence. Potential advantages related to the direct visualization of the fracture site and minimally invasive nature of arthroscopy were suggested throughout studies examined in this review. The presence of intra-articular pathology may lead to unexpectedly poor outcomes seen in some patients who undergo surgical fixation of ankle fractures with an otherwise anatomic reduction on postoperative radiographs; the ability to diagnose and address these lesions with arthroscopy, therefore, has the potential to improve patient outcomes. To date, however, available literature has not shown that significant improvements in anatomical reductions and treatment of these intra-articular injuries provide any improvement in outcomes over standard fixation methods. Few prospective randomized controlled studies have been performed comparing these 2 operative techniques, rendering any suggestion that AAORIF improves clinical outcomes over traditional open fixation difficult to justify. Further research is indicated for what may be a potentially promising surgical adjunct prior to advocating for its routine use in patients.

Dataset Information

In Vivo Syndesmotic Overcompression After Fixation of Ankle Fractures With a Syndesmotic Injury.

Objectives

Design

Setting

Patients

Intervention

Main outcome measurement

Results

Conclusions

Level of evidence

Publications

In Vivo Syndesmotic Overcompression After Fixation of Ankle Fractures With a Syndesmotic Injury.

Similar Datasets

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