Treatment of Ankle Fractures with Open Reduction Internal Fixation via Improved Posterolateral Incision.
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ABSTRACT:
SUBMITTER: Hu JZ
PROVIDER: S-EPMC6583721 | biostudies-literature | 2015 Aug
REPOSITORIES: biostudies-literature
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Treatment of Ankle Fractures with Open Reduction Internal Fixation via Improved Posterolateral Incision.
Hu Ju-zheng JZ Shi Zhan-ying ZY Tang Jing-li JL Zhu Cheng-ming CM
Orthopaedic surgery 20150801 3
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Project description:BackgroundArthroscopy can be used to assist the open reduction internal fixation (ORIF) approach in the treatment of acute ankle fractures. Arthroscopy can also help to assess the articular surface but is performed in only 1% of ankle fracture cases.PurposeWe aimed to investigate (1) whether arthroscopy-assisted ORIF (AORIF) would lead to improved postoperative functional outcomes compared to conventional ORIF and (2) whether differences in postoperative complication rates exist between these 2 techniques.MethodsA systematic review was performed; 2 researchers independently searched the online databases of PubMed, Scopus, Embase, Cochrane, and Google Scholar. All studies that directly investigated the outcomes of AORIF versus conventional ORIF in the treatment of ankle fractures and contained quantitative data were eligible for inclusion. The Cochrane tools for bias assessment were applied independently by 2 researchers.ResultsSix articles (2 randomized controlled trials and 4 retrospective cohort studies) were included in this systematic review. The meta-analysis of functional outcome scores resulted in a standardized mean difference of 0.6 (confidence interval [CI]: [0.3, 0.9]) favoring AORIF, after excluding 2 studies due to missing standard deviations. The overall complication rate was similar between the 2 groups, with a pooled odds ratio of 1.1 (CI: [0.4, 3.0]).ConclusionThe findings of this systematic review and meta-analysis suggest that AORIF might improve postoperative outcomes without increasing the complication rate when compared to conventional ORIF. However, due to the inherent clinical heterogeneity of the included studies, further well-designed randomized controlled trials are required.
| S-EPMC11748374 | biostudies-literature
Project description:Standalone open reduction-internal fixation (ORIF) of unstable ankle fractures is the current standard of care. Intraoperative stress radiographs are useful for assessing the extent of ligamentous disruption, but arthroscopic visualization has been shown to be more accurate. Concomitant arthroscopy at the time of ankle fracture ORIF is useful for accurately diagnosing and managing syndesmotic and deltoid ligament injuries. The arthroscopic ankle drive-through sign is characterized by the ability to pass a 2.9-mm shaver (Smith & Nephew, Andover, MA) easily through the medial ankle gutter during arthroscopy, which is not usually possible with both an intact deltoid ligament and syndesmosis. This arthroscopic maneuver indicates instability after ankle reduction and fixation and is predictive of the need for further stabilization. Furthermore, when this sign remains positive after fracture fixation, it may guide the surgeon to further evaluate the adequacy of fixation for the possible need for further fixation of the syndesmosis or deltoid. We present the case of an ankle fracture managed with arthroscopy-assisted ORIF and describe the clinical utility of the arthroscopic ankle drive-through sign.
| S-EPMC4948602 | biostudies-literature
Project description:The purpose of our study was to compare the curative effect of two surgical methods for Schatzker type I to III tibia plateau fractures, arthroscopy assisted reduction percutaneous internal fixation (ARIF) and open reduction internal fixation (ORIF), with the intent of evaluating the quality of evidence to assist treatment selection. Searches of PubMed, Cochrane and China National Knowledge Infrastructure (CNKI) databases were performed to identify randomized controlled trials (RCTs) and quasi-RCTs comparing ARIF and ORIF regarding the following outcomes: functional outcomes, perioperative complications and post-traumatic osteoarthritis. Odds ratios (OR) and weighted mean differences (MDs) were pooled using either a fixed-effects model or random-effects model, depending on the heterogeneity of the trials included in the analysis. 19 RCTs and one quasi-RCT provided the data from 1272 patients. ARIF was associated with better functional outcomes, a lower risk of perioperative complications, and lower risk of post-traumatic osteoarthritis. After consideration of the quality of evidence of the included studies, the advantages provided by ARIF are not substantive over ORIF for the treatment of Schatzker type I to III tibia plateau fractures, except reducing the risk of perioperative complications.
| S-EPMC6145938 | biostudies-literature
Project description:BackgroundAnkle fractures are common and can be associated with severe morbidity. Risk factors for short-term adverse events and readmission after open reduction and internal fixation (ORIF) of ankle fractures have not been fully characterized.Questions/purposesThe purpose of our study was to determine patient rates and risk factors for (1) any adverse event; (2) severe adverse events; (3) infectious complications; and (4) readmission after ORIF of ankle fractures.MethodsPatients who underwent ORIF for ankle fracture from 2005 to 2012 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP(®)) database using International Classification of Diseases, 9(th) Revision and Current Procedural Terminology codes. Patients with missing perioperative data were excluded from this study. Patient characteristics were tested for association with any adverse event, severe adverse events, infectious complications, and readmission using bivariate and multivariate logistic regression analyses.ResultsOf the 4412 patients identified, 5% had an adverse event. Any adverse event was associated with insulin-dependent diabetes mellitus (IDDM; odds ratio [OR], 2.05; 95% confidence interval [CI], 1.35-3.1; p = 0.001), age ≥ 60 years (OR, 1.97; 95% CI, 1.22-3.2; p = 0.006), American Society of Anesthesiologists classification ≥ 3 (OR, 1.69; 95% CI, 1.2-2.37; p = 0.002), bimalleolar fracture (OR, 1.6; 95% CI, 1.08-2.37; p = 0.020), hypertension (OR, 1.47; 95% CI, 1.04-2.09; p = 0.031), and dependent functional status (OR, 1.47; 95% CI, 1.02-2.14; p = 0.040) on multivariate analysis. Severe adverse events occurred in 3.56% and were associated with ASA classification ≥ 3 (OR, 2.01; p = 0.001), pulmonary disease (OR, 1.9; p = 0.004), dependent functional status (OR, 1.8; p = 0.005), and hypertension (OR, 1.65; p = 0.021). Infectious complications occurred in 1.75% and were associated with IDDM (OR, 3.51; p < 0.001), dependent functional status (OR, 2.4; p = 0.002), age ≥ 60 years (OR, 2.28; p = 0.028), and bimalleolar fracture (OR, 2.19; p = 0.030). Readmission occurred in 3.17% and was associated with ASA classification ≥ 3 (OR, 2.01; p = 0.017).ConclusionsIDDM was associated with an increased rate of adverse events after ankle fracture ORIF, whereas noninsulin-dependent diabetes mellitus was not. IDDM management deserves future study, particularly with respect to glycemic control, a potential confounder that could not be assessed with the ACS-NSQIP registry. Increased ASA class was associated with readmission, and future prospective investigations should evaluate the effectiveness of increasing the discharge threshold, discharging to extended-care facilities, and/or home nursing evaluations in this at-risk population.Level of evidenceLevel III, prognostic study.
| S-EPMC4317425 | biostudies-literature
Project description:IntroductionAlthough displaced intra-articular calcaneal fractures were historically treated nonoperatively because of unreliable outcomes, they are now commonly treated with open reduction and internal fixation (ORIF).Step 1 preoperative planning and operative setupCoronal images are most helpful.Step 2 incision and soft-tissue managementElevate the flap using the "no-touch" technique to minimize wound complications.Step 3 reduce posterior facet and perform provisional stabilizationAchieve anatomic reduction of the medial calcaneal wall before proceeding with the remainder of the fracture reduction.Step 4 apply lag fixation and a lateral neutralization plateUse a traditional nonlocking plate and be sure that at least one lag screw achieves purchase.Step 5 close woundUse the "no-touch" technique, with the goal of tension-free wound closure.Step 6 postoperative careWatch closely for drainage or delayed healing.Results & preop/postop imagesORIF is a viable treatment option for displaced intra-articular calcaneal fractures without contraindication for older patients.What to watch forIndicationsContraindicationsPitfalls & Challenges.
| S-EPMC8343974 | biostudies-literature
Project description:Background and purposeDuring acetabular fracture surgery, the acetabular roof is difficult to visualize with 2-dimensional fluoroscopic views. We assessed whether intraoperative 3-dimensional (3D) imaging can aid the surgeon to achieve better articular reduction and improve implant fixation.Patients and methodsWe operated on 72 acetabular fractures using intraoperative 3D imaging and compared the operative results, duration of surgery, and complications with those for 42 consecutive acetabular fracture operations conducted using conventional fluoroscopic imaging. Postoperative reduction was evaluated on reconstructed coronal and sagittal images of the acetabulum.ResultsThe fracture severity and patient characteristics were similar in the 2 groups. In the 3D group, 46 of 72 patients (0.6) had a perfect result after open reduction and internal fixation, and in the control group, 17 of 42 (0.4) had a perfect result. The mean difference in postoperative articular incongruity was 0.5 mm (95% CI: 0.4-0.7). In 29 of 72 operations, the intraoperative 3D scans led to intraoperative correction of the reduction and an improved result. The duration of surgery and infection rate were similar in the 2 groups.InterpretationIntraoperative 3D imaging, which is not time-consuming, allowed the surgeon to correct malreductions and screw placement in 29 of 72 operations, leading to better articular reduction and more precise screw placement than in operations where conventional fluoroscopic imaging was used to control the reduction.
| S-EPMC4750767 | biostudies-literature
Project description:Current surgical techniques in ankle fracture management now include arthroscopic-assisted reduction and internal fixation. The need for minimally invasive fracture reduction techniques, which preserve soft tissue envelops and assists in overall anatomic reduction, can be refined and improved. The ankle is an ideal anatomic location for arthroscopic-assisted reduction and internal fixation due to the high incidence of intra-articular pathology and the poor long-term sequela of nonanatomic reduction. Thus, we propose using prone posterior ankle arthroscopic reduction internal fixation for posterior ankle fracture variants.
| S-EPMC5263098 | biostudies-literature
Project description:BackgroundThe best treatment strategy for fractures to the posterior malleolus (PM) is still intensively debated. The aim of this systematic review was to compare the patient-rated outcome following open reduction and internal fixation (ORIF) for fractures of the PM to either closed reduction using AP screws (CRIF) or no treatment in bi- or trimalleolar ankle fractures.MethodsSystematic literature research (MEDLINE (PubMed), CINAHL, Scopus, Central and EMBASE) according to the PICOS and PRISMA guidelines. Eligible were studies comparing the outcome following ORIF to any other treatment strategy for fractures to the posterior malleolus in isolated bi- or trimalleolar ankle fractures.ResultsTwelve studies were eligible for a qualitative analysis and 6 for a quantitative analysis. Overall, a considerable heterogeneity among the studies was observed. The most commonly used outcome score was the American Orthopaedic Foot & Ankle Society ankle-hindfoot score (AOFAS). The final follow-up ranged from 12 to 160 months. Four studies compared ORIF to CRIF of the PM. The quantitative analysis revealed significantly better AOFAS scores for ORIF (90.9 vs 83.4 points; P < .001; I2 = 0%). Three studies compared ORIF to untreated PM fragment. The quantitative analysis again revealed superior AOFAS scores for ORIF (92.0 vs 82.5 points; P < .001; I2 = 99%). A similar trend was observed for the Ankle Fracture Scoring System and American Academy of Orthopaedic Surgeons Foot and Ankle Questionnaire scores as well as the quality of reduction.ConclusionDespite a considerable heterogeneity, the data available point to a superior outcome following ORIF for fractures to the PM when compared to CRIF or no treatment.
| S-EPMC10394961 | biostudies-literature
Project description:BackgroundOpen reduction internal fixation (ORIF) has long been the conventional procedure for managing displaced patella fracture. This surgical approach has certain drawbacks, which might affect clinical outcomes and patient prognosis. Minimally invasive percutaneous fixation (MIPF) was proposed to overcome these disadvantages. Few in-depth investigations have been performed to determine the superiority of MIPF over ORIF. The aim of this study was to compare the efficacies of MIPF and ORIF for patella fractures.MethodsThe PubMed, Cochrane Library, Embase, and Scopus databases were searched for relevant studies from November 26 to December 17, 2020. Non-English publications and pediatric orthopedic articles were excluded. Statistical analysis was performed using Review Manager, version 5.4, with mean differences (MDs), standardized mean differences (SMDs), odds ratios (ORs), and respective 95% confidence intervals (CIs) calculated using a random effects model. The primary outcomes were the pain score, knee range of motion, and joint functionality. The secondary outcomes were the surgical time, complications, and implant removal rate.ResultsSix articles with a total of 304 patients were included in the meta-analysis. Pooled analysis revealed that patients with MIPF had a significantly reduced pain score (MD = - 1.30, 95% CI = - 1.77 to -0.82; p < 0.00001) and increased knee extension angles (MD = 0.72, 95% CI = 0.18 to 1.25; p = 0.009) at 3-month follow-up. Furthermore, knee flexion angles (MD = 8.96, 95% CI = 5.81 to 12.1; p < 0.00001) and joint functionality (SMD = 0.54, 95% CI = 0.21 to 0.86; p = 0.001) had statistically improved at 2 years. However, no difference was observed between MIPF and ORIF with regard to the surgical time. The risk of complications (OR = 0.10, 95% CI = 0.05 to 0.18; p < 0.00001) and implant removal rate (OR = 0.20, 95% CI = 0.07 to 0.57; p = 0.003) were significantly lower with MIPF than with ORIF.ConclusionsMIPF is more favorable than ORIF in terms of the pain score, knee range of motion, joint functionality, complications, and implant removal rate. Thus, it can be adopted as an alternative to ORIF.
| S-EPMC8369684 | biostudies-literature
Project description:PurposeComminuted fractures with poor bone quality in the elderly are associated with poor outcomes. An alternative to open reduction and internal fixation (ORIF) alone, primary or acute total hip arthroplasty (aTHA), allows early mobilization with full weight bearing. In this study, we aim to analyze whether treatment of aTHA with/withtout ORIF (limited ORIF) vs ORIF alone yields better intra-operative results, functional outcomes, and less complications.MethodsPubMed, Cochrane, Embase, and Scopus databases were searched in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Random-effects model and 95% confidence intervals were used. The outcomes of interest were surgery time, blood loss, length of hospital stay, Harris hip score (HHS), 36-Item Short Form Survey (SF-36), complication rate, surgical site infection rate, heterotopic ossification rate, reoperation rate, and mortality rate.ResultsTen observational studies with a total of 642 patients (415 ORIF alone and 227 aTHA with/without ORIF) were included in the systematic review. Compared to ORIF alone, aTHA with limited ORIF provided higher HHS (P = 0.029), better physical function (P = 0.008), better physical component summary (P = 0.001), better mental component summary (P = 0.043) in postoperative 1-year SF-36, lesser complication rate (P = 0.001), and lesser reoperation rate (P = 0.000), but however greater bodily pain (P = 0.001) in acetabular fractured elderlies.ConclusionsAcute THA with limited ORIF is favorable alternative to ORIF technique alone. It provided better HHS, physical, and mental component summary in SF-36 and yielded lower complication and reoperation rate compare to ORIF alone.
| S-EPMC10321052 | biostudies-literature