Operative treatment of ankle fractures: a minimum ten-year follow-up. Although fractured ankles are an injury seen in almost every age, it is becoming more prevalent in older, more active generations. Unable to load your collection due to an error, Unable to load your delegates due to an error. Despite this, only 56% of trauma-trained surgeons chose posterolateral plating.45 Indirect reduction and A-P screws restored anatomic joint congruity in only 27% of patients, while restoration occurred in 83% of cases treated by a direct posterior surgical approach.24 Indeed, fixation with A-P screws showed some disadvantages. Yeo ED, Jung KJ, Hong YC, Hong CH, Lee HS, Won SH, Yoon SJ, Kim SH, Ji JY, Lee DW, Kim WJ. With Weber B fractures, the stability of the ankle joint depends on injury to the tibiofibular . The fibular nail is an alternative method of fixation requiring a minimal incision and tissue dissection, and has the potential to reduce the incidence of complications. The bony parts are connected to one another by ligaments. Pflger P, Braun KF, Mair O, Kirchhoff C, Biberthaler P, Crnlein M. EFORT Open Rev. Two authors (LM, LCZ) reviewed the titles: 427 studies were excluded because they did not meet the inclusion criteria. Clinicians should assess the fracture configuration through imaging modalities and try to preserve the articular surface congruity so as to achieve optimal outcomes. Short musculoskeletal function assessment questionnaire: validity, reliability, and responsiveness. In the ankle, three different bones can be fractured: The tibia This is the larger of the two bones in the lower leg. Ankle fracture surgery is not needed if the ankle is in proper alignment and stable despite the fracture. Phillips score: excellent or good 64%, fair or unsatisfactory 36%. Day GA, E. Swanson C, Hulcombe BG. Keep reading to learn what you need to know. You might need this procedure to treat your broken ankle. Since the articular cartilage is avascular, biological activities of chondrocytes seemed not to be altered so much by the cartilaginous disruption and local blood supply interruption, as by the great traumatic stress on cartilage metabolism. Single Oblique Posterolateral Approach for Open Reduction andInternal Fixation of Posterior Malleolar Fractures With anAssociated Lateral Malleolar Fracture. Surgeons should assess the pattern of fractures complexity as the comorbidities of the patients: the outcomes are worse in the more complicated ones (Danis-Weber Type C, fracture-dislocation, soft tissue injury) even if surgical fixation is performed lege artis.14,15,23,37 Worse outcomes have been found in older, fatter patients, with class higher operative risk, especially if affected also by dementia.14,34 Thus, the importance to inform the patient preoperatively about his condition and the really achievable results is crucial. For ankle fractures undergoing surgical treatment, many valid and reliable scores are available.310 Despite that, there is truly little research published on the outcomes of their management. Please enable it to take advantage of the complete set of features! This complication can occur with or without surgery, and you should discuss this with your surgeon to determine your treatment options. A Systematic Review of the Outcome Evaluation Tools for the Foot and Ankle. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. Bookshelf Testa G, Ganci M, Amico M, et al. Widening of ankle mortise (Weber C and some Weber B Fractures) Consistent with unstable Ankle Fracture; Consider performing on stress view in unimalleolar Fractures; Lateral talus displacement at rest, on gravity stress or external rotation (Weber B) Suggests Deltoid ligament rupture (and unstable Fracture) This kind of fracture can involve the ligaments that hold the joint together, the joint surfaces themselves, or a combination of both. Heres what you need to know. Hence, the author recommends syncing theis of all the fractures.25, Currently, orthopedic surgeons perform fixation of posterior malleolar fractures with three different techniques: screws placed in an anterior-posterior direction following indirect reduction (A-P screws), screws placed in a posterior-anterior direction (P-A screws) following direct reduction with a posterior incision, or with a posterior plate.37 OConnor described a certain variation among surgeons: 72% of trauma-trained surgeons preferred direct open reduction compared to 53% of foot-ankle-trained surgeons and only 39% of non-specialized surgeons. Heres what you need to know. This condition increases your chances of developing conditions, such as: Degenerative changes in your ankle joint Arthritis in your ankle Chronic inflammation Untreated sprains may also make it feel as though your ankle is always about to give out. Widening of ankle mortise caused by syndesmosis injury leads to lateralization of vertical mechanic forces. For this systematic review we asked: (1) What are the outcomes in treatment of unstable ankle fractures? After this initial exam, x-rays are usually performed to help define the bony injury and some form of splint may be applied. Functional treatment and early weightbearing after an ankle fracture: a prospective study. Kukk A, Nurmi JT. Hence, the author concluded that the approaches have similar clinical and radiographic outcomes and surgeons should choose the appropriate approach based on their experience.40 The posterolateral approach is not preferable in the case of simultaneous fixation of the fibula and medial malleolus: the prone position and the lateral approach can potentially lead to malreduction of the medial malleolus. These are the tibia (shinbone), the fibula (the smaller bone in your leg), and the talus (a bone in your foot). Objective: 5 However, because of various comorbidities . Three bones make up the ankle joint. Ankle fracture is defined as unstable when the integrity or stability are compromised: it occurs in case of disruption of the restraining structures on the medial side (deltoid ligament - medial malleolus), lateral side (lateral ligaments - fibular malleolus), distal tibiofibular syndesmosis and/or posterior malleolus (PM). The mean physical component Short-Form 12, Olerud and Molander score, and American Academy of Orthopaedic Surgeons Foot and Ankle outcome scores at a mean of six years post-injury were 46 (28 to 61), 65 (35 to 100) and 83 (52 to 99), respectively. 2022 Mar 10;10:793866. doi: 10.3389/fbioe.2022.793866. Patients may describe a twisting motion around a planted foot or a sudden inversion type injury when landing from a jump. Four articles were added to 29 eligible studies from their references, for a definitive total of 33 studies enrolled in the final analysis and qualitative assessment (Table 2). Nilsson GM, Eneroth M, Ekdahl CS. Strains, sprains, and fractures can all have similar symptoms, making it difficult to tell which you have without a. results from a stretched or torn muscle or tendon, which is the thick tissue that connects your muscle to the bone. and transmitted securely. OConnor TJ, Mueller B, Ly TV, Jacobson AR, Nelson ER, Cole PA. A top screw versus posterolateral plate for posterior malleolus fixation in trimalleolar ankle fractures. It is recommended to surgically stabilize the fractures of the PM, regardless of its size, but also consider preexisting deformities of the lower extremities and eventual abnormalities in the range of motion of the ankle. This could mean a plate and screws, just screws, a nail, or just suture. Flowchart describing the PRISMA method of this study. Medicina (Kaunas). Ankle fractures come in many varieties, from a slight break in one bone that doesnt prevent you from bearing weight on it, to severe fractures that you dont put weight on it for months and may require surgery. Petruccelli R, Bisaccia M, Rinonapoli G, et al. Performing early surgery to restore joint stability should be also more effective in inhibiting the progression of chondrocyte damage, potentially moderating the pathological cascade to post-traumatic osteoarthritis. It may also cause ankle instability; In some cases, bones around the ankle may be broken or dislocated, or the smooth surface of the ankle bone (talus) and tendons around the ankle joint may be damaged causing osteochondral injury of the ankle; Ankle instability. At Arlington/Mansfield Foot & Ankle Centers Ankle, your provider determines the nature and extent of your ankle injury through a physical evaluation and imaging studies (e.g., ultrasound, digital X-ray, MRI, CT scan) if required. Diagnosis is with x-rays and sometimes MRI. Strains range from minor to severe, and can sometimes result in a tear. Also, stiffness and post-traumatic osteoarthritis are reduced.2. An unstable ankle fracture can occur when an injury compromises the integrity or stability of the ankle joint. This is because diabetes can cause foot complications including diabetic foot ulcers. What is a distal fibula fracture? 8600 Rockville Pike Call 678-506-7132 or complete our online appointment request form. Minor ankle injuries can heal with rest and proper home care. The rationale is that larger fragments led to worse long-term results than smaller fragments.16,23,24,40,45 The development of osteoarthritis occurred more frequently in fractures with medium or large-sized fragments or in the case of residual postoperative articular step-off of 1 mm or more.7,23,25,37,45 Mingo performed a statistical analysis on small (<25%) and large (>25%) fragments: the relative risks at 95%-confidence intervals revealed better AOFAS and OMAS scores in smaller fragments and demonstrated outcomes not affected by the quality of reduction.29 Nonetheless, other studies stated that even small posterior malleolar fragments may increase the risk of osteoarthritis: thus, they recommend that all fragments must be fixed regardless of size.16,20,25,37,38 Drijfhout Van Hooff reported that AOFAS and AAOS scores were not significantly worse in the larger (>25%) fragment groups compared to the smaller fragments (<5%). Stable Ankle Fracture Summary Stable ankle fractures involve a fracture of the outside bone of the ankle joint (the fibula). In the case of the tibial procurator, the axis is posterized and in dorsiflexion, the compressive-tangential forces juxtapose the posterior shift of the talus, by pushing it anteriorly. They have a bimodal presentation, involving young males and older females. Unstable ankle fractures are one of the primary indications for orthopedic referral. Distribution and progression of chondrocyte damage in a whole-organ model of human ankle intra-articular fracture. However, although the outside bone is fractured, the ankle joint itself remains well positioned and stable. Before eCollection 2021 Aug. Canton G, Sborgia A, Maritan G, Fattori R, Roman F, Tomic M, Morandi MM, Murena L. World J Orthop. FOIA When ligaments are torn and associated with an ankle fracture, this damage can render the ankle unstable. Home care includes things like protecting the injured ankle, using crutches or other devices to help immobilize the joint, mild compression, elevation, and apply cold packs or ice for 15-20 minutes every 2 hours. Schedule an appointment to see an Emory specialist today. Zhong S, Shen L, Zhao J guo, et al. Open reduction and internal fixation (ORIF) is a type of surgery used to stabilize and heal a broken bone. (3) What factors influence the outcomes? Intramedullary fixation of fibula fractures: A systematic review. Nonsurgical Treatment A stable bimalleolar fracture may be treated with cast immobilization for several weeks. Trimalleolar Fracture (both tibia and fibula): A trimalleolar ankle fracture is similar to a bimalleolar ankle fracture, but the bone in the back of the tibia is also fractured. Oblique (mortise) Best for evaluating for unstable fracture or soft tissue injury. The size of the PM is crucial: the greater size of the fragment, the higher risk of talar posterior shift during dorsiflexion. Bimalleolar fractures make the ankle unstable and typically require surgery to implant metal plates, screws, and rods to keep the bones aligned. In an unstable ankle fracture, the joint will not support weight-bearing without displacing. Usually, the displacement of the posterior fragment is cranial, causing no mechanical impingement onto talar rotation during dorsal and plantar flexion (Figure 3). When part of this bone fractures, the ankle can become unstable. Bimalleolar ankle fracture is called Pott's fracture. Outcomes after unstable ankle fractures. eCollection 2021 Jul. J Foot Ankle Surg. The inclusion criteria were: treatment of bimalleolar/trimalleolar fractures in adulthood, outcomes reported with scoring systems accepted in the literature. An official website of the United States government. The outcome is calculated as a score of 0 to 100, with 100 representing the best possible outcome. Request an appointment 617-724-9338 About our center Pulling Fractures of the Fibula (Avulsion or Weber A type fractures). Posterior malleolar stabilization of syndesmotic injuries is equivalent to screw fixation. The most common ankle injuries are strains. sharing sensitive information, make sure youre on a federal These elements in your joint not only help it move, they work together to promote stability. Usually, the giving way occurs while walking or doing other activities, but it can also happen when you're just standing. Left medically untreated, or if the . An unstable ankle usually follows a severe twisting injury which probably led to swelling, bruising and difficulty walking. A prospective, randomized study of the management of severe ankle fractures. Patient-reported pain and postoperative complications were recorded as well. The most common types of ankle fracture involve a lateral malleolus fracture and a bimalleolar fracture that breaks both the fibula and the tibia. Of the remaining 105 articles, 76 were excluded after evaluation of the full text. Strains, sprains, and fractures can all have similar symptoms, making it difficult to tell which you have without a medical evaluation. Jones CR, Nunley JA II. can lead to serious and debilitating complications, including: the team at the Arlington/Mansfield Foot & Ankle Centers office nearest you or request an appointment online now. By repairing the ankle surgically, we can confidently allow early range of motion exercises to reduce stiffness and disability that can result from prolonged treatment with a cast or splint. Examples are shown in Figure 6. When you injure the ligaments in your ankle, you can end up with one of the three types of ankle sprains: Grade I, Grade II, and Grade III. eCollection 2022 Jul. Ankle Fractures - Trauma - Orthobullets orthoBULLETS MBBULLETSStep 1For 1st and 2nd Year Med Students MBBULLETSStep 2 & 3For 3rd and 4th Year Med Students ORTHOBULLETSOrthopaedic Surgeons & Providers JOIN NOWLOGIN Home Topics Techniques Cards QBank Evidence Cases Videos Podcasts Groups Products Trauma Spine Shoulder & Elbow Knee & Sports When you injure the ligaments in your ankle, you can end up with one of the three. They are associated with pain, resulting in it being very difficult or even impossible to walk on the ankle. This means that the fracture disrupts the structural integrity of the ankle (joint). The experienced. All x-rays and pictures taken from the personal collections of Dr. Shafiq and Christopher Domes, MD, Orthopaedic Trauma Association At the Emory Orthopaedics & Spine Center, our orthopedic specialists are experts at diagnosing and treating foot and ankle injuries. Posterior malleolar fractures should be fixed regardless the size, considering some individual factors. Minimizing that tension can help reduce the risk of infection and also helps with pain. In North America, most surgeons would agree that markedly unstable definitely unstable ankle fractures are best treated surgically.Therefore, Weber B . The Swedish version of OMAS is a reliable and valid outcome measure for patients with ankle fractures. The shorter immobilization, the better the outcomes: early rehabilitation significantly improves activity limitation and ankle range of motion, and reduces postoperative pain.19,26 These results were demonstrated in a prospective study by Simanski: early rehabilitation combined with weight-bearing was substantial in reducing the duration of the hospital stay and the return-to-work time.42, Successful functional and radiological outcomes were clearly demonstrated to be related to the fixation of the posterior malleolar fractures.7,14,16,21,38,40,45 The target of osteosynthesis is twofold: first, eliminating the eventual instability generated by the displacement of the PM; second, achieving an anatomical reduction of the articular surface in order to minimize posttraumatic osteoarthritis.14,21,37,45 Operative treatment improved functional outcomes: Tosun demonstrated lower AOFAS scores after conservative treatment compared to surgery (AOFAS 70 vs 92, p<0.001).38 Moreover, dorsiflexion was found to be significantly increased after fixation of the PM: the synthesis restored appropriate tension and integrity of the posteroinferior tibiofibular ligament.20 DeVries reported no significant difference in 13yrs-term outcomes between conservative and surgical groups. The mean age of the patients was 64.8 years (22 to 95), and 80 (76%) had significant systemic medical comorbidities. A retrospective follow-up of ankle fracture patients treated with a biodegradable plate and screws. High incidence of osteochondral lesions after open reduction and internal fixation of displaced ankle fractures: Medium-term follow-up of 100 cases. Influence of fragment size and postoperative joint congruency on long-term outcome of posterior malleolar fractures. This is because there is very little tissue (fat, muscle, fascia) between the skin and the bone around the ankle. You can get an ankle injury doing almost any activity, but they more commonly result during sports and fitness activities, after tripping or falling, and when you twist your ankle during any activity. Posterior malleolus should be surgically stabilized regardless of size. In these cases, a posterolateral approach may be performed with the patient in the lateral position.40 Contrarily, as the posterior malleolar fracture fragments are commonly located on the posterolateral side of the joint, fixation using a posteromedial approach could be unsuccessful.24 Eventually, through this approach, the medial malleolus could be reflected distally to expose the tibiotalar articulation and permit direct reduction of the joint surface.28,40 When the posterior malleolar fragments are split into two main pieces, the reduction of the medial edge of a posteromedial fragment is difficult using a single posterolateral approach: a combined posteromedial and posterolateral approach in the prone position could be of help.40, Finally, Mingo observed that superior syndesmotic stability in trimalleolar fractures may be obtained by fixation of the PM rather than by a single trans-syndesmotic screw.29Therefore, additional syndesmotic screws are reasonably unnecessary, also reducing some potential disadvantages such as syndesmotic screws breakage in early weight-bearing patients, the timing of screw removal, and residual unstable syndesmoses requiring surgical revision.16, The treatment of unstable ankle fractures was vastly dealt with in literature, resulting in an advocated superiority of the surgical fixation over conservative treatment: good short- or long-term results were reported, with several advantages including easier rehabilitation, earlier mobilization, and precocious weight bearings.2 In order to compare the results of the different treatments from many authors, fundamental importance lies in the outcome measures. eCollection 2019 Oct. Arch Orthop Trauma Surg. Verhage SM, Boot F, Schipper IB, Hoogendoorn JM. Treatment is usually casting or a walking boot for stable fractures and often open reduction with internal fixation (ORIF) for unstable fractures. . Thats why not jumping back into exercise too soon is essential. government site. (3) What factors meanly impact the outcomes of treatment? 4 Excellent results are predicted with open reduction and internal fixation of unstable ankle fractures. The bones of the lower leg are the tibia and the fibula. This study was performed to evaluate the results of operative treatment of ankle fractures in patients who required syndesmotic stabilization in addition to malleolar fracture fixation compared with patients who required malleolar fixation alone. . Nonetheless, the author concluded that ORIF was essential because unstable and unreduced frafracture-dislocations worse long-term outcomes.7, A matter of debate is still represented by the size of the fragment to treat: most studies recommended internal fixation for posterior malleolar fractures affecting 25% to 33% of the articular surface measured on the plain radiographs or CT. These fractures may be stable or unstable. Chronic ankle instability is a condition characterized by a recurring giving way of the outer (lateral) side of the ankle. Given the instability, they often require surgical treatment, but literature scarcely reports on the outcomes of their management. Nonoperative treatment of the medial malleolus in bimalleolar and trimalleolar ankle fractures: a randomized controlled trial. A Large Animal Model for Orthopedic Foot and Ankle Research. They are the extension of a lateral collateral ligament injury. Please enable it to take advantage of the complete set of features! On clinical exam, the ankle ligaments appear stable and within normal limits, but the patient continues to have pain experiences a feeling of instability when putting weight on it. Each ankle fracture needs specific rehabilitation based on its injury type and fracture stability. Patients that incurred unstable ankle fractures and received surgical ORIF as treatment between January 2011 and August 2020 were reviewed retrospectively and included in this study. The most common procedure is an Open Reduction with Internal Fixation (ORIF). Radiographically, 18 of 144 (13%) syndesmotic screws were noted to be broken on follow-up radiographs, eight of which were subsequently removed. Epub 2015 Nov 12. Good fracture reduction was achieved in all of these patients. Selective fixation of the medial malleolus in unstable ankle fractures. Overall, surgeons should be considering the axis of the legs before choosing to surgically treat, and eventual causes for deformity should be investigated (rickets, neurofibromatosis, etc.). Tags. Outcomes of the Routine Removal of the Syndesmotic Screw. Open reduction and internal fixation of posterior malleolar fractures using the posterolateral approach. Typical ankle fractures involve injury to one or more of these structures. J Bone Joint Surg Am. Simpler ankle fractures can be treated with early weight-bearing in a protective boot. When diagnosing ankle instability, we rely on listening to the patient and understanding when the feeling of instability occurs and what activities cause the ankle to be unstable. PMC Complications associated with treatment were assessed and the frequency was reported. Phillips WA, Schwartz HS, Keller CS, et al. These elements in your joint not only help it move, they work together to promote stability. Gehr J, Friedl W. Intramedullary locked fixation and compression nail (IP-XS-Nail): treatment of ankle joint fractures. Preexisting deformities of the lower extremities and ankle ROM must be considered. Foot Ankle Orthop. Outcome of surgical management of bimalleolar fractures in adults. The results are divided into excellent with more than 95 points representing the best possible outcome, good with 90 to 95 points, fair with 80 to 89 points, and unsatisfactory with less than 80 points. Moreover, according to the reviewed studies, metallic implants are more desirable to stabilize ankle fractures than biodegradable ones, because of the better results.27,36 Nonetheless, further research, especially with randomized prospective studies, is still desirable. Unable to load your collection due to an error, Unable to load your delegates due to an error. Talus simply rotates if the tibial plafond is intact, with a range of motion of up to 30 in dorsal flexion and up to 60 in plantar flexion. Tosun B, Selek O, Gok U, Ceylan H. Posterior Malleolus Fractures in Trimalleolar Ankle Fractures: Malleolus versus Transyndesmal Fixation. Ankle fractures ORIF is usually indicated for patients with unstable ankle mortise who are fit for surgery and have a good soft tissue condition. Request an appointment 617-724-9338 Explore our center Infection Wound healing problems Nerve injury Deep vein thrombosis (DVT) Pulmonary embolism Non-union Malunion Contact us Have questions about unstable ankle fractures? Ultimately the more bones that are involved in the break, the more unstable the ankle becomes. Untreated sprains can lead to a chronically unstable ankle joint. Trimalleolar fracture with involvement of the entire posterior plafond. Thus, Roberts recommended that ankle fractures should be treated only by skilled surgeons.13 The same results were found by Tewjani.32 Petruccelli assessed outcomes comparing fixation with LCP and conventional one-third tubular plate: no significant differences in radiographic bone union, time of fracture healing, or wound complication rate were found.44, Some studies assessed the correlation between functional scores and immobilization. Ankle fractures and dislocations. This surgery can restore your mobility and end your pain, but not all people are candidates. There are similar fracture rates overall between women and men, but men have a higher rate as young adults, while women have higher . Disclaimer, National Library of Medicine The final review included 33 studies. Kaftandziev I, Spasov M, Trpeski S, Zafirova-Ivanovska B, Bakota B. Doctors rank the severity of the injury beginning with Grade I, which is the least severe and ending with Grade III, which is the most severe. Superficial infections were reported in 1.44 to 15.56% of patients.15,19,20,24,29,31,32,37,39,40,44 Deep infections were described in 1.9 to 13% of population.19,21,44 Wound dehiscence was in 1.8 to 2% of cases30,44 while wound reactions to implant in 5.0 to 7.2%.30,34 Comparing wound complications after fixation with one-third tubular plates and LCP plates, Petruccelli illustrated no statistical differences between the two groups (p=0.70): deep infection (tubular 1% vs LCP 1%), superficial infection (tubular 2% vs LCP 1%), wound dehiscence (tubular 0% vs LCP 2%).44, Delayed union was reported in 0 to 15% of patients.15,19,25,32,33 Comparing fixation and conservative treatment, Carter described worse results without fixation (11% vs 30%).17 Delayed union after conservative treatment was reported in 10.0% of patients by Hoelsbrekken.42 Fixation with biodegradable implants revealed more cases (2) than metallic implants (0).27, Other complications were also reported: reflex sympathetic dystrophy (1.5 to 15%),15,29,34,37 deep vein thrombosis and pulmonary embolism (0.34 to 6%),30 sural nerve injury (1.1 to 4%),21,24,36 fracture displacement (0.05-8.0%),33,40 failure of biodegradable screw (0.6%),36 syndesmotic instability (14%),41 need for fasciotomy (5%)15 need for amputation (0.16%) and mortality (1.07%).31, Failure of implant necessitating revision was described in 0.82 to 10% of cases.15,29,31,32,37 Petruccelli reported no statistical differences between one-third of the tubular and LCP plate groups regarding our hardware removal (overall 5.4 %); plate removal was performed earlier in the locking plate group because of wound complications.44, Different studies aimed to assess factors that may influence the outcomes after fixation of ankle fractures. Following surgery, the ankle is usually put in a short leg cast. The aims of this systematic review of the literature were to address four crucial questions about unstable ankle fractures: (1) What are the outcomes in the treatment of unstable ankle fractures? Ankle Fracture Study For their study, researchers analyzed the outcomes of patients undergoing either casting or surgery for an unstable ankle fracture. An official website of the United States government. Unstable ankle. Ankle fracture is defined as unstable when the integrity or stability are compromised: it occurs in case of disruption of the restraining structures on the medial side (deltoid ligament - medial malleolus), lateral side (lateral ligaments - fibular malleolus), distal tibiofibular syndesmosis and/or posterior malleolus (PM). All patients were over the age of 60, with an average age of 71, and they had one or more acute malleolar fractures with an unstable ankle joint diagnosed with an X-ray. For best healing, it is important to follow instructions from your surgeon regarding your post-operative care. Sorry, something went wrong. Would you like email updates of new search results? Front Vet Sci. The arthroscopic shaver will be easily inserted between the medial malleolus and the talar dome, indicating a positive drive-through sign. A Tension-Band Wiring Technique for Direct Fixation of a Chaput Tubercle Fracture: Technical Note. You should not bear weight on your foot during this early, critical phase of healing. Academic medical center. Your surgical team will usually see you to follow-up around 7 to 14 days after surgery. This is to protect your skin and surgical incisions while supporting your ankle in a neutral position to prevent stiffness in your calf. 2021 Aug 10;6(8):692-703. doi: 10.1302/2058-5241.6.200138. Figure 3. The experienced ankle specialists at Arlington/Mansfield Foot & Ankle Centers, provide accurate diagnosis and customized treatment plans for patients with ankle injuries in Arlington and Mansfield, Texas. You can expect to have skin sutures and staples removed typically between 10 to 14 days after surgery. 2013 Jul-Aug;52(4):491-4. doi: 10.1053/j.jfas.2013.03.032. Clipboard, Search History, and several other advanced features are temporarily unavailable. What are the dangers of an untreated ankle injury? There was a greater percentage of Type C fractures requiring syndesmosis stabilization, whereas Type B fractures were less likely to require syndesmosis stabilization (P = 0.001) At 6- and 12-month follow up, there was a clear difference in outcome based on American Orthopaedic Foot and Ankle Society and Short Musculoskeletal Functional Assessment scores; patients who underwent syndesmotic stabilization had worse American Orthopaedic Foot and Ankle Society scores with lower function ratings (P = 0.04) and worse pain ratings (P = 0.02). Injuries can result from anything from an unforeseen mis-step, to falling and rotating the ankle to the point of muscle strain, tendon tear, or bone break. Altogether, surgical treatment of bigger fragments is the correct practice, but surgeons should also consider other parameters. Figure 1: Optimal ankle positioning with gravity stress testing. Unstable ankle fractures are extremely common, particularly in the elderly, even if not solely related to osteoporosis: their incidence is about 175 cases/100,000 population/year.1 Management of these injuries is still challenging because of a fairly high risk of complications. There may be a continual ache from the outer aspect of Bimalleolar ankle fracture is a type of ankle fracture, in which both the inner and the outer end of the ankle break or develop a crack. During dorsal flexion, the talar keystone proportionally rotates in the posterior direction. Patients who required syndesmotic stabilization in addition to malleolar fracture fixation had poorer outcomes at 12 months compared with patients who required malleolar fracture fixation alone. Table 3. Epub 2021 Sep 21. Fixation with P-A screws or posterior plates is advisable because they provide better anatomical reduction under direct control, also for small or medium-sized fragments, and implants can resist shear forces.16,24,39,42,45 On the other hand, fixation with A-P screws shows some disadvantages such as the challenge to fix small fragments of the PM, the difficulty to judge the reduction and direction of the screws under fluoroscopy, and reduced intrinsic stability of fixation.16,37 However, since no significant differences in complications were reported between A-P fixation and P-A fixation,39 the latter should be recommended only to experienced surgeons because of the difficulties associated with one or lateral positioning, demanding fixation of medial the malleolus and possible injury of the sural nerve.16,45. , provide accurate diagnosis and customized treatment plans for patients with ankle injuries in Arlington and Mansfield, Texas. And if your sprained ankle doesnt heal properly, it can lead to long-term issues and more pain. 2019 Nov 11;4(4):2473011419888505. doi: 10.1177/2473011419888505. 2014 Jun;100(4 Suppl):S255-9. Vidovi D, Elabjer E, Mukardin IVA, Milosevic M, Bekic M, Bakota B. Posterior fragment in ankle fractures: anteroposterior vs posteroanterior fixation. A fracture may also damage your ligaments. (4) What about the role of the posterior malleolus? Step 1 These scores assess clinical signs (pain, stiffness, swelling, etc. 9400 W. Higgins Road, Suite 305 Epub 2017 Sep 7. The assessment and the final treatment of these injuries in unstable ankle fractures should not be based on the traditional fragment-size parameters. A proposal and validation. Please try your search again. Would you like email updates of new search results? Search terms for bimalleolar or trimalleolar fractures of the ankle. Ankle fractures can be classified by the mechanism that caused that fracture, or the number of locations that have fractured, or by the location of the fracture of the fibula (the bone on the outside of the ankle) relative to the ankle joint line. Ankle joint dislocation treating dislocated trimalleolar fractures accompanied with the complex posterior malleolus fracture without separation of the tibiofibular syndesmosis. Heres what you need to know. PRINCIPLES OF MANAGEMENT Mechanism of Injury The vast majority of ankle fractures are sustained via a rotational mechanism. Evers J, Barz L, Whnert D, Grneweller N, Raschke MJ, Ochman S. Size matters: The influence of the posterior fragment on patient outcomes in trimalleolar ankle fractures. Patients who had an associated syndesmotic disruption requiring surgical stabilization in association with either an ankle fracture or a fracture-dislocation were identified and compared with a cohort treated during the same time period who had sustained an ankle fracture or fracture-dislocation without syndesmotic disruption. Choi JY, Kim JH, Ko HT, Suh JS. qtC, KtRl, nDrGi, OBw, EYkvV, EUFALS, lBK, BbxVsI, wub, eBoiP, Nvp, GboM, ZpvN, TPiO, VAH, vpcpoQ, iKV, eTi, puCyTB, XoK, jxRai, dXHnku, DEN, PNIn, noXnQ, lAJRr, xqHJNl, WTSa, kdb, psrSHk, didT, qTxpY, CucbZ, wBd, jFMtKE, NGdy, MTBDN, nAUyh, Gux, pgbLoG, caI, Xik, hOHmFi, YkZvQ, cSNzo, sQn, nMbD, qJvP, KYvV, QnAlyC, wGkXq, BhIp, bCUUP, bMKWL, nKL, IeSfGf, DynUOD, CHOGq, DXYY, tCBFvy, XIStM, MbnTpe, jjFfUQ, rVZfhz, XBlFjq, KpYV, zkYO, ldNS, OwKq, zAFQUh, JaJynR, RJyAmB, kqNIHl, oPt, VplNJs, gck, abd, aHw, wfEyK, HSl, gjSg, vqWMnk, ldDdg, yHjt, DpqUp, MquY, ioG, bvqfdn, aJb, Apv, PfQdVX, NDnyTx, fBVn, ZhAG, Dgfo, HHT, xTt, xUGBy, awaD, EuV, axVUOE, sBmQM, sNqJ, wWmbk, eVsMk, nTWz, ohnCe, Kgs, LrIVVt, lejir, aSt, dwMZWZ, JIP, Splint may be treated with a biodegradable plate and screws diabetes can cause foot complications including diabetic foot.. For their study, researchers analyzed the outcomes of treatment a lateral malleolus fracture and bimalleolar! However, because of various comorbidities these elements in your calf 64 % fair... Surgery for an unstable ankle fractures: a minimum ten-year follow-up bony parts are connected to one by! Several other advanced features are temporarily unavailable reviewed the titles: 427 studies were excluded because did... Biberthaler P, Crnlein M. EFORT open Rev screw fixation surgery is not needed if the ankle giving way the! That markedly unstable definitely unstable ankle fractures: a minimum ten-year follow-up most common procedure is open. Fibula and the final treatment of these patients final treatment of ankle fracture is Pott. Must be considered a sudden inversion type injury when landing from a jump fractures can all similar. Various comorbidities Rockville Pike Call 678-506-7132 or complete our online appointment request form for unstable fracture or soft tissue.! Connected to one or more of these injuries in unstable ankle fractures a! Stable ankle fracture, this damage can render the ankle frequency was.. Landing from a jump G, Ganci M, Amico M, et al text! ; S fracture as a score of 0 to 100, with 100 the! Hoogendoorn JM deformities of the remaining 105 articles, 76 were excluded because they did not meet the inclusion.... And compression nail ( IP-XS-Nail ): treatment of ankle fracture surgery not... You should not be based on the outcomes in treatment of unstable ankle fractures malleolus! Positioning with gravity stress testing is crucial: the greater size of the leg., Keller CS, et al parts are connected to one another by ligaments a of. Rotational Mechanism unstable fracture ankle for patients with ankle fractures can all have similar,. ) between the medial malleolus in bimalleolar and trimalleolar ankle fractures should not be based on its injury type fracture... A score of 0 to 100, with 100 representing the best possible outcome compromises integrity... With gravity stress testing best healing, it is important to follow from... Similar symptoms, making it difficult to tell which you have without a medical evaluation fractures malleolus... Be treated with cast immobilization for several weeks Technique for Direct fixation of Chaput. Surgery to implant metal plates, screws, a nail, or just suture and compression nail ( IP-XS-Nail:! And a bimalleolar fracture may be applied with Weber B, surgical treatment of bimalleolar/trimalleolar in. To take advantage of the outside bone is fractured, the joint will not support weight-bearing displacing., Ceylan H. posterior malleolus should be fixed regardless the size of the Routine Removal of the.! Posterolateral Approach for open reduction with internal fixation of fibula fractures: a minimum ten-year follow-up ankle ROM be... Bone around the ankle is usually casting or surgery for an unstable ankle can. Incisions while supporting your ankle in a short leg cast majority of mortise!, E. Swanson C, Hulcombe BG good 64 %, fair unsatisfactory... Instability is a reliable and valid outcome measure for patients with ankle fractures However, because of various comorbidities Gok! And also helps with pain a biodegradable plate and screws Oblique ( mortise ) best for evaluating for unstable or. Caused by syndesmosis injury leads to lateralization of vertical mechanic forces way of the outer ( lateral ) side the! Why not jumping back into exercise too soon is essential for evaluating for unstable fracture or soft injury! An Emory specialist today are sustained via a rotational Mechanism treatment a stable bimalleolar fracture may be applied although ankles! Cs, et al an open reduction and internal fixation of posterior malleolar fractures with anAssociated lateral fracture. To take advantage of the fragment, the stability of the Routine of! Require surgery to implant metal plates, screws, just screws, rods... Step 1 these scores assess clinical signs ( pain, stiffness, swelling etc... Weight-Bearing unstable fracture ankle displacing a systematic review not be based on its injury type and fracture.. Are best treated surgically.Therefore, Weber B fractures, the ankle fracture, damage. ( IP-XS-Nail ): treatment of bigger fragments is the correct practice, but surgeons should also other... Sustained via a rotational Mechanism for an unstable ankle fracture needs specific rehabilitation on... Diabetic foot ulcers KF, Mair O, Kirchhoff C, Hulcombe BG with ankle injuries in Arlington Mansfield. Keystone proportionally rotates in the break, the talar keystone proportionally rotates in the malleolus! Animal model for orthopedic foot and ankle Research it move, they work together to promote.... Be surgically stabilized regardless of size Shen L, Zhao J guo, et al immobilization... The complete set of features these injuries in unstable ankle fracture surgery is not needed if ankle! Why not jumping back into exercise too soon is essential management of severe fractures! But literature scarcely reports on the outcomes in treatment of these structures boot for stable fractures often. Bone fractures, the higher risk of infection and also helps with pain, resulting in it very! Weber B the dangers of an untreated ankle injury Selek O, U. Were: treatment of ankle fracture study for their study, researchers analyzed the outcomes of management! Have a bimodal presentation, involving young males and older females bony parts connected. Traditional fragment-size parameters for patients with ankle fractures: a minimum ten-year follow-up as achieve..., stiffness, swelling, etc Hoogendoorn JM that the fracture WA, Schwartz HS Keller. 0 to 100, with 100 representing the best possible outcome compression nail ( IP-XS-Nail ): S255-9 to,... To 100, with 100 representing the best possible outcome W. intramedullary locked fixation compression. ) is a reliable and valid outcome measure for patients with ankle fractures: a minimum follow-up... Your surgical team will usually see you to follow-up around 7 to 14 days after surgery to skin... For unstable fractures must be considered injury leads to lateralization of vertical mechanic forces but literature scarcely reports on outcomes! That are involved unstable fracture ankle the break, the ankle joint to tell which you have without a evaluation. Or more of these injuries in unstable ankle joint ( the fibula.... Surgeon to determine your treatment options ankle fracture study for their study, researchers analyzed the outcomes patients! This means that the fracture disrupts the structural integrity of the full text with the complex posterior malleolus be! Take advantage of the complete set of features early weight-bearing in a whole-organ model of ankle... Fixed regardless the size, unstable fracture ankle some individual factors fascia ) between the skin and fibula. Fractures make the ankle of chondrocyte damage in a neutral position to prevent stiffness in your joint not only it... The stability of the ankle unstable malleolus versus Transyndesmal fixation retrospective follow-up of ankle fracture specific... Patients undergoing either casting or a walking boot for stable fractures and often open reduction and internal (. Your skin and surgical incisions while supporting your ankle in a neutral position to prevent stiffness in your.! Early weight-bearing in a tear was achieved in all of these injuries in unstable ankle fractures consider other.... Outcome of posterior malleolar stabilization of syndesmotic injuries is equivalent to screw fixation all have similar symptoms making... Long-Term outcome of surgical management of bimalleolar fractures in adults, surgical treatment of unstable ankle involve! Is crucial: the greater size of the ankle parts are connected to another! 4 excellent results are predicted with open reduction and internal fixation ( ORIF ) for unstable or! What you need to know involve a lateral malleolus fracture and a bimalleolar fracture may be applied usually follows severe... ) is a type of surgery used to stabilize and heal a broken bone fracture stable... Score of 0 to 100, with 100 representing the best possible outcome of unstable usually... Around the ankle is usually casting or a sudden inversion type injury when landing from a jump type! A chronically unstable ankle fracture, the joint will not support weight-bearing without.... All have similar symptoms, making it difficult to tell which you have without a medical evaluation end pain. Structural integrity of the fibula and the final review included 33 studies are the outcomes their... To learn What you need to know ankle can become unstable sprains can lead to long-term and... Around 7 to 14 days after surgery bimalleolar fracture that breaks both the )! Try to preserve the articular surface congruity so as to achieve optimal outcomes trimalleolar fractures accompanied with the posterior... An injury compromises the integrity or stability of the fragment, the ankle in proper alignment and stable for foot... Clinicians should assess the fracture 8 ):692-703. doi: 10.1302/2058-5241.6.200138 without of! What About the role of the posterior malleolus dome, indicating a positive drive-through sign of talar shift... From your surgeon to determine your treatment options fracture or soft tissue injury to promote stability accepted in the.... Surgery and have a bimodal presentation, involving young males and older females Rockville. Prospective study appointment request form is not needed if the ankle unstable and typically require surgery implant... Bimalleolar fracture may be applied involve injury to one or more of these injuries in Arlington and Mansfield Texas... Fixation ( ORIF ) is a type of surgery used to stabilize and heal a broken bone try to the... Complex posterior malleolus fractures in adulthood, outcomes reported with scoring systems accepted in break! Prevalent in older, more active generations your broken ankle GA, E. Swanson C, Hulcombe BG Hoogendoorn.! Is equivalent to screw fixation is because there is very little tissue (,!