ObjectiveTo compare the effectiveness of flexible fixation and rigid fixation in the treatment of ankle pronation-external rotation fractures with distal tibiofibular syndesmosis.MethodsA retrospective analysis was made on the clinical data of 50 patients with ankle pronation-external rotation fractures and distal tibiofibular syndesmosis treated between January 2013 and December 2015. Suture-button fixation was used in 23 patients (flexible fixation group) and cortical screw fixation in 27 patients (rigid fixation group). There was no significant difference in age, gender, weight, side, fracture type, and time from trauma to surgery between 2 groups (P>0.05). The operation time, medial clear space (MCS), tibiofibular clear space (TFCS), tibiofibular overlap (TFO), American Orthopaedic Foot and Ankle Society (AOFAS) score, and Foot and Ankle Disability Index (FADI) score were compared between 2 groups.ResultsThe operation time was (83.0±9.1) minutes in the flexible fixation group and was (79.6±13.1) minutes in the rigid fixation group, showing no significant difference (t=1.052, P=0.265). All patients achieved healing of incision by first intention. The patients were followed up 12-20 months (mean, 14 months). The X-ray films showed good healing of fracture in 2 groups. There was no screw fracture, delayed union or nounion. The fracture healing time was (12.1±2.5) months in the flexible fixation group and was (11.3±3.2) months in the rigid fixation group, showing no significant difference between 2 groups (t=1.024, P=0.192). Reduction loss occurred after removal of screw in 2 cases of the rigid fixation group. At last follow-up, there was no significant difference in MCS, TFCS, TFO, AOFAS score and FADI score between 2 groups (P>0.05).ConclusionSuture-button fixation has similar effectiveness to screw fixation in ankle function and imaging findings, and flexible fixation has lower risk of reduction loss of distal tibiofibular syndesmosis than rigid fixation.
ObjectiveTo evaluate the biomechanical characteristics and effectiveness of repairing anteroinferior tibiofibular ligament and fixing the posterior malleolar fracture in reconstructing syndesmotic stability after ankle fracture of pronation-external rotation type (PER) stage IV. MethodsTwenty-four normal lower extremity cadaver specimens were collected and made into intact ankle specimens. A MTS Bionix 858 test system was used to measure the maximum rotation of the foot under a static axial load of 150 N, internal rotation torque to the tibia at a rate of 1°/second and 4 N·m torque. Then a fracture of PER stage IV model was established in each specimen. Internal fixation of lower tibiofibular ligament union was performed by screws in group A, fixation of posterior malleolar fractures in group B, fixing posterior malleolar fracture combined with repairing anteroinferior tibiofibular ligament in group C (8 specimens each group). Then the maximum rotation of the foot was measured under the same condition, and the syndesmotic stability was calculated. Between July 2009 and September 2012, 32 patients with ankle fracture of PER stage IV were treated. There were 19 males and 13 females with an average age of 35 years (range, 20-63 years). The locations were the left ankle in 14 cases and the right ankle in 18 cases. The time from injury to admission was 3.5 hours on average (range, 1-72 hours). Open reduction and plate compression internal fixation were performed in fibula, and medial malleolus was fixed by conpression screws, then anteroinferior tibiofibular ligament was mended and posterior malleolar fracture was fixed by screws. ResultsThe preservation rates of syndesmotic stability after repair were 46.2%±12.3%, 62.6%±10.7%,and 66.5%±12.6% in groups A, B,and C, respectively; groups B and C were significantly superior to group A (P<0.05),but no significant difference was found between groups B and C (P>0.05). All patients achieved wound healing by first intention, and were followed up 12-24 months (mean,15 months). All fractures healed,with an average healing time of 11.2 weeks (range, 10-14 weeks) on the X-ray films. No seperation of inferior tibiofibular syndesmosis was observed during the follow-up period. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 88.4 on average (range, 61-98) at last follow-up; the results were excellent in 13 cases,good in 15 cases, and fair in 4 cases, with an excellent and good rate of 87.5%. ConclusionIn patients with ankle fracture of PER stage IV, a combination of fixing the posterior malleolar fracture and repairing anteroinferior tibiofibular ligament can reconstruct syndesmotic stability effectively.
ObjectiveTo investigate the clinical features of ankle fractures involving Tillaux-Chaput in adults, and to observe the surgical effectiveness. MethodsBetween May 2009 and May 2013, 15 adult patients with ankle fractures involving Tillaux-Chaput were treated by open reduction and internal fixation. There were 12 males and 3 females, with an average age of 32 years (range, 19-45 years). The causes included sport injury (8 cases), traffic accident injury (5 cases), and falling injury from height (2 cases). The left ankle was involved in 5 cases and the right side in 10 cases. There were 2 open fractures (Gustilo type I) and 13 close fractures. Five patients had single Tillaux-Chaput fractures. The mean time between injury and surgery was 8.5 days (range, 3 hours to 15 days). According to the Lauge-Hansen classification, there were 9 cases of supination-external rotation, 5 cases of pronation-external rotation, and 1 case of pronation-abduction. ResultsPrimary healing of incisions was obtained in 13 patients without infection and neurovascular injury; 2 patients had superficial infection which was cured after oral antibiotics and dressing change. All cases were followed up for 23 months on average (range, 13-36 months). X-ray films showed complete fracture healing at 10-16 weeks postoperatively (mean, 13 weeks) in all cases. The mean American Orthopaedic Foot and Ankle Society (AOFAS) score was 87 (range, 78-99), with an excellent and good rate of 80% (excellent in 9 cases, good in 3 cases, and fair in 3 cases). ConclusionOpen reduction and internal fixation for ankle fractures involving Tillaux-Chaput in adults can achieve excellent effectiveness.
Objective To summarize the diagnosis and treatment of fibular fracture in ankle fracture. MethodsRelevant literature at home and abroad in recent years was widely consulted, and various types of fractures were discussed and summarized according to Danis-Weber classification. ResultsConservative treatment is not an ideal treatment for type A avulsion fracture. The operation method should be determined according to the position and size of bone mass. For simple type B fracture, both conservative treatment and surgical treatment can achieve good results. When the position of type C fracture is high and does not affect the stability of ankle joint, it can be treated conservatively, while when the position is low and affects the stability of ankle joint, it needs surgical treatment. ConclusionFirst of all, whether the fibular fracture in the ankle fracture is stable or not should be determined. Whether it is treated surgically or not, the purpose is to restore the tibiofibular syndesmosis and restore the motor function of the ankle.
Objective To explore the choice of weight-bearing time and the clinical effect of different starting time of weight bearing after internal fixation of ankle fracture. Methods A total of 48 patients undergoing routine internal fixation for closed ankle fractures were selected. They were randomly divided into a tiral group and a control group, with 24 patients in each group. The patients in the tiral group started weight bearing one week after operation, while the ones in the control group did that four weeks after operation. The two groups were followed up for evaluation according to the modified Weber scale 2, 4, 8, and 12 weeks after operation, and the scale scores were presented as median (lower quartile, upper quartile). Results The fractures recovered well and no complications occurred. Two weeks after operation, the pain score [3.00 (2.00, 3.00) vs. 2.00 (1.00, 2.00)] and swelling score [3.00 (3.00, 4.00) vs. 2.00 (1.00, 2.00)] were significantly different between the trial group and the control group (P<0.05), but there was no significant difference in other indexes of the modified Weber scale between the two groups (P>0.05). Four weeks after operation, the swelling score was significantly different between the two groups [2.00 (2.00, 3.00) vs. 1.00 (0.00, 1.00), P<0.05], but there was no significant difference in other indexes of the modified Weber scale between the two groups (P>0.05). Eight and twelve weeks after operation, there was no significant difference in any of the modified Weber scale scores between the two groups (P>0.05). Conclusions It is feasible to start weight bearing one week after internal fixation of ankle fracture. Although swelling and pain will occur, it does not affect fracture healing or functional recovery.
ObjectiveTo evaluate the difference between using and not using syndesmotic screw to treat pronation external rotation (PER) ankle fracture combined with separation of distal tibiofibular syndesmosis. MethodsBetween April 2011 and October 2014, 46 cases of PER ankle fracture combined with separation of distal tibiofibular syndesmosis were treated, and syndesmotic screw was used in 24 cases (fixation group) and syndesmotic screw was not used in 22 cases (non-fixation group). There was no significant difference in gender, age, weight, cause of injury, side, injury to operation time, and fracture type between 2 groups (P > 0.05). The time for full weight-bearing, fracture healing time, and complications were recorded after operation. Anteroposterior and lateral X-ray films were taken to measure the tibiofibular overlap (TBOL) and tibiofibular clear space (TBCS). Baird-Jackson score was used to evaluate functional recovery of the ankle. ResultsAll incision healed by first intention without complications. The cases were followed up 13-18 months (mean, 15.2 months) in 2 groups. The time for full weight-bearing was 8-12 weeks (median, 11 weeks) in fixation group, which was significantly later than that in non-fixation group (range, 6-10 weeks; median, 8 weeks) (Z=-5.049, P=0.000). X-ray examination showed reduction of separation of distal tibiofibular syndesmosis. All fractures healed. The fracture healing time was (13.83±1.37) weeks in fixation group, and was (13.91±1.31) weeks in non-fixation group, showing no significant difference (t=-0.191, P=0.945). No separation of distal tibiofibular syndesmosis, delayed union, nonunion, loosening, or breakage of fixation devices was observed in 2 groups. There was no significant difference in TBOL, TBCS, Baird-Jackson score and the excellent and good rate between 2 groups (P > 0.05). ConclusionIf the medial, lateral, and posterior structures of the ankle could be repaired according to injury, no significant influence on functional outcome of ankle or radiologic findings could be detected whether syndesmotic fixation is given or not in treating PER ankle fracture (exclude Maisonneuve fracture) combined with separation of distal tibiofibular syndesmosis.
ObjectiveTo explore the clinical value of computer-assisted surgical planning in the treatment of ankle fractures. MethodsBetween January 2012 and January 2014, open reduction and internal fixation were performed on 42 patients with ankle fractures. There were 22 males and 20 females with an average age of 52 years (range, 19-72 years). The causes were spraining injury (20 cases), traffic accident injury (14 cases), and falling from height injury (8 cases). The time from injury to operation was 5 hours to 12 days (mean, 2.5 days). All fractures were closed trimalleolar fractures. According to Lauge-Hansen classification, 25 cases were rated as supination extorsion type IV, 13 as pronation extorsion type IV, and 4 as pronation abduction type Ⅲ. The preoperative planning was made by virtual reduction and internal fixation using Superimage software. ResultsThe mean operation time was 93.7 minutes (range, 76-120 minutes). Delayed wound healing occurred in 1 case, and secondary healing was obtained after treatment; primary healing of incision was achieved in the other patients. Postoperative X-ray films and CT images showed anatomic reduction of fracture and good position of internal fixation. All patients were followed up 14.6 months on average (range, 9-27 months). The range of motion of the affected ankle was close to the normal side at 6-8 weeks. The mean fracture healing time was 13.1 weeks (range, 11-17 weeks). Degenerative change of the ankle joint was observed in 3 cases (7.1%) with manifestation of mild narrowing of joint space on the X-ray films at last follow-up. According to Baird-Jackson score system, the results were excellent in 24 cases, good in 13 cases, and fair in 5 cases, with an excellent and good rate of 88%. ConclusionComputer-assisted surgical planning for ankle fractures can help surgeons identify type of ankle fractures and improve surgical scheme for guiding fracture reduction and selecting and placing implants, so good effectiveness can be obtained.
Objectives To systematically review the economic burden of surgical treatment for ankle fracture in China. Methods PubMed, EMbase, CNKI, WanFang Data and VIP databases were electronically searched to collect studies on economic burden of surgical treatment for ankle fracture in China from inception to December 1st, 2017. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Description analysis were then performed by Excel software. Results A total of 67 studies were included. The analysis showed that: the average cost of hospitalization generally tend to rise during 2004 to 2013. The highest was 17 700 yuan in 2013. After 2013, the expense gradually stabilized. The average annual growth rate of hospitalization costs was 12.3% during 2004 to 2016. The percentage of hospitalization costs accounted for the per capita disposable income of households in region was stable during 2004 to 2016 (around 60%). Conclusions Although the average hospitalization costs in China generally show an upward trend, the percentage of hospitalization costs accounted for the per capita disposable income of household is relatively stable. The study on the indirect economic burden is required to be further carried out. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo investigate the safety, feasibility, and efficacy of full repair strategy under small incision in the treatment of closed Lauge-Hansen pronation-external rotation type Ⅳ ankle fracture.MethodsThe clinical data of 57 patients with closed Lauge-Hansen pronation-external rotation type Ⅳ ankle fracture treated by full repair strategy (fracture, ligament, and cartilage repair) under small incision between January 2012 and January 2017 were retrospectively analyzed. There were 31 males and 26 females, with an average age of 41.1 years (range, 21-65 years). The causes of injury included traffic accident injury in 33 cases and falling injury in 24 cases. All of them were closed fractures, including 20 cases of medial malleolus fracture, 37 cases of complete medial malleolus but deep and shallow rupture of deltoid ligament. The average time from injury to admission was 9.6 hours (range, 3-34 hours). The quality of reduction of distal tibial articular surface (based on Ketz-Sanders standard), the reduction of tibiofibular syndesmosis (the anterior and posterior distances of distal tibiofibular syndesmosis and the lateral ankle twist angle measured by CT scan at 10 mm above the ankle joint line), and the fracture healing were evaluated. The medial clear space (MCS), tibiofibular clear space (TFCS), and distal fibular tip to lateral process of talus (DFTL) were measured on the X-ray films of ankle points. Before and after operation, the pain and functional improvement of ankle joint were evaluated by visual analogue scale (VAS) score and American Orthopedic Foot and Ankle Association (AOFAS) score, and the activities of ankle dorsiflexion and plantar flexion were measured.ResultsThree cases with osteochondral lesions of the talus were found during operation and all were treated with microfracture techniques. Tournament paralysis occurred in 2 cases after anesthesia. The surgical incisions healed by first intention in all patients. All the 57 patients were followed up 24-84 months, with an average of 38.6 months. All patients achieved bone healing without bone nonunion and malunion at 12 months after operation. The reduction quality of distal tibial articular surface was excellent in 56 cases and good in 1 case at 3 months after operation, the excellent and good rate was 100%. There was no significant difference in the MCS, TFCS, DFTL, anterior distance of distal tibiofibular syndesmosis, posterior distance of distal tibiofibular syndesmosis, and lateral ankle twist angle between the affected and healthy sides at 12 months after operation (P>0.05). At last follow-up, the VAS score, AOFAS score, ankle dorsiflexion and plantar flexion activities of the affected side were significantly improved when compared with preoperative ones (P<0.05). Compared with the healthy side, there was no significant difference in ankle dorsiflexion and plantar flexion activities (P>0.05).ConclusionFull-repair strategy under small incisions for the treatment of Lauge-Hansen pronation-external rotation type Ⅳ ankle fracture is effective and safe. It can not only reduce wound complications, but also improve the quality of joint reduction of the ankle joint and distal tibiofibular syndesmosis. Full repair of ligaments and cartilage can improve the internal fixation strength and joint stability of the ankle joint.