An evolution in the management of fractures of the ankle

Bali, N; Aktselis, Ioannis; Ramasamy, Arul; Mitchell, Stephen Α.; Fenton, Paul

doi:10.1302/0301-620x.99b11.bjj-2017-0558.r1

Cited by 37 publications

(9 citation statements)

References 25 publications

(25 reference statements)

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“…The preoperative CT imaging is helpful in determining the optimal surgical approach. The posterolateral and posteromedial approaches have both been reported to be safe in terms of both wound management and radiographic follow-up 22,23 . Our experience is that the direct approach to the posterior malleolar fracture should be performed where possible, rather than the indirect approach and anterior-to-posterior fixation.…”

Section: Discussionmentioning

confidence: 99%

Posterior Malleolar Ankle Fractures

Mason

Kaye

Widnall

et al. 2019

JBJS OA

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Background: There is increasing acceptance that the clinical outcomes following posterior malleolar fractures are less than satisfactory. We report our results of posterior malleolar fracture management based on the classification by Mason and Molloy. Methods: All fractures were classified on the basis of computed tomographic (CT) scans obtained preoperatively. This dictated the treatment algorithm. Type-1 fractures underwent syndesmotic fixation. Type-2A fractures underwent open reduction and internal fixation through a posterolateral incision, type-2B fractures underwent open reduction and internal fixation through either a posteromedial incision or a combination of a posterolateral with a medial-posteromedial incision, and type-3 fractures underwent open reduction and internal fixation through a posteromedial incision. Results: Patient-related outcome measures were obtained in 50 patients with at least 1-year follow-up. According to the Mason and Molloy classification, there were 17 type-1 fractures, 12 type-2A fractures, 10 type-2B fractures, and 11 type-3 fractures. The mean Olerud-Molander Ankle Score was 75.9 points (95% confidence interval [CI], 66.4 to 85.3 points) for patients with type-1 fractures, 75.0 points (95% CI, 61.5 to 88.5 points) for patients with type-2A fractures, 74.0 points (95% CI, 64.2 to 83.8 points) for patients with type-2B fractures, and 70.5 points (95% CI, 59.0 to 81.9 points) for patients with type-3 fractures. Conclusions: We have been able to demonstrate an improvement in the Olerud-Molander Ankle Score for all posterior malleolar fractures with the treatment algorithm applied using the Mason and Molloy classification. Mason classification type-3 fractures have marginally poorer outcomes, which correlates with a more severe injury; however, this did not reach significance. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Posterior Malleolar Ankle Fractures

Mason

Kaye

Widnall

et al. 2019

JBJS OA

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“…[ 16 ] In addition, the incision for the mPM approach is placed at the midpoint between the angiosomes of the posterior and anterior tibial arteries, which helps to minimize environmental soft tissue damage. [ 17 ] Minimally invasive plate osteosynthesis using the PL and mPM approaches has been developed through cadaveric studies and preliminary clinical cases; further studies to validate these techniques are essential. [ 18 , 19 ]…”

Section: Discussionmentioning

confidence: 99%

Comparison of four posterior approaches of the ankle: A cadaveric study

Mitsuzawa¹,

Takeuchi²,

Maki³

et al. 2020

OTA International: The Open Access Journal of Orthopaedic Trauma

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Objectives: The purpose of this study is to provide a detailed comparison of 4 posterior approaches of the ankle: the posteromedial, modified posteromedial (mPM), Achilles tendon-splitting (TS), and posterolateral approaches. Methods: Cadaveric dissections were performed to assess the influence of the medial and lateral retraction forces on the neuro-vascular bundle with suspension scales and to measure the medial and lateral exposed areas of the posterior tibia and talus. Data was acquired with the ankle in neutral position and in plantar flexion. Results: Both the mPM and TS approaches provided excellent visualization of the posterior tibia with the ankle in plantar flexion (16.6 cm 2 and 16.2 cm 2 , respectively). The medial aspect of the posterior tibia, however, was significantly better exposed in the mPM approach than in the TS approach with the ankle in neutral position (8.9 cm 2 vs 6.5 cm 2 ). The lower value for medial retraction force in the mPM approach (1.9 N in neutral position and 0.9 N in plantar flexion) indicated a lower risk of injury to the neuro-vascular bundle (the tibial nerve and the posterior tibial artery). The posterior talus, however, is best visualized through the TS approach with the ankle in neutral position (4.5 cm 2 ). Conclusions: The current study demonstrated the usefulness of the mPM approach. When internal fixation of the fibula is unnecessary, the mPM approach is preferable, considering the potential damage to the Achilles tendon associated with the TS approach.

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“…10 Injury to the PM has a great impact on the prognosis of ankle fractures because it plays a significant role in the syndesmosis and the overall stability of the ankle joint. 2,3,25 For surgical treatment of the PM, open reduction and internal fixation (ORIF) with either screws or plate osteosynthesis is the most common treatment. 20 However, open procedures may further compromise the fragile soft tissue envelope of the ankle, with wound complications noted in 11% to 30% of patients.…”

Section: Introductionmentioning

confidence: 99%

“…10 Injury to the PM has a great impact on the prognosis of ankle fractures because it plays a significant role in the syndesmosis and the overall stability of the ankle joint. 2,3,25…”

Section: Introductionmentioning

confidence: 99%

Trimalleolar Fractures Treated by Open Reduction Internal Fixation Compared With Arthroscopically Assisted Reduction and Minimally Invasive Surgery

et al. 2023

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Background: Currently, the standard of treatment for trimalleolar (TM) fracture is osteosynthesis through open reduction and internal fixation (ORIF). This study assessed whether arthroscopically assisted reduction and minimally invasive surgery (AARMIS) can be an alternative surgical method for TM fractures. Methods: This retrospective cohort study included 49 patients with TM that were surgically treated. 27 patients received ORIF and 22 patients underwent AARMIS . At baseline, we recorded the patient’s demographic features, fracture pattern (AO-OTA and Haraguchi classification), and surgical method. For postoperative results, we examined the patient’s radiographic outcome, including time to union, quality of fracture reduction, as well as functional outcomes (American Orthopaedic Foot & Ankle Society ankle hindfoot score, ankle range of motion, and visual analog scale of pain) and perioperative complications. Results: At mean follow-up of 46.6[Formula: see text] (ORIF) and 36.4[Formula: see text] months (AARMIS), both groups had comparable radiographic outcomes. No significant difference in rates of early ankle OA were detected. In terms of functional outcome, VAS pain and AOFAS score at postoperative day 3, postoperative month 3, and at final follow-up were not different. In terms of range of motion, we did not find a significant difference in mean range of motion. Conclusion: Patients with TM fractures treated with AARMIS achieved satisfactory results and was not significantly different in radiographic and functional performance compared with ORIF. Level of Evidence: Level III, retrospective cohort study.

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An evolution in the management of fractures of the ankle

Cited by 37 publications

References 25 publications

Posterior Malleolar Ankle Fractures

Posterior Malleolar Ankle Fractures

Comparison of four posterior approaches of the ankle: A cadaveric study

Trimalleolar Fractures Treated by Open Reduction Internal Fixation Compared With Arthroscopically Assisted Reduction and Minimally Invasive Surgery

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