Evaluation of the Deltoid Complex in Supination External Rotation Ankle Fractures

Motley, Travis A.; Carpenter, Brian; Clements, J. Randolph; Moxley, Dpm Kelly; Garrett, Allen

doi:10.3827/faoj.2010.0304.0001

Cited by 4 publications

(4 citation statements)

References 17 publications

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“…The best method for assessing deltoid ligament integrity remains unsolved (15). Medial tenderness, ecchymosis and swelling is by some seen as unreliable predictors of deltoid ligament injury (16)(17)(18). Magnetic resonance imaging (MRI) has been argued the best noninvasive method of evaluating the deltoid ligament, but has the disadvantage of high costs and often low availability (16,19).…”

Section: Discussionmentioning

confidence: 99%

“…Medial tenderness, ecchymosis and swelling is by some seen as unreliable predictors of deltoid ligament injury (16)(17)(18). Magnetic resonance imaging (MRI) has been argued the best noninvasive method of evaluating the deltoid ligament, but has the disadvantage of high costs and often low availability (16,19). A stress tests with measurement of the medial clear space is presented in some studies as the method of choice but in others as unreliable and associated with the risk of generating false positive results, exposing stable fractures to the risks of surgery (20)(21)(22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

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Fractures of the lateral malleolus – a retrospective before-and-after study of treatment and resource utilization following the implementation of a structured treatment algorithm

Rydberg

Skoglund

Brezicka

et al. 2022

BMC Musculoskelet Disord

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Background In 2015 a study of isolated lateral malleolar fractures (AO/OTA44-B1) treated at Sahlgrenska University hospital (SU) during two consecutive years revealed large-scale variation in the choice of treatment and planned follow-up. The study resulted in the development of a structured treatment algorithm (TA) for ankle fractures. We investigated the effects of this well-implemented TA on the classification, treatment and follow-up of lateral malleolar fractures. Methods The current study is an uncontrolled, non-randomized, retrospective before-and-after study comparing a group of AO/OTA44-B1 fractures treated at SU before the introduction of the TA for ankle fractures (1 April 2012 to 31 March 2014) with a group treated after the introduction of the TA (1 September 2017 to 31 August 2019). Results In all the studied parameters regarding treatment for AO/OTA44-B1 fractures, a statistically significant change was seen after the introduction of the TA. Surgical treatment reduced from 32% (95% CI 27.5 – 36.5) pre-TA to 10% (95% CI 6.9 – 13.1) post-TA, while the number of patients permitted full weight-bearing increased from 41% (95% CI 36.3 – 45.7) to 84% (95% CI 80.1 – 87.9). Conclusions A thoroughly implemented treatment algorithm can reduce the number of surgical treatments for stable ankle fractures. The current study demonstrates that a structured treatment algorithm can standardize the management of ankle fractures and make decisions less dependent on the surgeon’s discretion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Fractures of the lateral malleolus – a retrospective before-and-after study of treatment and resource utilization following the implementation of a structured treatment algorithm

Rydberg

Skoglund

Brezicka

et al. 2022

BMC Musculoskelet Disord

View full text Add to dashboard Cite

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“…There is an apparent difficulty in clinically determining whether or not a lateral malleolar fracture has an associated injury to the medial ligament. Clinical signs like medial tenderness, ecchymosis and swelling are commonly considered, as well as tests for stability like the external rotation test [17] or stress gravity radiographs [18]. Since this fact determines whether the fracture is a stable B1 fracture or an unstable B2 fracture, it affects both the treatment of choice and the reliability of the fracture classification.…”

Section: Discussionmentioning

confidence: 99%

Classification and treatment of lateral malleolar fractures - a single-center analysis of 439 ankle fractures using the Swedish Fracture Register

Rydberg

Zorko

Sundfeldt

et al. 2020

BMC Musculoskelet Disord

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Background: The decision regarding which trans syndesmotic ankle fractures to treat surgically and which to treat non-surgically is a matter of debate. The aim of this study was to describe the epidemiology of ankle fractures treated at Sahlgrenska University Hospital (SU) during a 2-year period and analyze the current diagnostic process, classification and choice of treatment for lateral malleolar fractures at the level of the syndesmosis. Methods: Observational data regarding all ankle fractures treated at SU between 1 April 2012 and 31 March 2014 was collected from the Swedish Fracture Register. For identified AO/OTA44-B1 fractures, medical records and radiographs were reviewed and analyzed. Results: The study included 1332 ankle fractures. 838 (63%) were B-fractures and 512 (38%) of these were B1 fractures. 439 of the patients with B1 fractures were included in the detailed study and of these 309 (70%) were treated non-surgically and 130 patients (30%) surgically. According to the preoperative physical examination described in the medical records, medial tenderness was found in 73 (24%) of the non-surgically treated patients. Among the surgically treated patients 18% (n = 24) were found to have no medial tenderness. For the nonsurgically treated patients with medial tenderness, the treatment plan was changed to surgical treatment after the 1-week radiographic follow-up in 1 patient (1%) and 1 patient (1%) was treated surgically after 3 months due to non-union. Conclusions: The current study demonstrates the difficulty involved in distinguishing whether or not a transsyndesmotic lateral malleolar fracture has an associated medial ligament injury or not. As this distinguishes if the fracture is stable or not it affects the choice of subsequent treatment. The results of the study also indicate a lack of consensus on how to classify and treat lateral malleolar fractures at the level of the syndesmosis. The study further suggests that there is no need to check non-surgically treated stable fractures with follow-up radiographic examination at 1 week.

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“…The tibiofibular overlap (TFO) was measured as the maximum amount of overlap on mortise view [24,25]. The medial clear space (MCS) was measured as the distance between the medial border of the talus and the lateral border of the medial malleolus on a line parallel and 5 mm below the talar dome [25,26]. All measurements were recorded to the nearest 0.1 mm (Fig.…”

Section: Imaging Methodologymentioning

confidence: 99%

Injury mechanism affects the stability of suture-button syndesmosis fixation

Chen

Huang

et al. 2020

J Orthop Surg Res

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Background Ankle syndesmosis injury is a common condition, and the injury mechanism can be sorted into pure syndesmosis injury, Weber-B, and Weber-C type fractures. This study aims to evaluate the treatment outcomes and stability of suture-button fixation for syndesmosis injury with different injury mechanisms. We hypothesized that injury mechanisms would alter the stability of suture-button fixation. Methods We retrospectively reviewed 63 patients with ankle syndesmosis injury who underwent surgery with TightRope (Arthrex, Naples, FL, USA) from April 2014 to February 2019. The stability of suture-button fixation with TightRope was evaluated by comparing the preoperative, postoperative, and final follow-up measurements of tibiofibular clear space (TFCS), tibiofibular overlap (TFO), and medial clear space (MCS). A subgroup analysis for each demographic group and injury type including pure syndesmosis injury, Weber-B, and Weber-C type fractures were performed. Results Syndesmosis was effectively reduced using TightRope. After the index surgery, the tibiofibular clear space was reduced from 7.73 to 4.04 mm, the tibiofibular overlap was increased from 3.05 to 6.44 mm, and the medial clear space was reduced from 8.12 to 3.54 mm. However, syndesmosis widening was noted at the final follow-up, especially in Weber-C type fractures (TFCS 3.82 to 4.45 mm, p < 0.01 and TFO 6.86 to 6.29 mm, p = 0.04). Though widened, the final follow-up values of tibiofibular clear space and tibiofibular overlap were in the acceptable range. Postoperatively and at the final follow-up, medial clear space was found to be significantly larger in the Weber-C group than in the pure syndesmosis and Weber-B groups (p < 0.05). Conclusions Suture-button fixation can offer anatomic reduction and dynamic fixation in syndesmosis injuries. However, when using this modality for Weber-C type fractures, more attention should be focused on the accuracy of reduction, especially of medial clear space, and rediastasis should be carefully monitored. Trial registration This trial was retrospectively approved by TMU-JIRB. Registration number N202004122, and the date of approval was May 06, 2020. Level of evidence III

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Evaluation of the Deltoid Complex in Supination External Rotation Ankle Fractures

Cited by 4 publications

References 17 publications

Fractures of the lateral malleolus – a retrospective before-and-after study of treatment and resource utilization following the implementation of a structured treatment algorithm

Fractures of the lateral malleolus – a retrospective before-and-after study of treatment and resource utilization following the implementation of a structured treatment algorithm

Classification and treatment of lateral malleolar fractures - a single-center analysis of 439 ankle fractures using the Swedish Fracture Register

Injury mechanism affects the stability of suture-button syndesmosis fixation

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