Negative prognostic factors in surgical treatment for trimalleolar fractures

Testa, Gianluca; Ganci, Marco; Amico, Mirko; Papotto, Giacomo; Giardina, Serena Maria Chiara; Sessa, Giuseppe; Pavone, Vito

doi:10.1007/s00590-019-02430-6

Cited by 20 publications

(34 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The average age of our cohort at time of injury was 77.8, which is similar to other cohorts [18,21]. According to our definition for a fragility fracture, only those over 60 years old were included; this itself was suggested to be a negative prognostic factor for surgical treatment of trimalleolar ankle fractures according to O&M score (p = 0.000002) and VAS score (p = 0.048) [31]. The average age of women and men in our cohort were 82.8 and 70.7, respectively; this was surprising given that women over 50 have a fourfold higher rate of osteoporosis than men [32].…”

Section: Patient Demographics and Surgical Managementsupporting

confidence: 61%

“…This could be due to biochemical relationships between insulin signalling and adipose tissue, including inhibition of intracellular lipase and increased triacylglycerol synthesis in liver [38]. Not only is average BMI in ankle fracture patients higher than age-matched controls [6], but a retrospective study of 48 patients suggested that morbidly obese patients (BMI ≥ 40) is a negative prognostic factor for ankle fracture management [31].…”

Section: Diabetes Mellitusmentioning

confidence: 99%

See 1 more Smart Citation

Ankle fusion with tibiotalocalcaneal retrograde nail for fragility ankle fractures: outcomes at a major trauma centre

Tennyson

Zhang

et al. 2021

Eur J Orthop Surg Traumatol

View full text Add to dashboard Cite

Purpose Fragility ankles fractures in the geriatric population are challenging to manage, due to fracture instability, soft tissue compromise, and patient co-morbidities. Traditional management options include open reduction internal fixation, or conservative treatment, both of which are fraught with high complication rates. We aimed to present functional outcomes of elderly patients with fragility ankle fractures treated with retrograde ankle fusion nails. Methods A retrospective observational study was performed on patients who underwent intramedullary nailing with a tibiotalocalcaneal nail. Twenty patients met the inclusion criteria of being over sixty and having multiple co-morbidities. Patient demographics, AO/OTA fracture classification, intra-operative and post-operative complications, time to mobilisation and union, AOFAS and Olerud-Molander scores, and patient mobility were recorded. Results There were seven males and thirteen females, with a mean age of 77.82 years old, five of whom are type 2 diabetics. Thirteen patients returned to their pre-operative mobility state, and the average Charlson Co-morbidity Index (CCI) was 5.05. Patients with a low CCI are more likely to return to pre-operative mobility status (p = 0.16; OR = 4.00). All patients achieved radiographical union, taking on average between 92.5 days and 144.6 days. The mean post-operative AOFAS and Olerud-Molander scores were 53.0 and 50.9, respectively. There were four cases of superficial infection, four cases of broken or loose distal locking screws. There were no deep infections, periprosthetic fractures, nail breakages, or non-unions. Conclusion Tibiotalocalcaneal nailing is an effective and safe option for managing unstable ankle fractures in the elderly. This technique leads to lower complication rates and earlier mobilisation than traditional fixation methods.

show abstract

Section: Patient Demographics and Surgical Managementsupporting

confidence: 61%

Section: Diabetes Mellitusmentioning

confidence: 99%

Ankle fusion with tibiotalocalcaneal retrograde nail for fragility ankle fractures: outcomes at a major trauma centre

Tennyson

Zhang

et al. 2021

Eur J Orthop Surg Traumatol

View full text Add to dashboard Cite

show abstract

“…In another study that examined poor results in trimalleolar fractures, advanced age, high ASA score, high BMI, and fractures with dislocation were observed to be factors for poor functional results. [16] Dislocation formed in ankle fractures suggests that the severity of the trauma continued and together with the dislocation, soft tissues are damaged more and there is an increased risk of cartilage injury. There are very few studies in the literature that have examined concomitant injuries in ankle fracture with dislocation.…”

Section: Discussionmentioning

confidence: 99%

Injury mechanisms of ankle fractures with dislocation and analysis of differences on functional outcome

Yaradılmış¹

2020

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

BACKGROUND:In the existing classifications, no importance is given to dislocations accompanying ankle fractures. The present study aims to investigate differences in injury mechanisms of ankle fractures with concomitant dislocation injury in respect of functional outcomes and complications. METHODS:A retrospective evaluation was carried out of 285 patients who underwent surgery in our clinic for an ankle fracture between January 2012 and December 2018. A comparison was made of functional scores and complications between the patients with ankle fracture with dislocation (AF-D group) and patients with ankle fracture without dislocation (AF-WD). The correlation of dislocation with current classifications (Lauge-Hansen and Danis-Weber) and the effects on functional outcomes were also evaluated. In addition to functional scores, a record was also made for each patient of infection during follow-up, soft-tissue defect, malalignment, non-union, arthrosis and Reflex Sympathetic Dystrophy Syndrome (RSD). RESULTS:The mean age of the patients was 44.7±12.04 years (range, 18-72 years) and the mean follow-up period was 3.2 years. Ankle fracture with dislocation was observed in 88 (30.8%). Similar functional results were determined in the AF-WD and AF-D groups with mean AOFAS 84.05±10.5, and 80.33±9.47, respectively (p=0.379), and mean VAS scores of 1±0.5 and 1.23±0.48, respectively (p=0.117). When the AOFAS values of the dislocation function results were evaluated according to the Lauge-Hansen and Danis-Weber subgroups, no significant difference was observed (p=0.562, 0.723). Arthrosis was seen in two of the AF-WD group and seven of the AF-D group (p=0.004). RSD was determined in two of the AF-WD group and in 10 of the AF-D group (p=0.000). From a medico-legal perspective, patients should be informed about arthrosis, and RSD is another significant problem encountered in this patient group. CONCLUSION:Although dislocation accompanying ankle fracture was not seen to worsen functional results, arthrosis and RSD were determined more often in these patients.

show abstract

“…1,2 In patients with diabetes or vascular disease the risk of complication is even greater, with surgical site infections and wound healing issues being common. 1,3,4 In comparison, intramedullary nail (IMN) fixation of the fibula for ankle fractures results in less wound complications, less implant removals, and similar union rates and functional outcomes. 5,6 Distal tibia pilon fractures, compared to ankle fractures, are at increased risk of wound complications secondary to their high-energy nature and at-risk soft tissue envelope.…”

Section: Introductionmentioning

confidence: 99%

Complications after fibula intramedullary nail fixation of pilon versus ankle fractures

Faber

Parry

Haidukewych

et al. 2021

Journal of Clinical Orthopaedics and Trauma

View full text Add to dashboard Cite

Background: Intramedullary nail (IMN) fixation of the fibula in malleolar ankle fractures has been shown to result in less wound complications then plate fixation. Therefore, IMN fibula fixation may also be associated with lower rates of wound complications when used for higher-risk pilon fractures. The purpose of this study was to compare complications of fibula IMN fixation in pilon versus malleolar ankle fractures. Methods: A retrospective cohort comparison was performed at an urban level one trauma center involving fibula fractures in 47 patients with AO/Orthopaedic Trauma Association (OTA) type 43 fractures and 48 patients with AO/OTA type 44 fractures being treated with fibula IMN fixation. Complications, fibula-specific complications, revision surgeries, and implant removals were reviewed. Results: There was no detectable difference in complications (27% vs. 23%, 95% confidence interval of the odds ratio (CIOR) 0.5 to 3.2), fibular-specific complications (6% vs. 10%, CIOR 0.1 to 3.5), revision surgeries (4% vs. 4%, CIOR 0.1 to 7.5), or symptomatic fibula implant removals (13% vs. 21%, CIOR 0.1 to 1.6) between pilon and ankle fracture groups, respectively. There was one (2%) fibular nonunion and one wound complication (2%) in each of the fracture groups. Conclusion: Fibula IMN fixation of pilon versus ankle fractures resulted in a similar number of complications. Comparative studies of fibula IMN and plate fixation are necessary to determine if the benefits of fibula IMN in ankle fractures extends to pilon fractures. Level of evidence: Level III, retrospective cohort.

show abstract

Negative prognostic factors in surgical treatment for trimalleolar fractures

Cited by 20 publications

References 26 publications

Ankle fusion with tibiotalocalcaneal retrograde nail for fragility ankle fractures: outcomes at a major trauma centre

Ankle fusion with tibiotalocalcaneal retrograde nail for fragility ankle fractures: outcomes at a major trauma centre

Injury mechanisms of ankle fractures with dislocation and analysis of differences on functional outcome

Complications after fibula intramedullary nail fixation of pilon versus ankle fractures

Contact Info

Product

Resources

About