Operative Treatment of Nonunion Following Distal Fibula and Medial Malleolar Ankle Fractures

Khurana, Sonya; Karia, Raj; Egol, Kenneth A.

doi:10.1177/1071100712473740

Cited by 26 publications

(13 citation statements)

References 16 publications

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“…In situations where a determination could not be made, a CT scan was obtained to confirm union. 2,10,11,13 Intraoperative culture results and complications with wound infection identified during follow-up visits were recorded. Other follow-up complications, such as development of iliac crest graft site and surgical wound hematoma, wound dehiscence, wound breakdown, and malunion following revision, were also noted.…”

Section: Methodsmentioning

confidence: 99%

Older Age Does Not Affect Healing Time and Functional Outcomes After Fracture Nonunion Surgery

Taormina

Shulman

Karia

et al. 2014

Geriatr Orthop Surg Rehabil

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Introduction: Elderly patients are at risk of fracture nonunion, given the potential setting of osteopenia, poorer fracture biology, and comorbid medical conditions. Risk factors predicting fracture nonunion may compromise the success of fracture nonunion surgery. The purpose of this study was to investigate the effect of patient age on clinical and functional outcome following long bone fracture nonunion surgery. Materials and Methods: A retrospective analysis of prospectively collected data identified 288 patients (aged 18-91) who were indicated for long bone nonunion surgery. Two-hundred and seventy-two patients satisfied study inclusion criteria and analyses were performed comparing elderly patients aged !65 years (n ¼ 48) with patients <65 years (n ¼ 224) for postoperative wound complications, Short Musculoskeletal Functional Assessment (SMFA) functional status, healing, and surgical revision. Regression analyses were performed to look for associations between age, smoking status, and history of previous nonunion surgery with healing and functional outcome. Twelve-month follow-up was obtained on 91.5% (249 of 272) of patients. Results: Despite demographic differences in the aged population, including a predominance of medical comorbidities (P < .01) and osteopenia (P ¼ .02), there was no statistical differences in the healing rate of elderly patients (95.8% vs 95.1%, P ¼ .6) or time to union (6.2 + 4.1 months vs. 7.2 + 6.6, P ¼ .3). Rates of postoperative wound complications and surgical revision did not statistically differ. Elderly patients reported similar levels of function up to 12 months after surgery. Regression analyses failed to show any significant association between age and final union or time to union. There was a strong positive association between smoking and history of previous nonunion surgery with time to union. Age was associated (positively) with 12-month SMFA activity score. Conclusions: Smoking and failure of previous surgical intervention were associated with nonunion surgery outcomes. Patient's age at the time of surgery was not associated with achieving union. Advanced age was generally not associated with poorer nonunion surgery outcomes.

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Section: Methodsmentioning

confidence: 99%

Older Age Does Not Affect Healing Time and Functional Outcomes After Fracture Nonunion Surgery

Taormina

Shulman

Karia

et al. 2014

Geriatr Orthop Surg Rehabil

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“…Factors that can increase the risk of non-union include increased age, obesity and history of smoking, none of which apply to our patient [2][3][4]11]. The patient is young, active and healthy with no history of substance or tobacco use.…”

Section: Discussionmentioning

confidence: 99%

“…When they are reported in the literature, it is most commonly rotational fibular fractures [2][3][4]. Walsh and DiGiovanni discuss one case of a DWA non-union in their retrospective case review [2].…”

Section: Discussionmentioning

confidence: 99%

Danis-Weber a Non-Union in a Teenager: A Case Report and Review of Literature

Sundling¹

2017

MOJOR

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Case: This case focuses on the occurrence and treatment of a non-union of a Danis-Weber A fracture in a teenage girl. After 5 months of protected weight bearing and the diagnosis of a non-union, a bone stimulator was added to the treatment plan. Two months later without noted healing, the patient was taken to the operating room for open reduction internal fixation with both allograft and autograft.

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“…1,2 This problem has become even rarer with the advent of routine operative management with anatomical reduction and fixation. 3,4 Surgery is indicated for symptomatic nonunions causing significant pain, inflammation, and instability. 1,5 The most cited surgical technique involves screw fixation with bone substitutes.…”

Section: Introductionmentioning

confidence: 99%

Nonunion of Medial Malleolus Fracture: Tension Band Wiring is an Effective Option Even in Failed Surgeries

Kumar¹,

Tanna²

2019

Journal of Foot and Ankle Surgery (Asia Pacific)

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Nonunions of medial malleolus (MM) are a relatively rare entity, especially after previous surgical stabilization. These are routinely managed with compression screws and autografts. Usage of tension band wiring (TBW) is very common in acute MM fractures; however, its usefulness in nonunion scenarios has been sporadically reported. We treated a 7-year-old MM nonunion with TBW, which united well after 5 months of follow-up. We present this technique highlighting its critical steps and additionally review previous cases that were treated similarly with good outcomes.The surgery was done in supine position with the affected limb in 45-60° of flexion at the knee and the hip abducted and externally rotated, forming a figure of "4" position. Alternatively, surgery can be done in an ipsilateral lateral decubitus with the side to be operated at the bottom. The normal leg can be flexed at the knee to facilitate the intraoperative C-arm imaging. A small radiolucent sandbag or bolster can be placed underneath the ankle as per the surgeon's preference.

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Operative Treatment of Nonunion Following Distal Fibula and Medial Malleolar Ankle Fractures

Abstract: Level III, retrospective comparative series.

Cited by 26 publications

References 16 publications

Older Age Does Not Affect Healing Time and Functional Outcomes After Fracture Nonunion Surgery

Older Age Does Not Affect Healing Time and Functional Outcomes After Fracture Nonunion Surgery

Danis-Weber a Non-Union in a Teenager: A Case Report and Review of Literature

Nonunion of Medial Malleolus Fracture: Tension Band Wiring is an Effective Option Even in Failed Surgeries

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