Principles and guidelines in the management of ankle fractures in adults

Kyriacou, Harry; Mostafa, Ahmed M H A M; Davies, Benjamin M; Khan, Wasim

doi:10.1177/1750458920969029

Cited by 18 publications

(22 citation statements)

References 38 publications

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“…The treatment of a fractured bone can be broadly divided into two categories: surgical and nonsurgical approaches, with the latter referring to fracture immobilization and stabilization. 1 Surgical reconstructive therapies for bone defects include the Ilizarov procedure, Masquelet technique, and autologous bone grafts. 2 Additional measures include applying growth factors (both osteoinductive and angiogenic).…”

Section: ■ Introductionmentioning

confidence: 99%

“…Bone fractures are one of the most common injuries to the musculoskeletal system. The treatment of a fractured bone can be broadly divided into two categories: surgical and non-surgical approaches, with the latter referring to fracture immobilization and stabilization . Surgical reconstructive therapies for bone defects include the Ilizarov procedure, Masquelet technique, and autologous bone grafts .…”

Section: Introductionmentioning

confidence: 99%

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Osteo-Immunomodulatory Role of Interleukin-4-Immobilized Plasma Immersion Ion Implantation Membranes for Bone Regeneration

Wei

Tan

et al. 2023

ACS Appl. Mater. Interfaces

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Barrier membranes for guided tissue regeneration are essential for bone repair and regeneration. The implanted membranes may trigger early inflammatory responses as a foreign material, which can affect the recruitment and differentiation of bone cells during tissue regeneration. The purpose of this study was to determine whether immobilizing interleukin 4 (IL4) on plasma immersion ion implantation (PIII)-activated surfaces may alter the osteo-immunoregulatory characteristics of the membranes and produce pro-osteogenic effects. In order to immobilize IL4, polycaprolactone surfaces were modified using the PIII technology. No discernible alterations were found between the morphology before and after PIII treatment or IL4 immobilization. IL4-immobilized PIII surfaces polarized macrophages to an M2 phenotype and mitigated inflammatory cytokine production under lipopolysaccharide stimulation. Interestingly, the co-culture of macrophages (on IL4-immobilized PIII surfaces) and bone marrow-derived mesenchymal stromal cells enhanced the production of angiogenic and osteogenic factors and triggered autophagy activation. Exosomes produced by PIII + IL4-stimulated macrophages were also found to play a role in osteoblast differentiation. In conclusion, the osteo-immunoregulatory properties of bone materials can be modified by PIII-assisted IL4 immobilization, creating a favorable osteoimmune milieu for bone regeneration.

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Section: ■ Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Osteo-Immunomodulatory Role of Interleukin-4-Immobilized Plasma Immersion Ion Implantation Membranes for Bone Regeneration

Wei

Tan

et al. 2023

ACS Appl. Mater. Interfaces

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“…Up to 25% of all ankle fractures require surgical care [ 2 ]. A decision to operate is usually based on fracture stability and the patient’s fitness for surgery [ 3 ]. Surgical repair of ankle fractures has been shown to be safe and effective, with low rates of 30-day reoperation (1.15%) and emergency room visits (4.39%) [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Incidence, costs and post-operative complications following ankle fracture – A US claims database analysis

Vanderkarr

Ruppenkamp

Parikh³

et al. 2022

BMC Musculoskelet Disord

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Background The epidemiology and payer costs for ankle fractures are not well documented. This study evaluated: (1) the incidence of ankle fracture and ankle surgery following fracture in the US population; and (2) the clinical presentation of patients presenting with ankle fractures requiring surgery, their complication rates, and payer costs. Methods Patients in the IBM® MarketScan® Commercial and Medicare Supplemental databases with an inpatient/outpatient diagnosis of ankle fracture from 2016 to 2019 were stratified by age group and gender, and rates of fracture per 10,000 enrollees were estimated. Surgically-treated patients between January 2016 – October 2021 were further analyzed. One-year post-surgical outcomes evaluated complication rates (e.g., infection, residual pain), reoperations, and 1-year payments. Standard descriptive statistics were calculated for all variables and outcomes. Generalized linear models were designed to estimate payments for surgical care and incremental payments associated with postoperative complications. Results Fracture cases affected 0.14% of the population; 23.4% of fractures required surgery. Pediatric and elderly patients were at increased risk. From 3 weeks to 12 months following index ankle surgery, 5.5% (5.3% - 5.7%) of commercially insured and 5.9% (5.1% - 6.8%) of Medicare patients required a new surgery. Infection was observed in 4.4% (4.2% - 4.6%) commercially insured and 9.8% (8.8% - 10.9%) Medicare patients, and residual pain 3 months post-surgery was observed in 29.5% (28.7% - 30.3%) commercially-insured and 39.3% (36.0% - 42.6%) Medicare patients. Commercial payments for index surgery ranged from $9,821 (95% CI: $9,697 - $9,945) in the ambulatory surgical center to $28,169 (95% CI: $27,780 - $28,559) in the hospital inpatient setting, and from $16,775 (95% CI: $16,668 - $16,882) in patients with closed fractures, to $41,206 (95% CI: $38,795 - $43,617) in patients with Gustilo III fractures. Incremental commercial payments for pain and infection averaged $5,200 (95% CI: $4,261 - $6,139) and $27,510 (95% CI: $21,759 - $33,261), respectively. Conclusion Ankle fracture has a high incidence and complication rate. Residual pain affects more than one-third of all patients. Ankle fracture thus presents a significant societal impact in terms of patient outcomes and payer burden.

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“…For these reasons, early surgical fixation is recommended for unstable fractures of the ankle [9]. Conventionally, these surgeries are planned using 2-dimensional (2D) imaging modalities, such as computed tomography (CT) and X-ray imaging [10].…”

Section: Introductionmentioning

confidence: 99%

Does using 3D printed models for pre-operative planning improve surgical outcomes of foot and ankle fracture fixation? A systematic review and meta-analysis

Wood

Ahmed

2022

Eur J Trauma Emerg Surg

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Purpose The systematic review aims to establish the value of using 3D printing-assisted pre-operative planning, compared to conventional planning, for the operative management of foot and ankle fractures. Methods The systematic review was performed according to PRISMA guidelines. Two authors performed searches on three electronic databases. Studies were included if they conformed to pre-established eligibility criteria. Primary outcome measures included intraoperative blood loss, operation duration, and fluoroscopy time. The American orthopaedic foot and ankle score (AOFAS) was used as a secondary outcome. Quality assessment was completed using the Cochrane RoB2 form and a meta-analysis was performed to assess heterogeneity. Results Five studies met the inclusion and exclusion criteria and were eventually included in the review. A meta-analysis established that using 3D printed models for pre-operative planning resulted in a significant reduction in operation duration (mean difference [MD] = − 23.52 min, 95% CI [− 39.31, − 7.74], p = 0.003), intraoperative blood loss (MD = − 30.59 mL, 95% CI [− 46.31, − 14.87], p = 0.0001), and number of times fluoroscopy was used (MD = − 3.20 times, 95% CI [− 4.69, − 1.72], p < 0.0001). Using 3D printed models also significantly increased AOFAS score results (MD = 2.24, 95% CI [0.69, 3.78], p = 0.005), demonstrating improved ankle health. Conclusion The systematic review provides promising evidence that 3D printing-assisted surgery significantly improves treatment for foot and ankle fractures in terms of operation duration, intraoperative blood loss, number of times fluoroscopy was used intraoperatively, and improved overall ankle health as measured by the AOFAS score.

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Principles and guidelines in the management of ankle fractures in adults

Cited by 18 publications

References 38 publications

Osteo-Immunomodulatory Role of Interleukin-4-Immobilized Plasma Immersion Ion Implantation Membranes for Bone Regeneration

Osteo-Immunomodulatory Role of Interleukin-4-Immobilized Plasma Immersion Ion Implantation Membranes for Bone Regeneration

Incidence, costs and post-operative complications following ankle fracture – A US claims database analysis

Does using 3D printed models for pre-operative planning improve surgical outcomes of foot and ankle fracture fixation? A systematic review and meta-analysis

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