ABSTRACT
The study aims to evaluate the clinical application of posterior tibial artery or peroneal artery perforator flap in the treatment of plate exposure after ankle fracture fixation. A posterior tibial artery or peroneal artery perforator flap was used on 16 patients with plate exposure after ankle fracture fixation in our hospital between July 2018 and July 2021. The time required to harvest the flap, the amount of intraoperative blood loss, the duration of postoperative drainage tube placement, the outcome of the flap and the healing observed at the donor site are reported. The sizes of the flaps were 2.5-7.0 cm × 5.0-18.0 cm and averaged 4.0 cm × 12.0 cm. The time required to harvest the posterior tibial artery or peroneal artery perforator flap ranged from 35 to 55 min and averaged 45 min. The amount of intraoperative blood loss ranged from 20 to 50 mL and averaged 35 mL. The duration of postoperative drainage tube placement ranged from 3 to 5 days and averaged 4 days. A total of 15 flaps survived and one flap had partial necrosis and survived after conservative treatment. All donor area defects were directly sewed and stitched without complications. There are multiple advantages of the posterior tibial artery or peroneal artery perforator flap, including simple preparation technique, reliable repair of the defects and without the need for performing microvascular anastomosis. It can be safely used in curing plate exposure after ankle fracture fixation and worth popularizing in grassroots hospitals.
ABSTRACT
Background: The purpose of this study was to determine the impact of surgeon volume on outcomes following ankle fracture fixation. Methods: Over 7 years, 362 patients who met inclusion criteria (>18 years with rotational ankle fractures) were identified and treated by orthopaedic surgeons at several hospitals within an academic medical center and were retrospectively reviewed. Surgeons that completed less than 24 ankle fixations per year (<90th percentile) during the study period were classified as low-volume (LV) and surgeons completing 24 or more ankle fixations per year (>90th percentile) were classified as high-volume (HV). Chart review was conducted to gather data regarding perioperative, radiographic, inpatient, and long-term outcome data (average 12-month follow-up). Results: One hundred thirty-four patients (37.0%) were treated by LV surgeons and 228 (63.0%) were treated by HV surgeons. Although both cohorts had a similar breakdown of fracture patterns (P = .638), the LV cohort had a greater incidence of open fractures (P = .024). No differences were found regarding wait time to surgery, surgery duration, and LOS. Radiographically, more patients in the HV cohort achieved anatomic mortise after surgery (96.5% vs 89.6%, P = .008). Patients in the LV cohort took longer to heal radiographically (4.27 ± 2.4 months vs 5.59 ± 2.9 months, P < .001), and also had higher rates of reoperation and hardware removal (P < .05). Lastly, all cost variables were lower for high-volume surgeons (P < .05). Conclusion: In this single-center study, we found that patients treated by LV surgeons took 30% longer to heal radiographically and had greater reoperation rates than those treated by HV surgeons. Additionally, patients treated by high-volume surgeons had more anatomic postoperative radiographic ankle mortise reductions and was less cost-effective than when performed by high-volume surgeons. Level of Evidence: Level III, retrospective comparative study.
ABSTRACT
PURPOSE OF REVIEW: Ankle fractures and diabetes mellitus are both increasing in prevalence. Patients with both diabetes and an ankle fracture have been shown to have an increased rate of complications which can be catastrophic. The purposes of this review are to identify factors placing patients at an increased risk and offer guidance on the management of these injuries, in order to reduce potential complications. RECENT FINDINGS: Non-operative management of unstable ankle fractures in patients with diabetes results in an unacceptably high rate of complications. Operatively managed patients with uncomplicated diabetes seem to fair as well as patients without diabetes. Thus, it is important to recognize patients as either complicated or uncomplicated at the onset of their treatment based on comorbidities. There is limited evidence to guide the management of ankle fractures in patients with diabetes, in particular those deemed complicated. Non-operative management of unstable fractures in diabetic patients should be avoided.
ABSTRACT
Impingement, tibial erosions, and "painful hardware" caused by a lag screw used for malleolar fracture stabilization are rare occurrences. We report a case of a symptomatic lag screw, used to fix a distal fibular fracture, that impinged on the distal tibial and causing symptoms. Awareness of the condition and early diagnosis based on thoughtful review of CT images are key to symptom alleviation. A review of the published data on the complication of "painful hardware" following ankle fracture fixation is also presented.