[Lateral malleolar fractures : when to operate ?] / Fractures isolées de la malléole externe : quand opérer.

Ankle fractures account for 10 % of all fractures in adults. The incidence of ankle fractures is rising, particularly as the population ages. Two thirds are isolated malleolar fractures. The most used classifications are anatomical, Weber's and Lauge-Hansen's classifications. The treatment of lateral malleolar fractures may be conservative or surgical, depending on the ankle stability. To test this, a weight-bearing X-ray is required. If this is not possible on the day of trauma, it can be done 7 days later. Conservative treatment consists of a six-week immobilization in a splint or plaster cast, with weight-bearing as tolerated. Surgical treatment is mandatory for unstable fractures.

Les fractures de la cheville représentent 10 % des fractures chez les adultes. Leur incidence est en augmentation, notamment en raison du vieillissement de la population. Les fractures malléolaires isolées en constituent les deux tiers. Les classifications les plus souvent utilisées sont celles anatomiques de Weber et de Lauge-Hansen. Le traitement des fractures de la malléole externe peut être conservateur ou chirurgical, selon la stabilité de la cheville. Pour tester la stabilité, une radiographie en charge est nécessaire. Si ce n'est pas possible le jour de traumatisme, un contrôle à 7 jours peut être organisé. Le traitement conservateur consiste en une immobilisation dans une attelle ou un plâtre en charge totale en fonction des douleurs pour six semaines. Le traitement chirurgical est réservé aux fractures instables.

Biomechanical Effects of Hindfoot Alignment in Supination External Rotation Malleolar Fractures: A Human Cadaveric Model.

BACKGROUND: Pressure distribution in the ankle joint is known to be dependent on various factors, including hindfoot alignment. We seek to evaluate how hindfoot alignment affects contact pressures in the ankle joint in the setting of supination external rotation (SER) type ankle fractures. METHODS: SER fractures were created in 10 human cadaver lower extremity specimens, simulating progressive stages of injury: without fracture (step 0), SER fracture and intact deltoid ligament (step 1), superficial deltoid ligament disruption (step 2), and deep deltoid ligament disruption (step 3). At each step, varus and valgus alignment was simulated by displacing the calcaneal tuberosity 7 mm medial or lateral. Each limb was axially loaded following each osteotomy at a static load of 350 N. The center of force (COF), contact area (CA), and peak contact pressure (PP) under load were measured, and radiographs of the ankle mortise were taken to analyze the medial clear space (MCS) and talar tilt (TT). RESULTS: The COF (5.3 mm, P = .030) and the CA (-188.4 mm2, P = .015) changed in step 3 in the valgus hindfoot alignment compared to baseline parameters, indicating the importance of deep deltoid ligament integrity in maintaining normal ankle joint contact stress in the valgus hindfoot. These changes were not seen in the setting of varus alignment (COF: 2.3 mm, P = .059; CA -121 mm2, P = .133). PP were found to not change significantly in either varus or valgus (varus: -4.9 N, P = .132; valgus: -4 N, P = .464).The MCS demonstrated widening in step 3 compared to step 2 (0.7 mm, P = .020) in both varus and valgus hindfoot. The TT increased significantly in step 3 in the valgus hindfoot (2.8 degrees, P = .020) compared to step 0. CONCLUSION: SER-IV fractures with valgus hindfoot alignment showed significant changes in pressure distribution and radiographic parameters when compared to SER-IV fractures with varus hindfoot alignment. CLINICAL RELEVANCE: Based on this cadaver modeling study, patients with SERIV fracture with varus hindfoot alignment and complete deltoid ligament lesion may not need fracture fixation, whereas those with valgus hindfoot alignment likely need fracture fixation.

[Postoperative compressive neuropathies after orthopedic surgeries]. / Neuropathies périphériques dues au positionnement opératoire en chirurgie orthopédique.

Peripheral neuropathies after orthopedic surgery are a rare complication (0.14 % on average) but with a significant impact on quality of life that requires close monitoring and physiotherapy sessions. Surgical positioning is a preventable cause responsible for about 20-30 % of the observed neuropathies. Orthopedic surgery is one of the most affected areas because of the positions maintained for long periods of time that are particularly at risk of compression or nerve stretching. The objective of this article is to list, through a narrative review of the literature, the most frequently affected nerves, the clinical presentation as well as the risk factors, and to draw general practitioner's attention to this issue.

Les neuropathies périphériques après une intervention chirurgicale orthopédique sont une complication rare (0,14 % en moyenne) mais avec un impact important sur la qualité de vie, et nécessitent un suivi rapproché et des séances de physiothérapie. Parmi les causes évitables, le positionnement opératoire est responsable d'environ 20 à 30 % des neuropathies observées. La chirurgie orthopédique représente l'un des secteurs les plus touchés en raison des positions à risque de compression ou d'étirement nerveux maintenues pendant de longues durées. L'objectif de cet article est de présenter, par une revue narrative de la littérature, les nerfs les plus fréquemment touchés, le tableau clinique ainsi que les facteurs de risques associés, afin de sensibiliser le médecin de premier recours à cette problématique.