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2.
Unfallchirurg ; 123(1): 43-56, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31965280

RESUMO

Ankle fractures and associated ligamentous injuries are the most common injuries of a load-bearing joint. There is still no general consensus with respect to the pathomechanism, the treatment indications and surgical techniques. The medium and long-term results are affected by a particularly high risk of posttraumatic arthritis in bimalleolar and trimalleolar fractures and fracture dislocations. There is consensus on the necessity of a thorough preoperative analysis and postoperative control of reduction for which 3D imaging is increasingly generously employed. This detects relevant pathologies, such as bony syndesmotic avulsion and partial impaction of the tibial plafond that may go unnoticed on plain radiographs. Anatomic reconstruction of the ankle mortise, the detection and treatment of syndesmotic instability, reconstruction of the tibial notch and exact placement of the distal fibula into the latter are important prognostic factors.


Assuntos
Fraturas do Tornozelo , Traumatismos do Tornozelo , Instabilidade Articular , Fraturas do Tornozelo/terapia , Traumatismos do Tornozelo/terapia , Articulação do Tornozelo , Fíbula , Humanos
4.
Zhongguo Gu Shang ; 32(11): 1014-1020, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31870049

RESUMO

OBJECTIVE: To compare clinical effect of modified anterolateral approach combined with modified posteromedial approach and conventional posterolateral approach combined with medial-aided in treating trimalleolar fractures. METHODS: From January 2015 to August 2017, 108 patients with trimalleolar fractures were enrolled and randomly divided into modified approaches (experimental group) and conventional approaches(control group). There were 53 patients in experimental group including 31 males and 22 females aged from 18 to 67 years old with an average of(40.2±16.4) years old; 19 patients on the left side and 34 patients on the right side; 39 patients were supination external rotation and 14 patients were pronation-external rotation; preoperative waiting time ranged from 6 to 14 d with an average of(9.6±3.1) d; performed operation through modified anterolateral approach combined with modified posteromedial approach. There were 55 patients in control group, including 34 males and 21 females aged from 19 to 69 years old with an average of (42.1±15.3) years old; 18 patients on the left side and 37 patients on the right side; 42 patients were supination external rotation and 13 patients were pronation-external rotation; preoperative waiting time ranged from 7 to 16 d with an average of (10.3±3.4) d; performed operation through conventional posterolateral approach combined with medial-aided. Operation time, intraoperative blood loss, postoperative drainage volume, cases of incision complications and excellent-good reduction, fracture healing time, cases of nerve injury and muscular flexor contracture, cases of incision complications between two groups were compared; AOFAS score were used to evaluate clinical efficacy at 1 year after operation. RESULTS: All patients were followed up from 12 to 24 months with an average of (16.4 ±7.5) months. Operation time, intraoperative blood loss, postoperative drainage volume and incision complication in experimental group were (95.3±22.6) min, (114.7±68.7) ml, (127.5±87.8) ml and 1 case, respectively; while in control group were (112.5±53.8) min, (155.2±79.6) ml, (178.4±73.8) ml and 3 cases respectively; the data in experimental group were better than that of control group. In experimental group, 36 cases got excellent results, 14 good and 3 poor on the quality of reduction, while 30 patients got excellent results, 15 good and 10 poor in control group; the experimental group was better than control group. Fracture healing time in experimental group were(5.5±1.6) months, 2 patients occurred incision complications, while(6.7±2.1) months, 12 patients in control group; the experiment group were better than control group. Postoperative AOFAS score at 12 months in experimental group was 92.9±18.4, and better than control group 80.3±38.3; 32 patients got excellent results, 17 good, 3 moderate and 1 poor in experimental group; 25 patients got excellent results, 18 good, 8 moderate and 4 poor in control group; there was statistical difference between two groups. CONCLUSIONS: Both of modified anterolateral approach combined with modified posteromedial approach and conventional posterolateral approach combined with medial-aided in treating trimalleolar fractures could receive good clinical effect. While compared with conventional posterolateral approach combined with medial-aided, modified anterolateral approach combined with modified posteromedial approach is more fit for blood supply of local soft tissue, and has advantages of less trauma, safety operation and clearly exposure.


Assuntos
Fraturas do Tornozelo , Adolescente , Adulto , Idoso , Fraturas do Tornozelo/terapia , Estudos de Casos e Controles , Feminino , Fixação Interna de Fraturas , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Supinação , Resultado do Tratamento , Adulto Jovem
5.
J Bone Joint Surg Am ; 101(19): 1768-1774, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31577682

RESUMO

BACKGROUND: As orthopaedic surgery moves toward bundled payments, there is growing interest in identifying patients at high risk of early postoperative adverse events. The purpose of this study was to develop and validate a risk-stratification system for the occurrence of early adverse events among patients treated with open reduction and internal fixation (ORIF) for a closed fracture of the ankle. METHODS: Patients undergoing ORIF for a closed ankle fracture during the period of 2006 to 2017, as documented by the American College of Surgeons National Surgical Quality Improvement Program, were identified. For the 60% of patients randomly selected as the development cohort, multivariate Cox proportional hazards modeling was used to identify factors that were independently associated with the occurrence of adverse events (including events such as reoperation, surgical site infection, and pulmonary embolism). On the basis of these results, a nomogram analysis was used to generate a point-based risk-stratification system. To evaluate the validity of the point-based system, the system was applied to the remaining 40% of patients constituting the validation cohort and tested for its ability to predict adverse events. RESULTS: Of the 7,582 patients in the development cohort, 455 developed an adverse event (estimated adverse event risk of 6%). On the basis of Cox proportional-hazards regression, patients were assigned points for each of the following significant risk factors: +1 point for age of 40 to 59 years, +3 points for age of 60 to 79 years, +5 points for age of ≥80 years, +1 point for female sex, +2 points for chronic obstructive pulmonary disease (COPD), +2 points for insulin-dependent diabetes, +3 points for anemia, and +4 points for end-stage renal disease. The validation cohort included 5,263 patients. Among this second cohort, the risk-stratification system predicted the risk of early adverse events (p < 0.001; Harrell C = 0.697). CONCLUSIONS: The occurrence of early adverse events following ORIF for closed ankle fractures was associated with greater age, female sex, COPD, insulin-dependent diabetes, anemia, and end-stage renal disease. We present and validate a simple point-based risk-stratification system to predict the risk of early adverse events. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Fraturas do Tornozelo/terapia , Fixação Interna de Fraturas/métodos , Redução Aberta/métodos , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Anemia/complicações , Fraturas do Tornozelo/complicações , Diabetes Mellitus Tipo 1/complicações , Feminino , Humanos , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/complicações , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais
6.
Unfallchirurg ; 122(12): 992-996, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31578602

RESUMO

A luxation fracture of the ankle characterized by a dislocation of the fibula posterior to the tibial tubercle is defined as a Bosworth injury. The Bosworth fracture is a frequently overlooked complex injury of the ankle joint. Associated injuries such as a pilon fracture and posterior malleolus fracture have rarely been reported. In the case of a closed irreducible ankle fracture dislocation, Bosworth injuries should be considered as a potential cause. This article reports the course, treatment and clinical outcome 12 months after trauma of a Bosworth fracture with associated impaction of the posteromedial pilon and fracture of the posterior malleolus. To date, there are only few reports of comparable injuries in the German language literature.


Assuntos
Fraturas do Tornozelo , Luxações Articulares , Tornozelo , Fraturas do Tornozelo/diagnóstico , Fraturas do Tornozelo/terapia , Articulação do Tornozelo , Fíbula , Fixação Interna de Fraturas , Humanos , Luxações Articulares/diagnóstico , Luxações Articulares/terapia
7.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(11): 1351-1357, 2019 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-31650747

RESUMO

Objective: To investigate the safety and effectiveness of anatomical approach osteoligaments repair technique in treatment of pronation ankle fractures. Methods: The clinical data of 53 patients with pronation ankle fractures between April 2015 and October 2016, who were treated with anatomical approach osteoligaments repair technique applied for fracture reduction and internal fixation, were analysed retrospectively. There were 35 males and 18 females with an average age of 33.1 years (range, 18-60 years). The cause of injury included traffic accidents in 27 cases, tumbling in 5 cases, fall from height in 4 cases, twisted injury in 6 cases, sports injuries in 4 cases, and bruises in 7 cases. According to Lauge-Hansen classification, there were 44 cases of pronation external rotation stage Ⅳ and 9 cases of pronation abduction stage Ⅲ. The interval between injury and operation was 4-10 days (mean, 7 days). Postoperative pain and function of ankles were assessed by American Orthopedic Foot and Ankle Score (AOFAS) and visual analogue pain scale (VAS) score. The medial clear space (MCS), tibiofibular clear space (TFCS), distal fibular tip to lateral process of talus (DFTL), the anterior and posterior tibiofibular syndesmosis distance, and the lateral malleolus twist angle were measured by X-ray films and CT of bilateral ankle joints. Results: The tourniquet application time was 55-90 minutes (mean, 72.5 minutes); the frequency of fluoroscopy was 5-13 times (mean, 8.9 times). All incisions healed by first intention and no infection, deep vein thrombosis occurred after operation. All patients were followed up 28-48 months (mean, 36 months). There was no significant difference in postoperative MCS, TFCS, DFTL, the anterior and posterior tibiofibular syndesmosis distance, and the lateral malleolus twist angle between bilateral ankle joints ( P>0.05). At last follow-up, no ankle instability occurred and the degenerative changes of ankle joints (Kellgren-Lawrence grading Ⅱ) occurred in 5 cases. The average AOFAS score of the ankle joint was 90.84 (range, 85-95); mean VAS score was 1.23 (range, 0-5). The average dorsiflexion and plantar flexion of ankle joints was 20.24° (range, 15-25°) and 42.56° (range, 30-50°), respectively. Conclusion: Anatomical approach osteoligaments repair technique in treatment of pronation ankle fractures can expose the talocrural joint and lower tibiofibular syndesmosis clearly, repair the osteoligaments injury directly, and assist the syndesmosis and talocrural joint reduction, and decline the incidence of ankle degeneration.


Assuntos
Fraturas do Tornozelo/terapia , Adolescente , Adulto , Traumatismos do Tornozelo , Articulação do Tornozelo , Feminino , Fixação Interna de Fraturas , Fraturas Ósseas , Humanos , Masculino , Pessoa de Meia-Idade , Pronação , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
8.
J Foot Ankle Surg ; 58(5): 933-937, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474404

RESUMO

Nine percent of all fractures affect the ankle, with an annual incidence of 122/100,000 in Edinburgh, UK. While unstable fractures are usually treated surgically, there has been no recent systematic review of the evidence supporting this decision. In this systematic review, relevant electronic databases (such as MEDLINE and CINHAL) were searched from inception to February 2017. Five randomized controlled trials that examined surgical versus conservative interventions in 951 adults with closed ankle fractures, with follow-up for at least 6 months, were selected for further synthesis of evidence. The risk of selection bias in all selected trials was relatively low. However, most of the trials had a high risk of performance and detection bias. Three of the 5 selected trials used the validated functional Olerud Molander Ankle Score. One trial (n = 43), reported a statistically better score for the surgical group at 27-month follow-up, whereas a second (n = 81) and a third (n = 620) trial found no significant difference at 12 and 6 months, respectively. No significant differences between surgical and conservative treatments were reported in 2 trials (n = 111) and (n = 96) in nonvalidated functional outcome measures. Other outcomes were malunion (9/334 [2.6%] versus 48/301 [15.9%], p < .0001) and nonunion (3/408 [0.7%] versus 28/383 [7.3%], p < .0001) and were considerably higher in the conservatively treated group. Early treatment failure was significantly lower with surgery (7/435 [1.6%] versus 70/419 [16.7%], p < .0001). The risk of malunion, nonunion, and loss of reduction were greater in nonoperative care. However, the 2 treatment approaches provided equivalent functional outcomes.


Assuntos
Fraturas do Tornozelo/terapia , Tratamento Conservador , Fixação de Fratura , Humanos
9.
Emerg Nurse ; 27(5): 23-30, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31475502

RESUMO

AIM: Stable ankle injuries are highly prevalent in the UK. Prevention of complications and reoccurrence is essential. The literature shows that plaster of Paris and AirLoc brace are clinically effective treatments for such injuries. However, there is no research measuring patients' satisfaction with these treatments. This study compared options in the treatment of severe ankle sprains and distal fibular avulsion fractures from patients' perspectives. The aim was to determine patients' preferred treatment between below knee plaster cast and AirLoc brace in the management of stable ankle injuries. METHOD: A total of 39 patients who presented at an urban hospital with stable ankle injuries were recruited into a randomised controlled trial. Patient satisfaction levels were measured by questionnaire one week into treatment. The null hypothesis was 'there is no significant difference in satisfaction levels between the two devices'. FINDINGS: There were statistically significant higher patient satisfaction levels in the AirLoc group compared to the plaster cast group. After analysis by the unrelated t -test, the null hypothesis was rejected. Comfort, daily activities, sleep, work and social life were the main contributing factors. Additionally, 67% of the AirLoc group compared to 46% of the plaster cast group were able to return to work. The number needed to treat for one additional AirLoc patient to return to work was 4.8 (five patients). CONCLUSION: Patients' preferred treatment is the AirLoc brace. The inquiry method could be used to provide patient-centred care in other fields.


Assuntos
Fraturas do Tornozelo/terapia , Traumatismos do Tornozelo/terapia , Entorses e Distensões/terapia , Atividades Cotidianas , Adolescente , Adulto , Braquetes , Moldes Cirúrgicos , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Inquéritos e Questionários , Reino Unido
11.
BMC Musculoskelet Disord ; 20(1): 388, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455297

RESUMO

BACKGROUND: Ankle fractures cause considerable pain, loss of function and healthcare resource use. High quality randomised controlled trials are required to evaluate the optimal management protocols for ankle fracture. However, there is debate regarding the most appropriate outcome measure to use when assessing patients with ankle fractures. The aim of this systematic review is to identify and summarise primary outcome measure use in clinical trials of non-pharmacological interventions for adults with an ankle fracture. METHODS: We performed comprehensive searches of the Medline, Embase, CINAHL, AMED and Cochrane CENTRAL databases, as well as ISRCTN and ClinicalTrials.gov online clinical trial registries on 19/06/2019 with no date limits applied. The titles and abstracts were initially screened to identify randomised or quasi-randomised clinical trials of non-pharmacological interventions for ankle fracture in adults. Two authors independently screened the full text of any articles which could potentially be eligible. Descriptive statistics we used to summarise the outcome measures collected in these articles including an assessment of trends over time. Secondary analysis included a descriptive summary of the multi-item patient reported outcome measures used in this study type. RESULTS: The searches returned a total of 3380 records. Following application of the eligibility criteria, 121 records were eligible for inclusion in this review. The most frequently collected primary outcome measures in this type of publication was the Olerud Molander Ankle Score, followed by radiographic and range of movement assessments. There was a total of 28 different outcome measures collected and five different multi-item, patient reported outcome measures collected as the primary outcome measure. There was a sequential increase in the number of this type of study published per decade since the 1980's. CONCLUSION: This review demonstrates the wide range of measurement methods used to assess outcome in adults with an ankle fracture. Future research should focus on establishing the validity and reliability of the outcome measures used in this patient population. Formulation of a consensus based core outcome set for adults with an ankle fracture would be advantageous for ensuring homogeneity across studies in order to meta-analyse trial results.


Assuntos
Fraturas do Tornozelo/terapia , /métodos , Adulto , Consenso , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Reprodutibilidade dos Testes
12.
Arch Orthop Trauma Surg ; 139(10): 1399-1405, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31203381

RESUMO

INTRODUCTION: The use of evaporative coolants in the management of acute musculoskeletal injury has received increasing attention recently. However, its efficacy compared with conventional cryotherapy in treating injured human subjects remains unclear. The purpose of this study is to compare the efficacy of evaporative coolants with that of ice packs in preoperative management of edema and pain in patients with an ankle fracture. MATERIAL AND METHODS: Sixty-three patients in need of surgical treatment for ankle fracture were randomly assigned to either an evaporative coolant group or an ice pack group. Both treatments were applied for 5 days after injury and outcomes were measured daily. The primary outcome was a reduction in edema as measured by the figure-of-eight-20 method and the secondary outcome was measured by visual analog scale (VAS) for pain. RESULTS: Two-way analysis of variance with repeated measures showed no significant group effect and no significant group-by-time interaction in terms of reduction of edema and VAS score for pain between two groups. No adverse effects were reported in either group. CONCLUSION: Evaporative coolants exhibited comparable efficacy to ice packs in preoperative cryotherapy of ankle fractures without adverse effects. While evaporative coolants are more expensive than ice packs, they can present a viable option for cryotherapy. LEVEL OF EVIDENCE: Level I, prospective randomized study.


Assuntos
Fraturas do Tornozelo/terapia , Crioterapia/métodos , Edema/terapia , Dor Musculoesquelética/terapia , Manejo da Dor/métodos , Cuidados Pré-Operatórios/métodos , Adolescente , Adulto , Idoso , Análise de Variância , Fraturas do Tornozelo/complicações , Bandagens , Feminino , Humanos , Gelo , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
14.
Med Sci Monit ; 25: 4233-4243, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31172985

RESUMO

BACKGROUND This study aimed to retrospectively assess the feasibility and efficacy of three-dimensional (3D) printing technology in the treatment of high-energy trans-syndesmotic ankle fracture dislocation - "log-splitter" injury - and to evaluate the efficacy and prognosis. MATERIAL AND METHODS We included 29 patients (17 males and 12 females; mean age, 44.0±13.2 years) with log-splitter injury from June 2011 to December 2016, divided into a routine group (n=13) and a 3D printing group (n=16) according to the surgical method used. Operation time, intraoperative blood loss, fluoroscopy times, fracture union time, functional outcomes based on AOFAS (American Orthopedic Foot and Ankle Society) score, and postoperative complications were observed and recorded. RESULTS Compared with the routine treatment group, 3D printing technology had better safety and efficacy for the treatment of log-splitter injury and the advantages of shorter operation time, less intraoperative blood loss, fewer fluoroscopies needed, and higher rate of good functional outcome (P<0.001, P<0.001, P<0.001, and P=0.017, respectively). However, no significant difference was noted in the rate of anatomical reduction, mean AOFAS score at the last follow-up (mean time, 19.9±2.8 months), or postoperative complications between the 2 groups (P=0.370, P=0.156, and P=0.485, respectively). CONCLUSIONS Surgery assisted by 3D printing technology to treat log-splitter injury is feasible and effective, and may be a good optional approach to formulate a reasonable personalized surgical plan and to optimize the outcomes.


Assuntos
Fraturas do Tornozelo/terapia , Fixação Interna de Fraturas/métodos , Adulto , Idoso , Tornozelo , Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Parafusos Ósseos , Feminino , Fratura-Luxação , Fixação de Fratura , Humanos , Luxações Articulares , Masculino , Pessoa de Meia-Idade , Impressão Tridimensional , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
15.
Biomed Res Int ; 2019: 4265782, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31111053

RESUMO

Treatment of pilon fractures remains challenging due to the difficulty of fracture reduction and associated soft tissue complications. The aim of this study was to evaluate the pitfalls and strategies of posterior column reduction in the treatment of complex tibial pilon fractures (AO/OTA 43-C3). Thirteen AO/OTA classification 43-C3 type pilon fractures treated between January 2013 and January 2016 were retrospectively analyzed. Nine cases were treated by external fixation within 26 hours (range, 6-56 hours) after injury. The definitive open reduction and internal fixation (ORIF) was performed after the wound was healed without infection and soft tissue swelling had subsided. During the delayed/second-stage operation, the articular surface of the distal tibial plafond was reduced through the posterolateral and anterior approaches. X-ray and CT scans were performed pre- or postoperatively. The reduction quality was evaluated using Burwell-Charnley's radiographic criteria. The follow-up was performed routinely and all complications were recorded. Ankle function was evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. During the delayed/second-stage operation, primary reduction of the posterior column was performed entirely through posterolateral approaches. However, poor posterior column reduction was revealed by fluoroscopy in four cases, three of which were readjusted through the posterolateral and anterior approaches, and the fourth was adjusted directly through the anterior approach. Postoperative CT scan revealed that the step-off of the articular surface was less than 2 mm in 12 cases, and in only one case the step-off was greater than 2 mm but less than 5 mm. The satisfactory rate was 92.3% according to Burwell-Charnley's reduction criteria. Eleven patients were followed up regularly; superficial infections occurred in two cases but healed after wound care treatment in 3 and 5 weeks, respectively. All eleven fractures were healed within an average of 3.6 months (range, 2.6-5 months). The average range of ankle motion was 19° of dorsiflexion and 28° of plantar-flexion. The mean AOFAS ankle-hindfoot score was 82 (range, 61-92). In our opinion, we suggest that the reduction of the articular surface should be performed through combined posterolateral and anterior approaches in a delayed operation, with flexible fixation of the posterior column. If the posterior column is poorly reduced, the articular surface can easily be manipulated through anterior approaches. According to this strategy, satisfactory outcomes of AO/OTA C3 pilon fractures would be anticipated.


Assuntos
Fraturas do Tornozelo/terapia , Fixação Interna de Fraturas/métodos , Fraturas da Tíbia/terapia , Adulto , Fraturas do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/terapia , Articulação do Tornozelo , Placas Ósseas , Fixadores Externos , Feminino , Fixação de Fratura , Fraturas Expostas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Tíbia , Fraturas da Tíbia/diagnóstico por imagem , Tomógrafos Computadorizados , Resultado do Tratamento
16.
Bone Joint J ; 101-B(5): 512-521, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31038989

RESUMO

The medial malleolus, once believed to be the primary stabilizer of the ankle, has been the topic of conflicting clinical and biomechanical data for many decades. Despite the relevant surgical anatomy being understood for almost 40 years, the optimal treatment of medial malleolar fractures remains unclear, whether the injury occurs in isolation or as part of an unstable bi- or trimalleolar fracture configuration. Traditional teaching recommends open reduction and fixation of medial malleolar fractures that are part of an unstable injury. However, there is recent evidence to suggest that nonoperative management of well-reduced fractures may result in equivalent outcomes, but without the morbidity associated with surgery. This review gives an update on the relevant anatomy and classification systems for medial malleolar fractures and an overview of the current literature regarding their management, including surgical approaches and the choice of implants. Cite this article: Bone Joint J 2019;101-B:512-521.


Assuntos
Fraturas do Tornozelo/terapia , Fixação de Fratura/métodos , Dispositivos de Fixação Ortopédica/efeitos adversos , Fraturas do Tornozelo/diagnóstico , Articulação do Tornozelo/anatomia & histologia , Articulação do Tornozelo/cirurgia , Fixação de Fratura/efeitos adversos , Humanos , Complicações Pós-Operatórias
18.
Br J Hosp Med (Lond) ; 80(4): 201-203, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30951430

RESUMO

Ankle fractures are a common injury in children and adolescents - 1 in 1000 children will sustain an ankle fracture each year. Understanding the diagnosis and management of these injuries is vital for any doctor or clinician working in the emergency department, orthopaedics or providing community care. This review identifies the important features of high- and low-risk ankle fractures, how to prevent the use of unnecessary radiation and the management of these injuries. Fractures may be at high or low risk of instability and are managed accordingly. Many can be treated with conservative management in a cast, including unstable injuries following reduction. However, particular fracture patterns associated with the tibial growth plate need careful assessment of fracture reduction with cross-sectional imaging before committing to conservative management.


Assuntos
Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/terapia , Fixação de Fratura/métodos , Fratura Avulsão/diagnóstico por imagem , Fratura Avulsão/terapia , Fraturas Salter-Harris/diagnóstico por imagem , Fraturas Salter-Harris/terapia , Fraturas do Tornozelo/diagnóstico , Criança , Tomada de Decisão Clínica , Gerenciamento Clínico , Epífises/lesões , Fratura Avulsão/diagnóstico , Humanos , Radiografia , Fraturas Salter-Harris/diagnóstico
19.
BMJ Case Rep ; 12(4)2019 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-30948406

RESUMO

Displaced medial malleolar fractures, either in isolation or as part of an unstable ankle fracture dislocation, are conventionally treated with internal fixation. We outline the case of a 76-year-old man with diabetes presenting with a grossly deformed open ankle fracture and extruded tibia through a large medial wound. Following irrigation, wound debridement and minimally invasive fibular fixation, the medial fracture reduced anatomically. Contrary to traditional teaching, the medial malleolus was left without fixation. The patient mobilised partially weight-bearing, progressing to both clinical and radiographic union by 3 months. Nine months following an injury, he walks unaided, can squat and drive and has no medial pain or instability with an Olerud-Molander Ankle Score of 80/100, indicating a good outcome. This is the first reported case of such unique management in the literature and highlights the potential to treat open medial malleolar fractures safely without fixation, particularly when concerned about the soft tissue envelope.


Assuntos
Fraturas do Tornozelo/terapia , Tratamento Conservador/métodos , Tíbia/lesões , Idoso , Humanos , Masculino
20.
Ann R Coll Surg Engl ; 101(8): 539-545, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30855167

RESUMO

INTRODUCTION: This study aimed to review the literature to establish whether there is a best treatment for low-risk ankle fractures in children. MATERIALS AND METHODS: A systematic review and meta-analysis of trials was undertaken, which compared interventions for 'low-risk' ankle fractures in children. A meta-analysis was performed using a random effects model. RESULTS: Four trials were identified reporting outcomes from 256 patients. All trials reported results using a device that permitted ankle motion compared with more rigid immobilisation. Overall risk of bias was low for three trials and high for one trial. Two trials assessed time to return to normal function. Patients treated in a splint or with a bandage recovering 6-7.5 days sooner than those treated with rigid immobilisation. One trial demonstrated that children returned to school sooner if treated in a bandage rather than in a cast. Two trials found a higher Activity Scale for Kids performance score at four weeks for children treated with splint compared with rigid immobilisation. There was no clear advantage to any device in patient satisfaction, quality of life or total costs. DISCUSSION: There is no clear best treatment for these injuries. Studies had significant limitations and outcomes were heterogeneous, limiting meta-analysis. CONCLUSION: There is a need for a definitive trial to establish the best treatment for ankle fractures and a core outcome set to ensure study findings are consistent and can be analysed in future meta-analyses.


Assuntos
Fraturas do Tornozelo/terapia , Fixação de Fratura/métodos , Fraturas do Tornozelo/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Braquetes , Moldes Cirúrgicos , Criança , Humanos , Qualidade de Vida , Recuperação de Função Fisiológica
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