PURPOSE The purpose of this study is to evaluate the incidence of ankle injury in ipsilateral tibial shaft fractures and to assess the risk factors for ankle injury associated with tibial shaft fractures. MATERIALS AND METHODS Sixty patients with tibial shaft fractures were enrolled in this retrospective study. The incidence and characteristics of ankle injury were evaluated, and fracture classification, fracture site, and fracture pattern of the tibial shaft fractures were analyzed for assessment of the risk factors for ankle injury combined with tibial shaft fractures. RESULTS Ankle injury occurred in 20 cases (33%). There were four cases of lateral malleolar fracture, four cases of posterior malleolar fracture, two cases of distal tibiofibular ligament avulsion fracture, and 10 cases of complex injury. Fourteen cases (70%) of 20 cases of ankle injury were diagnosed from x-ray films, and the other six cases were recognized in ankle computed tomography (CT). Ankle injury occurred in 45.1% of distal tibial shaft fractures and found in 41.4% of A type, but there was no statistical significance. Ankle injury was observed in 54% of cases of spiral pattern of tibial shaft fracture and the incidence was statistically higher than 19% of cases of non-spiral pattern tibial shaft fracture. CONCLUSION Ankle injury was observed in 33% of tibial shaft fractures; however, only 70% could be diagnosed by x-ray. Ankle injury occurred frequently in cases of spiral pattern of tibial shaft fracture, and evaluation of ankle injury with CT is recommended in these cases.
Citations
Citations to this article as recorded by
Usefulness of Computed Tomography on Distal Tibia Intra-Articular Fracture Associated with Spiral Tibia Shaft Fracture Seong-Eun Byun, Sang-June Lee, Uk Kim, Young Rak Choi, Soo-Hong Han, Byong-Guk Kim Journal of the Korean Fracture Society.2016; 29(2): 114. CrossRef
Biodegradable implants made of co-polymers composed of L-lactide, D-lactide, and trimethylene carbonate were used in the present case. To our knowledge, only one reported tissue reaction has been associated with ankle fracture treated with third-generation implants internationally and none yet domestically. We report a delayed foreign-body reaction of ankle fracture treated with a third-generation biodegradable plate and screws. We suggest that ankle fracture patients treated with biodegradable implants should be advised of this possible complication and should be followed for at least 2 years.
PURPOSE We evaluated the results between the methods of open reduction and internal fixation using plate and screws and the methods of closed reduction and fixation with rush pin in lateral malleolar fractures. MATERIALS AND METHODS We analysed the 33 fractures of lateral malleolus which had been treated by open reduction and internal fixation using plate and screws or closed reduction and fixation with rush pin from January 1995 to January 2002 and had been observed over 1 year. The 33 patients were observed for the comparison of radiologic and clinical results in according to the measure of McLennan and Ungersma. RESULTS Among the 33 cases, 15 cases were treated by open reduction and internal fixation with plate, and 18 cases were treated by closed reduction and Rush rods fixation. In according to the measure of McLennan and Ungersma, good radiologic result was 60% (9 cases) and excellent clinical result was 27% (4 cases) in plate fixation, and good radiologic result was 61% (11 in 18 cases) and excellent clinical result was 39% (7 in 18 cases) in Rush rods fixation. CONCLUSION In ankle fractures of elderly patients who have soft tissue problems and osteoporotic bony quality, radiologic and clinical results of internal fixation of distal fibula were relatively same between fixation with plate and screws and Rush rods. Therefore, closed reduction and internal fixation with Rush rods is one of the good treatment modalities of distal fibular fracture.
OBJECT: This study investigated to know the factors affecting the radiological results of the ankle fracture after open reduction and internal fixation over the age 60 years.
PATIENTS & METHOD: Open reduction and internal fixation on patient with closed displacement ankle fracture over the age 60 years were studied in 51 cases. Statistical analysis by t-test was used to assess the factors affecting to the post-operation radiological results among the age, sex, classification of fracture, the degree of fracture displacement, bone fragility between anatomical reduction group and non-anatomical reduction group in average 16 months, RESULTS: There are statistical significance(p<0.05) of the sex and bone fragility in post-operation radiological results. CONCLUSION The radiological results in old age with ankle fracture is affected by sex and bone fragility in open reduction & internal fixation.
PURPOSE The purpose of this study is to analyze the clinical and radiographic prognostic factors which may affect the postoperative clinical results of the unstable ankle fractures. MATERIALS AND METHODS This study is based on 75 unstable ankle fractures treated by open reduction and internal fixation from May 1994 to August 2000, with a minimum follow-up period of 12 months(range : 13 months-7 years 3 months). The 75 patients were average 40.5 years old with male: female ratio of 52:23. Based on Lauge-Hansen classification, the supination-external rotation type was the most common with 42 (56.0%) cases. The clinical results was assessed by American Orthopaedic Foot and Ankle Society(AOFAS) functional scale. The sex, age, side of injury, body weight, trauma-operation interval, operation time, cause of injury as the possible postoperative clinical prognostic factors and fracture type, anatomical reduction of fracture, preoperative medial clear space, postoperative medial clear space, talo-crural angle, talar tilt, tibio-fibular clear space, tibio-fibular overlap space as the possible radiographic prognostic factor were statistically analyzed RESULT: Postoperative AOFAS functional scale was average 81.0 points with 23(30.7%) cases excellent, 17(22.7%) good, 18(24.0%) fair and 17(22.7%) cases poor results. The age, the operation time(p<0.001) and the anatomical reduction of fracture(p<0.005) were found to be statistically significant factors affecting the prognosis. The other clinical and radiographic factors did not significantly affect the clinical results. CONCLUSION The surgically treated unstable ankle fractures in patients whose age was above 41 years old or operation time exceeding 90 minutes or unsatisfied anatomical reduction of fractures showed significantly poor clinical results.
Citations
Citations to this article as recorded by
Analysis of Bone Mineral Density of Ankle Fracture Patients Tae Hyung Kim, Jae Hyung Lee, Seung-Hwan Park Journal of the Korean Orthopaedic Association.2021; 56(4): 334. CrossRef
PURPOSE To evaluate the clinical results between the posterior and lateral plate for distal fibular fixation in the bimalleolar, trimalleolar fracture and isolated lateral malleolar fractures with more than 3 mm of displacement. MATERIALS AND METHODS We reviewed 69 cases treated by open reduction and internal fixation with the posterior or lateral plate for distal fibular fractures in the bimalleolar, trimalleolar fractures and isolated lateral malleolar fractures with more than 3mm of displacement. The follow up period was more than 12 months. RESULTS In the posterior plate group, radiographically there were no intraarticular screw, loss of fixation, nonunion and malunion, but 2 cases of distal tibiofibular synostosis were developed. In physical examination, there were no wound complication, palpable screws, peroneal tendinitis and limitation of motion, but 2 patients who had distal tibiofibular synostosis complained of mild discomfort after walking. CONCLUSION The posterior plate for distal fibular fixation is thought to be a favorable method and can be recommended as the fixation modality of choice regardless of level of fracture, because of increased biomechanical stability and few complication.
In the treatment of ankle f1racture, anatomical reduction and restoration of ankle mortise is very important. But tranf-syndesmotic screw fixation for syndesmosis seperation is dependent on the condition in operation field. The purpose of this study is to analyse the radiographic and clinical relults. to evaluate the need for trans-syndesmotic screw fixaition, and to know the effectiveness of radiogrphic landmarks for diagnofis of the syndesmosis separation, retrospectively. The patients were divided into two groups. The Croup I(25cases) were treated with trant-syndetmotic screw and group II(42 cases) were treated without trans-syndesmotic screw fixation .
The clinical results were excellent in 13, good 9 in group I and excellent in 19, good in 17 in group II. The radiographic results were excellent in 6, good in 8 in group I and excellent in 23, good 14 in group II. In the radiographic findings, the false negative result of tibiofibular overlap was 15.6%(M: 20.8%, F: 10.4%), tibiofibular clear space was 16.8%(M: 21.6%, F: 11.9%) and ratio of tibiofibular overlap to fibular width was 14.2%(M: 14.9%, F: 13.6%).
There was no siginificant statsitical difference in the ratio of tibiofibular overlap to fibular width between male and female.
We consider that the ratio of tibiofibular overlap to tibiofibular width are more reliable diagnostic criteria for syndemosis separation than the tibiofibular overlap and tibiofibular clear space. Trans-syndesmotic tcrew fixation is not alswaya required to maintain the integrity of the tibiofibular syndesmosis if the diastasis was satisfactorily reduced with rigid fixation.
Posterior malleolar fractures are usually caused by an abduction or external rotation injury. indications for open reduction of the posterior malleolar fracture depend on its size and the amount of displacement. If the fragment of the posterior malleolus involves more than 25% to 30% of the articular surface, it should be treated by anatomical reduction and internal fixation. Authors analysed twenty-three patients of ankle fractures with the posterior malleolar fractures who were treated in Kangbuk Samsung Hospital between March 1993 and March 1997. Thirteen patients whose posterior malleolar fracture involved less than 30% of articular surface were treated conservatively (Group 1), while ten patients with involvement of more than 30% of articular surface were treated by open reduction and internal fixation. Among the ten patients treateed by open reduction, the five patients were indirectly fixed through anterior approach (Group 2), another five patients were directly fixed through posterior approach (Group 3). In group 1, the patients whose opsterior malleolus involved more than 25% of articular surface have unsatisfactory results compared to patients whose posterior malleolus involved less than 25% of articular surface(P<0.04). The results of the treatment were better in those directly fixed through posterior appproach than in those indirectly fixed through anterior approach regardless of size of the fragment(P<0.05).
Citations
Citations to this article as recorded by
Treatment of the Trimalleolar Fracture Using Posterolateral Approach: Minimum 2-year Follow Up Results Gwang Chul Lee, Jun-Young Lee, Sang-Ho Ha, Jae-Won You, Sang-Hong Lee, Hong-Moon Sohn, Ki-Young Nam, Kwang-Hyo Seo Journal of the Korean Fracture Society.2011; 24(4): 328. CrossRef
The Treatment of Posterolateral Malleolar Fractures using Percutaneous Reduction Technique Jae-Sung Lee, Han-Jun Lee, Jae-Hyun Yoo, Hee-Chun Kim Journal of the Korean Fracture Society.2009; 22(1): 19. CrossRef
Treatment of the Posterior Malleolar Fragment of Trimalleolar Fracture Using Posterolateral Approach - Preliminary Report - Jun-Young Lee, Sang-Ho Ha, Kyung-Hwan Noh, Sang-Jun Lee The Journal of the Korean Orthopaedic Association.2009; 44(4): 422. CrossRef
Radiologic Analysis and Treatment of Posterior Malleolar Fractures of the Ankle Jae Sung Lee, Soo Yong Kang, Han Jun Lee, Young Bong Ko Journal of the Korean Fracture Society.2009; 22(2): 98. CrossRef
The ankle fracture with diastasis of distal tibiofibular jointis caused by an axial loading force with concomitant external rotation or other force. Many surgeons have treated this injuries by rigid fixation medial and lateral malleoli with syndesmotic fixation. But recently, syndesmotic fixation is not required to maintain the syndesmotic fixation on ankle fracture. seventy-five patients of ankle fracture with syndesmotic injury treated at Korea veterans Hospital from Jan. 1990 to Dec. 1996 were analysed in clinical and radiological aspect. The syndesmotic fixation was not necessary if the both medial and lateral injury was rigidly stabilized by fixation or ligament repair.
The ankle is a modified hinge joint consisting of tibial plafond, medial and lateral malleolus, talus and many soft tissue structures, which play important role in weight bearing and walking.
Ankle joint injury is determined by patients age, quality of bone, the position of a ankle at trauma, direction and degree, velocity of force. Hence, it is very important to understand the mechanism of trauma in order to make definite diagnosis and proper treatment.
The authors analysed 71 cases(66 patients) of the ankle fracture which were admitted and treated in Orthopaedic Department, Chonnam University Hospital from Aug. 1985 to June 1994.
The most common type of the ankle fracture was supination external rotation type(17 cases, 23.9%), by the classification of Lauge-Hansen, and type C(30 cases, 42.3%) by the AO classification.
According to the criteria of Meyer using the clinical and radiological result, pronation-external rotation type gave the best result and the worst results obtained from pronation-dorsiflexion type.
We concluded that classification of Lauge-Hansen & AO were useful in the diagnosis and treatment of ankle fracture and accurate reduction and rigid internal fixation of the lateral malleolus, distal fibula and distal tibiofbular diastasis was important in treatment of the ankle fracture.
We have investigated total 294 cases of ankle fractures, which were treated and followed for average 17 months after treatment at St. Marys hospital since 1980, to detect the complications and to define their provoking factors. The results were as follows; 1. Twenty-six cases out of total 294 cases of ankle fracture(8.8%) were complicated clinically and radiologically.
2. Their complications are osteoarthritis(8/26, 31%), diastasis of distal tibio-fibular syndesmosis(9/26, 34.6%), varus ankle deformity(5/26, 19.2%), malunion(6/26, 23%), non-union and ankle instability(each 2/26, 7.7%) in its order, but 14 cases of the 26 cases complained painful limited ankle motion and limp. So, clinical symptoms are not closely related with radiologic changes in complications of ankle fracture.
3. The complications are common in elderly patients over 50 of their ages(12.26, 46%) and in younger patients under 16 of their ages(5/26, 20%).
4. The complications are frequently found in pronation-external rotation injuries(6/61, 1O%), pronation-dorsiflexion(9/14, 64%) and supination-external rotation injuries(8/165, 4.8%) in orders.
5. Malpractice with misuse of instrument(12/26, 46%), mistakes in preoperative evaluation and neglect any ankle fracture or diastasis of syndesmosis(8/26, 30.7%) and severity of injuries(6.26, 23%) are common causes of complications of ankle fractures.
6. Varus ankle deformity due to early epiphyseal closure are shown in 5 cases(5/28, 20%) and three of them are treated with supramalleolar corrective osteotomies and Langenskiolds physolysis In conclusion, the complications of ankle fracture could be reduced by accurate pre-operative evaluation to detect the hidden soft tissue injuries or fracture mechanism and by also anatomic reduction, rigid internal fixation and early ankle motions. childrens ankle fracture will induce angular deformity and limb length discrepancy due to frequent epjphyseal damage, so long-term follow up should be kept in mind until their skeletal growth are ceased.
Injury of distal tibiofibular syndesmosis Is usually associated with pronation-external rotation, supination-extemal rotation or pronation-abduction injuries at the ankle. In general, there are two methods of treatment for injured distal tibioflbular syndesmosis. The first is direct repair of injured syndesmosis and the second is internal fixation with trans-syndesmotic screw for stability of distal tibiofibular joint. The latter method is generally used because the procedure is simple and the outcome is relatively good.
Our patients who had been injured of distal tibiofibular syndesmosis that associated with ankle fractures had treated with open reduction, internal fixation and transfixing screw, and early range of motion exercise was started for decreasing joint stiffness and degenerative change. Between March 1990 and August 1994, twelve patients were treated by open reduction and internal fixation and trans-syndesmotic screw fixation. Early range of motion exercise was started ater 3 weeks, and trans-syndesmotic screw was removed and partial weighting bearing was started at 8-12 weeks after sugery. After full weight bearing, follow up clinical examination and full weight bearing ankle roentgenography was evaluated.
The results was as followed 1. Among the 12 cases, male was 7, Female was 5, and the mean age was 30.7 years and the average follow-up period was 27.3 months 2. Range of motion exercise was started at postoperative day 3 weeks.
3. Trans-syndesmotic screw was removed at postoperative day 8-12 weeks and partial weight bearing walking ambulation was started.
4.The full weight bearing ankle anterior-posterior roentgenography was evaluated.
5. There was 3 complicated cases, traumatic arthritis 1 case, infection with diastasis 1 case and distal tibiofibular fusion 1 case.
6. The excellant and good result were achieved in 9 cases(75%)
The ankle fracture with diastasls of distal tibiofibular joint is caused by an axial loading force with concomitant external rotation and associated with severe ankle fracture in addition to talai subluxation due to rupture of the distal tibiofibular syndesmosis. In order to restore the normal ankle mortise, operative anatomical reduction and temporary stabilization of the syndesmosis is mostily required until early ligament healing is present. Twelve cases among ninety-six cases of the ankle fracture were associated with diastasis and treated in the Department of Orthopedic Surgery, Kyungpook National University Hospital during the period from January, 1988 to May, 1991. We analysed these cases according to injury mechanism, radiographic criterion, the patterns of associated medial and lateral injury and treatment result. The results obtained were as follows; 1. The incidence of trauma was most frequent in 5th decade(5 cases).
2. Diastasls was produced by 3 mechanism according to Lauge-Hansen classification : (pronalion-external rotation : 7, Suplnatlon-external rotation : 3, pronation-Abduction;2).
3. All were associated with fibular fracture : proximal fibular fracture was most common (7cases).
4. All had disruption of the medial structures (medial ligament rupture 3, medial malleolusfracture 9).
5. Although the cases were small, there seems no significant differences between transfixation group and unfixation group when accurate anatomical restoration of the distal tibiofibular syndesmosis was achieved.
The ankle is the most congrous joint in the lower extremity, bearing up to five times the body weight. Many clinical studies of ankle fractures have proven that good results depend upon an antomic reduction of the fracture. There remains, however, controversy as to the best method of obtaining this goal. More recently there has been interest in anatomic reduction & authors analysed 58 cases of ankle fractures treated operatively at Chosun University Hospital from january 1981 to December 1988.
1. The result of treatment was good or exellent in 49 cases(84.5%) of clinical results in 51 cases(87.9%) of radiological result, according to the criteria of Meyer.
2. Operative treatment affords the most predictable way to carry out an absolutely anatomic reduction of fractures & a low complication rate.
3. Most of the unsatisfactory group were severe displacement, commivuted fracture due to high violence.
Lauge-Hansens classification system and Webers classification system are the two most commonly used systems in ankle fractures. both are based on causative mechanism but both have some deficiencies. Authors intended to decide which is easily applicable in clinical practice and shwich provides more information about treatement, especially that of diastasis.
So we analysed 143 cases of ankle fractures in Seoul National University Hospital, Kang-nam General Hospital and Namseoul Hospital from January 1983 to December 1988.
The results obtained are as follows.
1. Webers type A fractures correspond not only supination-adduction but also to pronation-abduction and pronation-dorsiflexion. Type B fractures correspond most closely to supination-external rotation and possibly to pronation abduction and pronation external rotation. Type C fractures show the nearest equivalence to pronation-external rotation and occasionally correspond to supination-external roation or pronation-abduction.
2. Diastasis was noted in 16 cases(28%) of type B and in 18 cases(74%) of type C and this lower incidence was seemed to be due to neglect of diastasis at physical examination or during operation.
3. It seemed to be more reasonable to fix the diastasis with tibiofibular fixation screw especially in type C.
4. Webers simpler classification system, which can explain the hidden ligamentous injury such as diastasis, was more easily applicable in daily use than Lauge-Hansen classification.