Introduction The goal of this retrospective, observational, case series study was to evaluate the medium-long-term clinical and radiographic results of the three most common surgical osteosynthesis techniques used for the treatment of articular tibial pilon fractures: ORIF, MIPO, and EF. Materials and Methods A consecutive series of patients with articular pilon fractures who underwent surgery at our institution were enrolled in this study. Fractures were classified according to the Müller AO classification system. Overall outcomes took the following into account: radiographic quality of reduction, evaluated using Ovadia and Beals' criteria; clinical assessment, evaluated using the AOFAS questionnaire; and general health, evaluated with the SF36-v2 Health Survey. Results A total of 94 articular pilon fractures (34 type 43-B and 60 43-C) were evaluated with a mean follow-up of 56.34 months (range 33–101). The techniques used were ORIF, MIPO, and EF in 63 (67%), 17 (18.9%), and 14 cases (14.1%), respectively. According to Ovadia and Beals' criteria, good, fair, and poor results were reported in 61 (64.89%), 26 (27.66%), and 7 (7.45%) cases, respectively. The mean AOFAS score was 82.41 for MIPO, 79.83 for ORIF, and 50.57 for EF, respectively. Thirty-nine patients (41.49%) presented early and/or late complications. Conclusion Satisfactory outcomes using the three different techniques were reported. In particular, the radiographic outcomes were inversely proportional to the fracture comminutions and statistically different between internal and external osteosynthesis, but comparable between ORIF and MIPO techniques. On the other hand, the clinical outcomes were closely related to the soft tissue conditions and the anatomical reconstruction of the joint.
Background:The purpose of this non-randomized retrospective study was to investigate outcomes of minimally displaced, proximal 5MTB fractures, treated by a below-knee walking cast or a functional elasticated bandage with a support of a flat hardsoled shoe. Methods: A consecutive patient series was divided into two groups: the cast group (CG) and the functional group (FG). The subjects were radiologically and clinically evaluated according to Mehlhorn and Lawrence-Botte classification, and AOFAS Midfoot score, respectively. Results: 154 patients were followed up for a median of 15 months (range 12-24). There was no significant difference (p > 0.05) among the outcomes of each fracture pattern regarding the treatment choice.However, an earlier return to sports was noted in the FG, while Type-3 fractures achieved the worst results.
Conclusion:Type-1 and 2 minimally displaced 5MTB proximal fractures can be successfully treated conservatively without weight-bearing restriction and without benefit of a cast with respect to a functional elasticated bandage. Level of clinical evidence: level III retrospective comparative study.
Introduction: Recently, Cromeens proposed a new interpretation of the deltoid ligament (DL) using its attachment sites to define individual components. The aim of this cadaveric study was to evaluate the reproducibility of this new classification and investigate anatomical variations of the ligament to contribute to reaching an evidencebased consensus regarding its ligamentous constituent bands, their origins and insertions. Methods: The classification was applied to study only four components of the DL: the tibiocalcaneonavicular (TCN), the superficial posterior tibiotalar (sPTT), the deep anterior tibiotalar (dATT) and the deep posterior tibiotalar (dPTT) ligaments. Fifteen fresh frozen ankles were dissected and the deltoid ligament components de-fined by their attachment sites and measured on the three axes.Results: The TCN, sPTT and dPTT ligaments were identified in all of the specimens. The TCN was the widest and longest ligament with variable thickness. The sPTT ligament was the second thicker and longer. The dATT ligament, the smaller and thinner, was not identified in 3 specimens. The dPTT ligament was the second wider, which in 3 cadavers presented an accessory bundle, the deep intermedial tibiotalar ligament (dITT ligament). Conclusions: Cromeens's attachment-based classification was proved to be simple, rational and reproducible in allowing the methodological description of the different bands of the DL. Our findings showed that the dITT ligament must be considered a secondary bundle of the dPTT ligament, which was not always identified in all specimens. Level of evidence: IV.
Clinical relevanceThe anatomical data regarding the deltoid ligament bands and their variations described in this study should promote correct management of ankle sprains in cases of deltoid ligament injury or instability, often trivialized, addressing the proper treatment: conservative or operative.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.