Ankle stability in ankle fracture

Lambert, Laura-Ann; Falconer, Luke; Mason, Lyndon

doi:10.1016/j.jcot.2020.03.010

Cited by 18 publications

(11 citation statements)

References 39 publications

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“…Rupture of the syndesmosis can reduce tibioperoneal overlap. When a junctional tear is associated with a fibula fracture, the talus may be displaced 2 to 3 mm laterally, even when the deep deltoid ligament is intact (2,(4)(5)(6)13).…”

Section: Anatomymentioning

confidence: 99%

“…It is essential to recognize that stability in the ankle joint is the fundamental pillar in the correct treatment strategies in ankle trauma.a stable and normal ankle can be conceptualized as one that can move along its physiological limits; however, conceptualizing instability within a fracture is a relatively more difficult, because in instability, the physiological limits are exceeded actively or passively proving that the stabilizing structures are insufficient. Usually, the stability of the ankle is passively ensured by the compliance of the bones that form the joint, the ligaments that surround the joint and the nearby extrinsic muscles; these often lose their stabilizing competence through trauma (2,3).…”

Section: Introductionmentioning

confidence: 99%

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Fractures of the Bones in the Ankle Joint

García¹,

Castillo²,

Chiluisa³

et al. 2023

EPRA

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Introduction: Ankle fractures are usually frequent in emergency departments worldwide, with an incidence of 187/100,000 inhabitants per year. Especially the type B fracture according to Webers classification, which may lead to long-term osteoarthritis in approximately 14%. It is essential to recognize that stability in the ankle joint is the fundamental pillar in the correct treatment strategies in ankle trauma. Objective: to describe current information related to ankle bone fractures, etiology, anatomy, epidemiology, mechanism of action, presentation, classification, evaluation, prognosis, treatment and complications of ankle fractures. Methodology: a total of 38 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 26 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: ankle fracture, fractura do tornozelo, ankle, tibia, fibula, ankle fracture. Results: Bimalleolar ankle fractures occur in a quarter of the patients and trimalleolar fractures in the remaining 5% to 10%. The incidence of ankle fractures is close to 187 per 100,000 inhabitants per year. Open fractures are infrequent, representing only 2 % of all fractures of the ankle joint. In children, these injuries are also frequent, occupying the second place after hand and wrist injuries, especially in those between 10 and 15 years of age. Likewise, pediatric ankle fractures occur in a 2:1 male to female ratio, representing 5% of all fractures in children and approximately 9% to 18% of all fissure injuries. Conclusions: the ankle joint is complex, in gynglimus, formed by the fibula, the tibia and the talus and also deeply related to the ligamentous complexes. The bony anatomy that provides stability is formed by the distal part of the tibia and fibula, its articulation with the talus and with each other. Generally ankle fractures are caused by different trauma mechanisms such as impact, twisting and crushing injuries. Ankle injury depends on several factors such as mechanism, chronicity, bone quality, patients age, magnitude, direction, impact velocity and foot position. A complete and comprehensive medical history is essential in the medical evaluation. X-rays are the first-line adjunctive tests that aid in the evaluation of an injury that impacts the ankle. The classification system is important for the treatment decision. The treatment of fractures of the ankle bones can be performed conservatively or surgically, depending on certain criteria, and immobilization should be performed afterwards to reduce the risk of complications. It is essential to follow the ATLS scheme in order to define and manage any alteration that may be life-threatening for the patient. Ankle fracture-dislocation requires urgent manipulation to recover the ankle mortise. KEY WORDS: fracture, ankle, tibia, fibula, bones.

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Section: Anatomymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fractures of the Bones in the Ankle Joint

García¹,

Castillo²,

Chiluisa³

et al. 2023

EPRA

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“…Fibular fracture displacement alone does not seem to be a predictor of pathological ankle joint kinematics after injury [ 14 ]. The medial deltoid ligament complex is believed to be the most important stabilizing structure in ILMFs [ 3 , 15 – 17 ]. Deltoid ligament incompetence can result in lateral displacement of the talus, defined as talar shift (TS), leading to altered ankle joint kinematics [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…The medial deltoid ligament complex is believed to be the most important stabilizing structure in ILMFs [ 3 , 15 – 17 ]. Deltoid ligament incompetence can result in lateral displacement of the talus, defined as talar shift (TS), leading to altered ankle joint kinematics [ 15 ]. Patients with displaced ILMFs without apparent TS in diagnostic non-weightbearing, non-stressed radiographs could thus be described as “potentially stable".…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of displaced isolated lateral malleolar fractures: incidence of adverse events requiring revision: a retrospective cohort study

et al. 2022

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Background Recent systematic reviews support that non-operative management should be the standard treatment for all stable isolated lateral malleolar fractures (ILMFs), regardless of fibular fracture displacement. Surgical fixation of ILMFs carries a risk of adverse events (AEs), and many patients will later require implant removal. We wanted to estimate the incidence of AEs requiring revision after surgical fixation of “potentially stable” displaced ILMFs before non-operative treatment became standard care in our department. Materials and methods To identify patients with “potentially stable” ILMFs who had been treated surgically in a historical cohort, we retrospectively applied the stability-based classification system, introduced by Michelson et al., to a cohort of 1006 patients with ankle fractures treated surgically from 2011 to 2016. The primary outcome of this retrospective cohort study was the incidence of AEs that had functionally significant adverse effects on outcome and required revision in the first 12 months after surgery. AEs were graded and categorized using the Orthopedic Surgical Adverse Events Severity (OrthoSAVES) System. Results The study population comprised 108 patients with “potentially stable” displaced ILMFs; 4 patients (3.7% [95% CI (0.1–7.3%]) experienced AEs requiring revision in the first twelve months after surgery. There were 5 additional patients (4.6%) with functionally significant AEs where revision surgery was not indicated within the first twelve months after surgical fixation. A further 5 patients (4.6%) had AEs managed in the outpatient clinic (grade II); 36 patients (33.3%) required secondary implant removal due to implant-related discomfort. Conclusions Surgical fixation of ILMFs carries a risk of severe AEs, and many patients will subsequently need implant-removal procedures. Further prospective studies are required to ascertain whether non-operative treatment can lower the risk of AEs and the need for additional surgical procedures.

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“…Con estas proyecciones podremos entonces, realizar una adecuada clasificación de la fractura y, con ello, tener una adecuada planeación prequirúrgica. 1,8,9 Ya que se ha hecho una adecuada y acertada clasificación de la fractura y, por ende, una buena planeación prequirúrgica, el punto clave para un óptimo resultado será la restauración anatómica de las estructuras involucradas en la reconstrucción de la articulación tibio-peroneo-astragalina, ya que, al tratarse de una articulación, es primordial lograr una consolidación primaria. 4,10,11,12 Una manera sencilla pero útil de clasificar las fracturas de tobillo es con la clasificación de Danis-Weber, ya que es una clasificación relativamente simple, útil y conocida mundialmente.…”

Section: Introductionunclassified

Factores de riesgo para presentar dolor crónico de tobillo en pacientes con fractura de tobillo clasificados con Danis Weber y AO en el Centenario Hospital Miguel Hidalgo

Ávila-Méndez¹,

Ortiz-Díaz²,

Flores-Álvarez³

2021

LUXMED

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Introducción: Las fracturas de tobillo son las lesiones óseas más comunes en cualquier grupo de edad y, por lo general, son causadas por un mecanismo de baja energía. Una de las clasificaciones más usadas es la de Danis-Weber, la cual nos habla de la probabilidad de lesión sindesmal; sin embargo, no nos habla de las complicaciones o probabilidad de padecer dolor crónico. Objetivo: Identificar los factores de riesgo que pudieran presentar los pacientes con fractura de tobillo que puedan influenciar la presencia de dolor crónico de tobillo. Material y métodos: Se realizó una revisión sistemática de 142 expedientes clínicos electrónicos de pacientes con diagnóstico de fractura de tobillo clasificada con Danis-Weber, en el periodo de 2016 a 2019, que cumplieron con los criterios de inclusión. Resultados: Se obtuvo una muestra de 142 pacientes, se analizaron variables como Weber, tratamiento, medición de claro medial, dolor crónico, complicación y mecanismo de lesión. Se obtuvieron diferencias estadísticamente significativas en las variables de medición de claro medial (p ≤0.01); y, en cuanto a dolor crónico, en donde es más probable que los pacientes con Weber B o C presenten dolor crónico (p = 0.02). Conclusiones: Hay factores de riesgo para padecer dolor crónico de tobillo como el padecer una fractura de tipo Weber B o C; existe una relación en la probabilidad de lesión del ligamento deltoideo con la clasificación de Danis-Weber.

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Ankle stability in ankle fracture

Cited by 18 publications

References 39 publications

Fractures of the Bones in the Ankle Joint

Fractures of the Bones in the Ankle Joint

Surgical treatment of displaced isolated lateral malleolar fractures: incidence of adverse events requiring revision: a retrospective cohort study

Factores de riesgo para presentar dolor crónico de tobillo en pacientes con fractura de tobillo clasificados con Danis Weber y AO en el Centenario Hospital Miguel Hidalgo

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