Early posttraumatic ankle osteoarthritis following ankle fracture-dislocations in a sub-Saharan African setting

Fonkoué, Loïc; Sarr, Lamine; Muluem, Kennedy Olivier; Guèye, Alioune Badara; Dembelé, Bamory; Fon, Clovis; Ngongang, Olivier; Diémé, C; Sané, A.

doi:10.1016/j.otsr.2021.102996

Cited by 9 publications

(3 citation statements)

References 24 publications

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“…The authors concluded that dislocated ankle fractures were associated with a higher incidence of articular malreduction and poorer functional outcomes compared to those without dislocation at a mean follow-up of 31 months. In other study by Regan et patients with ankle fracture-dislocations surgically treated after a mean follow-up period of 27.2 (16). Compared to the previous literature on the topic, our cohort showed a higher rate of posttraumatic osteoarthritis (90%) among patients with dislocated ankle fractures at a mean of 14.6 years.…”

Section: Discussionmentioning

confidence: 42%

Long-term Clinical and Radiographic Outcomes Following Surgical Treatment for Ankle Fracture-Dislocations: Do poor radiographic outcomes always matter?

Pehlivanoglu,

Demirel,

Koyuncu

et al. 2024

Journal of the American Podiatric Medical Association

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Background Ankle fractures constitute 10% of all traumatic fractures in clinical practice. Concurrent tibiotalar dislocations form 21-36% of all ankle fractures. Although mechanism of injury is similar to non-dislocated ankle fractures, fracture-dislocations cause more extensive bone and soft tissue damage. Treatment is a challenge for orthopedic surgeons due to concomitant pathologies. It is associated with malreduction, chronic pain and most importantly, posttraumatic osteoarthritis. We aimed to investigate the relationship between ankle osteoarthritis radiographic stage and clinical outcomes. Methods 27 patients (17 female, 10 male) were included in the study. Records and data were retrospectively analyzed. Clinical status at the final follow-up was evaluated by a single orthopedic surgeon. Range of motion (ROM), American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score, visual analogue scale (VAS) were the clinical parameters that were assessed. Radiological assessment was made by standard anteroposterior [AP], lateral, and mortise views. Pre-operative osseo-ligamentous injury pattern, presence of posterior malleolar fracture, syndesmosis injury and post-operative ankle osteoarthritis were investigated. Results For 27 patients that were evaluated, at the final follow-up, mean AOFAS was 85 ± 8.12, and mean VAS during daily activities was 1.52 ± 0.70. Mean ankle dorsiflexion and plantar flexion were significantly lower on the affected sides (14.07 ± 7.97° and 36.30 ± 6.59°) than on the unaffected sides (28.15 ± 2.82° and 46.30 ± 2.97°), respectively (p < 0.001). No significant difference for inversion and eversion was observed. Twenty-four patients demonstrated radiographic signs of ankle osteoarthritis, and three remained without evidence of osteoarthritis. No significant difference was found among Takakura’s stages in any of the variables. Conclusion The results illustrated that although post-traumatic osteoarthritis rate was high for ankle fracture-dislocation patients, surgical treatment achieved excellent functional results. Even if advanced stages of ankle arthritis according to Takakura’s classification developed, patients had satisfactory clinical and functional results.

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Section: Discussionmentioning

confidence: 42%

Long-term Clinical and Radiographic Outcomes Following Surgical Treatment for Ankle Fracture-Dislocations: Do poor radiographic outcomes always matter?

Pehlivanoglu,

Demirel,

Koyuncu

et al. 2024

Journal of the American Podiatric Medical Association

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“…Assessment of bias was completed in three observational studies and two randomised studies [20,[24][25][26][27]. Assessment of bias was not possible using Cochrane Collaboration tools in one study as it did not compare two or more interventions and was simply a description of outcomes of a single intervention [23].…”

Section: Risk Of Biasmentioning

confidence: 99%

Clinical outcomes of ankle fractures in sub-Saharan Africa: a systematic review

Davies

Pennington

Dhadwal³

et al. 2022

Eur J Orthop Surg Traumatol

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Purpose Ankle fractures may cause disability and socioeconomic challenges, even when managed in a high-resource setting. The outcomes of ankle fractures in sub-Saharan Africa are not widely reported. We present a systematic review of the patient-reported outcomes and complications of patients treated for ankle fractures in sub-Saharan Africa. Methods Medline, Embase, Google Scholar and the Cochrane Central Register of Controlled Trials were searched, utilising MeSH headings and Boolean search strategies. Ten papers were included. Data included patient demographics, surgical and non-surgical management, patient-reported outcome measures and evidence of complications. Results A total of 555 patients with ankle fractures were included, 471 of whom were followed up (range 6 weeks–73 months). A heterogenous mix of low-quality observational studies and two methodologically poor-quality randomised trials demonstrated mixed outcomes. A preference for surgical management was found within the published studies with 87% of closed fractures being treated operatively. A total of five different outcome scoring systems were used. Most studies included in this review were published by well-resourced organisations and as such are not representative of the actual clinical practice taking place. Conclusion The literature surrounding the clinical outcomes of ankle fractures in sub-Saharan Africa is sparse. There appears to be a preference for surgical fixation in the published literature and considering the limitations in surgical resources across sub-Saharan Africa this may not be representative of real-life care in the region.

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“…This nding was comparable to that of the study of Przkora et al [25] on a series of 14 patients with unstable ankle fractures treated with temporary vertical transarticular pins; there were three patients who showed radiographic evidence of early posttraumatic osteoarthritis due to the initial intra-articular fractures. Fonkoue et al [40] also demonstrated that posttraumatic ankle osteoarthritis was positively predicted by ankle malreduction, regardless of treatment type. Overall, transarticular xation with K-wires may cause cartilage damage in the tibiotalar joint.…”

Section: Discussionmentioning

confidence: 95%

Comparison of temporary external and percutaneous k-wire fixations for treatment of ankle fracture–dislocations

Xie

Zhang

Cui

et al. 2023

Preprint

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Purpose Ankle fracture–dislocations are among the most severe injuries, and the use of an external fixator as a recommended fixation method has some disadvantages. The aim of this study was to compare the clinical outcomes and complication rates of external and K-wire fixations in the treatment of ankle fracture dislocations. Methods A total of 67 patients with ankle fracture–dislocations requiring temporary external or percutaneous K-wire fixation were included. The exclusion criteria were pilon fractures, open fractures, and those who required acute open reduction internal fixation (ORIF). The American Orthopaedic Foot and Ankle Society (AOFAS) ankle–hindfoot score, a 10-point visual analog scale (VAS) score (range 0–10), and complications before and after the definitive surgery were recorded. Results A significant difference between the two groups was not observed for age, sex, affected side, fracture type, smoking status, or diabetes. The average AOFAS scores were 83.2 and 83.3, the median VAS scores were 3 and 3, and the complication rates were 32.4% and 6.7% in the external and K-wire fixation groups, respectively (p = 0.010). However, skin necrosis, re-dislocation of the ankle, surgical wound infection, and posttraumatic ankle osteoarthritis frequency were not significantly different between the groups, except for pin-sites infection (p = 0.036). Conclusion Ankle fracture–dislocations using percutaneous k-wire fixation showed a low rate of complications and favorable clinical outcomes. This method could be a good alternative treatment option for ankle fracture-dislocations.

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Early posttraumatic ankle osteoarthritis following ankle fracture-dislocations in a sub-Saharan African setting

Cited by 9 publications

References 24 publications

Long-term Clinical and Radiographic Outcomes Following Surgical Treatment for Ankle Fracture-Dislocations: Do poor radiographic outcomes always matter?

Long-term Clinical and Radiographic Outcomes Following Surgical Treatment for Ankle Fracture-Dislocations: Do poor radiographic outcomes always matter?

Clinical outcomes of ankle fractures in sub-Saharan Africa: a systematic review

Comparison of temporary external and percutaneous k-wire fixations for treatment of ankle fracture–dislocations

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