Operative Treatment of Ankle Fracture-Dislocations

Lindsjö, U

doi:10.1097/00003086-198510000-00005

Cited by 177 publications

(63 citation statements)

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“…There are very few large, long-term series for these fractures: either the follow-up is rather short [5,14] or long- Step-off 1mm term results are derived from only small groups of patients [15][16][17]. Our follow-up rate of 76% is just within the the limit of acceptance, and may be explained by the fact that quite a lot of our patients are winter tourists from abroad.…”

Section: Discussionmentioning

confidence: 99%

The Volkmann dogma: a retrospective, long-term, single-center study

Heim¹,

Niederhauser

Simbrey

2010

Eur J Trauma Emerg Surg

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Introduction There has been (and still is) some controversy about the treatment of malleolar fractures with an additional fracture of the posterior malleolus (Volkmann triangle) in the last few years. Should a posterior malleolus with a fragment that is larger than 25% of the articular surface be fixed? Can long-term results be influenced by the fixation of the Volkmann triangle? Materials and methods In a consecutive series of 43/56 patients with a dislocated malleolar fracture, clinical and radiological results were analyzed after a follow-up of 7.3 years (4-11 years). There were 15 men with an average age of 53 years and 28 women with an average age of 62 years, respectively. Eleven fragments were fixed. At inspection, 16 patients displayed a cartilage lesion at the talar dome.Results No or only slight arthrosis was found on X-rays of 37/43 patients. Six patients showed moderate or severe arthrosis. The Olerud-Molander score was 95.5 in patients without a Volkmann triangle, 98.5 in the presence of a small, unfixed fragment, and 90.6 with a large fixed fragment. Patients with no cartilage damage on perioperative inspection presented less severe arthrosis in the long-term results, while those with documented cartilage damage during the operation had more severe arthrosis. The Olerud-Molander score was 97.2 without cartilage damage and 94.5 with cartilage damage. Conclusion In conclusion, the presence of a Volkmann triangle impairs prognosis; fixation, even with anatomic results, does not return the score to ''normal.'' Cartilage damage seems to play a crucial role in the long-term outcome.

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Section: Discussionmentioning

confidence: 99%

The Volkmann dogma: a retrospective, long-term, single-center study

Heim¹,

Niederhauser

Simbrey

2010

Eur J Trauma Emerg Surg

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“…Nach Lindsjö [14] beträgt deren Inzidenz 1,14‰/Jahr, nach Koval et al [10] sogar 4,2‰. Berücksichtigt man sta tionäre und ambulante Behandlungskos ten, kommt dieser Verletzung eine hohe sozioökonomische Bedeutung zu.…”

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“…Während die ersteren zumeist funk tionell und ambulant konservativ zur Ausheilung gebracht werden, ist für die zweite Gruppe die operative Stabilisie rung vorgesehen. Ziel ist die millimeter genaue Rekonstruktion, um somit ein Höchstmaß an Kongruenz und Funk tion wieder zu gewinnen [4,14,17,30]. Alleinige geschlossene Repositionsgips behandlungen werden nur in Ausnahme fällen durchgeführt, wenn z.…”

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Ungeplante Zweiteingriffe nach Frakturen des oberen Sprunggelenks

et al. 2010

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The purpose of the present study was to analyze the risk factors associated with unexpected second procedures and strategies of revision surgery. Within a 5 year period 647 patients with closed ankle fractures AO type 44 were identified of which 77 (11.9%) needed revision surgery. Complications were addressed to 4 main groups: deep infections (IG) were seen in 29 patients (4.5%), problems with primary wound closure (WG) in 22 patients (3.4%), insufficient reduction (KG) in 22 patients (3.4%) and other causes (RG) included 4 patients (0.6%). Significant predictive factors for soft tissue complications were higher age, comorbidities with peripheral arteriosclerosis, high American Society of Anesthesiologists (ASA) score and diabetes mellitus. AO 44 type B2 and B3 fractures were often associated with soft tissue problems. The more complex fracture types AO 44 C1-C3 and A2-A3 were significantly associated with problems of insufficient congruency post-surgery. The distribution of the mean revision rate was significantly different (p<0.01) for all groups: IG 4.59, WG 3.5, KG 1.55, RG 1.25. In summary, we strongly recommend immediate reduction of displaced fractures and to consider a more detailed fracture classification. To reduce the amount of unexpected ankle procedures individual risk factors should be weighed against the advantages of optimal open reduction and internal fixation.

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“…Prompt operative treatment of displaced ankle fractures decreases morbidity and improves functional outcome (10)(11)(12). The treatment of malleolar fractures with accurate open reduction and stable internal fixation using AO method and principles was found to give a high percentage of excellent and good results..…”

Section: Discussionmentioning

confidence: 99%