Revisiting the Concept of Talar Shift in Ankle Fractures

Lloyd, John; Elsayed, Sherief; Hariharan, Kartik; Tanaka, Hiro

doi:10.1177/107110070602701006

Cited by 154 publications

(95 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It seems that most surgeons are concerned by inadequate reduction and stabilisation of these fragments, which involve the articular surface. This is in accordance with data showing that 1 mm of tibiotalar displacement was sufficient to result in a 42 % increase in tibiotalar contact pressure [15,20], thereby potentially promoting early ankle-joint arthritis. Moreover, this study revealed that surgeons involved in foot and ankle and trauma practice are essentially those that most likely shifted treatment preference further towards operative intervention when concomitant posterior malleolar fragment is observed on CT. Surgeons who were not foot and ankle or trauma subspecialists were not significantly affected in their treatment preferences when viewing radiographs only compared with viewing CT images.…”

Section: Discussionsupporting

confidence: 80%

The effect of minimally displaced posterior malleolar fractures on decision making in minimally displaced lateral malleolus fractures

Palmanovich

Brin

Laver

et al. 2013

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Purpose Despite the high incidence of cases of minimally displaced lateral or posterior malleolus ankle fractures, treatment guidelines are still an issue of controversy. The purpose of this study was to delineate treatment preferences among orthopaedic surgeons in these fractures with and without concomitant posterior malleolus fractures. We hypothesized that concomitant minimally displaced fractures of the posterior malleolus can shift treatment preference towards operative intervention. Methods A questionnaire-based study was conducted among orthopaedic surgeons attending the 2012 European Federation of National Associations of Orthopaedics and Traumatology Conference (EFORT) in Berlin, Germany. Treatment preferences were reported for minimally displaced lateral malleolus fractures seen on radiographs and were then compared with treatment preferences when computed tomography (CT) was added revealing a concomitant minimally displaced posterolateral fracture of the posterior malleolus. Results The cohort comprised 177 surgeons from all six continents. When radiographs showing a minimally displaced lateral malleolus fracture were presented, nonoperative management was indicated by 35 % (62) of participants, whereas 65 % (115) preferred operative intervention. After CT views were added showing an accompanying minimally displaced posterolateral posterior malleolus fracture, 79 % (140) suggested operative intervention and only 21 % (37) advocated nonoperative management (p =0.03). ConclusionsMost surgeons prefer open reduction with internal fixation for minimally displaced lateral malleolar fractures. The presence of concomitant posterior malleolus fractures in these cases shifts treatment preference further towards open reduction with internal fixation. Because the posterior malleolus fragment might not be well delineated on standard ankle radiographs, a high index of suspicion is warranted, and the use of CT should be considered in these cases.

show abstract

Section: Discussionsupporting

confidence: 80%

The effect of minimally displaced posterior malleolar fractures on decision making in minimally displaced lateral malleolus fractures

Palmanovich

Brin

Laver

et al. 2013

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

show abstract

“…A change in the contact stresses of the joint. It was demonstrated experimentally that a lateral talus shift of 1 mm produces a decrease in the contact area of 42% [18,19], which underlines the importance of the lateral malleolus, considering that ''the talus not only goes with the lateral malleolus, but also stays with it'' [20]. In relation to the assumed reduction in contact area in the presence of a Volkmann triangle, statistical experimental studies have shown that the larger the Volkmann triangle, the greater the change in the contact area [7,9].…”

Section: Discussionmentioning

confidence: 99%

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

Heim¹,

Niederhauser

Simbrey

2010

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

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.

show abstract

“…367 Th e loads were applied to the tibia, as was done in previous studies. 253,264,323 Th e reallife situation might have been better imitated by also loading the fi bula, which transmits 7% of the total force through the lower leg. 157 However, loading the fi bula would probably not have had any notable eff ect on the results because the pressure distribution would have shift ed slightly to the lateral side, 389 with minor eff ects on the medially located implant.…”

mentioning

confidence: 99%