Study of the relation between the posterior malleolus fracture and the development of osteoarthritis

Abarquero-Diezhandino, Ana; Luengo-Alonso, Gonzalo; Alonso-Tejero, D.; Sánchez-Morata, Enrique; Olaya-González, Carlos; Rico, Jesús Vilá y

doi:10.1016/j.recote.2019.11.002

Cited by 8 publications

(10 citation statements)

References 31 publications

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“…The search identified 2224 references, of which 129 were assessed as a full-text article and 34 studies were included examining 3447 patients ( Fig. 1 ) ( 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ). The reasons for exclusion of 95 studies have been recorded.…”

Section: Resultsmentioning

confidence: 99%

The prognosis of ankle fractures: a systematic review

Swierstra¹,

Enst²

2022

EFORT Open Reviews

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The aim of this study was to update the scientific evidence for ankle fracture prognosis by addressing radiographic osteoarthritis, time course and prognostic factors. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included if they were randomized controlled trials, controlled trials or observational studies, including case series and case-control studies investigating radiologically confirmed osteoarthritis in adults with a classified ankle fracture, treated with or without surgery, with a minimum follow-up of 1 year. Also included were studies examining prognostic factors predicting radiologically confirmed osteoarthritis. Tibial plafond and talus fractures were excluded. Thirty-four studies were included examining 3447 patients. Extracted data included study type, inclusion and exclusion criteria, age, number of patients, number of fractures according to the author-reported classification method, radiological osteoarthritis, follow-up period, prognostic factors, and treatment. Severe heterogeneity was visible in the analyses (I2 > 90%), reflecting clinical heterogeneity possibly arising from the presence of osteoarthritis at baseline, the classifications used for the fractures and for osteoarthritis. The incidence of osteoarthritis was 25% (95% CI: 18–32) and 34% (95% CI: 23–45) for more severe fractures with involvement of the posterior malleolus. The severity of the trauma, as reflected by the fracture classification, was the most important prognostic factor for the development of radiographic osteoarthritis, but there is also a risk with simpler injuries. The period within which osteoarthritis develops or becomes symptomatic with an indication for treatment could not be specified.

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Section: Resultsmentioning

confidence: 99%

The prognosis of ankle fractures: a systematic review

Swierstra¹,

Enst²

2022

EFORT Open Reviews

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“…He reported on 31 of 32 cases that rapidly developed severe posttraumatic ankle arthritis even after only slight malreduction of the ankle mortise [162]. Several well-known studies confirmed Willenegger's early observations, and today, it is generally accepted that even a small syndesmotic displacement of less than 1 mm can have devastating consequences for the rapid development of posttraumatic ankle arthritis [1,59,62,65,100,102,111,116,123,153]. Significant increases in tibiotalar contact pressures occur when external rotation stresses are added to axial loading in an unstable tibiofibular syndesmosis.…”

Section: Importance Of Anatomic Reductionmentioning

confidence: 90%

“…To address the posterior malleolus when treating ankle fractures, surgeons should choose the most adequate approach based on the fracture pattern and their own experience [3,[14][15][16][17]99,146,152,154,155]. Anatomical reduction and stable fixation of the posterior malleolus are critical to improve outcomes [1,3,[14][15][16][17]21,43,46,50,84,86,99,144,146,153,154].…”

Section: Role Of the Posterior Malleolusmentioning

confidence: 99%

“…Furthermore, according to Verhage, the posterior fragment size is not a clear indication for its fixation [153]. A step-off, however, seems to be an important indicator for developing posttraumatic osteoarthritis and worse functional outcome [1,21,43,153]. Therefore, displaced posterior fragments involving the intra-articular surface need to be reduced and fixated to prevent postoperative persisting step-off [153].…”

Section: Role Of the Posterior Malleolusmentioning

confidence: 99%

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Evidence-Based Surgical Treatment Algorithm for Unstable Syndesmotic Injuries

Regauer¹,

Mackay

Nelson

et al. 2022

JCM

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Background: Surgical treatment of unstable syndesmotic injuries is not trivial, and there are no generally accepted treatment guidelines. The most common controversies regarding surgical treatment are related to screw fixation versus dynamic fixation, the use of reduction clamps, open versus closed reduction, and the role of the posterior malleolus and of the anterior inferior tibiofibular ligament (AITFL). Our aim was to draw important conclusions from the pertinent literature concerning surgical treatment of unstable syndesmotic injuries, to transform these conclusions into surgical principles supported by the literature, and finally to fuse these principles into an evidence-based surgical treatment algorithm. Methods: PubMed, Embase, Google Scholar, The Cochrane Database of Systematic Reviews, and the reference lists of systematic reviews of relevant studies dealing with the surgical treatment of unstable syndesmotic injuries were searched independently by two reviewers using specific terms and limits. Surgical principles supported by the literature were fused into an evidence-based surgical treatment algorithm. Results: A total of 171 articles were included for further considerations. Among them, 47 articles concerned syndesmotic screw fixation and 41 flexible dynamic fixations of the syndesmosis. Twenty-five studies compared screw fixation with dynamic fixations, and seven out of these comparisons were randomized controlled trials. Nineteen articles addressed the posterior malleolus, 14 the role of the AITFL, and eight the use of reduction clamps. Anatomic reduction is crucial to prevent posttraumatic osteoarthritis. Therefore, flexible dynamic stabilization techniques should be preferred whenever possible. An unstable AITFL should be repaired and augmented, as it represents an important stabilizer of external rotation of the distal fibula. Conclusions: The current literature provides sufficient arguments for the development of an evidence-based surgical treatment algorithm for unstable syndesmotic injuries.

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“…Dentro de los síntomas se mencionan: dolor tipo difuso, de variable intensidad y duración, exacerbado por el movimiento de la articulación; tumefacción al final del día, especialmente si se realizaron actividades donde se debía levantar peso; rigidez, comúnmente después de largos periodos de inactividad y que va aumentando en intensidad conforme progresa el tiempo y disminución del rango de movimiento. (49,50). Algunas opciones de manejo conservador son el uso de antiinflamatorios no esteroideos, zapatos ortopédicos; como alternativas quirúrgicas se proponen la artroplastia y artrodesis (21).…”

Section: Complicacionesunclassified

Fractura trimaleolar

Ovares¹,

Calderón²,

Marroquín³

et al. 2022

Rev.méd.sinerg.

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Las fracturas trimaleolares representan el 7%-11% de las fracturas de tobillo y generalmente son causadas por traumas de alta energía. Son fracturas inestables que requieren reparación quirúrgica en la mayoría de los casos pues se asocia con un mejor resultado funcional por lo que se debe considerar en todos los pacientes, incluso en aquellos con comorbilidades. En este tipo de fracturas el compromiso del maléolo posterior es el componente de mayor complejidad y se asocia a un peor pronóstico. El manejo de este tipo de fracturas aún es controversial, principalmente en cuanto al orden de la reparación de los maléolos y en los materiales de fijación que deben utilizarse.

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Study of the relation between the posterior malleolus fracture and the development of osteoarthritis

Cited by 8 publications

References 31 publications

The prognosis of ankle fractures: a systematic review

The prognosis of ankle fractures: a systematic review

Evidence-Based Surgical Treatment Algorithm for Unstable Syndesmotic Injuries

Fractura trimaleolar

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