Versorgung der Sprunggelenkfraktur

Kamin, Konrad; Notov, Dmitri; Al-Sadi, Onays; Kleber, Christian; Rammelt, Stefan

doi:10.1007/s00113-019-00753-x

Cited by 13 publications

(2 citation statements)

References 56 publications

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“…16,17,19,22 Compared to simple ankle fractures, AFDs require more complex treatment because primary open reduction and internal fixation (ORIF) is often hindered by posttraumatic soft tissue swelling. 8,9 Although cases indicated for emergency surgery due to open fractures or neurologic/vascular impairment are often treated with ankle-spanning external fixation (ExFix), primary treatment for cases with moderate to severe soft tissue swelling should include immediate closed reduction followed by immobilization. Alternative primary immobilization options for AFDs include plaster of Paris constructs, such as lower leg splints and below-knee casts, with the latter providing greater stability.…”

Section: Introductionmentioning

confidence: 99%

Temporary Cast Application in Dislocated Ankle Fractures Leads to High Rates of Secondary Loss of Reduction: Does the Lauge-Hansen Injury Type Matter?

Mandelka,

Wikanardi,

Beisemann

et al. 2024

Foot Ankle Int.

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Background: For the temporary treatment of ankle fracture dislocations (AFDs), previous studies indicate higher rates of secondary loss of reduction (LOR) with splint immobilization, prompting consideration for expanding indications for external fixation (ExFix). However, these studies did not investigate the influence of fracture morphology to further improve patient selection. The aim of this study was to investigate the influence of Lauge-Hansen injury type on the LOR rate in bimalleolar or trimalleolar AFDs for temporary cast vs ExFix immobilization. Methods: In this retrospective cohort study, patients with isolated AFD cases treated at our institution from 2011 to 2020 were reviewed. Inclusion criteria required radiographs depicting initial dislocation and appropriate reduction after Cast or ExFix immobilization. Exclusion criteria encompassed concomitant injuries, open fractures, conservative management as well as surgery performed within 48 hours or at a different facility. Patients were grouped by temporary treatment (Cast or ExFix). The primary endpoint was LOR prior to definitive surgery across various Lauge-Hansen types. Results: The LOR rate was significantly higher in the cast group (40/152, 26.3%) compared to the ExFix group (5/191, 2.6%; P < .0001). In the cast group, LOR was associated with an increase in time to definitive surgery by a mean of 3 days ( P < .002). During cast treatment, LOR was significantly more likely for pronation abduction ( P = .001) and supination external rotation injuries ( P < .0001), whereas no significant differences were observed for pronation external rotation ( P = .006), supination adduction ( P > .99), and fractures not classifiable ( P > .99). Conclusion: In cases of AFDs resulting from supination external rotation or pronation abduction trauma according to the Lauge-Hansen classification, especially in the setting of an additional posterior malleolar fracture, primary application of external fixation should be considered to reduce the risk for secondary loss of reduction. Level of Evidence: Level III, retrospective cohort study.

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Section: Introductionmentioning

confidence: 99%

Temporary Cast Application in Dislocated Ankle Fractures Leads to High Rates of Secondary Loss of Reduction: Does the Lauge-Hansen Injury Type Matter?

Mandelka,

Wikanardi,

Beisemann

et al. 2024

Foot Ankle Int.

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“…These include anatomical locking plates [12] and intramedullary nails [13] for distal fibular fractures. Locking plates and intramedullary nails were designed predominantly for the elderly population, as they were shown to enhance the biomechanical stability and reduce wound healing problems especially in patients at risk [14][15][16][17][18][19]. However, the authors are not aware of any study evaluating the actual implementation of these modern treatment strategies into daily practice.…”

Section: Introductionmentioning

confidence: 99%

Trends of incidence and treatment strategies for operatively treated distal fibula fractures from 2005 to 2019: a nationwide register analysis

Milstrey

Baumbach²,

Pfleiderer

et al. 2021

Arch Orthop Trauma Surg

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Introduction Valid epidemiological data about distal fibular fractures and their treatment strategies are missing. Innovative osteosynthesis techniques were introduced and improved during the past 15 years. The aim of this study was to investigate the epidemiologic development and the implementation of new treatment strategies in a nationwide register in Germany over a period of 15 years. Materials and methods Data of the German Federal Statistical Office from 2005 until 2019 were screened. Adults with a fracture of the distal fibula were included. Data were separated for gender, age and treatment strategy. Results During the past 15 years, there was a steady annual incidence of distal fibula fractures of 74 ± 32 per 100,000 people without any significant changes (p = 0.436). 60.1% ± 0.6% of all fractures occurred in females. The annual incidence for male was nearly constant over the different age groups, whereas for female, there was a clear increase in incidence above the age of 40. Whereas 66% of fractures in between 20 and 30 years of age occurred in male, approximately 70% of fractures above the age of 60 occurred in females. The relative quantity of locking plates increased from 2% in 2005 to 34% in 2019. In 2019, only 1.02% of the patients were operated with an intramedullary nail. Conclusions Operatively treated distal fibular fractures revealed an age dependent increase in incidence in postmenopausal women compared to younger females. Regarding the treatment strategy, there was an increase in application of locking plates. The data implicate a typical fragility fracture related age and gender distribution for distal fibula fractures.

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