The Experts below are selected from a list of 201 Experts worldwide ranked by ideXlab platform
C. Niek Dijk - One of the best experts on this subject based on the ideXlab platform.
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The diagnosis and treatment of deltoid ligament lesions in supination–external rotation ankle Fractures: a review
Strategies in Trauma and Limb Reconstruction, 2012Co-Authors: Sjoerd A. S. Stufkens, Michel P. J. Bekerom, Markus Knupp, Beat Hintermann, C. Niek DijkAbstract:The supination–external rotation or Weber B type Fracture exists as a stable and an unstable type. The unstable type has a medial malleolus Fracture or deltoid ligament lesion in addition to a fibular Fracture. The consensus is the unstable type and best treated by open reduction and internal fixation. The diagnostic process for a medial ligament lesion has been well investigated but there is no consensus as to the best method of assessment. The number of deltoid ruptures as a result of an external rotation mechanism is higher than previously believed. The derivation of the injury mechanism could provide information of the likely ligamentous lesion in several Fracture patterns. The use of the Lauge-Hansen classification system in the assessment of the initial X-ray images can be helpful in predicting the involvement of the deltoid ligament but the reliability in terms of sensitivity and specificity is unknown. Clinical examination, stress radiography, magnetic resonance imaging, arthroscopy, and ultrasonography have been used to investigate medial colLateral integrity in cases of ankle Fractures. None of these has shown to possess the combination of being cost-effective, reliable and easy to use; currently gravity stress radiography is favoured and, in cases of doubt, arthroscopy could be of value. There is a disagreement as to the benefit of repair by suture of the deltoid ligament in cases of an acute rupture in combination with a Lateral Malleolar Fracture. There is no evidence found for suturing but exploration is thought to be beneficial in case of interposition of medial structures.
T O White - One of the best experts on this subject based on the ideXlab platform.
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gravity stress radiographs does a positive radiograph mean an unstable ankle
Orthopaedic Proceedings, 2018Co-Authors: Bugler K E, G. Smith, T O WhiteAbstract:Assessment of stability in ankle Fractures is key in deciding the most appropriate mode of treatment. Stress radiographs have been suggested as a potential method for assessing ankle stability in patients with apparently isolated Lateral Malleolar Fractures. Whilst stress radiographs have been found to be both sensitive and specific in cadaveric experiments, recent clinical studies have suggested that a widened medial clear space (MCS) on stress radiographs may not equate to a functionally unstable ankle. We aimed to assess whether patients with an apparently isolated Lateral Malleolar Fracture on presentation but with a positive gravity stress radiograph (GSR) could be successfully managed non-operatively.A prospective study of all patients with Lateral Malleolar Fractures presenting to our orthopaedic trauma department was undertaken. Patients with an oblique distal fibular Fracture pattern and no obvious MCS widening on routine radiographs underwent a GSR. Measurements of the radiographic MCS and super...
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gravity stress radiographs does a positive radiograph mean an unstable ankle
Journal of Bone and Joint Surgery-british Volume, 2014Co-Authors: K E Bugler, G. Smith, T O WhiteAbstract:Assessment of stability in ankle Fractures is key in deciding the most appropriate mode of treatment. Stress radiographs have been suggested as a potential method for assessing ankle stability in patients with apparently isolated Lateral Malleolar Fractures. Whilst stress radiographs have been found to be both sensitive and specific in cadaveric experiments, recent clinical studies have suggested that a widened medial clear space (MCS) on stress radiographs may not equate to a functionally unstable ankle. We aimed to assess whether patients with an apparently isolated Lateral Malleolar Fracture on presentation but with a positive gravity stress radiograph (GSR) could be successfully managed non-operatively. A prospective study of all patients with Lateral Malleolar Fractures presenting to our orthopaedic trauma department was undertaken. Patients with an oblique distal fibular Fracture pattern and no obvious MCS widening on routine radiographs underwent a GSR. Measurements of the radiographic MCS and superior clear space (SCS) were made and compared with published criteria. 155 patients were included in the study and treated non-operatively fully weight bearing in either a cast or removable boot. Following Fracture union all patients had both anatomical alignment of the ankle mortise and good or excellent function. The MCS of 79% of these patients was found to be greater than 4 mm with 19% greater than 6 mm. All of these patients were successfully managed non-operatively. The currently used criteria for measurements on stress radiographs result in high numbers of false positive cases. This may be leading to unnecessary surgery. Further investigation is required in order to identify other clinical or radiographic criteria that may be of use in the assessment of functional ankle stability after Fracture.
Sjoerd A. S. Stufkens - One of the best experts on this subject based on the ideXlab platform.
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The diagnosis and treatment of deltoid ligament lesions in supination–external rotation ankle Fractures: a review
Strategies in Trauma and Limb Reconstruction, 2012Co-Authors: Sjoerd A. S. Stufkens, Michel P. J. Bekerom, Markus Knupp, Beat Hintermann, C. Niek DijkAbstract:The supination–external rotation or Weber B type Fracture exists as a stable and an unstable type. The unstable type has a medial malleolus Fracture or deltoid ligament lesion in addition to a fibular Fracture. The consensus is the unstable type and best treated by open reduction and internal fixation. The diagnostic process for a medial ligament lesion has been well investigated but there is no consensus as to the best method of assessment. The number of deltoid ruptures as a result of an external rotation mechanism is higher than previously believed. The derivation of the injury mechanism could provide information of the likely ligamentous lesion in several Fracture patterns. The use of the Lauge-Hansen classification system in the assessment of the initial X-ray images can be helpful in predicting the involvement of the deltoid ligament but the reliability in terms of sensitivity and specificity is unknown. Clinical examination, stress radiography, magnetic resonance imaging, arthroscopy, and ultrasonography have been used to investigate medial colLateral integrity in cases of ankle Fractures. None of these has shown to possess the combination of being cost-effective, reliable and easy to use; currently gravity stress radiography is favoured and, in cases of doubt, arthroscopy could be of value. There is a disagreement as to the benefit of repair by suture of the deltoid ligament in cases of an acute rupture in combination with a Lateral Malleolar Fracture. There is no evidence found for suturing but exploration is thought to be beneficial in case of interposition of medial structures.
Robinson Esteves Santos Pires - One of the best experts on this subject based on the ideXlab platform.
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nailing the fibula alternative or standard treatment for Lateral Malleolar Fracture fixation a broken paradigm
European Journal of Trauma and Emergency Surgery, 2020Co-Authors: Vincenzo Giordano, Robinson Esteves Santos Pires, Guilherme Boni, Junji Miller Fukuyama, Hilton A. Koch, Alexandre Leme Godoysantos, Peter V. GiannoudisAbstract:Despite the fact that open reduction and internal fixation with a plate, either non-locked or locked, is the standard of care for managing Lateral malleolus Fractures, intramedullary (IM) fixation of the fibula has been recently introduced as an alternative, mainly for some potential complicated situations. We hypothesized that almost all patterns of distal fibula Fracture can be safely fixed with an IM device, with the potential benefit of providing biomechanical efficiency, but using a soft-tissue friendly implant. Here, we present a multicenter case series based on a proposed algorithm. Sixty-nine consecutive patients were managed with fibular IM fixation for closed Malleolar Fractures. Twenty patients were managed by IM screw fixation and 49 by fibular nailing. Outcome was measured both according to the American Orthopaedic Foot and Ankle Society (AOFAS) score for ankle and hindfoot, and the time to bone union. The mean AOFAS for Group I was 99.35 ± 1.95 points and that for Group II was 89.30 ± 16.98 points. There were no significant differences between the Fracture pattern, according to the Lauge-Hansen classification, and post-operative levels of pain and functional activity among patients in both groups (p > 0.05). All Fractures healed uneventfully in both groups. The mean time to union for Group I was 8.15 weeks and for Group II was 8.25 weeks (p > 0.05). In this multicenter case series, intramedullary fixation for the Lateral malleolus Fracture presented itself as a viable and safe option for the treatment of almost all patterns of fibula Fracture in adults. Overall, we were able to demonstrate the potential indications of the proposed algorithm for the choice of IM implant for the Lateral malleolus Fracture in terms of the Lauge-Hansen staged classification.
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Minimally invasive percutaneous plate osteosynthesis for ankle Fractures: a prospective observational cohort study
European Journal of Orthopaedic Surgery & Traumatology, 2014Co-Authors: Robinson Esteves Santos Pires, Vincenzo Giordano, Cyril Mauffrey, Marco Antônio Percope Andrade, Leonardo Brandão Figueiredo, João Carlos Belloti, Fernando Baldy ReisAbstract:Background The gold standard for the surgical management of ankle Fractures is through open reduction and internal fixation. The rate of wound problems has been reported to be as high as 18 %, especially in patients with poor vascular supply or in diabetics. Minimally invasive percutaneous plate osteosynthesis (MIPPO) has been described as a potential solution for these patients. Patients and methods This is a prospective observational cohort study. From October 2009 to February 2010, and following ethical approval of our research, adult patients admitted at our level I trauma center with a closed Lateral Malleolar displaced unstable Fracture (Lauge-Hansen supination-external rotation) with or without a medial-sided injury and patients with an undisplaced Fracture associated with medial clear space opening on external rotation stress radiographs were recruited and managed using MIPPO technique. All patients were followed up for a minimum of 12 months post-surgery (12–20 with a mean of 16.5 months). Trauma mechanism, comorbidities, classifications, trauma-surgery interval, image intensifier duration, surgery duration, complications, and function American Orthopaedic Foot and Ankle Society (AOFAS) were analyzed. Results Thirty-two patients were recruited of which 20 fulfilled the inclusion criteria (16 females, 4 males) and were available for follow-up. Ten Fractures (50 %) were classified as 44-B1, 7 Fractures (35 %) as 44-B2, and 3 Fractures (15 %) as 44-B3 according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association classification (100 % were supination-external rotation injuries). At 8 weeks post-surgery, all Fractures had healed. The duration of surgery ranged between 15 and 73 min (average 32.8) from skin incision to closure. There were 2 complications (1 malunion and 1 skin necrosis requiring implant removal). At 12-month follow-up, AOFAS average was 88.3 (72–100 standard deviation of 6.8 points). Conclusion MIPPO technique proved to be a viable option for Lateral Malleolar Fracture treatment with a low complication rate and high functional outcome at 1 year. It is particularly useful in patients with a high risk of wound complication.
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percutaneous lag screw fixation for Lateral Malleolar Fracture technique description and case report
Journal of trauma and treatment, 2013Co-Authors: Robinson Esteves Santos Pires, Daniel Baumfeld, Daniel Balbachevsky, Pedro Jose Labronici, Tiago Baumfeld, Marcelo Back Sternick, Fernando Baldy Dos ReisAbstract:Open reduction and internal fixation with plate and screws is the standard treatment for displaced or unstable Lateral Malleolar Fractures. Despite functional satisfactory results obtained using this technique, complications including infection, skin necrosis, and discomfort caused by the plate are reported in 10-20% of cases. Several minimally invasive techniques have emerged as alternatives to avoid these complications. The present study aims to describe a technique and case report for percutaneous treatment of Lateral Malleolar Fractures applying only screw fixation.
Beat Hintermann - One of the best experts on this subject based on the ideXlab platform.
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The diagnosis and treatment of deltoid ligament lesions in supination–external rotation ankle Fractures: a review
Strategies in Trauma and Limb Reconstruction, 2012Co-Authors: Sjoerd A. S. Stufkens, Michel P. J. Bekerom, Markus Knupp, Beat Hintermann, C. Niek DijkAbstract:The supination–external rotation or Weber B type Fracture exists as a stable and an unstable type. The unstable type has a medial malleolus Fracture or deltoid ligament lesion in addition to a fibular Fracture. The consensus is the unstable type and best treated by open reduction and internal fixation. The diagnostic process for a medial ligament lesion has been well investigated but there is no consensus as to the best method of assessment. The number of deltoid ruptures as a result of an external rotation mechanism is higher than previously believed. The derivation of the injury mechanism could provide information of the likely ligamentous lesion in several Fracture patterns. The use of the Lauge-Hansen classification system in the assessment of the initial X-ray images can be helpful in predicting the involvement of the deltoid ligament but the reliability in terms of sensitivity and specificity is unknown. Clinical examination, stress radiography, magnetic resonance imaging, arthroscopy, and ultrasonography have been used to investigate medial colLateral integrity in cases of ankle Fractures. None of these has shown to possess the combination of being cost-effective, reliable and easy to use; currently gravity stress radiography is favoured and, in cases of doubt, arthroscopy could be of value. There is a disagreement as to the benefit of repair by suture of the deltoid ligament in cases of an acute rupture in combination with a Lateral Malleolar Fracture. There is no evidence found for suturing but exploration is thought to be beneficial in case of interposition of medial structures.
