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Phinit Phisitkul - One of the best experts on this subject based on the ideXlab platform.

  • Effect of Posterior Malleolus Fracture on Syndesmotic Reduction: A Cadaveric Study.
    The Journal of bone and joint surgery. American volume, 2018
    Co-Authors: Elizabeth Fitzpatrick, Jessica E Goetz, Tinnart Sittapairoj, Vinay Hosuru Siddappa, John E. Femino, Phinit Phisitkul
    Abstract:

    Background:Syndesmotic malreduction and Fractures of the posterior Malleolus negatively influence outcomes of rotational ankle Fractures. Recent data have shown that posterior Malleolus fixation contributes to the stability of the syndesmosis. The purpose of this study was to analyze syndesmotic red

  • Effect of Posterior Malleolus Fracture on Syndesmosis Reduction
    Foot & Ankle Orthopaedics, 2016
    Co-Authors: Phinit Phisitkul, Jessica E Goetz, Elizabeth Fitzpatrick, Tinnart Sittapairoj, Vinay Hosuru Siddappa, Bryan Den Hartog, John E. Femino
    Abstract:

    Category:TraumaIntroduction/Purpose:Syndesmotic malreduction and the presence of posterior Malleolus Fractures negatively influence outcomes in rotational ankle Fractures. While there are no universally accepted criteria for posterior malleolar fixation, it has recently been shown that posterior malleolar fixation contributed to the stability of the syndesmosis. However, little is known if and how anatomic or non-anatomic fixation of the posterior Malleolus affects syndesmotic reduction. A study analyzing syndesmotic reduction in specimens with varying in size and quality of reduction of the posterior Malleolus was conducted.Methods:Nine through-knee cadaveric specimens were randomized into two groups with small (a third of the fibular notch, n=4) and large (two-third of the fibular notch, n=5) posterior malleolar fragments. A model of stage IV supination external rotation injury after fibular repair was created by sharply releasing anterior inferior tibiofibular ligament, superficial and deep deltoid lig...

  • Effect of Posterior Malleolus Fracture on Syndesmosis Reduction
    SAGE Publishing, 2016
    Co-Authors: Phinit Phisitkul, Jessica E Goetz, Tinnart Sittapairoj, Elizabeth M. Fitzpatrick, Vinay Hosuru Siddappa Md Mbbs, Bryan Den Hartog, John E. Femino
    Abstract:

    Category: Trauma Introduction/Purpose: Syndesmotic malreduction and the presence of posterior Malleolus Fractures negatively influence outcomes in rotational ankle Fractures. While there are no universally accepted criteria for posterior malleolar fixation, it has recently been shown that posterior malleolar fixation contributed to the stability of the syndesmosis. However, little is known if and how anatomic or non-anatomic fixation of the posterior Malleolus affects syndesmotic reduction. A study analyzing syndesmotic reduction in specimens with varying in size and quality of reduction of the posterior Malleolus was conducted. Methods: Nine through-knee cadaveric specimens were randomized into two groups with small (a third of the fibular notch, n=4) and large (two-third of the fibular notch, n=5) posterior malleolar fragments. A model of stage IV supination external rotation injury after fibular repair was created by sharply releasing anterior inferior tibiofibular ligament, superficial and deep deltoid ligaments, and interosseous membrane. Posterior malleolar Fracture with predefined sizing was created with preservation of posterior inferior tibiofibular ligament. High resolution CT scan was obtained in each specimen at the four stages; intact, neutral- axis syndesmotic clamping only, with anatomic fixation of the posterior Malleolus, and with non-anatomic fixation of the posterior Malleolus using a 4.8 mm interposed spacer. Measurement of syndesmotic reduction in both anteroposterior and mediolateral planes was made automatically using a validated technique assisted by custom-developed software at 1 cm proximal to the ankle joint. Results: The presence of either a neutral-axis clamping alone or with an anatomically reduced Fracture fragment caused a slight anterior shift of the fibula that was more pronounced in the smaller fragment group. Two-way ANOVA indicated no significant effects of fragment size (p=0.73) or reduction (p=0.09) on AP fibular movement. However, presence of non-anatomical fixation caused the fibula to move significantly posteriorly in the presence of a large posterior malleolar fragment (p=0.03 and p=0.01 relative to the intact and clamping only states). In the mediolateral direction, a neutral-axis clamping alone and clamping with an anatomically reduced Fracture fragment both increased medial translation of the distal fibula. The non-anatomic reduction model of the posterior Malleolus associated with corresponding lateral displacement of the distal fibula. Conclusion: The overall anteroposterior reduction of the syndesmosis using neutral-axis clamping was generally not affected by posterior malleolar Fracture except in a non-anatomic fixation of large fragments. Mediolateral syndesmotic reduction was affected by the conditions of posterior malleolar fixation with best results in anatomic fixation but the intact state was still not replicated. Malreduction of the posterior Malleolus led to a corresponding syndesmotic malreduction. When a posterior malleolar fixation is indicated in cases with syndesmotic injury, anatomic Fracture fixation is paramount as it can affect syndesmotic reduction especially with larger fragments

  • forceps reduction of the syndesmosis in rotational ankle Fractures a cadaveric study
    Journal of Bone and Joint Surgery American Volume, 2012
    Co-Authors: Phinit Phisitkul, Thomas Ebinger, Jessica E Goetz, Tanawat Vaseenon, Lawrence J Marsh
    Abstract:

    Background: Recent studies have shown that it is difficult to accurately reduce and assess the reduction of the syndesmosis after ankle injury. The syndesmosis is most commonly reduced with use of reduction clamps to compress across the tibia and fibula. However, intraoperative techniques to optimize forceps reductions to restore syndesmotic relationships accurately have not been systematically studied. The purpose of the present study was to evaluate the accuracy of syndesmosis reduction with different rotational vectors of clamp placement. Methods: Ten through-the-knee cadaveric specimens were used. Markers were placed on the tibia and fibula to produce consistent clamp placement and radiographic evaluation. A computed tomographic scan of the ankle was made to serve as a control, followed by a stepwise destabilization of the anterior inferior tibiofibular ligament, syndesmosis, deltoid ligament, small posterior Malleolus Fracture, and large posterior Malleolus Fracture. Following each step in the destabilization, clamps were applied to compress the syndesmosis at varying angles and computed tomography was performed to measure the alignment of the syndesmosis as compared with that on the control scan. Results: In all degrees of induced instability, and for all vectors of clamp placement, a small but consistent amount of overcompression of the syndesmosis was observed. The average overcompression (and standard deviation) for all samples was 0.93 ± 0.70 mm. Both obliquely oriented clamp arrangements consistently caused fibular malreductions in the sagittal plane. Placing the clamp in the neutral anatomical axis reduced the syndesmosis most accurately, with an average displacement of 0.1 ± 0.77 mm compared with control through all degrees of instability. Conclusions: Clamp placement in the neutral anatomical axis reduced the syndesmosis most accurately in our cadaveric model, although slight overcompression was frequently observed. Placing the clamp obliquely malreduced the unstable syndesmosis. Clinical Relevance: Clampplacementintheneutralanatomicalaxisappearstobepreferredinthesyndesmosisreduction.

John Y Kwon - One of the best experts on this subject based on the ideXlab platform.

  • medial tenderness revisited is medial ankle tenderness predictive of instability in isolated lateral Malleolus Fractures
    Injury-international Journal of The Care of The Injured, 2020
    Co-Authors: Derek S Stenquist, Christopher P Miller, Brian Velasco, Patrick Cronin, John Y Kwon
    Abstract:

    Introduction Determining deltoid ligament incompetence in supination external rotation (SER) injuries commonly relies on stress radiography, given several studies demonstrating low predictive value of physical examination. Stress radiography can be difficult to obtain and may result in suboptimal radiographs with equivocal determination of stability. This study revisits the concept of medial ankle tenderness and its association with mortise instability. Methods Patients who presented with an isolated lateral Malleolus Fracture underwent prospective data collection. VAS scores were recorded with palpation at the lateral malleolar Fracture site, anterior deltoid ligament, and posterior deltoid ligament. Three non-weightbearing radiographs of the ankle and a gravity stress view were obtained. Statistical analysis was performed to determine a correlation between tenderness and instability defined as MCS widening > 4 mm on gravity stress x-ray. Results 51 patients met inclusion criteria. Group I (stable) and Group II (unstable) demonstrated no difference in tenderness over the lateral Malleolus (p = 0.94) or anterior deltoid (p = 0.12), but patients in Group II reported significantly more tenderness over the posterior deltoid (p = 0.03). Taking the higher pain score from either anterior or posterior deltoid palpation, patients with unstable ankle Fractures reported significantly more tenderness with medial palpation (p = 0.02). The relative risk of having an unstable ankle Fracture with any tenderness to palpation over either the anterior or posterior deltoid ligament was 1.77 (95% CI 1.03 - 3.06, P = 0.039). When comparing no pain versus the presence of any pain with palpation medially, the sensitivity for any medial tenderness to detect an unstable ankle Fracture was 0.76 (specificity 0.59, PPV 0.79, NPV 0.56). Conclusion Patients with any medial tenderness were at significantly higher risk of having an unstable SER ankle Fracture in this study, but strict reliance on the presence or absence of medial tenderness without stress radiographs would lead to an unacceptable number of both false positive and false negative determinations of instability. However, our findings suggest that medial tenderness is associated with instability. The 0.79 PPV of any medial tenderness for instability may be useful to cast doubt on equivocal stress radiography and prompt surgeons to repeat stress radiography or shorten the interval for radiographic follow up. Level of evidence Diagnostic study, Level II-1 (development of diagnostic criteria on basis of consecutive patients [with universally applied reference "gold" standard]).

  • ankle gravity stress view in the seated position a technical tip
    Injury-international Journal of The Care of The Injured, 2019
    Co-Authors: Jorge Briceno, Bonnie Chien, Christopher P Miller, Brian Velasco, John Y Kwon
    Abstract:

    Abstract The ankle gravity stress view (GSV) is often utilized to elucidate instability in patients with an apparent, isolated lateral Malleolus Fracture. While this has been demonstrated to have advantages over the manual external rotation stress test, positioning in the lateral decubitus position can be difficult, uncomfortable and time-intensive. We report a simple and safe technique that allows one to obtain a gravity stress view of the ankle with the patient seated.

  • ankle Fracture following hip arthroscopy
    Orthopedics, 2012
    Co-Authors: Eric D Schiffman, Joseph C Mccarthy, John Y Kwon
    Abstract:

    This article describes a case of an ankle Fracture following hip arthroscopy. A 58-year-old woman underwent hip arthroscopy for a labral tear. She was placed in a lateral decubitus position with her foot in a padded boot. Traction was maintained for approximately 30 minutes. She was instructed to bear weight as tolerated with crutches postoperatively. At 2-week follow-up, she reported ipsilateral ankle pain. Radiographs revealed a minimally displaced medial Malleolus Fracture. She was treated with a cast followed by a cam walker boot and successfully went on to complete union and resolution of her symptoms. The following risk factors exist for ankle Fracture after hip arthroscopy: history of ankle sprains, ligamentous laxity (more common in women), and small feet with large calves (more likely to become plantarflexed during traction). Distraction performed with the ankle rotated is also likely to place added stress on the medial or lateral ligamentous structures. It is important to counsel patients preoperatively about the risk of ankle pain after hip arthroscopy, to be aware of the possibility of ankle pathology postoperatively, and to have a low threshold for ordering radiographs. Radiographs are warranted if patients continue to have ankle pain after 72 hours postoperatively.

Ashley E Levack - One of the best experts on this subject based on the ideXlab platform.

  • posterior Malleolus Fracture displacement is associated with rotational ankle Fracture stability in patients without medial malleolar Fractures
    HSS Journal, 2020
    Co-Authors: Ashley E Levack, Elizabeth Gausden, Aleksey Dvorzhinskiy, David S Wellman, Dean G Lorich
    Abstract:

    Background The optimal method for the determination of ankle stability remains controversial in rotational ankle Fractures without medial bony injury.

  • posterior Malleolus Fracture displacement is associated with rotational ankle Fracture stability in patients without medial malleolar Fractures
    HSS Journal, 2020
    Co-Authors: Ashley E Levack, Elizabeth Gausden, Aleksey Dvorzhinskiy, David S Wellman, Dean G Lorich
    Abstract:

    The optimal method for the determination of ankle stability remains controversial in rotational ankle Fractures without medial bony injury. The purposes of this study were to (1) evaluate whether posterior malleolar (PM) Fracture displacement is associated with deltoid ligament injury in supination-external rotation (SER) ankle Fractures and (2) compare the diagnostic accuracy of PM displacement and magnetic resonance imaging (MRI) evaluation of the deep deltoid ligament in identifying Fractures with deltoid ligament incompetence. Patients with rotational bimalleolar injuries containing lateral malleolar and PM Fractures without bony medial injury were included. After operative lateral and PM fixation, an external rotation stress test was performed to evaluate deltoid ligament stability. Operative dictations were reviewed to confirm injury pattern, stability on stress test, and visual inspection of the deltoid ligament. Maximum PM displacement was assessed on lateral X-ray. Pre-operative MRI of the ankle was performed following closed reduction and splinting. The final cohort consisted of 13 trimalleolar equivalent Fractures (torn deltoid ligament) and 20 bimalleolar Fractures (medial Malleolus and deltoid ligament intact). Average PM displacement was significantly higher for SER trimalleolar equivalent patterns when measured on lateral X-ray. The sensitivity of detecting trimalleolar equivalent Fracture was higher on all reported X-ray findings than the sensitivity obtained by the reported MRI findings of deltoid ligament injury. PM displacement on X-ray is a useful adjuvant along with external rotation stress radiography and MRI evaluation of deep deltoid integrity to distinguish between stable and unstable Fracture patterns and thus helps facilitate treatment decisions.

Prabhakar Rao - One of the best experts on this subject based on the ideXlab platform.

Joshua A Metzl - One of the best experts on this subject based on the ideXlab platform.

  • high energy achilles tendon rupture with associated medial Malleolus Fracture and traumatic peroneal dislocation a case report
    Foot and Ankle Specialist, 2021
    Co-Authors: Mark Bowers, Kenneth J Hunt, Joshua A Metzl
    Abstract:

    Fracture, Achilles tendon rupture, or traumatic dislocation of the peroneal tendons are often seen in isolation after a trauma or sports-related injury. However, in rare circumstances, a combination of these injuries can occur simultaneously. Multiple previous case reports describe a combination of 2 of these injuries. Missed or delayed diagnosis is common in these combination injuries and can lead to significant patient morbidity and result in long-term consequences. We report a case of a 35-year-old man who sustained an Achilles tendon rupture with an associated medial Malleolus Fracture and traumatic peroneal dislocation after a snowboarding injury. These injuries were treated surgically, and at 9 months postoperatively, the patient had returned to all activities. Clinicians should have a high index of suspicion for concomitant injuries with higher-energy trauma to the ankle and should perform a thorough history, physical examination, and plain radiographs at a minimum.Levels of Evidence: LEVEL 5.