The Experts below are selected from a list of 3732 Experts worldwide ranked by ideXlab platform
Harm Hoekstra - One of the best experts on this subject based on the ideXlab platform.
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functional outcome and general health status after plate osteosynthesis of posterior Malleolus fractures the quest for eligibility
Injury-international Journal of The Care of The Injured, 2020Co-Authors: Maarten Mertens, Julia Wouters, Johannes Kloos, Stefaan Nijs, Harm HoekstraAbstract:Abstract Introduction The necessity for reduction and fixation of posterior Malleolus fractures remains under debate. Therefore, we assessed the functional outcome and quality after plate osteosynthesis of the posterior Malleolus, identified the main drivers of outcome and aimed to determine which patient and fracture type are eligible for plate osteosynthesis of the posterior Malleolus. Materials and methods A prospective patient cohort of 50 patients with an ankle fracture including the posterior Malleolus underwent plate osteosynthesis via a posterior approach, and was compared to a retrospective patient cohort of 85 consecutive patients who did not. Twenty-five demographic, operative and postoperative characteristics were assessed. Outcome was recorded using questionnaires: AOFAS, EQ-5D, EQ-5D-VAS, EQ-5D-TTO, sensory nerve‐associated complications, and flexion deficit of the hallux. Results Direct reduction and plate osteosynthesis of posterior Malleolus fractures was inferior to non-operative treatment. Subanalysis of trimalleolar fractures revealed that the outcome of plate osteosynthesis was equal. Both fracture type and plate osteosynthesis were independent drivers of the outcome; Haraguchi type 3 posterior Malleolus fractures were associated with the best functional outcome and quality of life scores. Comorbidity, age, postoperative complications and reintervention largely determined the outcome. Up to 30% of the patients reported (temporarily) flexion deficit of the hallux and 38% numbness at the lateral side of the foot. Conclusions There is no indication for routine plate osteosynthesis of all posterior Malleolus fractures. Careful patient selection, less invasive surgery and modified postoperative rehabilitation seem mandatory to improve the outcome and prevent adverse effects.
Tom Burke - One of the best experts on this subject based on the ideXlab platform.
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Less is more: lag screw only fixation of lateral malleolar fractures.
International Orthopaedics, 2006Co-Authors: Paul B. Mckenna, Kieran O’shea, Tom BurkeAbstract:Displaced fractures of the lateral Malleolus are typically treated with plate osteosynthesis with or without the use of lag screws, and immobilisation in a plaster cast for up to 6 weeks. Fixation through a smaller incision with less metal, such as lag screw only fixation, would theoretically lead to decreased infection rates and less irritation caused by hardware. The purpose of this study was to evaluate the benefits and success of lag screw only fixation of the lateral Malleolus in non-comminuted oblique fractures of the lateral Malleolus. A total of 25 patients who had non-comminuted unstable oblique fractures of their lateral Malleolus that had been surgically fixed with lag screws only were retrospectively evaluated. All patients were younger than 60 years of age. Evaluation of the success of fixation, complications, resultant mobility and patient satisfaction was based on information gathered from chart reviews, X-ray findings and a standardised questionnaire based on the AOFAS Foot and Ankle Outcomes Questionnaire. These results were compared to an age-matched group of 25 consecutive patients treated with plate osteosynthesis. Of the 25 patients fixed with lag screws, nine had an unstable fracture of the lateral Malleolus only, ten were bimalleolar fractures and six were trimalleolar. Eighteen patients were treated with two lag screws, and seven were treated with three lag screws. The bi- and trimalleolar fractures were treated with standard partially threaded cancellous screws. None of the lag screw-only group lost reduction. There were no documented wound infections in the lag screw group as compared to three deep infections in the plate group. Lag screw-only patients reported no palpable hardware as compared to 50% of the plate group. AOFAS scores at a mean of 12 months post-operative were similar in both groups. Lag screw only fixation of the lateral Malleolus is a safe and effective method that has a number of advantages over plate osteosynthesis, in particular less soft tissue dissection, less prominent, symptomatic and palpable hardware and a reduced requirement for secondary surgical removal.
Christopher W. Digiovanni - One of the best experts on this subject based on the ideXlab platform.
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Contribution of the Medial Malleolus to Tibiotalar Joint Contact Characteristics
Foot & ankle specialist, 2014Co-Authors: Craig R. Lareau, Jason T. Bariteau, David Paller, Sarath Koruprolu, Christopher W. DigiovanniAbstract:Background. Isolated medial Malleolus fractures are typically treated operatively to minimize the potential for articular incongruity, instability, nonunion, and posttraumatic arthritis. The literature, however, has not clearly demonstrated inferior outcomes with conservative treatment of these injuries. This study measured the effects of medial Malleolus fracture and its resultant instability on tibiotalar joint contact characteristics. We hypothesized that restoration of anatomical alignment and stability through fixation would significantly improve contact characteristics. Methods. A Tekscan pressure sensor was inserted and centered over the talar dome in 8 cadaveric foot and ankle specimens. Each specimen was loaded at 700 N in multiple coronal and sagittal plane orientations. After testing fractured samples, the medial Malleolus was anatomically fixed before repeat testing. Contact area and pressure were analyzed using a 2-way repeated-measure ANOVA. Results. In treated fractures, contact areas were higher, and mean contact pressures were lower for all positions. These differences were statistically significant in the majority of orientations and approached statistical significance in pure plantarflexion and pure inversion. Decreases in contact area varied from 15.1% to 42.1%, with the most dramatic reductions in positions of hindfoot eversion. Conclusions. These data emphasize the importance of the medial Malleolus in maintaining normal tibiotalar contact area and pressure. The average decrease in contact area after simulated medial malleolar fractures was 27.8% (>40% in positions of hindfoot eversion). Such differences become clinically relevant in cases of medial malleolar nonunion or malunion. Therefore, we recommend anatomical reduction and fixation of medial Malleolus fractures with any displacement. Level of Evidence: Therapeutic Level V—cadaveric study
Maarten Mertens - One of the best experts on this subject based on the ideXlab platform.
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functional outcome and general health status after plate osteosynthesis of posterior Malleolus fractures the quest for eligibility
Injury-international Journal of The Care of The Injured, 2020Co-Authors: Maarten Mertens, Julia Wouters, Johannes Kloos, Stefaan Nijs, Harm HoekstraAbstract:Abstract Introduction The necessity for reduction and fixation of posterior Malleolus fractures remains under debate. Therefore, we assessed the functional outcome and quality after plate osteosynthesis of the posterior Malleolus, identified the main drivers of outcome and aimed to determine which patient and fracture type are eligible for plate osteosynthesis of the posterior Malleolus. Materials and methods A prospective patient cohort of 50 patients with an ankle fracture including the posterior Malleolus underwent plate osteosynthesis via a posterior approach, and was compared to a retrospective patient cohort of 85 consecutive patients who did not. Twenty-five demographic, operative and postoperative characteristics were assessed. Outcome was recorded using questionnaires: AOFAS, EQ-5D, EQ-5D-VAS, EQ-5D-TTO, sensory nerve‐associated complications, and flexion deficit of the hallux. Results Direct reduction and plate osteosynthesis of posterior Malleolus fractures was inferior to non-operative treatment. Subanalysis of trimalleolar fractures revealed that the outcome of plate osteosynthesis was equal. Both fracture type and plate osteosynthesis were independent drivers of the outcome; Haraguchi type 3 posterior Malleolus fractures were associated with the best functional outcome and quality of life scores. Comorbidity, age, postoperative complications and reintervention largely determined the outcome. Up to 30% of the patients reported (temporarily) flexion deficit of the hallux and 38% numbness at the lateral side of the foot. Conclusions There is no indication for routine plate osteosynthesis of all posterior Malleolus fractures. Careful patient selection, less invasive surgery and modified postoperative rehabilitation seem mandatory to improve the outcome and prevent adverse effects.
Craig R. Lareau - One of the best experts on this subject based on the ideXlab platform.
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tibialis posterior tendon entrapment within posterior malleolar fracture fragment
American journal of orthopedics, 2016Co-Authors: Amanda Fantry, Craig R. Lareau, Bryan G Vopat, Brad D BlankenhornAbstract:Management of posterior Malleolus fractures continues to be controversial, with respect to both need for fixation and fixation methods. Fixation methods include an open posterior approach to the ankle as well as percutaneous reduction and fixation with or without arthroscopy for visualization of the articular surface. Plain radiographs are unreliable in identifying fracture pattern and intraoperative reduction, making arthroscopy a valuable adjunct to posterior Malleolus fracture management. In this article, we report a case of tibialis posterior tendon entrapment within a posterior Malleolus fracture, as identified by arthroscopy and managed with open reduction. Tibialis posterior tendon entrapment within a posterior Malleolus has not been previously reported. Ankle arthroscopy for posterior Malleolus fractures provides an opportunity to identify soft-tissue or tendinous entrapment, articular surface reduction, and articular cartilage injuries unlikely to be identified with fluoroscopy alone and should be considered in reduction and fixation of posterior Malleolus fractures.
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Contribution of the Medial Malleolus to Tibiotalar Joint Contact Characteristics
Foot & ankle specialist, 2014Co-Authors: Craig R. Lareau, Jason T. Bariteau, David Paller, Sarath Koruprolu, Christopher W. DigiovanniAbstract:Background. Isolated medial Malleolus fractures are typically treated operatively to minimize the potential for articular incongruity, instability, nonunion, and posttraumatic arthritis. The literature, however, has not clearly demonstrated inferior outcomes with conservative treatment of these injuries. This study measured the effects of medial Malleolus fracture and its resultant instability on tibiotalar joint contact characteristics. We hypothesized that restoration of anatomical alignment and stability through fixation would significantly improve contact characteristics. Methods. A Tekscan pressure sensor was inserted and centered over the talar dome in 8 cadaveric foot and ankle specimens. Each specimen was loaded at 700 N in multiple coronal and sagittal plane orientations. After testing fractured samples, the medial Malleolus was anatomically fixed before repeat testing. Contact area and pressure were analyzed using a 2-way repeated-measure ANOVA. Results. In treated fractures, contact areas were higher, and mean contact pressures were lower for all positions. These differences were statistically significant in the majority of orientations and approached statistical significance in pure plantarflexion and pure inversion. Decreases in contact area varied from 15.1% to 42.1%, with the most dramatic reductions in positions of hindfoot eversion. Conclusions. These data emphasize the importance of the medial Malleolus in maintaining normal tibiotalar contact area and pressure. The average decrease in contact area after simulated medial malleolar fractures was 27.8% (>40% in positions of hindfoot eversion). Such differences become clinically relevant in cases of medial malleolar nonunion or malunion. Therefore, we recommend anatomical reduction and fixation of medial Malleolus fractures with any displacement. Level of Evidence: Therapeutic Level V—cadaveric study
