• Ankle fractures
• Bayesian analysis
• Quigley’s technique
• Weber B/C

• Humans
• Ankle Fractures/surgery
• Ankle Fractures/therapy
• Adult
• Female
• Middle Aged
• Retrospective Studies
• Male
• Traction/methods
• Aged
• Adolescent
• Young Adult
• Time-to-Treatment
• Casts, Surgical
• Bayes Theorem
• Splints
• Fracture Healing
• Closed Fracture Reduction/methods
• Soft Tissue Injuries

• Technion - Israel Institute of Technology

• Ankle
• Fracture-related infection
• Open reduction internal fixation
• Risk factors
• Surgical site infection

• Humans
• Ankle Fractures/surgery
• Surgical Wound Infection/prevention & control
• Surgical Wound Infection/diagnosis
• Surgical Wound Infection/therapy
• Surgical Wound Infection/epidemiology
• Surgical Wound Infection/etiology
• Risk Factors
• Antibiotic Prophylaxis
• Anti-Bacterial Agents/therapeutic use
• Debridement
• Fracture Fixation, Internal/adverse effects

• Ankle
• Bone Fractures
• Orthopedic Procedures

• Clinical research
• Fracture mapping
• Lateral malleolus fracture
• Morphological classification

• Humans
• Retrospective Studies
• Male
• Female
• Ankle Fractures/diagnostic imaging
• Ankle Fractures/surgery
• Ankle Fractures/classification
• Middle Aged
• Adult
• Imaging, Three-Dimensional/methods
• Tomography, X-Ray Computed/methods
• Aged
• Young Adult
• Adolescent

• RDJ2022-13 Peking University People's Hospital Scientific Research Development Funds
• L234015 Natural Science Foundation of Beijing Municipality

• ankle fractures
• early presentation
• hospital stay
• late presentation
• surgical timing

• ankle joint
• manual therapy
• mobilisation
• ultrasound

• Computed tomography
• Diagnostic accuracy
• Foot and ankle trauma
• Plain radiography
• Treatment planning

• Humans
• Tomography, X-Ray Computed/methods
• Female
• Retrospective Studies
• Adult
• Foot Injuries/diagnostic imaging
• Male
• Ankle Injuries/diagnostic imaging
• Ankle Injuries/therapy
• Middle Aged
• Fractures, Bone/diagnostic imaging
• Fractures, Bone/therapy
• Radiography/methods
• Patient Care Planning
• Young Adult
• Aged
• Emergency Service, Hospital
• Foot/diagnostic imaging

• ankle fractures
• internal fixation
• open fracture reduction
• randomized clinical trial
• vancomycin powder

• inpatient care
• length of stay
• outpatient care
• postoperative outcomes
• trimalleolar ankle fracture

• Ankle fracture
• Fracture dislocation
• Immobilization
• Orthopedic surgery
• Reposition

• Humans
• Fractures, Bone
• Joint Dislocations
• Joint Diseases

• biomechanical
• gait analysis
• kinematics
• kinetics
• multisegment foot model

• anatomy
• musculoskeletal system
• bone

• Humans
• Ankle Fractures/surgery
• Ankle Joint/surgery
• Fracture Fixation, Internal/methods
• Pain
• Retrospective Studies
• Running
• Treatment Outcome

• trauma
• fracture repair

• Humans
• Ankle Fractures
• Ankle
• Joint Instability/diagnosis
• Ankle Joint
• Ankle Injuries/diagnosis
• Ankle Injuries/surgery

• 1-2019 AO Foundation
• Friedrich-Schiller-Universität Jena (1010)

• anatomy
• health occupations
• medical research
• signs and symptoms

• Humans
• Ankle
• Ankle Fractures/diagnostic imaging
• Ankle Fractures/surgery
• Ankle Joint/diagnostic imaging
• Ankle Joint/surgery
• Intra-Articular Fractures
• Surgical Wound
• Fracture Fixation, Internal
• Printing, Three-Dimensional
• Steel
• Treatment Outcome
• Retrospective Studies

• 2021-NCRC-CXJJ-PY-02 the Innovation Fund of National Clinical Research Center for Orthopedics and Sports Medicine
• 22-321-32-13 the Science and Technology Plan Project of Shenyang City

• Complex ankle fractures
• osteosynthesis
• soft tissue management

• Achilles rupture
• American football
• Jones fracture
• Lisfranc injuries
• ankle fracture
• ankle sprains
• sports medicine
• turf toe

• Humans
• United States/epidemiology
• Orthopedic Surgeons/education
• Ankle/surgery
• Fellowships and Scholarships
• Orthopedics/education
• Orthopedic Procedures/adverse effects
• Fractures, Bone
• Ankle Injuries
• Surgeons

• 3D printing
• fractures - bone
• internal fixation
• posterolateral approach
• trimalleolar fracture

• Guizhou Provincial Science and Technology Projects
• Key Research and Development

• Ankle Fractures
• Fracture Fixation, Internal
• Functionality
• Gait
• Sick Leave

• Humans
• Female
• Adolescent
• Adult
• Ankle Fractures/diagnosis
• Ankle Fractures/surgery
• Retrospective Studies
• Fracture Fixation, Internal
• Pain
• Treatment Outcome

• Ankle fracture
• Cost efficiency
• Intermittent pneumatic compression
• Posttraumatic edema
• Vascular impulse technology

• Ankle and foot fracture
• bone loss
• orthopedic treatment
• randomized controlled trial
• transcutaneous electrical acupoint stimulation

• ankle arthritis
• ankle trauma
• bone loss
• fresh osteochondral allograft
• medial malleolus
• type iiia open medial malleolus fracture

The purpose of this study was to explore the safe and most effective initiation time for the functional recovery of patients with peri-ankle fractures after surgery.

We searched electronic databases, including the Cochrane Library, Embase, PubMed and the reference lists of relevant articles published from inception to October 30, 2021. Two researchers independently performed literature screening and data extraction and evaluated the quality of the included literature using the Newcastle–Ottawa Scale. Network meta-analysis, including consistency testing, publication bias, and graphical plotting, was performed using Stata (v16.0).

A total of 25 articles involving 1756 patients were included in this study. The results of the meta-analysis showed that functional exercise within 2 days after surgery may result in lower VAS scores compared to other techniques (P < 0.05). Functional exercise within 12 months may lead to higher AOFAS scores than that of other techniques (P < 0.05). The total postoperative complication rate, including deep vein thrombosis, showed no statistically significant differences between any two interventions (P > 0.05). The results of the surface under the cumulative ranking (SUCRA) showed that functional exercise within two days postoperatively may have the lowest VAS scores (SUCRA = 82.8%), functional exercise within 1 week postoperatively may have the lowest deep vein thrombosis rate (SUCRA = 66.8%), functional exercise within 10 days postoperatively may have the fewest total postoperative complication rate (SUCRA = 73.3%) and functional exercise within 12 months postoperatively may contribute to the highest AOFAS scores (SUCRA = 85.5%).

The results of this study suggest that initiation of rehabilitation within two days after surgery may be the best time to reduce postoperative pain; rehabilitation interventions within 10 days after surgery may be the optimal time for reducing the total postoperative complication rate, including deep vein thrombosis; and continued functional exercise within 12 months after surgery may steadily and ideally improve the function of the ankle joint.

Systematic Review Registration: doi: 10.37766/inplasy2021.12.0030, identifier: INPLASY2021120030

In this study, we examine human skeletal remains from the church of Saint Francis of Paola located in the small town of Sant’Angelo di Brolo, in the Italian region of Sicily. The preserved skeletal remains were temporarily transferred from their permanent resting place in the crypt for a macroscopic examination and evaluation. Various established methods were used to estimate age at death, sex, stature, any evidence of disease(s) as well as the fact that there was a minimum of 15 individuals. The findings were then subdivided into different groups of pathologies and recorded as individual cases. Amongst which, dental issues and cases of trauma were most prevalent. Additional conditions such as joint disease, congenital, metabolic and multifactorial disorders were also identified. The prevalence of dental decay indicates that the group’s diet consisted largely of carbohydrates, and that their oral hygiene was poor. Furthermore, evidence of trauma and poor healing suggested that the town was isolated from the main medical centres of the island. Severe complications of traumas linked with a loss of movement and overall independence, as well as physical pain, must have had a significant impact on the lives of those affected.

Scientific publication and original articles remain the primary method of sharing scientific findings and advancing the knowledge base of that subject. Despite the value of these publications, little research has surveyed what topics are being published. This study aims to identify and characterize the most common topics in current foot and ankle literature.

We reviewed all 1514 published articles in a 5.5-year period (January 2014–June 2019) in 2 foot and ankle–specific journals: Foot & Ankle International (FAI) and Foot and Ankle Surgery (FAS). The articles were sorted into different topic domains to identify the 3 most common categories of publication. The top 3 domains were further characterized by level of evidence (LOE) as well as citations.

The 3 most published topics in foot and ankle literature were hallux valgus (8.3%), total ankle arthroplasty (TAA) (8.3%), and ankle fracture (6.6%). These 3 subjects accounted for 351 articles (23.2%). Other common topics were patient-reported outcomes (5.0%), osteochondritis dissecans (3.9%), syndesmotic injury (3.8%), ankle instability (3.7%), hallux rigidus (3.0%), and anatomy (2.8%). The average LOE for articles on hallux valgus, TAA, and ankle fracture was 3.27 from FAI, and the average number of annual citations for a given article in both journals was 3.05. Based on our study, there is no correlation between LOE and number of overall citations, but there is a significant, negative linear correlation in ankle fracture data. We also found that articles on TAA had the highest impact factor and that articles from FAI were cited more often than articles from FAS.

The 3 most published topics in foot and ankle literature comprise only 23.2% of all articles. This finding is indicative of the wide variety of cases performed by orthopaedic foot and ankle surgeons. High-quality data are still needed in all topics.

Level III, retrospective cohort study.

A trimalleolar ankle fracture is considered unstable and treatment is generally performed operatively. Computed tomography is important for the operative planning by providing an elaborated view of the posterior malleolus.

Cite this article: EFORT Open Rev 2021;6:692-703. DOI: 10.1302/2058-5241.6.200138

• ankle joint
• fibula
• fracture fixation
• tibia
• trimalleolar ankle fractures

• Haraguchi classification
• Trimalleolar fracture
• internal fixation
• posterior malleolus

Ankle injuries are commonplace in the athletic population, with lateral ligament sprains accounting for the majority of them. The medial ligament complex, the distal tibiofibular syndesmosis as well as any of the bones that constitute the ankle joint can also be injured. Typical mechanisms of injury include inversion-plantarflexion and external rotation on a supinated, dorsiflexed or pronated foot. Lesions of the ankle present with similar symptoms of pain, swelling and tenderness. Therefore, a thorough history and physical examination must be obtained to make the correct diagnosis. This is especially critical for athletes as certain injuries can lead to termination of their career if not treated accurately on time. Imaging may be useful in some cases to confirm or rule out differential diagnoses. Most injuries can be managed conservatively using the Protection, Rest, Ice, Compression and Elevation protocol followed by a comprehensive rehabilitation programme. Surgery is reserved for grade III ligament tears that are refractory to initial non-operative treatment and displaced fractures that are unlikely to unite without surgical intervention. The objective of this review is to discuss the common ankle injuries encountered in the athletic population and the approaches to their diagnosis and management.

• Ankle sprain
• Athlete
• Deltoid ligament
• Lateral ligament
• Syndesmosis
• Fracture

Lateral malleolus fractures occur frequently. The common techniques for fixing purely lateral malleolus fractures are often challenging, owing to the extent of soft tissue damage and fracture non-union. Herein, we report a new treatment that entails minimally invasive insertion and continuous compression of the broken ends as a novel technique, and evaluate its clinical results.

This study enrolled 21 patients (13 males and 8 females; mean age 32.06±3.45 years, range 23–69 years) with purely lateral malleolus fractures. Each patient underwent open reduction treatment with a mini locking plate for internal fixation and compression of the fracture end with an Arched Shape-Memory Connector (ASC). The clinical assessments were made using the American Orthopedic Foot and Ankle Society (AOFAS) scores, which were recorded at the final follow-up visit.

The patients were followed for an average of 14.7±1.2 months (range, 12–18 months). None of the patients showed surgical failure, and all of the purely lateral malleolus fractures healed in an average of 12.6±1.5 weeks (range, 10–16 weeks). The mean AOFAS score was 88.94 (range, 83–90).

The new treatment had beneficial outcomes for purely lateral malleolus fractures. Mini locking plates are minimally invasive for surgical intervention, and combined with continuous concentrated compression with an ASC to accelerate osseous healing, they aid in restoration of function and enable early rehabilitation with a low incidence of postoperative complications.

• Mini locking plate
• minimally invasive technique
• purely lateral malleolus fractures
• shape-memory alloy

• ankle fractures
• nurse
• nurse, South Africa
• pre-operative physiotherapy
• prehabilitation

To analyze the indications, radiological short-term outcomes, and complications of ankle fractures in geriatric patients treated with a triangular external fixator (AEF) until fracture healing. Furthermore, the effect of an additional osteosynthesis to AEF on the radiological outcome was investigated.

Retrospective analysis of ankle fractures treated in a Level I Trauma Center between 2005 and 2015 with an AEF in patients aged ≥ 65 years until fracture has healed. The combination of AEF and at least one additional osteosynthesis of a malleolus was defined as hybrid external fixator (HEF). At the time of AEF removal, a preserved ankle joint congruity was defined as good radiological outcome. Incongruity more than 2 mm was defined as poor radiologic results.

16 patients (13 women, 3 men) with a mean age of 74 years (SD 6.2) were treated with AEF until fracture healing, 9 with a single AEF and 7 with a HEF. Stabilization with HEF (n = 7 [100%]) showed higher rates of good radiological outcome than AEF alone (n = 4 [44%] of 9; p = 0.034). The duration of therapy did not differ between HEF and AEF (70 day vs 77 days). 4 patients (22%) required surgical revision.

It could be shown that osteosynthesis in addition to AEF leads to a better radiological short-term results than using AEF alone. Therefore, in the situation where an AEF is considered as the definitive treatment option for an ankle fracture in geriatric patients with expected or existing soft tissue problems, it should be done or completed as a HEF.

Therapeutic level IV.

• Ankle
• External fixator
• Fracture
• Geriatric
• Minimal-invasive

• Aged
• Ankle Fractures/diagnostic imaging
• Ankle Fractures/surgery
• Ankle Joint
• External Fixators
• Female
• Fracture Fixation, Internal
• Humans
• Infant, Newborn
• Male
• Retrospective Studies
• Tibial Fractures
• Treatment Outcome

• Projekt DEAL

Due to the overwhelming demand for trauma services, resulting from increasing emergency department attendances over the past decade, virtual fracture clinics (VFCs) have become the fashion to keep up with the demand and help comply with the BOA Standards for Trauma and Orthopaedics (BOAST) guidelines. In this article, we perform a systematic review asking, “How useful are VFCs?”, and what injuries and conditions can be treated safely and effectively, to help decrease patient face to face consultations. Our primary outcomes were patient satisfaction, clinical efficiency and cost analysis, and clinical outcomes.

We performed a systematic literature search of all papers pertaining to VFCs, using the search engines PubMed, MEDLINE, and the Cochrane Database, according to the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) checklist. Searches were carried out and screened by two authors, with final study eligibility confirmed by the senior author.

In total, 21 records were relevant to our research question. Six orthopaedic injuries were identified as suitable for VFC review, with a further four discussed in detail. A reduction of face to face appointments of up to 50% was reported with greater compliance to BOAST guidelines (46.4%) and cost saving (up to £212,000).

This systematic review demonstrates that the VFC model can help deliver a safe, more cost-effective, and more efficient arm of the trauma service to patients.

Cite this article: Bone Joint Open 2020;1-11:683–690.

• Fracture clinics
• Trauma and orthopaedics
• Trauma triage
• Virtual fracture clinics

• Maisonneuve injury
• ankle fracture
• fixation options
• malreduction
• syndesmosis

• PCL biodegradable scaffolds
• ankle joint fractures
• biomechanics
• finite element simulation
• posterior malleolus fracture

Ankle fracture–dislocation with a syndesmotic injury has been treated with syndesmotic screw fixation. There are little evidences about the safety and efficacy of syndesmotic screw removal on the syndesmotic malreduction. This study aimed to evaluate the effects of syndesmotic screw removal of distal attachment of the fibula and tibia bones on the syndesmotic reduction and also impact of syndesmotic screw removal on the final functional score of ankle joint.

Patients who underwent syndesmotic screw fixation for diagnosed syndesmosis injury during internal fixation surgery for ankle fractures from April 2017 to March 2018 were assessed for enrollment in our study. During open reduction and internal fixation for ankle fracture, existence of syndesmosis injury was evaluated using the Cotton test and external rotation stress test. Appropriate rehabilitation including short leg cast and nonweight bearing have been accomplished for a duration 12 weeks before removing of syndesmotic screws. At 12 weeks, screws were removed. After 1-month weight bearing, bilateral axial computed tomography (CT) scan and single-leg weight-bearing X-ray for injured ankle were obtained.

Of all 60 participants, 42 cases (70%) were male and 18 cases (30%) were female. Postoperative ankle radiographies were normal except one case with increased medial clear space. It was interesting findings that from total 60 cases, 18 patients (30%) had evidence of syndesmosis malreduction on postoperative initial CT scan, and after removing of syndesmotic screws (12 weeks) and a period of weight bearing and rehabilitation (4 weeks), there is evidence of appropriate reduction in 13 cases (of 18 patients [72.2%]) on final CT scans.

Syndesmotic screw removal and weight bearing may be advantageous to achieve final anatomic reduction of the syndesmosis. Syndesmotic screw removal at appropriate time could not improve foot functional outcomes; however, more studies with the larger sample size are required to confirm the results of the study.

• Ankle fracture
• syndesmosis injury
• syndesmotic screw
• syndesmotic screw removal

• Syndesmotic rupture
• Weber B-type
• ankle fracture
• mid-to-long-term follow-up

• ankle fractures
• barriers and facilitators
• choosing wisely
• de-implementation
• distal radius fractures
• radiography

• Artifact reduction
• Complications, postoperative
• Ligament reconstruction
• Osteosynthesis
• Soft tissue differentiation

Purpose  The purpose of this study was to determinate the overall postoperative complication and reoperation rates related to open reduction and internal fixation (ORIF) of ankle fractures.

Methods  All patients who had undergone an ankle fracture operation at our institution from January 2005 through December 2013 were identified by querying the hospital surgical procedure database for diagnoses codes. Medical records, surgical procedure, and outpatient control reports were reviewed to collect pre-, intra-, and postoperative details. All data obtained were retrospectively analyzed by the authors to evaluate the postoperative complications and the type of further surgical treatment required to treat them.

Results  A total of 378 consecutive patients were included in the study. Overall complications rate was 36.0%. Minor complications (4.5%) were represented by superficial infection (1.3%) and impaired wound healing (3.2%). All these patients required advanced wound care and prolonged oral antibiotics. Major complications (31.5%) included: residual pain (17.2%), deep infection (3.4%), malunion (2.4%), posttraumatic ankle osteoarthritis (5.0%), implant breakage (0.3%), complex regional pain syndrome (1.3%), and arthrofibrosis (1.9%). Note that 21.7% of major complications required further surgical procedure. Reoperations included arthroscopic debridement (15.1%), hardware removal and debridement of all necrotic tissue (4.5%), and ankle fusion (2.1%). Surgery was necessary mainly for pain removal and function recovery.

Conclusion  Ankle fracture ORIF represents a satisfying surgical treatment. Nevertheless, postoperative complications are not uncommon. Minor complications can be easily managed with medications and repeated outpatient controls. Reoperation is occasionally required to treat major complications. Revision surgery is mandatory to ensure pain relief and function improvement.

Level of Evidence  Level II, retrospective cohort study.

• ankle fracture
• complication
• open reduction and internal fixation postoperative
• reoperation

• Ankle
• Joint dislocation
• Patella
• Prehospital
• Shoulder

• Ankle fracture
• Chiropractic
• Diagnostic imaging
• Diagnostic ultrasonography