fractures

The Key Role of the Lateral Malleolus in Displaced Fractures of the Ankle*

BY ISADORE G. YABLON, M.D.t, FREDERICK G. HELLER, M.D.t, AND LEROY SHOUSE, M.D.t, BOSTON, MASSACHUSETTS


From the Boston University Medical Center, Universiti Hospital, Boston


ABSTRACT: The reason why late degenerative arthritis developed in some patients who had sustained displaced bimalleolar fractures of the ankle was investigated. The roentgenograms indicated that incomplete reduction of the lateral malleolus and a residual talar tilt were present. When bimalleolar fractures were created in cadavera the talus could be anatomically repositioned only when the lateral malleolus was accurately reduced. Fifty-three patients with bimalleolar fractures were treated by anatomically fixing the lateral malleolus with a four-hole plate. There was an anatomical reduction of the talus and medial malleolus in each instance and there were no late cases of degenerative arthritis when these patients were followed for from six months to nine years. We concluded that the lateral malleolus is the key to the anatomical reduction of bimalleolar fractures, because the displacement of the talus faithfully followed that of the la lateral malleolus.
 

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The Role of Ankle Arthroscopy on the Surgical Management of Ankle Fractures

FOOT & ANKLE INTERNATIONAL Copyright © 2001 by the American Orthopaedic Foot & Ankle Society, Inc.

David B. Thordarson, MD.; Ravinder Bains, MD.; Lane E. Shepherd, M.D. Los Angeles, CA


ABSTRACT Nineteen patients were prospectively randomized for operative treatment of their ankle fracture to be supplemented with or without ankle arthroscopy. All patients had an SER or PER fracture with an intact medial malleolus requiring operative treatment without evidence of intra-articular debris preoperatively. All patients underwent plate fixation of their fibula fracture and had a similar postoperative protocol. Ten patients were randomized to the control group with plate fixation only and nine patients randomized to the plate fixation plus operative arthroscopy. The average follow-up was 21 months. The arthroscopic examination of the study group revealed eight of the nine patients to have articular damage to the dome of the talus. Minimal arthroscopic treatment of these joints was required. All patients healed their fractures. No difference was noted between SF-36 scores or lower extremity scores between the two groups. At short term follow-up, it does not appear that the arthroscopic procedure will impact upon the patient's eventual outcome in this small group of patients.

 

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The Effect of Fibular Malreduction on Contact Pressures in an Ankle Fracture Malunion Model*

BY DAVID B. THORDARSON, M.D.f, SOHEL MOTAMED, B.S4, THOMAS HEDMAN, PH.D.t, EDWARD EBRAMZADEH, PH.D.8, AND SAM BAKSHIAN, M.DJ, LOS ANGELES, CALIFORNIA

Investigation performed at the Department of Orthopaedic Surgery, University of Southern California, Los Angeles


ABSTRACT: Nine fresh-frozen cadaveric specimens were disarticulated through the knee, and the soft tissues, except for the interosseous ligaments and interosseous membrane, were removed to the level of the ankle. The subtalar joint was secured with screws in neutral position (approximately 5 degrees of valgus). Contact pressures in the tibiotalar joint were measured with use of low-grade pressure-sensitive film, which was placed through an anterior capsulotomy. For each measurement, 700 newtons of load was applied to the specimen for one minute. The film imprints were scanned, and the contact pressures were quantitated in nine equal quadrants over the talar dome. A fracture displacement device was secured to the distal end of the fibula; the device allowed for individual or combined displacements consisting of shortening, lateral shift, and external rotation of the fibula. The ankle was maintained in neutral flexion. The ligamentous injury associated with a pronation-lateral rotation fracture of the ankle was simulated by dividing the deep fibers of the deltoid ligament, the anterior-inferior tibiofibular ligament, and the interosseous membrane to a point that was an average of fifty-three millimeters proximal to the ankle joint. Baseline contact area and contact pressure in the joint were determined, followed by measurements after two, four, and six millimeters of shortening of the fibula; after two, four, and six millimeters of lateral shift of the fibula; and after 5,10, and 15 degrees of external rotation of the fibula. The three types of displacement were tested individually as well as in combination. 

 

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