Ankle fractures in the elderly: Do we have new concepts?

The relevance of geriatric ankle fractures is continuously increasing. Treatment of these patients remains challenging and requires adapted diagnostic and therapeutic strategies, as compliance to partial weight bearing is difficult to maintain compared to younger patients. In addition, in the elderly even low impact injuries may lead to severe soft tissue trauma, influencing timing and operative strategies.

Immediate weight bearing without immobilization for operatively treated ankle fractures is safe - A systematic review.

Background: This systematic literature review compared weight bearing (WB) vs. partial- / non-weight bearing (NWB) and mobilization (MB) vs. immobilization (IMB) for surgically treated ankle fractures.

Trends of incidence and treatment strategies for operatively treated distal fibula fractures from 2005 to 2019: a nationwide register analysis.

Introduction: Valid epidemiological data about distal fibular fractures and their treatment strategies are missing. Innovative osteosynthesis techniques were introduced and improved during the past 15 years. The aim of this study was to investigate the epidemiologic development and the implementation of new treatment strategies in a nationwide register in Germany over a period of 15 years.

[Operative treatment of bimalleolar fractures].

Objective: Anatomical restoration of the function and anatomy of the talocrural joint, anatomical reduction of fractures of the lateral and medial malleoli and to address ligamentous instability when achieving exercise stability.

Indications: Dislocated and intra-articular fractures of the lateral and medial malleoli.

Contraindications: Infections, peripheral arterial occlusive disease, critical soft tissue conditions.

[Ankle fractures in older patients : What should we do differently?].

As a result of the demographic developments ankle fractures in older patients are part of routine trauma surgery. Due to comorbidities, such as diabetes mellitus, reduced bone quality and limited compliance in follow-up treatment, these fractures are prone to complications. The primary goal in the treatment of older patients with ankle fractures is to maintain mobility.

Leave it or fix it? How fixation of a small posterior malleolar fragment neutralizes rotational forces in trimalleolar fractures.

Introduction: This study investigated the effects of a small posterior malleolar fragment (PMF), containing less than 25% articular surface area, on ankle joint stability via computed tomography (CT) scanning under full weight bearing in a human cadaveric ankle fracture model.

Materials And Methods: A trimalleolar fracture with a PMF of less than 25% articular surface area was created in 6 pairs of fresh-frozen human cadaveric lower legs. The specimens were randomized into 2 groups stabilized by internal fixation including a positioning screw for syndesmotic reconstruction.

[Arthrodesis of the Upper Ankle and Subtalar Joint - Indication and Technique].

Arthrodesis of the upper ankle and subtalar joint are still frequently used and at the moment the gold standard in the therapy of severe arthritis and deformity of the ankle joint and hindfoot. The spectrum of indications is wide, beginning from posttraumatic or degenerative changes to postinfectious, rheumatoid and diabetic causes of arthritis and as a salvage procedure after failed ankle arthroplasty. The types of arthrodesis have to be differentiated from each other: tibiotalar, subtalar and tibiotalcalcaneal fusion.

Trends in arthrodeses and total joint replacements in Foot and Ankle surgery in Germany during the past decade-Back to the fusion?

Background: The goal of this study was to analyze trends in Foot and Ankle surgery in Germany during the past ten years.

Methods: Data of the German Federal Statistical Office from 2008 until 2018 were screened. We focused on the analysis of fusions and total joint replacements.

Comparison of clinically used bilayer collagen membrane and trilayer collagen prototype fixation stability in chondral defects at the talus - An experimental human specimen study.

Background: The purpose of this human specimen experimental study was to compare the fixation stability of clinically used bilayer collagen membrane with fibrin glue with trilayer collagen prototype without fibrin glue in chondral defects at the medial or lateral talar shoulder (both matrices from Geistlich Pharma AG, Wollhusen, Switzerland).

Methods: Eleven human specimens were used. The membranes were implanted in standardized chondral defects at the medial and lateral talar shoulder randomized.

Extracorporal shock wave therapy for the treatment of arthrodesis non-unions.

Introduction: Non-union is a regular complication of arthrodeses. Standard treatment includes revision surgery with frequent need for re-revision due to persistent non-union. Particularly patients with concomitant diseases are at risk of secondary complications.

[Bilateral well-leg compartment syndrome in a child after abdominal trauma : A review of the literature and treatment recommendations illustrated by a case study].

This article reports a case of a bilateral well leg compartment syndrome (WLCS) in a 9-year-old girl who presented to the emergency room 24 h after blunt abdominal trauma and liver laceration. The abdomen was already packed on presentation. The patient presented a manifest compartment syndrome of both lower legs 48 h after the second look surgery and removal of the packing.

[Outcome after surgical treatment of calcaneal fractures].

Background: After controversial discussions in the literature about therapy regimens for calcaneal fractures, a retrospective study of patients operatively treated in a maximum care trauma center was conducted.

Objective: Investigation of the influencing factors on the treatment quality of operatively treated patients with calcaneal fractures.

Material And Methods: Between 2005 and 2013 a total of 90 patients with calcaneal fractures were surgically treated in this hospital with locking plate osteosynthesis.

Better is the foe of good: Outcome of operatively treated ankle fractures in the elderly.

Background: Ankle fractures are the second most common fractures of the lower extremities. Nonetheless, no standardized treatment protocol for unstable ankle fractures of the elderly exists today. Choices to treat ankle fractures are debated controversially, including (1) conservative treatment, (2) open reduction and internal fixation (ORIF), and (3) primary hind-foot arthrodesis.

The role of a small posterior malleolar fragment in trimalleolar fractures: a biomechanical study.

Aims: The aim of this study was to investigate the effect of a posterior malleolar fragment (PMF), with < 25% ankle joint surface, on pressure distribution and joint-stability. There is still little scientific evidence available to advise on the size of PMF, which is essential to provide treatment. To date, studies show inconsistent results and recommendations for surgical treatment date from 1940.

High-resolution MRI (3T-MRI) in diagnosis of wrist pain: is diagnostic arthroscopy still necessary?

Introduction: 3T MRI has become increasingly available for better imaging of interosseous ligaments, TFCC, and avascular necrosis compared with 1.5T MRI. This study assesses the sensitivity and specificity of 3T MRI compared with arthroscopy as the gold standard.

3D Optical Investigation of 2 Nail Systems Used in Tibiotalocalcaneal Arthrodesis: A Biomechanical Study.

Background: Although retrograde intramedullary nails for tibiotalocalcaneal arthrodesis (TTCA) are an established fixation method, few studies have evaluated the stability of the available nail systems. The purpose of this study was to compare biomechanically the primary stability of 2 nail-systems, A3 (Small Bone Innovations) and HAN (Synthes), in human cadavers and analyze the exact point of instability in TTCA by means of optical measurement.

Methods: In 6 pairs of lower legs (n = 12) of fresh-frozen human cadavers with osteoporotic bone structure, bone mineral density (BMD) was determined.

Delayed Surgical Reconstruction of a Peroneal Tendon Rupture in an Accessory Os Peroneum.

A fracture of the os peroneum is a rare cause of ankle and foot pain and is often overlooked and not assumed. Only a few case reports have discussed the different etiologies, options for diagnosis, and therapeutic interventions for acute cases. We present a case of delayed diagnosis of an os peroneum fracture due to a distortion of the ankle that occurred during air sports.

A modified and enhanced test setup for biomechanical investigations of the hindfoot, for example in tibiotalocalcaneal arthrodesis.

Background: Tibiotalocalcaneal arthrodesis (TTCA) using intramedullary nails is a salvage procedure for many diseases in the ankle and subtalar joint. Despite "newly described intramedullary nails" with specific anatomical shapes there still remain major complications regarding this procedure. The following study presents a modified biomechanical test setup for investigations of the hindfoot.

[Hallux amputation].

Objective: Debridement of infected tissue with the main aim being the re-establishment of mobilization with preservation of standing and walking ability. Prevention of secondary pressure points or amputations due to inadequate resection or deficient soft tissue cover.

Indications: In the case of increasing necrosis of the big toe, surgical abrasion and/or amputation is considered unavoidable.

Size matters: The influence of the posterior fragment on patient outcomes in trimalleolar ankle fractures.

Introduction: Ankle fractures are increasing in incidence. The more complicated the lesion is, the higher the risk of developing posttraumatic arthrosis. Severe posttraumatic arthrosis results in a reduced quality of life.

Results of a prospective thyroid ultrasound screening program in adenomatous polyposis patients.

Background: Patients with adenomatous polyposis may be at increased risk for developing thyroid cancer (TC). However, screening guidelines for TC in these patients are not well established.

Methods: Patients with a diagnosis of familial adenomatous polyposis, attenuated familial adenomatous polyposis, and gene mutation-negative adenomatous polyposis enrolled in our Hereditary Colorectal Cancer Family Registry were eligible for a screening thyroid ultrasound (US).

Comparing the outcomes between Chopart, Lisfranc and multiple metatarsal shaft fractures.

Objectives: Complex midfoot injuries could lead to severe functional impairment of mobility and quality of daily living. Aim of this study was to compare the clinical and functional outcomes of Chopart, Lisfranc fractures and multiple metatarsal shaft fractures.

Design: Retrospective case series.

Biomechanical analysis of the efficacy of locking plates during cyclic loading in metacarpal fractures.

Purpose: To analyse the biomechanical characteristics of locking plates under cyclic loading compared to a nonlocking plate in a diaphyseal metacarpal fracture.

Methods: Oblique diaphyseal shaft fractures in porcine metacarpal bones were created in a biomechanical fracture model. An anatomical reduction and stabilization with a nonlocking and a comparable locking plate in mono- or bicortical screw fixation followed.

Biomechanical comparison of stability of tibiotalocalcaneal arthrodesis with two different intramedullary retrograde nails.

Background: The aim of the study was to compare the initial construct stability of two retrograde intramedullary nail systems for tibiotalocalcaneal arthrodesis (TTCF) (A3, Small Bone Innovations; HAN, Synthes) in a biomechanical cadaver study.

Methods: Nine pairs of human cadaver bones were instrumented with two different retrograde nail systems. One tibia from each pair was randomized to either rod.