Locking plates for distal fibula fractures in young and elderly patients:A retrospective study

BACKGROUND Ankle fractures are common injuries in the young and elderly populations.To prevent post-traumatic arthritis,an anatomic reconstruction of the ankle structure is mandatory.Open reduction and internal fixation is the treatment of choice among orthopaedics.Conventional plates allow stability of the fracture if bone quality is present.Locking plates might offer an advantage for the treatment of lateral malleolar fracture in patients with comminution,severe instability,distal fractures,or osteoporotic bone.Our hospital introduced a new locking plate for fracture of the distal fibula.AIM To evaluate locking plates in terms of outcomes and complications in young and elderly patients.METHODS We retrospectively reviewed a total of 67 patients treated for displaced distal fibula fractures.Demographic data,number of comorbidities,use of inter fragmentary screw,complication,time of fracture healing,partial or full weight bearing,and reoperation were recorded for all patients.Clinical outcome was assessed by the American Orthopedic Foot and Ankle Society clinical scoring system.Radiographs were obtained at 4,8,12,16,20,and 24 wk until radiographic union was obtained.RESULTS All patients displayed complete bony union on radiographic assessment,and no patients developed any serious complications.We observed two superficial infections,one delayed wound healing,and two plate intolerances.Significant differences were observed between the two age groups in terms of radiographic healing(11.9 wk in younger patients vs 13.7 wk in older patients;P=0.011)and in the American Orthopedic Foot and Ankle Society score at 6 mo after surgery(88.2 in younger patients vs 86.0 in older patients;P=0.001)and at 12 mo after surgery(92.6 in younger patients vs 90.0 in older patients;P=0.000).CONCLUSION Locking plates provide a stable and rigid fixation in multifragmentary and comminuted fractures or in the presence of poor bone quality.

Fibula fractures management

Isolated distal fibula fractures represent the majority of ankle fractures.These fractures are often the result of a low-energy trauma with external rotation and supination mechanism.Diagnosis is based on clinical signs and radiographic exam.Stress X-rays have a role in detecting associated mortise instability.Management depends on fracture type,displacement and associated ankle instability.For simple,minimally displaced fractures without ankle instability,conservative treatment leads to excellent results.Conservative treatment must also be considered in overaged unhealthy patients,even in unstable fractures.Surgical treatment is indicated when fracture or ankle instability are present,with several techniques described.Outcome is excellent in most cases.Complications regarding wound healing are frequent,especially with plate fixation,whereas other complications are uncommon.

Correlative Factors Research of Tibial Shaft Fracture with Ipsilateral Posterior Malleolar Crack Fractures

Background:Missed diagnosis rate of spiral tibia shaft fracture with posterior malleolus crack fracture(PMCF)is high in the clinical.However,the mechanism and related factors of fracture are still unclear.Moreover,PMCF has been observed in other types of tibial shaft fractures.Objective:To explore the correlative factors of tibial shaft fracture with ipsilateral PMCF,decrease the rate of clinical missed diagnosis,strengthen the effective fixation of PMCF,and reduce the incidence of traumatic arthritis.Methods:From September 2014 to May 2019,we collected 137 tibiofibular fracture.Only 68 cases involved in ankle joint CT examination and were retrospectively analyzed.The patients were divided into posterior malleolus group(30 cases)and non-posterior malleolus group(38 cases)according to whether come up PMCF or not.The posterior malleolus group contained 24 males and 6 females,27-77(47.57±11.79)years old,the non-posterior malleolus group contained 23 males and 15 females,18-85(48.71±13.84)years old.The gender,age,location,fibula fracture and tibial shaft fracture classification were observed for univariate and multivariate analysis.Results:The probability of PMCF was higher with right tibial shaft fracture(OR=3.6995%CI:1.13-12.08 P<0.05);the probability of PMCF following distal fibular fracture was higher than that without fibular fracture(OR=11.3695%CI:1.72-75.05 P<0.05);the probability of PMCF with type A tibial shaft fracture was higher than type C(OR=4.8295%CI:1.19-19.58 P<0.05).Conclusion:Right type A tibial shaft fracture accompanied by distal fibular fracture are very important factors related to PMCF,which needs highly attention to avoid clinical missed diagnosis.

Hoffa＇s fracture with ipsilateral fibular fracture in a 16-year-old girl： An approach to a rare injury

Hoffa＇s fracture is an uncommon fracture of the femoral condyle with coronal orientation of the fracture line. The mechanism of injury in pediatric Hoffa＇s fracture is road traffic accident, sports injury, and trivial injury. Clinical examination and proper imaging is important for diagnosis of pediatric Hoffa＇s fracture because of high chances of missing these injuries which can lead to nonunion and malunion at the fracture site. Open reduction and anatomical reduction of intraarticular fragment is the gold standard treatment of these fractures. We present a rare case of Hoffa＇s fracture in a 16-year-old girl with asso- ciated ipsilateral fibular fracture.

Preventable iatrogenic cause of foot-drop in knee injuries with literature review

Purpose Common peroneal nerve palsy is quite disabling and every effort should be made to prevent its injury during the treatment.Methods We retrospectively reviewed the prospectively collected data of 7 cases of tibial plateau fractures in association with proximal fibula fracture from January 2019 to September 2019 who presented to emergency room of our hospital.Results In addition to fibular neck fracture,the first case had type 6 tibial plateau displaced fracture and the second case had displaced acetabular fracture with instability of knee with tibial tuberosity avulsion.common peroneal nerve palsy developed following application of distal tibial skeletal traction in both the cases.Other 6 such cases remained neurologically intact as traction was not applied to them.Conclusion Such iatrogenic complication could have been prevented if the injury pattern of"concomitant medial and lateral columns"of the proximal leg is kept in mind by the treating surgeon before applying skeletal traction.