A Comprehensive Analysis of Patients with Malreduced Ankle Fractures Undergoing Re-operation

Overview

Journal Int Orthop

Specialty Orthopedics

Date 2013 Nov 21

PMID 24252973

Citations 22

Authors

Mikko T Ovaska

Tatu J Makinen

Rami Madanat

Veikko Kiljunen

Jan Lindahl

Affiliations

Soon will be listed here.

Abstract

Purpose: The present study aimed to determine the most common surgical errors resulting in early re-operation following ankle fracture surgery.

Methods: We performed a chart review to determine the most common types of malreductions that led to early re-operation following ankle fracture surgery. From 2002 to 2011, we identified 5,123 consecutive ankle fracture operations in 5,071 patients. Seventy-nine patients (1.6%) which underwent re-operation due to malreduction detected in postoperative radiographs. These patients were compared with an equal number of age- and sex-matched controls which did not need further surgery.

Results: The most common indication for re-operation was syndesmotic malreduction (47 of 79 patients, 59%). Four main types of errors related to syndesmotic reduction or fixation were identified, with the most common being fibular malpositioning within the tibiofibular incisura. Other indications for re-operation were fibular shortening and malreduction of the medial malleolus. Fracture dislocation, fracture type, posterior malleolar fracture, associated medial malleolar fracture, duration of index surgery, and fixation of an associated medial malleolar fracture with other than two parallel screws were also associated with re-operation. Correction of the malreduction was successfully achieved in the majority (84%) of cases needing further surgery.

Conclusion: Early re-operation after ankle fracture surgery was most commonly caused by errors related to syndesmotic reduction or failure to restore fibular length. In the majority of cases, postoperative malreduction was successfully corrected in the acute setting.

Citing Articles

Effect of co-morbidities on outcomes of first metatarsophalangeal joint fusion: A systematic review.

Agrawal S, Sridhar S, Harrison M, Houchen-Wolloff L, Divall P, Mangwani J J Orthop. 2024; 58:29-34.

PMID: 39040136 PMC: 11260351. DOI: 10.1016/j.jor.2024.06.030.

Temporary immobilization methods for closed low-energy ankle fracture-dislocations: comparative analysis of a retrospective cohort.

Gonzalez-Morgado D, Bargallo-Granero J, Pujol O, Altayo-Carulla M, Castellanos-Alonso S, Reverte-Vinaixa M Eur J Orthop Surg Traumatol. 2024; 34(5):2457-2464.

PMID: 38796813 DOI: 10.1007/s00590-024-03966-y.

Radiologic evaluation of ankle fracture malunions of the fibula.

Park S, Miao T, Naraghi A, Linda D, White L Skeletal Radiol. 2024; 53(11):2321-2332.

PMID: 38580773 DOI: 10.1007/s00256-024-04663-x.

Prevalence and Characteristics of Patients Requiring Surgical Reinterventions for Ankle Fractures.

Reyes-Valdes A, Martinez-Ledezma M, Fernandez-Quezada D, Guzman-Esquivel J, Cardenas-Rojas M J Clin Med. 2023; 12(18).

PMID: 37762784 PMC: 10532131. DOI: 10.3390/jcm12185843.

Anterior Incisura Fibularis Corner Landmarks Can Safely Validate the Optimal Distal Tibiofibular Reduction in Malleolar Fractures-Prospective CT Study.

Rozis M, Zachariou D, Vavourakis M, Vasiliadis E, Vlamis J Diagnostics (Basel). 2023; 13(15).

PMID: 37568978 PMC: 10417129. DOI: 10.3390/diagnostics13152615.

References

Sagi H, Shah A, Sanders R . The functional consequence of syndesmotic joint malreduction at a minimum 2-year follow-up. J Orthop Trauma. 2012; 26(7):439-43. DOI: 10.1097/BOT.0b013e31822a526a. View

Schepers T . Acute distal tibiofibular syndesmosis injury: a systematic review of suture-button versus syndesmotic screw repair. Int Orthop. 2012; 36(6):1199-206. PMC: 3353089. DOI: 10.1007/s00264-012-1500-2. View

Thordarson D . Patients with a crooked radiograph after ankle fracture: what to do?. Foot Ankle Int. 2012; 33(4):355-8. DOI: 10.3113/FAI.2012.0355. View

Weening B, Bhandari M . Predictors of functional outcome following transsyndesmotic screw fixation of ankle fractures. J Orthop Trauma. 2005; 19(2):102-8. DOI: 10.1097/00005131-200502000-00006. View

Mukhopadhyay S, Metcalfe A, Guha A, Mohanty K, Hemmadi S, Lyons K . Malreduction of syndesmosis--are we considering the anatomical variation?. Injury. 2011; 42(10):1073-6. DOI: 10.1016/j.injury.2011.03.019. View

Van Wensen R, van den Bekerom M, Marti R, van Heerwaarden R . Reconstructive osteotomy of fibular malunion: review of the literature. Strategies Trauma Limb Reconstr. 2011; 6(2):51-7. PMC: 3150649. DOI: 10.1007/s11751-011-0107-2. View

Nielson J, Sallis J, Potter H, Helfet D, Lorich D . Correlation of interosseous membrane tears to the level of the fibular fracture. J Orthop Trauma. 2004; 18(2):68-74. DOI: 10.1097/00005131-200402000-00002. View

Horisberger M, Valderrabano V, Hintermann B . Posttraumatic ankle osteoarthritis after ankle-related fractures. J Orthop Trauma. 2008; 23(1):60-7. DOI: 10.1097/BOT.0b013e31818915d9. View

Ebraheim N, Elgafy H, Padanilam T . Syndesmotic disruption in low fibular fractures associated with deltoid ligament injury. Clin Orthop Relat Res. 2003; (409):260-7. DOI: 10.1097/01.blo.0000052935.71325.30. View

10.

Vasarhelyi A, Lubitz J, Gierer P, Gradl G, Rosler K, Hopfenmuller W . Detection of fibular torsional deformities after surgery for ankle fractures with a novel CT method. Foot Ankle Int. 2007; 27(12):1115-21. DOI: 10.1177/107110070602701219. View

11.

van den Bekerom M . Diagnosing syndesmotic instability in ankle fractures. World J Orthop. 2012; 2(7):51-6. PMC: 3302043. DOI: 10.5312/wjo.v2.i7.51. View

12.

Nielson J, Gardner M, Peterson M, Sallis J, Potter H, Helfet D . Radiographic measurements do not predict syndesmotic injury in ankle fractures: an MRI study. Clin Orthop Relat Res. 2005; (436):216-21. DOI: 10.1097/01.blo.0000161090.86162.19. View

13.

van den Bekerom M, Hogervorst M, Bolhuis H, van Dijk C . Operative aspects of the syndesmotic screw: review of current concepts. Injury. 2008; 39(4):491-8. DOI: 10.1016/j.injury.2007.11.425. View

14.

Leeds H, Ehrlich M . Instability of the distal tibiofibular syndesmosis after bimalleolar and trimalleolar ankle fractures. J Bone Joint Surg Am. 1984; 66(4):490-503. View

15.

Thur C, Edgren G, Jansson K, Wretenberg P . Epidemiology of adult ankle fractures in Sweden between 1987 and 2004: a population-based study of 91,410 Swedish inpatients. Acta Orthop. 2012; 83(3):276-81. PMC: 3369155. DOI: 10.3109/17453674.2012.672091. View

16.

Rukavina A . The role of fibular length and the width of the ankle mortise in post-traumatic osteoarthrosis after malleolar fracture. Int Orthop. 1999; 22(6):357-60. PMC: 3619680. DOI: 10.1007/s002640050277. View

17.

Beris A, Kabbani K, Xenakis T, Mitsionis G, Soucacos P, Soucacos P . Surgical treatment of malleolar fractures. A review of 144 patients. Clin Orthop Relat Res. 1997; (341):90-8. View

18.

Wikeroy A, Hoiness P, Andreassen G, Hellund J, Madsen J . No difference in functional and radiographic results 8.4 years after quadricortical compared with tricortical syndesmosis fixation in ankle fractures. J Orthop Trauma. 2009; 24(1):17-23. DOI: 10.1097/BOT.0b013e3181bedca1. View

19.

Ovaska M, Makinen T, Madanat R, Huotari K, Vahlberg T, Hirvensalo E . Risk factors for deep surgical site infection following operative treatment of ankle fractures. J Bone Joint Surg Am. 2013; 95(4):348-53. DOI: 10.2106/JBJS.K.01672. View

20.

Franke J, von Recum J, Suda A, Grutzner P, Wendl K . Intraoperative three-dimensional imaging in the treatment of acute unstable syndesmotic injuries. J Bone Joint Surg Am. 2012; 94(15):1386-90. DOI: 10.2106/JBJS.K.01122. View