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Weightbearing AND fracture

Sherif Dabash, Emmanuel D Eisenstein, Eric Potter, Nicholas Kusnezov, Ahmed M Thabet, Amr A Abdelgawad
Open reduction internal fixation is the gold standard for unstable ankle fracture fixation; however, complications in patients with multiple medical comorbidities are common. Intramedullary nail fixation of the fibula can help to mitigate these difficulties. A retrospective chart review was performed on all patients who underwent fixation for unstable ankle fracture between January 2015 and March 2016 at our level I trauma center. Comorbidities in the patient sample included were one or several of diabetes, renal disease, hypertension, advanced age with osteoporosis, hemorrhagic blisters, and alcoholism...
January 3, 2019: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Julie J Willeumier, Mustafa Kaynak, Peer van der Zwaal, Sven A G Meylaerts, Nina M C Mathijssen, Paul C Jutte, Panagiotis Tsagozis, Rikard Wedin, Michiel A J van de Sande, Marta Fiocco, P D Sander Dijkstra
BACKGROUND: Actual and impending pathologic fractures of the femur are commonly treated with intramedullary nails because they provide immediate stabilization with a minimally invasive procedure and enable direct weightbearing. However, complications and revision surgery are prevalent, and despite common use, there is limited evidence identifying those factors that are associated with complications. QUESTIONS/PURPOSES: Among patients treated with intramedullary nailing for femoral metastases, we asked the following questions: (1) What is the cumulative incidence of local complications? (2) What is the cumulative incidence of implant breakage and what factors are associated with implant breakage? (3) What is the cumulative incidence of revision surgery and what factors are associated with revision surgery? METHODS: Between January 2000 and December 2015, 245 patients in five centers were treated with intramedullary nails for actual and impending pathologic fractures of the femur caused by bone metastases...
September 2018: Clinical Orthopaedics and related Research
Jessica Zanovello, Barbara Bertani, Redento Mora, Gabriella Tuvo, Mario Mosconi, Luisella Pedrotti
Metatarsal fractures make up the greatest portion of foot fractures in children. Most of them are treated with closed reduction and non-weightbearing cast immobilization.Usually, these fractures heal uneventfully and delay union and pseudoarthrosis are rare. We report a case of a 10-year-old child with non-union of the second metatarsal following a traumatic fracture, caused by an accident 10 months before, and treated successfully by osteosynthesis with plate and screws. Good clinical outcome was achieved at 2 years follow-up...
October 19, 2018: La Pediatria Medica e Chirurgica: Medical and Surgical Pediatrics
Jean-Charles Giunta, Camille Tronc, Gael Kerschbaumer, Michel Milaire, Sébastien Ruatti, Jerôme Tonetti, Mehdi Boudissa
PURPOSES: Open reduction and internal fixation (ORIF) in osteoporotic acetabular fractures is quite difficult with high risk of implant failure. Total hip arthroplasty (THA) may be an effective option for treating acetabular fractures in appropriately selected patients, with immediate full weightbearing. The aim of the study was to evaluate the functional outcomes of primary THA for acetabular fractures in elderly patients. METHODS: Between 2010 and 2015, 27 elderly patients operated for acetabular fractures by primary THA were included...
October 18, 2018: International Orthopaedics
Jae Hwang Song, Chan Kang, Deuk Soo Hwang, Dong Hun Kang, June Woo Park
BACKGROUND: We compared the radiographic results and clinical outcomes of patients operated on via the extended sinus tarsi approach (ESTA) and the extended lateral approach (ELA) for treatment of displaced intraarticular calcaneal fractures. METHODS: We retrospectively studied the utility of the ELA (46 patients, 52 feet) and the ESTA (56 patients, 64 feet) in patients operated on between January 2009 and March 2015. We evaluated pre- and postoperative x-rays and computed tomography (CT) data...
October 5, 2018: Foot & Ankle International
Kempland C Walley, Evan P Roush, Christopher M Stauch, Allen R Kunselman, Kaitlin L Saloky, Jesse L King, Gregory S Lewis, Michael C Aynardi
BACKGROUND: The pathophysiology of adult-acquired flatfoot deformity (AAFD) is not fully explained by degeneration of the posterior tibial tendon alone. While a shortened or dysplastic lateral column has been implicated in flatfoot deformity in pediatrics, there is no study that has quantified the degree of dysplasia in adults with a stage IIb flatfoot deformity, or if any exists at all. METHODS: An institutional radiology database was queried for patients with posterior tibial tendon dysfunction (PTTD) who had computed tomography (CT) performed...
August 31, 2018: Foot & Ankle Specialist
Kwanchai Pituckanotai, Alisara Arirachakaran, Peerapong Piyapittayanun, Harit Tuchinda, Ekachot Peradhammanon, Jatupon Kongtharvonskul
Fractures of the metatarsals account for 35% of all foot fractures. Conservative management of fractures proximal to the metaphyseal-diaphyseal junction of the fifth metatarsal bone (pseudo-Jones) is protected weightbearing. The methods of protected weightbearing include a short-leg cast and splint (boot cast, Jones bandage, and elastic bandage). However, no consensus has yet been reached regarding which method is most suitable. We conducted a systematic review and meta-analysis to compare the outcomes of a short-leg cast and splint for pseudo-Jones metatarsal fractures...
September 2018: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Arne Burssens, Hannes Vermue, Alexej Barg, Nicola Krähenbühl, Jan Victor, Kris Buedts
BACKGROUND: Diagnosis and operative treatment of syndesmotic ankle injuries remain challenging due to the limitations of 2-dimensional imaging. The aim of this study was therefore to develop a reproducible method to quantify the displacement of a syndesmotic lesion based on 3-dimensional computed imaging techniques. METHODS: Eighteen patients with a unilateral syndesmotic lesion were included. Bilateral imaging was performed with weightbearing cone-beam computed tomography (CT) in case of a high ankle sprain (n = 12) and by nonweightbearing CT in case of a fracture-associated syndesmotic lesion (n = 6)...
August 20, 2018: Foot & Ankle International
Eric K Bonness, Justin C Siebler, Lori K Reed, Elizabeth R Lyden, Matthew A Mormino
OBJECTIVE: To evaluate an alternative protocol for allowing immediate weight-bearing (WB) as tolerated in a functional walking boot in patients with a medial clear space (MCS) of less than 4 mm on nonstressed initial radiographs with subsequent WB radiographs at 1-week follow-up to determine if this can differentiate stable from unstable distal fibular fractures. DESIGN: Retrospective case series. SETTING: Level 1 trauma center. PATIENTS: Seventy-nine patients who sustained an isolated distal fibular fracture with an MCS less than 4 mm on initial non-weight-bearing radiographs during a 6-year period...
October 2018: Journal of Orthopaedic Trauma
Gabriele Falzarano, Giuseppe Pica, Antonio Medici, Giuseppe Rollo, Michele Bisaccia, Raffaele Cioffi, Mario Pavone, Luigi Meccariello
The aim of our study was to investigate which technique among hybrid external fixation, plate and screws, and intramedullary nailing produces better outcomes in foot loading when treating type 43.A1, 43.A2, and 43.A3 fractures, according to the AO classification. From November 2011 to December 2014, 34 patients, including 25 (73.5%) males and 9 (26.5%) females with an average age of 32.3 (range 16 to 67) years, with a type A tibia fracture were treated with intramedullary nailing, plate and screws, or hybrid external fixation...
September 2018: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
S F Baumbach, W C Prall, M Braunstein, W Böcker, S Polzer, H Polzer
Fractures of the base of the fifth metatarsal bone are one of the most frequent fractures to the foot and ankle. Despite the high frequency and although a number of studies are now available, treatment frequently does not follow the available evidence. Among the reasons is the inconsistent terminology used and that the studies available are neglected. The aim of this review is to present the current classifications, the available treatment studies and to derive evidence-based treatment recommendations. The term "Jones fracture" has been used inconsistently for different fracture entities and should, therefore, not be used anymore...
September 2018: Der Unfallchirurg
Brett J Waverly, Matthew D Sorensen, Tyler K Sorensen
The treatment of Jones fractures has been controversial in terms of nonoperative versus operative management, given the high incidence of nonunion secondary to the delicate blood supply to the proximal fifth metatarsal. We report a retrospective review of a patient cohort treated with an early weightbearing protocol after operative intramedullary fixation in acute Jones fractures. Thirty-one consecutive patients with an acute Jones fracture underwent operative fixation with a single intramedullary solid screw...
May 2018: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Nabil A Ebraheim, Matthew Dailey, Scott Huff, Yihuai Qu, Erik White, Jiayong Liu
BACKGROUND: Ankle fractures involving syndesmosis disruption cause severely unstable joint conditions. Traditional invasive operations put certain patient groups at an increased risk of infection. There is limited literature discussing the outcomes of minimally invasive fixation of severe ankle fractures including syndesmotic injury, as clinicians may be tempted to treat these difficult cases with open reduction internal fixation (ORIF). METHODS: A retrospective case-control study was conducted on patients treated at a level one trauma center...
March 1, 2018: Foot & Ankle Specialist
Vishesh Khanna, Senthil N Sambandam, Munis Ashraf, Varatharaj Mounasamy
Critical to the success of a total knee arthroplasty (TKA) is the anatomical alignment. This may appear as a challenge in an extra-articular deformity (EAD) that may be inherent in certain people or result from fracture malunion, congenital disorders, nutritional, metabolic and infective causes. This appraisal aimed at providing the reader with an up-todate overview of the research carried out on, and existent evidence of EAD correction while planning a TKA. We reviewed the current English literature on TKA in extra-articular knee deformities...
December 14, 2017: Orthopedic Reviews
Jose A Blanco, Gemma Slater, Jitendra Mangwani
The incidence of venous thromboembolic (VTE) events (deep vein thrombophlebitis [DVT] or pulmonary embolism [PE]) in foot and ankle trauma has been low, and the risk/benefit ratio associated with chemoprophylaxis is controversial. We compared the 90-day incidence of VTE events in 3 cohorts: group 1, tendo-Achillis (TA) ruptures managed with full weightbearing in a walker boot; group 2, ankle fractures immobilized non-weightbearing in a below-the-knee cast; and group 3, ankle fractures managed surgically, followed by non-weightbearing in a below-the-knee cast...
May 2018: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
A Siebe De Boer, Esther M M Van Lieshout, Gerson Van Moolenbroek, Dennis Den Hartog, Michael H J Verhofstad
BACKGROUND: Post-operative weightbearing guidelines for displaced intra-articular calcaneal fractures (DIACF) have been pragmatically developed in the past, however hardly adapted to current health care insights. A period of six to nine weeks of non-weightbearing is usually recommended. It is unknown whether an earlier start of weightbearing is advisable. OBJECTIVES: The primary aim was to evaluate the effect of time to post-operative weightbearing on Böhler's angle...
April 2018: Injury
Lucas S Marchand, Dane C Todd, Patrick Kellam, Temitope F Adeyemi, David L Rothberg, Travis G Maak
BACKGROUND: Restoring normal femoral rotation is an important consideration when managing femur fractures. Femoral malrotation after fixation is common and several preventive techniques have been described. Use of the lesser trochanter profile is a simple method to prevent malrotation, because the profile changes with femoral rotation, but the accuracy of this method is unclear. QUESTIONS/PURPOSES: The purposes of this study were (1) to report the rotational profiles of uninjured femora in an adult population; and (2) to determine if the lesser trochanter profile was associated with variability in femoral rotation...
June 2018: Clinical Orthopaedics and related Research
Vinod K Panchbhavi, Barkha N Gurbani, Candace Bailey Mason, Wayne Fischer
Given the high prevalence of ankle fractures and morbidity of malalignment after fixation, an appropriate anatomic relationship between the distal fibula and adjacent tibia and talus is important. The tip of the lateral malleolus of the fibula has often been described to be at the level of the lateral talar process. However, no studies to date have examined the relationship of the distal fibular tip to the lateral process of the talus. We assessed 66 weightbearing mortise radiographs for variability of the distal fibular tip in relation to the lateral process of the talus...
January 2018: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Sebastian Felix Baumbach, Wolf Christian Prall, Michael Kramer, Mareen Braunstein, Wolfgang Böcker, Hans Polzer
BACKGROUND: Fractures to the base of the fifth metatarsal are common, but their treatment remains controversial. Especially for Lawrence and Botte (L&B) type II fractures, there is conflicting evidence and consequently no consensus. Further, many authors consider displacement, articular involvement, and number of fragments an indication for surgery, although evidence is missing. The aim of this study was to evaluate the outcome of functional treatment for all L&B type I and II fractures...
December 16, 2017: BMC Musculoskeletal Disorders
David A Porter
Fifth metatarsal fractures, otherwise known as "Jones" fractures, occur commonly in athletes and nonathletes alike. While recent occurrence in the popular elite athlete has increased public knowledge and interest in the fracture, this injury is common at all levels of sport. This review will focus on all three types of Jones fractures. The current standard for treatment is operative intervention with intramedullary screw fixation. Athletes typically report an acute episode of lateral foot pain, described as an ache...
February 2018: Foot & Ankle International
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