scholarly journals Medial insufficiency in postoperative weight-bearing radiographs in supination-external rotation type 4 bimalleolar ankle fractures: is the Lauge-Hansen classification insufficient in predicting medial soft tissue damage?

2021 ◽  
Author(s):  
Ali YÜCE ◽  
Mustafa YERLİ ◽  
Tahsin Olgun BAYRAKTAR ◽  
Bulent KARSLIOGLU ◽  
Yunus İMREN ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tissue Damage ◽  
External Rotation ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
Soft Tissue Damage ◽  
Supination External Rotation

scholarly journals Do weight bearing radiographs estimate the stability of an isolated distal fibula fracture?

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0052
Author(s):  
Sohail Yousaf ◽  
Daniel Hay
Keyword(s):  
Systematic Review ◽  
External Rotation ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
Controlled Trials ◽  
Distal Fibula ◽  
Fibula Fracture ◽  
Stress Radiographs ◽  
The Stability ◽  
Supination External Rotation

Category: Trauma Introduction/Purpose: Differentiating stable isolated fibula fractures consistent with supination external rotation (SER) II ankle fractures from unstable SER IV fractures is essential in determining the need for surgical stabilisation. Stress radiographs are usually required to assess stability including gravity stress views (GSV) and external rotation views (ER). There is no clear consensus as to which modality is most useful to determine stability in a fracture clinic or emergency setting. In last, few years clinical uncertainty about the reliability has led researcher to focus on weight bearing radiographs (WB) .We aim to review recent literature regarding reliability of WB radiographs to estimate the stability of supination external rotation ankle fractures. Methods: A systematic review of the literature relating to radiological assessment of stability of supination external rotation ankle fractures was conducted according to PRISMA guidelines. The systematic review was prospectively registered with PROSPERO. It involved the following steps: Researching the question-Do weight bearing radiographs estimate the stability of an isolated distal fibula fracture? Setting inclusion and exclusion criteria-All English language articles published in the including any Randomised controlled trials (RCT’s) and cohort studies. Data collection)– A literature search of Medline (PubMed), the Cochrane Bone, Joint, and Muscle Trauma Group trial register, the Cochrane central register of controlled trials, Embase and CINAHL was undertaken. The grey literature was searched. Key terms ‘supination external rotation fracture’, ‘stability’. Other variations to the key words were ‘weight bearing’, “axial load”, ‘stress x-rays’, ‘systematic reviews’ and ‘meta-analysis’. Results: A total of six studies met the inclusion criteria including 601 patients. No previous systematic review on stress radiographs including weight bearing was published. All studies concluded weight bearing radiographs is an easy, pain-free, safe and reliable method to estimate stability of isolated distal fibula fractures. No serious concerns or complications were reported. Conclusion: The evidence base contained many methodological limitations and most of the evidence was either level III or IV, and so any conclusion drawn from the research must be done so with caution. The studies suggest that GSV overestimates the instability which should be assessed with studies should focus on randomized controlled trials with narrow range of clinically useful outcome measures.

Weight-Bearing Cone-Beam CT Scan Assessment of Stability of Supination External Rotation Ankle Fractures in a Cadaver Model

2018 ◽  
Vol 39 (7) ◽  
pp. 850-857 ◽  
Author(s):  
Mark C. Lawlor ◽  
Melissa A. Kluczynski ◽  
John M. Marzo
Keyword(s):  
Ct Scan ◽  
Ankle Fracture ◽  
External Rotation ◽  
Imaging Modality ◽  
Cone Beam Ct ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
Cone Beam ◽  
Clear Space ◽  
Supination External Rotation

Background: The utility of computed tomography (CT) for measuring medial clear space (MCS) for determination of the stability of supination external rotation (SER) ankle fractures and in comparison to standard radiographs is unknown. We compared MCS on gravity stress (GS) radiographs to GS and weight bearing (WB) cone-beam CT (CBCT). Methods: An AO SER 44B3.1 ankle fracture was simulated in 10 human cadavers, also serving as controls. MCS was measured on GS radiographs, GS CBCT, and a simulated WB CBCT scan. Specimens were stable if MCS was <5 mm and unstable if MCS was ≥5 mm. Paired t tests were used to compare MCS from each imaging modality for controls versus SER injuries and stable versus unstable specimens. Results: Compared with controls assessed by GS radiographs, MCS was greater for an SER injury when assessed by GS radiograph and GS CBCT scan within the stable group. Compared with controls assessed by GS radiographs, MCS was greater for SER injuries when assessed by GS radiograph, GS CBCT scan, and WB CBCT within the unstable group. MCS was reduced for stable versus unstable SER injuries assessed by WB CBCT. Conclusion: In a cadaveric model of SER ankle fracture, the medial clear space was statistically significantly greater for the experimental condition when assessed by gravity stress radiograph and gravity stress CBCT scan. Under weight-bearing conditions, the cone-beam CT scanner distinguished between stable and unstable ankles in the experimental condition. Clinical Relevance: This study suggests that a WB cone-beam CT scan may be able to distinguish between stable and unstable SER ankle fractures and influence operative decision making.

Soft Tissue Repair in Supination-External Rotation IV Ankle Fractures

2017 ◽  
Vol 16 (3) ◽  
pp. 136-140
Author(s):  
Johanna C.E. Donders ◽  
Elizabeth B. Gausden ◽  
Ashley E. Levack ◽  
David L. Helfet ◽  
Dean G. Lorich
Keyword(s):  
Soft Tissue ◽  
Tissue Repair ◽  
External Rotation ◽  
Ankle Fractures ◽  
Soft Tissue Repair ◽  
Supination External Rotation

Enhancement of Thrombolysis In Vivo Without Skin and Soft Tissue Damage by Transcutaneous Ultrasound

1998 ◽  
Vol 89 (4) ◽  
pp. 171-177 ◽  
Author(s):  
Huai Luo ◽  
Yochai Birnbaum ◽  
Michael C. Fishbein ◽  
Thomas M. Peterson ◽  
Tomoo Nagai ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tissue Damage ◽  
Soft Tissue Damage

Health Related Quality of Life in Patients with Supination-External Rotation Stage IV Ankle Fractures

2005 ◽  
Vol 26 (12) ◽  
pp. 1038-1041 ◽  
Author(s):  
Ryan Finnan ◽  
Luke Funk ◽  
Michael S. Pinzur ◽  
Steven Rabin ◽  
Laurie Lomasney ◽  
...  
Keyword(s):  
Quality Of Life ◽  
External Rotation ◽  
Stage Iv ◽  
Ankle Fractures ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Rotation Stage ◽  
Supination External Rotation

Background: While open reduction of displaced ankle fractures generally is accepted as the standard of care, relatively little is known about the health related quality of life after treatment. It is generally accepted that clinical results of treatment for supination-external rotation stage IV ankle fractures are favorable. The goal of this investigation was to determine the relationship between clinical results and health-related quality of life outcome measures in a consecutive series of patients treated for closed supination-external rotation stage IV ankle fractures. Methods: Twenty-six of 156 patients who had operative treatment for closed, displaced supination-external rotation stage IV ankle fractures during a 9-year period, completed the Short Musculoskeletal Function Assessment (SMFA) outcome questionnaire. Radiographs and clinical records were reviewed to determine quality of operative repair, postoperative morbidity, and the development of post-traumatic arthritis. Results: There were no postoperative complications. Of the 26 patients who returned the SMFA questionnaires, 19 had “good,” and seven had “fair” reduction of their fractures. Six showed radiographic evidence of arthritis at followup. Study participants reported scores that were similar to the general population in five of the six domains of the SMFA. Their scores in the mobility index were statistically less favorable (23.72 vs. 13.61, p = 0.016) when compared to the general population. Participants with “good” operative reductions and no evidence of arthritis at followup showed no significant difference to the general population. Participants with either a “fair” operative reduction or evidence of postoperative arthritis at followup had less favorable scores in the daily activities (mean 13.45 vs. 11.82, p = 0.004), mobility (43.43 vs. 13.61, p = 0.001), dysfunction (32.89 vs. 12.70, p = 0.014), and bother (35.80 vs. 13.77, p = 0.020) domains, when compared to the general population. Conclusions: The results of this investigation suggest that patients with excellent radiographic operative reductions and no arthritis as early as 6 months after surgery sustain no lasting unfavorable effect on health related quality of life. Patients with “fair” radiographic reduction, or presence of arthritis or both at followup, are likely to have a negative effect on their quality of life.

The perils of dressings: a cautionary tale of ischaemia

2021 ◽  
Vol 30 (5) ◽  
pp. 420-422
Author(s):  
Alexandra Khoury ◽  
Kirsten Taylor ◽  
Tania Cubison
Keyword(s):  
Soft Tissue ◽  
Tissue Damage ◽  
Skin Grafting ◽  
Soft Tissue Damage ◽  
Cautionary Tale ◽  
Cause Analysis ◽  
Root Cause ◽  
Queen Victoria ◽  
Post Procedure ◽  
Learning Skill

A cohort of patients presented to Queen Victoria Hospital, UK, with iatrogenic toe ischaemia following application of a different, newly available post-procedure dressing with different properties to those usually used. This resulted in ischaemia with extensive skin and soft tissue damage, requiring debridement surgery and, in some cases, skin grafting. We aim to highlight the risk of morbidity from dressing application to the digits. This is a key learning skill for anyone who may either perform dressings or evaluate dressings on digits in the community and across multiple specialties in hospital. This article follows a thorough root cause analysis and addresses other possible causes of an acutely painful erythematous toe post-Zadek's procedure.

200 A Scoring System for Equine Dental Health

2021 ◽  
Vol 99 (Supplement_3) ◽  
pp. 107-107
Author(s):  
Jesse Fenton ◽  
Mary Beth Gordon ◽  
Erin B Perry ◽  
Zach Dombek ◽  
Micheal Jerina ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tissue Damage ◽  
Scoring System ◽  
Dental Health ◽  
Soft Tissue Damage ◽  
Kappa Statistics ◽  
Joint Movement ◽  
Dental Abnormalities ◽  
Nutrition Research ◽  
Chewing Ability

Abstract Scoring systems have been implemented in veterinary practice to indicate the severity of pathologies, such as lameness and gastric ulceration. The need for a scoring system of equine dentition in relation to digestive health has been identified. A scoring system would allow veterinarians, owners, and researchers to more accurately assess dental health and the resulting impact it may have on chewing ability. A proposed system, the Equine Dental Scoring System (EDSS), was developed via collaboration of a team of veterinarians and equine nutritionists familiar with equine dental abnormalities. The EDSS was designed to assign higher scores corresponding to increasing severity of dental abnormalities that would impede proper chewing. The proposed scoring system ranges from 0 to 5 as follows: 0) no sharp enamel points, soft tissue damage, or malocclusion, (1) sharp enamel points, but no soft tissue damage or malocclusion, (2) sharp enamel points and soft tissue damage, but no malocclusion, (3) mild malocclusion with all aligned teeth meeting level (ex. ramps, hooks), (4) moderate malocclusion with all teeth meeting but not level (ex. wave, smile, diagonal, frown), (5) major malocclusion with one or more teeth not meeting or inhibited temporomandibular joint movement (ex. step, shear, retained cap), and/or infection, and/or pain while chewing. The EDSS was validated by assessing agreement via the Cohen’s kappa statistic between four trained professionals scoring ten images of horse dentition. Both the weighted (к = 0.62) and unweighted (к = 0.73) kappa statistics indicated substantial agreement between scorers, signifying reliable repeatability of the EDSS. Presenting dental health in the form of a score would indicate severity of dental pathologies and allow for quantitative and statistical evaluation of dental health in nutrition research and veterinary medicine.

Sign in / Sign up

Export Citation Format

Share Document