A prospective cost analysis following operative treatment of unstable ankle fractures: 30 patients followed for 1 year

BACKGROUND: Ankle fractures remain one of the commonest injuries requiring operation. Quality of life and the overall costs associated with the treatment of such injuries are rarely reported. We did a pilot study to determine the cost of treating patients operatively with unstable ankle fractures and to measure the patients' quality of life (utility scores) over time. PATIENTS AND METHODS: 30 patients (17 men) were eligible and included in the study. They were on the average 52 (18-81) years old. All patients had type B Weber fractures (OTA 44B). RESULTS: The mean utility score from the Health Utilities Index immediately after surgery was 0.4. At 12 months follow-up, this score had increased to 0.78. The cost was, on average, USD 2,143 per patient. INTERPRETATION: Our findings indicate that patients operated on for ankle fractures had significant gains in health at an acceptable cost. These results provide data for studies of larger sample size.     

Health-related quality of life following operative treatment of unstable ankle fractures: a prospective observational study

BACKGROUND: Although Weber type B ankle fractures are often considered benign with a good prognosis, evidence from observational studies suggests that 17% to 24% of such patients may have less satisfactory outcomes. Although the explanation for variability in outcomes remains unclear, previous studies of other surgical procedures have suggested nonsurgery-related causes account for much of the variability in outcomes. METHODS: We conducted a prospective observational cohort study to evaluate health-related quality of life in 30 patients with unstable ankle fractures who were otherwise healthy. Only patients from 2 university-affiliated hospitals sustaining unstable type B Weber injury patterns requiring surgery were eligible. Patients provided detailed baseline information regarding alcohol consumption, smoking habits, and educational level. Patients completed the short form 36 questionnaire and a visual analogue pain scale at regular follow-up intervals. RESULTS: The average patient age was 51.6 years (SD 15.2 years), and 57% (17 out of 30) were male. The majority of fractures were the result of a fall (67%, 20 out of 30), and all were closed injuries. Almost half of all patients were smokers (47%, 14 out of 30), whereas 43% consumed alcohol on a weekly basis (13 out of 30). Forty-three percent of patients (13 out of 30) had obtained an elementary or high school level of education. Patients experienced significant improvements in all domains of the SF-36 questionnaire (P < 0.001), except general health, which remained essentially normal over the 24-month period. Study patients achieved scores similar to age-matched U.S. normative data across 6 of the 8 domains (Role Emotional, Social Function, Mental Health, Bodily Pain, Vitality, and General Health). However, patients' physical function and role physical scores remained significantly lower than US norms at 24 months (21.8 and 20.7 points lower on a 100-point scale, respectively; P < 0.001). Smoking history (P = 0.02), presence of a medial malleolar fracture (P = 0.02), and lower levels of education (P = 0.01) were significant independent predictors of lower physical function up to 3 months postoperation. Lower mental health domain scores were significantly associated with alcohol use (P = 0.02) and increasing age (P = 0.04). CONCLUSIONS: As is the case in many other areas, social factors may be important determinants of outcome in patients with traumatic fractures. Optimal orthopedic care may involve attention to modifiable risk factors, including smoking and alcohol consumption.     

A prospective trial comparing operative and manipulative treatment of ankle fractures

A series of 42 ankle fractures have been randomised into two groups respectively undergoing either open reduction and internal fixation or manipulative reduction and plaster. Their progress after removal of all external splintage has been followed using simple gait analysis techniques. There appears to be no difference in the outcome of treatment of the two groups in the early recovery period (up to 20 weeks).     

Results of operative fixation of unstable ankle fractures in geriatric patients.

It is widely accepted that operative fixation of unstable ankle fractures yields predictably good outcomes in the general population. The current literature, however reports less acceptable results in the geriatric population age 65 years and older. The current study analyzes the outcome of the surgical treatment of unstable ankle fractures in patients at least 65 years old. Twenty three patient over 65 years old were surgically treated after sustaining 21 (91%) closed and 2 (9%) open grade II unstable ankle fractures. Fractures were classified according to the Danis-Weber and Lauge-Hansen schemes. Fracture type was predominantly Weber B (21/23, 91%), or supination external rotation stage IV (21/23, 91%). Fracture union rate was 100%. There were three significant complications including a lateral wound dehiscence with delayed fibular union in an open fracture dislocation, and two below knee amputations, neither of which was directly related to the fracture treatment. There were three minor complications; one superficial wound infection and two cases of prolonged incision drainage, all of which resolved without further surgical intervention. Complications were associated with open fractures and preexisting systemic disease. These results indicate that open reduction and internal fixation of unstable ankle fractures in geriatric patients is an efficacious treatment regime that with results that are comparable to the general population.     

手术治疗不稳定锁骨骨折

目的探讨不稳定锁骨骨折手术治疗的临床疗效。方法2000年8月～2005年4月我院收治的50例锁骨骨折患者,按Robinson分类2B1型12例,2B2型24例;3A1型1例,3B1型13例,其中存在多发损伤13例。应用重建钛板治疗37例,锁骨钩钛板固定12例,1/3管状钛板固定1例。根据骨愈合时间、愈合质量、肩关节功能等情况综合评价疗效。结果50例患者随访2～57个月,平均19个月。骨折均愈合,时间2～4个月,平均2.5个月。3例出现畸形愈合,无感染或骨折不愈合。32例肩关节功能为优,18例为良。疗效评价:优22例,良23例,可5例,优良率90%。结论对于不稳定锁骨骨折,手术治疗能够使患者尽快恢复正常功能且未出现明显并发症,疗效满意。     

不稳定性肩胛骨骨折手术治疗体会

目的探讨不稳定性肩胛骨骨折手术复位内固定的手术适应证及疗效：方法总结19例不稳定性肩胛骨骨折手术复位内固定治疗的经验,并对疗效进行评估。结果所有患者随访10～28个月,根据Hardegger功能评定标准,优12例,良4例,可2例,差1例。结论严格掌握手术适应证、坚强内固定及早期功能锻烁,可获得满意疗效。     

Conservative versus operative treatment for displaced ankle fractures in patients over 55 years of age. A prospective, randomised study

Forty-seven patients over the age of 55 years with a displaced fracture of the ankle were entered into a prospective, randomised study in order to compare open reduction and internal fixation with closed treatment in a plaster cast; 36 were reviewed after a mean of 27 months. The outcome was assessed clinically, radiologically and functionally using the Olerud score. The results showed that anatomical reduction was significantly less reliable (p = 0.03) and loss of reduction significantly more common (p = 0.001) in the group with closed treatment. Those managed by open reduction and internal fixation had a significantly higher functional outcome score (p = 0.03) and a significantly better range of movement of the ankle (p = 0.044) at review.     

踝关节骨折54例手术治疗分析

踝关节骨折临床较为常见，由于踝关节承受全身重量，需有良好的稳定性和灵活性，处理不当易出现踝关节不稳及创伤性关节炎而致踝关节功能受损。我院自1999年1月至2002年8月，手术治疗各种踝关节骨折脱位54例，现报告如下。     

不稳定型骨盆骨折的救治及手术治疗

[目的]探讨不稳定型骨盆骨折的早期救治和二期手术治疗经验.[方法]回顾性分析总结2006年7月～ 2009年12月救治的21例不稳定型骨盆骨折的临床资料.平均年龄37岁(19～58岁);男13例,女8例;平均创伤严重性评分(ISS)为34分(16 ～59分);按照Tile分型:B型16例(B1型7例,B2型6例,B3型3例),C型5例;17例患者合并其他部位损伤.一期行稳定骨盆、抗休克、处理合并伤等,待生命体征稳定后行切开复位内固定治疗.术后通过Majeed量表评估患者功能愈后.[结果]本组病例平均随访27个月(16～ 42个月).平均手术时间为195 min (60～510 min);平均输血量为700 ml (400 ～1 800 ml);平均骨折愈合时间为13周(11 ～ 17周);平均Majeed评分为84.3分(62 ～ 100分),其中优10例,良9例,中2例,优良率为90.4％.有1例存在明显步态异常,1例存在马蹄足畸形,均为神经损伤患者.[结论]不稳定型骨盆骨折的合理术前急救处理非常重要,对于此类损伤,应及时稳定骨盆骨折并处理合并伤,在合适的手术时机二期行切开复位内固定治疗,多可获得满意的疗效.     

The operative treatment of unstable pelvic ring fractures.

Pelvic ring injuries due to high energy forces are among the most serious, involving the musculoskeletal system. Life threatening hemorrhage, local and distant associated injuries, deformity, pain and diminished functional capacity are all potential problems for a patient with a disrupted pelvis. There is a clear correlation between total blood loss, incidence of associated injuries, final functional result and the type of pelvic ring injury. Between January 1987 and July 1989, 44 patients with an unstable lesion, type B or type C in Tile's classification have been treated in the University Hospital Gasthuisberg of the Katholieke Universiteit Leuven. In 28 cases, primary stabilisation was done by means of an external fixator, "Monofixateur" type. The overall mortality rate was less than 7%. Thirty-five patients could be seen for follow-up six months to three years after injury. Our findings confirm that compared to type B lesions there is a higher incidence of pain, permanent deformity and diminished functional capacity in type C lesion (p < 0.05). The external fixator, used in the immediate post injury period provides an effective splint that reduces bleedings from bone and veins but cannot maintain reduction in lesions with rotational and vertical instability. In these cases, a semi-elective internal fixation, after defining the exact patho-anatomy by means of a CT-scan has to be performed in selected areas.     

The treatment of unstable ankle fractures in patients over eighty years of age

BACKGROUND: The current study examined the outcomes of operative treatment of unstable ankle fractures in patients at least 80 years old at the time of injury. METHODS: Of 2,682 patients who presented for treatment of ankle fractures, 17 patients met the study criteria. These patients had open reduction and internal fixation after sustaining 15 closed and two open unstable ankle fractures. There were 11 type B fractures and six type C fractures by the Danis-Weber classification, and 12 supination-external rotation and five pronation-external rotation fractures by the Laugen-Hansen classification systems. RESULTS: When noncompliant patients who developed complications were removed from analysis, the fixation failure and deep infection rates were 0% each. CONCLUSIONS: These results highlight the importance of patient compliance and non-weightbearing status in the treatment of ankle fractures in patients over 80 years.     

Closed treatment of ankle fractures. Stage II supination-eversion fractures followed for 20 years

Ninety-four conservatively treated patients with Lauge Hansen Stage II supination-eversion fractures of the ankle were interviewed after 16-25 years. Patients with pain were examined clinically and radiographically. Eighty-nine patients had good and five medium results. Our observations compare well with published reports of open treatment. We conclude that this particular fracture type is so benign that it can be treated closed without reduction.     

Closed treatment of ankle fractures: Stage II supination-eversion fractures followed for 20 years

Ninety-four conservatively treated patients with Lauge Hansen Stage II supination-eversion fractures of the ankle were interviewed after 16-25 years. Patients with pain were examined clinically and radiographically. Eighty-nine patients had good and five medium results. Our observations compare wen with published reports of open treatment. we conclude that this particular fracture type is so benign that it can be treated closed without reduction.     

影响不稳定性踝关节骨折手术疗效的相关因素分析

目的 总结影响不稳定性踝关节骨折手术疗效的因素.方法 对2000年1月至2009年7月行手术治疗且获得随访的97例闭合性不稳定性踝关节骨折患者资料进行分析,按Dan-ish-Weber分类:A型9例,B型58例,C型30例.采用克氏针张力带固定3例,拉力螺钉固定6例,钢板螺钉系统固定39例,钢板螺钉+拉力螺钉固定15例,钢板螺钉系统+拉力螺钉+腓骨钩固定34例.对患者年龄、性别、合并症、受伤至手术时间、骨折类型及治疗方法等6个可能的相关因素进行多因素分析. 结果 97例患者术后获3.5个月～9年(平均46.3个月)随访.末次随访时美国足踝外科协会踝与后足评分平均为90分(65～95分).单因素Logistic回归分析发现年龄、合并症和骨折类型的差异有统计学意义(P值、OR值及95% CI分别为0.005、1.073、1.017～1.203,0.019、0.134、0.063～0.351,0.005、1.274、1.171～1.439).多因素Logistic逐步回归分析发现仅年龄和骨折类型的差异有统计学意义(P值、OR值及95% CI分别为0.008、1.503、1. 391～1.701;0.007、1.247、1.153～1.394). 结论 影响踝关节骨折术后关节功能的主要因素是年龄和骨折类型.及时发现可能导致踝关节不稳定的因素,正确判断骨折的类型、明确有无伴随韧带损伤并选择适合的固定方法,是防止日后继发踝关节创伤性关节炎的最有效措施.