Skip to main content

Advertisement

SpringerLink
Log in

A comprehensive analysis of patients with malreduced ankle fractures undergoing re-operation

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Thur CK, Edgren G, Jansson KÅ, Wretenberg P (2012) Epidemiology of adult ankle fractures in Sweden between 1987 and 2004: a population-based study of 91,410 Swedish inpatients. Acta Orthop 83:276–281

    Article  PubMed  Google Scholar 

  2. Harris J, Fallat L (2004) Effects of isolated Weber B fibular fractures on the tibiotalar contact area. J Foot Ankle Surg 43:3–9

    Article  PubMed  Google Scholar 

  3. Lloyd J, Elsayed S, Hariharan K, Tanaka H (2006) Revisiting the concept of talar shift in ankle fractures. Foot Ankle Int 27:793–796

    PubMed  Google Scholar 

  4. Thordarson DB, Motamed S, Hedman T, Ebramzadeh E, Bakshian S (1997) The effect of fibular malreduction on contact pressures in an ankle fracture malunion model. J Bone Joint Surg Am 79A:1809–1815

    Google Scholar 

  5. Beris AE, Kabbani KT, Xenakis TA, Mitsionis G, Soucacos PK, Soucacos PN (1997) Surgical treatment of malleolar fractures. A review of 144 patients. Clin Orthop Relat Res 341:90–98

    Article  PubMed  Google Scholar 

  6. Leeds HC, Ehrlich MG (1984) Instability of the distal tibiofibular syndesmosis after bimalleolar and trimalleolar ankle fractures. J Bone Joint Surg Am 66A:490–503

    Google Scholar 

  7. Lindsjö U (1985) Operative treatment of ankle fracture-dislocations. A follow-up study of 306/321 consecutive cases. Clin Orthop Relat Res 199:28–38

    PubMed  Google Scholar 

  8. Rukavina A (1998) The role of fibular length and the width of the ankle mortise in post-traumatic osteoarthrosis after malleolar fracture. Int Orthop 22:357–360

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Kennedy JG, Soffe KE, Dalla Vedova P, Stephens MM, O’Brien T, Walsh MG, McManus F (2000) Evaluation of the syndesmotic screw in low Weber C ankle fractures. J Orthop Trauma 14:359–366

    Article  CAS  PubMed  Google Scholar 

  10. Pettrone FA, Gail M, Pee D, Fitzpatrick T, Van Herpe LB (1983) Quantitative criteria for prediction of the results after displaced fracture of the ankle. J Bone Joint Surg Am 65A:667–677

    Google Scholar 

  11. Sagi HC, Shah AR, Sanders RW (2012) The functional consequence of syndesmotic joint malreduction at a minimum 2-year follow-up. J Orthop Trauma 26:439–443

    Article  PubMed  Google Scholar 

  12. Weening B, Bhandari M (2005) Predictors of functional outcome following transsyndesmotic screw fixation of ankle fractures. J Orthop Trauma 19:102–108

    Article  PubMed  Google Scholar 

  13. Wikerøy AK, Høiness PR, Andreassen GS, Hellund JC, Madsen JE (2010) No difference in functional and radiographic results 8.4 years after quadricortical compared with tricortical syndesmosis fixation in ankle fractures. J Orthop Trauma 24:17–23

    Article  PubMed  Google Scholar 

  14. Horisberger M, Valderrabano V, Hintermann B (2009) Posttraumatic ankle osteoarthritis after ankle-related fractures. J Orthop Trauma 23:60–67

    Article  PubMed  Google Scholar 

  15. Lübbeke A, Salvo D, Stern R, Hoffmeyer P, Holzer N, Assai M (2012) Risk factors for post-traumatic osteoarthritis of the ankle: an eighteen year follow-up study. Int Orthop 36:1403–1410

    Article  PubMed Central  PubMed  Google Scholar 

  16. Thordarson DB (2012) Patients with a crooked radiograph after ankle fracture: what to do? Foot Ankle Int 33:355–358

    Article  PubMed  Google Scholar 

  17. Nielson JH, Gardner MJ, Peterson MG, Sallis JG, Potter HG, Helfet DL, Lorich DG (2005) Radiographic measurements do not predict syndesmotic injury in ankle fractures: an MRI study. Clin Orthop Relat Res 436:216–221

    Article  PubMed  Google Scholar 

  18. Beumer A, Swierstra BA (2003) The influence of ankle positioning on the radiography of the distal tibial tubercles. Surg Radiol Anat 25:446–450

    Article  CAS  PubMed  Google Scholar 

  19. Pneumaticos SG, Noble PC, Chatziioannou SN, Trevino SG (2002) The effects of rotation on radiographic evaluation of the tibiofibular syndesmosis. Foot Ankle Int 23:107–111

    PubMed  Google Scholar 

  20. van den Bekerom MP (2011) Diagnosing syndesmotic instability in ankle fractures. World J Orthop 2:51–56

    Article  PubMed Central  PubMed  Google Scholar 

  21. Ebraheim NA, Elgafy H, Padanilam T (2003) Syndesmotic disruption in low fibular fractures associated with deltoid ligament injury. Clin Orthop Relat Res 409:260–267

    Article  PubMed  Google Scholar 

  22. Nielson JH, Sallis JG, Potter HG, Helfet DL, Lorich DG (2004) Correlation of interosseous membrane tears to the level of the fibular fracture. J Orthop Trauma 18:68–74

    Article  PubMed  Google Scholar 

  23. Hsu YT, Wu CC, Lee WC, Fan KF, Tseng IC, Lee PC (2011) Surgical treatment of syndesmotic diastasis: emphasis on effect of syndesmotic screw on ankle function. Int Orthop 35:359–364

    Article  PubMed Central  PubMed  Google Scholar 

  24. Franke J, von Recum J, Suda AJ, Grützner PA, Wendl K (2012) Intraoperative three-dimensional imaging in the treatment of acute unstable syndesmotic injuries. J Bone Joint Surg Am 94A:1386–1390

    Article  Google Scholar 

  25. Miller AN, Carroll EA, Parker RJ, Boraiah S, Helfet DL, Lorich DG (2009) Direct visualization for syndesmotic stabilization of ankle fractures. Foot Ankle Int 30:419–426

    Article  PubMed  Google Scholar 

  26. Mukhopadhyay S, Metcalfe A, Guha AR, Mohanty K, Hemmadi S, Lyons K, O’Doherty D (2011) Malreduction of syndesmosis—are we considering the anatomical variation? Injury 42:1073–1076

    Article  CAS  PubMed  Google Scholar 

  27. Vasarhelyi A, Lubitz J, Gierer P, Gradl G, Rösler K, Hopfenmüller W, Klaue K, Mittlmeier TW (2006) Detection of fibular torsional deformities after surgery for ankle fractures with a novel CT method. Foot Ankle Int 27:1115–1121

    PubMed  Google Scholar 

  28. Schepers T (2012) Acute distal tibiofibular syndesmosis injury: a systematic review of suture-button versus syndesmotic screw repair. Int Orthop 36:1199–1206

    Article  PubMed Central  PubMed  Google Scholar 

  29. Marmor M, Hansen E, Han HK, Buckley J, Matityahu A (2011) Limitations of standard fluoroscopy in detecting rotational malreduction of the syndesmosis in an ankle fracture model. Foot Ankle Int 32:616–622

    Article  PubMed  Google Scholar 

  30. Elgafy H, Semaan HB, Blessinger B, Wassef A, Ebraheim NA (2010) Computed tomography of normal distal tibiofibular syndesmosis. Skeletal Radiol 39:559–564

    Article  PubMed  Google Scholar 

  31. van den Bekerom MP, Hogervorst M, Bolhuis HW, van Dijk CN (2008) Operative aspects of the syndesmotic screw: review of current concepts. Injury 39:491–498

    Article  PubMed  Google Scholar 

  32. Lee YS, Chen SW (2009) Lateral fixation of open AO type-B2 ankle fractures: the Knowles pin versus plate. Int Orthop 33:1135–1139

    Article  PubMed Central  PubMed  Google Scholar 

  33. Lee YS, Hsu TL, Huang CR, Chen SH (2010) Lateral fixation of AO type-B2 ankle fractures: the Acutrak plus compression screw technique. Int Orthop 34:903–907

    Article  PubMed Central  PubMed  Google Scholar 

  34. van Wensen RJ, van den Bekerom MP, Marti RK, van Heerwaarden RJ (2011) Reconstructive osteotomy of fibular malunion: review of the literature. Strategies Trauma Limb Reconstr 6:51–57

    Article  PubMed Central  PubMed  Google Scholar 

  35. Schepers T, Van Lieshout EMM, De Vries MR, Van der Elst M (2011) Increased rates of wound complications with locking plates in distal fibular fractures. Injury 42:1125–1129

    Article  CAS  PubMed  Google Scholar 

  36. SooHoo NF, Krenek L, Eagan MJ, Gurbani B, Ko CY, Zingmond DS (2009) Complication rates following open reduction and internal fixation of ankle fractures. J Bone Joint Surg Am 91A:1042–1049

    Article  Google Scholar 

  37. Ovaska MT, Mäkinen TJ, Madanat R, Vahlberg T, Hirvensalo E, Lindahl J (2013) Predictors of poor outcomes following deep infection after internal fixation of ankle fractures. Injury 44:1002–1006

    Article  PubMed  Google Scholar 

  38. Ovaska MT, Mäkinen TJ, Madanat R, Huotari K, Vahlberg T, Hirvensalo E, Lindahl J (2013) Risk factors for deep surgical site infection following operative treatment of ankle fractures. J Bone Joint Surg Am 95A:348–353

    Article  Google Scholar 

  39. Kessler B, Sendi P, Graber P, Knupp M, Zwicky L, Hintermann B, Zimmerli W (2012) Risk factors for periprosthetic ankle joint infection: a case–control study. J Bone Joint Surg Am 94A:1871–1876

    Article  Google Scholar 

  40. Gardner MJ, Demetrakopoulos D, Briggs SM, Helfet DL, Lorich DG (2006) Malreduction of the tibiofibular syndesmosis in ankle fractures. Foot Ankle Int 27:788–792

    PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland

    Mikko T. Ovaska, Tatu J. Mäkinen, Rami Madanat, Veikko Kiljunen & Jan Lindahl

Authors
  1. Mikko T. Ovaska
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tatu J. Mäkinen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rami Madanat
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Veikko Kiljunen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jan Lindahl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mikko T. Ovaska.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ovaska, M.T., Mäkinen, T.J., Madanat, R. et al. A comprehensive analysis of patients with malreduced ankle fractures undergoing re-operation. International Orthopaedics (SICOT) 38, 83–88 (2014). https://doi.org/10.1007/s00264-013-2168-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-013-2168-y

Keywords

Search

Navigation