Orthopaedic Articles - Articles for Orthopaedic Practice

Orthopaedic articles on current trends, tips & tricks and best evidence from top orthopaedic specialists.

Acute Osteochondral Injuries - Strategies for Management

Monika Volesky


Acute Osteochondral Injuries - Strategies for Management

Monika Volesky, M.D., FRCSC
Montreal, QC

Acute osteochondral fractures or lesions in the ankle can occur as isolated injuries, or more commonly, they are found in association with sprains or fractures of the ankle. Arthroscopic studies show that cartilage damage was noted in 25%4 to 66% of ankles with lateral ligament injuries and 98% of the ankles with deltoid ligament injuries3. Others1,5,3 have shown a high incidence of chondral or osteochondral injuries in ankle fractures, with cartilage lesions seen in 61% to 79% of acute ankle fractures, and the frequency and severity increasing from type-B to type-C fractures. It remains unclear whether these intra-articular injuries should change our clinical management. In a prospective randomized trial for operative treatment of ankle fractures with or without concomitant ankle arthroscopy, there was no difference in the lower extremity scores in the short-term between these two groups, despite a high incidence of talar dome cartilage damage8. A recently published long-term follow-up study, however, shows that initial cartilage damage seen arthroscopically following an ankle fracture is an independent predictor of the development of posttraumatic osteoarthritis7.


Ankle Fracture Complications: Salvaging a Failed ORIF

Alastair S.E. Younger


Ankle Fracture Complications: Salvaging a Failed ORIF

Ali G. A. Chaudhary, MB;ChB, FRCSC

Alastair Younger, MB;ChB, FRCSC, MSc, ChM
Vancouver, BC

Patients may present after an open reduction internal fixation with ongoing ankle pain. Cartilage defects are the most common cause in our practice. However, osteotomies, debridement and fusions may benefit select patients.

Less favourable outcome in patients over age of 65 years has been reported1,2. Most of the complications are related to the quality of bone and wound healing. Depending on the health of the patient, these complications may require symptomatic treatment or dressings only as further surgery is often inadvisable in the elderly.


Fixing the Difficult Ankle Fracture - Tips and Tricks

Brad Petrisor


Fixing the Difficult Ankle Fracture: Tips and Tricks

Rajrishi Sharma, M.D.
Department of Surgery, McMaster University

Brad A. Petrisor, MSc, M.D., FRCSC
Assistant Professor, Department of Surgery,
McMaster University
Hamilton, ON

Ankle fractures are amoung the most common fractures encountered by orthopaedic surgeons1-3. Despite this, however, observational studies suggest that malreduction following open reduction and internal fixation of unstable fractures may be as high as 24% of cases when assessed using standard radiographs and 52% using computerized tomography (CT)3,4. Complexity of ankle fracture fixation increases with involvement of the posterior malleolus, fibular bone comminution, with bone loss and marginal impaction of the plafond. With adequate preoperative planning and intraoperative techniques, successful fixation of these complex ankle fractures can be obtained.





Syndesmotic Injuries: Pearls and Pitfalls

Allan Syng-Luan Liew


Syndesmotic Injuries: Pearls and Pitfalls

Bradley E Slagel, M.D., FRCSC
Kingston, ON

Allan S. Liew, M.D., FRCSC
Ottawa, ON

Distal tibiofibular syndesmotic injuries occur in up to 20% of ankle fractures requiring internal fixation1,2. Patients with ankle injuries with concomitant syndesmotic disruption have more pain and poorer function one year post-injury compared to those with ankle fractures without syndesmotic injury3. This may reflect the severity of the initial injury; however, in their series of 25 ankles with postoperative X-ray and CT imaging, Gardner et al4 observed that up to 52% of syndesmoses were malreduced.



Treatment of Ankle Fractures in Diabetic Patients

Ian Le


Treatment of Ankle Fractures in Diabetic Patients

Ian L.D. Le, M.D, FRCSC
University of Calgary
Calgary, AB

In 2007, the Public Health Agency of Canada reported that more than two million Canadians (six percent of the population) were living with a diagnosis of diabetes. This is projected to increase six percent each year such that an estimated 2.8 million Canadians will have diabetes by 20121. It is inevitable that orthopaedic surgeons will need to have a sound approach to the management of ankle fractures in the diabetic population as this patient population expands.



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