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1. Progressive functional exercise versus best practice advice for adults aged 50 years or over after ankle fracture: protocol for a pilot randomised controlled trial in the UK - the Ankle Fracture Treatment: Enhancing Rehabilitation (AFTER) study. Full Text available with Trip Pro

Progressive functional exercise versus best practice advice for adults aged 50 years or over after ankle fracture: protocol for a pilot randomised controlled trial in the UK - the Ankle Fracture Treatment: Enhancing Rehabilitation (AFTER) study. Ankle fractures result in significant morbidity in adults, with prognosis worsening with increasing age. Previous trials have not found evidence supporting supervised physiotherapy sessions, but these studies have not focused on older adults or tailored (...) the exercise interventions to the complex needs of this patient group. The Ankle Fracture Treatment: Enhancing Rehabilitation study is a pilot randomised controlled trial to assess feasibility of a later definitive trial comparing best-practice advice with progressive functional exercise for adults aged 50 years and over after ankle fracture.The main objectives are to assess: (i) patient engagement with the trial, measured by the participation rate of those eligible; (ii) establish whether

2019 BMJ open

2. Predicting patient-reported and objectively measured functional outcome 6 months after ankle fracture in people aged 60 years or over in the UK: prognostic model development and internal validation. Full Text available with Trip Pro

Predicting patient-reported and objectively measured functional outcome 6 months after ankle fracture in people aged 60 years or over in the UK: prognostic model development and internal validation. To predict functional outcomes 6 months after ankle fracture in people aged ≥60 years using post-treatment and 6-week follow-up data to inform anticipated recovery, and identify people who may benefit from additional monitoring or rehabilitation.Prognostic model development and internal validation (...) .24 National Health Service hospitals, UK.Participants were the Ankle Injury Management clinical trial cohort (n=618) (ISRCTN04180738), aged 60-96 years, 459/618 (74%) female, treated surgically or conservatively for unstable ankle fracture. Predictors were injury and sociodemographic variables collected at baseline (acute hospital setting) and 6-week follow-up (clinic). Outcome measures were 6-month postinjury (primary) self-reported ankle function, using the Olerud and Molander Ankle Score (OMAS

2019 BMJ open

3. In elderly patients with ankle fractures who are unable to safely mobilise non-weight bearing using appropriate walking aids; does allowing partial weight bearing of the affected leg reduce the length of time spent in hospital, reduce complications of bed

Katie.Wills@nhs.net Clinical bottom line The search revealed no evidence to answer this question. Further research is required. Why is this important? Ankle fractures are the fifth most common fracture and have an incidence of 122/100,000 per year. A quarter of ankle fractures occur in patients over 60 years of age. For elderly patients with traumatic ankle fractures, current practice in many orthopaedic wards in the UK is to mobilise non-weight bearing (i.e hopping on the unaffected leg with the use (...) with a number of potential benefits to patients and health care utilisation (Bugler, 2015). Search timeframe 2006-2016 Inclusion Criteria Description Search terms Population and Setting Elderly in-patients (50+) with unilateral ankle fractures +/- Open Reduction Internal Fixation, unable to hop on the unaffected leg. Age >50 Patients with traumatic ankle fractures unable to safely hop on the unaffected leg to independently mobilise. Specific Question: In elderly patients with ankle fractures who are unable

2017 Public Health England

4. Randomised controlled trial: Close contact casting may result in similar outcomes compared with plate fixation for unstable ankle fractures in patients over 60?years old

fixation for unstable ankle fractures in patients over 60 years old Article Text Therapeutics/Prevention Randomised controlled trial Close contact casting may result in similar outcomes compared with plate fixation for unstable ankle fractures in patients over 60 years old Alastair Younger Statistics from Altmetric.com Commentary on: Willett K , Keene DJ , Mistry D , et al . Close contact casting vs surgery for initial treatment of unstable ankle fractures in older adults: a randomized clinical trial (...) . Context Surgery has been considered the mainstay of treatment for unstable ankle fractures. Early mobilisation and weight bearing is possible with stable anatomic fracture fixation (open reduction internal fixation (ORIF)). Surgery also increases the risk of wound problems. This study compared outcomes among older adults with ankle fractures who received ORIF versus close contact casting. Methods This study was prospective, powered and randomised to determine the outcomes at 6 months of adults aged 60

2017 Evidence-Based Medicine

5. Combined anterior and posterior ankle impingement syndrome with nonunion of Cedell fracture in a 58-year-old female: a case report. Full Text available with Trip Pro

Combined anterior and posterior ankle impingement syndrome with nonunion of Cedell fracture in a 58-year-old female: a case report. Combined anterior and posterior ankle impingement has seldom been reported. Cedell fracture, fracture of posteromedial tubercle of talus, is an uncommon and easily missed injury which may elicit posteromedial ankle impingement. The injury mechanisms and management strategies of these two lesions have been reported individually. But the concurrent lesion of both (...) of them has not been reported.We reported a 58-year-old female with combined anterior and posterior ankle impingement syndrome with nonunion of Cedell fracture in whom open osteophytes debridement, fracture internal fixation and posterior talotibial ligament reconstruction were performed. The AOFAS hindfoot score was 90 at 1 year follow-up. To our knowledge, this was the first reported case with anterior, posterior and posteromedial impingement which was treated operatively with an excellent short

2020 BMC Musculoskeletal Disorders

6. Orthopedic treatment and early weight-bearing for bimalleolar ankle fractures in elderly patients: Quality of life and complications. (Abstract)

Orthopedic treatment and early weight-bearing for bimalleolar ankle fractures in elderly patients: Quality of life and complications. Non-operative treatment of Weber's type B ankle fractures is essential in elderly patients. However, there is controversy in the post-reduction management of the fracture between the use of early weight-bearing or traditional treatment and non-weight-bearing for 6-8 weeks. There is limited evidence available regarding which rehabilitation regimen should (...) ). There were no significant differences in the complication rate between the two groups.Early weight-bearing improves the quality of life and functionality in elderly patients with Weber type B fracture without increasing complications.Copyright © 2019 Elsevier Ltd. All rights reserved.

2020 Injury

7. THE FIBULAR INTRAMEDULLARY NAIL VERSUS LOCKING PLATE AND LAG SCREW FIXATION IN THE MANAGEMENT OF UNSTABLE ELDERLY ANKLE FRACTURES: A CADAVERIC BIOMECHANICAL COMPARISON. (Abstract)

THE FIBULAR INTRAMEDULLARY NAIL VERSUS LOCKING PLATE AND LAG SCREW FIXATION IN THE MANAGEMENT OF UNSTABLE ELDERLY ANKLE FRACTURES: A CADAVERIC BIOMECHANICAL COMPARISON. To compare the biomechanical failure properties of the fibular intramedullary nail with locking plate and lag screw fixation in the management of unstable elderly distal fibular fractures.Twelve fresh-frozen cadaveric lower limbs (six matched-pairs) were studied. A simulated OTA/AO 44-B fracture was created, then randomly (...) allocated within each pair to intramedullary nail or locking plate fixation supplemented with an interfragmentary lag screw. The limbs were secured with the foot rigidly held in 20 of supination, loaded to 700N and subjected to progressive external rotation until failure.The mean specimen age was 86.5 years (61-97). Mean torque to failure was greater in the intramedullary nail group but did not reach statistical significance (23.5 Nm vs. 21.6 Nm; p=0.463). The nail failed at a significantly greater

2020 Journal of Orthopaedic Trauma

8. Three-Year Follow-up of a Trial of Close Contact Casting vs Surgery for Initial Treatment of Unstable Ankle Fractures in Older Adults Full Text available with Trip Pro

Three-Year Follow-up of a Trial of Close Contact Casting vs Surgery for Initial Treatment of Unstable Ankle Fractures in Older Adults 29584832 2018 04 12 2018 11 14 1538-3598 319 12 2018 03 27 JAMA JAMA Three-Year Follow-up of a Trial of Close Contact Casting vs Surgery for Initial Treatment of Unstable Ankle Fractures in Older Adults. 1274-1276 10.1001/jama.2018.0811 Keene David J DJ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford (...) Hospitals National Health Service Foundation Trust, Oxford, United Kingdom. Willett Keith K Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom. Ankle Injury Management (AIM) Trial Collaborators eng Equivalence Trial Journal Article Multicenter Study Pragmatic Clinical Trial Randomized Controlled Trial United States JAMA 7501160 0098-7484 AIM IM Aged Ankle Fractures surgery therapy Casts, Surgical Female Follow-Up Studies Fracture

2018 JAMA Controlled trial quality: uncertain

9. The epiphyseal scar joint line distance and age are important factors in determining the optimal screw length for medial malleoli fractures. (Abstract)

The epiphyseal scar joint line distance and age are important factors in determining the optimal screw length for medial malleoli fractures. The screw length is important to achieve a stable fixation for medial malleoli fractures. We aimed to evaluate the optimal screw length for different age groups in surgically treated medial malleoli fractures. The second aim was to identify the utility of the distance of epiphyseal scar to joint line or joint line to medullary space for assessment of screw (...) length.368 X-rays and computed tomography (CT) images of ankle joints were retrospectively evaluated for optimal screw length, epiphyseal scar to joint line distance, joint to medullary space distance. The mean screw length for each decade was calculated. The correlations of screw length with age, screw length with distance of epiphyseal scar to joint line, and screw length with distance of joint line to medullary space were evaluated.The optimal screw length was obviously decreased in patients in 61

2019 Injury

10. Supination adduction ankle fractures: Ankle fracture or pilon variant? (Abstract)

fractures.Following IRB approval, we retrospectively reviewed ankle and pilon fractures (OTA 43 & 44) treated at two academic level-1 trauma centers from 2008-2016. Our primary outcome was failure defined as either ankle arthrodesis or arthroplasty. Infection and significant arthrosis were also compared. We performed multivariate Cox regression to compare failure between SAD ankles and pilon fractures.Seventy-nine SAD ankle and 91 pilon fractures met inclusion criteria. Patient demographics including age and open (...) Supination adduction ankle fractures: Ankle fracture or pilon variant? Supination adduction (SAD) fractures are rotational ankle fractures with a characteristic vertical medial malleolus fracture and tension failure fibula fracture. While these fractures are considered rotational injuries, they can have joint impaction that could lead to early joint degeneration. The purpose of this study was to characterize SAD ankle fractures and compare these injuries with partial articular pilon

2020 Injury

11. Choosing Wisely: Low Risk Pediatric Ankle Fractures

al. Radiograph-Negative Lateral Ankle Injuries in Children: Occult Growth Plate Fracture or Sprain? JAMA Pediatr . 2016;170(1):e154114. [ ] (Visited 895 times, 1 visits today) Kathy Boutis Dr. Kathy Boutis is a pediatric emergency physician at The Hospital for Sick Children (SickKids), a Senior Associate Scientist in the Child Health Evaluative Sciences Program at SickKids Research Institute, and an Associate Professor with the University of Toronto. Latest posts by Kathy Boutis ( ) - January 23 (...) Choosing Wisely: Low Risk Pediatric Ankle Fractures Choosing Wisely: Low Risk Pediatric Ankle Fractures - CanadiEM Choosing Wisely: Low Risk Pediatric Ankle Fractures In by Kathy Boutis January 23, 2018 This post has been co-written by Drs. Kathy Boutis and Maxim Ben Yakov. The dogmas of the past are now being challenged for the most common minor pediatric fractures, and minor distal fibular fractures. Since these fractures are stable and have an excellent prognosis, they do not need

2018 CandiEM

12. Transarticular tibiotalocalcaneal nailing versus open reduction and internal fixation for treatment of the elderly ankle fracture: protocol for a multicentre, prospective, randomised controlled trial. Full Text available with Trip Pro

increasing the risks of complications. Tibiotalocalcaneal (TTC) nailing has been suggested as an alternative to ORIF which allows immediate weight bearing, and is suggested to result in fewer complications. This study aims to compare the two surgical techniques in the elderly population with ankle fractures.The study will be a multicentre, prospective, randomised controlled trial comparing ORIF to TTC nailing in 110 patients with ankle fractures aged 50 or above with a Charlson Comorbidity Index (...) Transarticular tibiotalocalcaneal nailing versus open reduction and internal fixation for treatment of the elderly ankle fracture: protocol for a multicentre, prospective, randomised controlled trial. Ankle fractures are common in the elderly population. Surgical fixation is technically challenging and often results in complications due to high rates of osteoporosis and vascular disease. Open reduction and internal fixation (ORIF) often requires prolonged periods of non-weight bearing

2019 BMJ open Controlled trial quality: uncertain

13. Ability of a Risk Prediction Tool to Stratify Quality and Cost of Older Patients with Operative Ankle Fractures. (Abstract)

Ability of a Risk Prediction Tool to Stratify Quality and Cost of Older Patients with Operative Ankle Fractures. To investigate the ability of a validated geriatric trauma risk prediction tool to stratify hospital quality metrics and inpatient cost for middle-aged and geriatric patients admitted from the ED for operative treatment of an ankle fracture.Prospective cohort study SETTING:: Single Academic Medical Center PATIENTS:: Patients aged 55 and older who sustained a rotational ankle fracture (...) and were treated operatively during their index hospitalization INTERVENTION:: Calculation of validated trauma triage score, Score for Trauma Triage in Geriatric and Middle Aged (STTGMA), using patient's demographic, injury severity, and functional status. Patients were stratified into groups based on scores to create a minimal-, low-, moderate-, and high-risk cohort.length of stay, complications, need for ICU/SDU level care, discharge location, and index admission costs RESULTS:: Fifty ankle fracture

2019 Journal of Orthopaedic Trauma

14. Comparison of risk factors for postoperative complications across age groups in patients undergoing ORIF of the ankle. (Abstract)

interventions for reducing postoperative comorbidity. The purpose of this study is to compare the incidence of and risk factors for adverse postoperative outcomes following ORIF of ankle fractures across patient age groups.Charts of patients age 18 years and older who underwent open reduction and internal fixation (ORIF) for any closed, non-polytraumatic, non-pilon ankle fracture at a single institution between the years 2008 and 2018 were reviewed. Demographic information, comorbidities, and postoperative (...) Comparison of risk factors for postoperative complications across age groups in patients undergoing ORIF of the ankle. Risk factors associated with various adverse outcomes for patients undergoing open reduction and internal fixation (ORIF) of the ankle, and how these risks differ between younger and older patient populations, has not been clearly established. Objective quantitative data may aid physicians in surgical decision making, individualizing postoperative management, and targeting

2019 Injury

15. Analysis of mortality and fixation failure in geriatric fractures using quantitative computed tomography. (Abstract)

patients without failure events (NE) (0.525 g/cm2) when controlling for age and time to radiographic follow-up.Our study illustrates that QCT is a reliable method for the determination of femoral neck BMD in elderly patients with geriatric fractures. Furthermore, lower BMD/T-Scores are associated with increased mortality and fixation failures in this patient population.Copyright © 2017 Elsevier Ltd. All rights reserved. (...) Analysis of mortality and fixation failure in geriatric fractures using quantitative computed tomography. While osteoporosis has been shown to be a contributing factor in low energy fractures in the elderly, limited data exists regarding the correlation of bone mineral density (BMD) and T-Scores to mortality and failure of fracture fixation. This study seeks to determine the relationship between femoral neck BMD in elderly patients with typical geriatric fractures and mortality and fracture

2017 Injury

16. Relationship of Prolonged Operative Time and Comorbidities With Complications After Geriatric Ankle Fractures. (Abstract)

Relationship of Prolonged Operative Time and Comorbidities With Complications After Geriatric Ankle Fractures. The incidence of geriatric ankle fractures has increased during the last few decades. In contrast to younger patients, increased complication rates have been observed. Thus, the goal of the present study was to identify risk factors for perioperative complications following open reduction and internal fixation of geriatric ankle fractures.Two hundred thirty-seven patients over the age (...) was the only independent risk factor for the development of a complication. The operative time as well as the presence of an open fracture represented risk factors for needing revision surgery. Comorbidities did not influence the development of complications.The operative management of geriatric ankle fractures was associated with a high complication rate. In the present study, the operative time was the only modifiable factor for the development of a complication that required revision surgery. During

2016 Foot & Ankle International

17. Acutely Limping Child Up To Age 5

for clinicians to order radiographs from the pelvis through the feet because of the patients’ typical lack of verbalization and inability to localize symptoms [9]. Radiographs of the lower extremities are often normal [10,11], with reports of fracture incidence ranging from 4% to 20% [12]. Spiral tibial fractures are by far the most common fractures found in children <4 years of age presenting with nonlocalized limp or refusal to bear weight. Other fractures in the ankle and foot are also described [12 (...) representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org ACR Appropriateness Criteria ® 5 Acutely Limping Child Up To Age 5 If initial imaging is normal but symptoms persist, follow-up radiographs or radiographs of areas besides the tibia/fibula may be useful. In the Baron et al study [13], approximately 10% of tibial fractures

2018 American College of Radiology

18. Morbidity and Mortality Associated with Geriatric Ankle Fractures: A Medicare Part A Claims Database Analysis. Full Text available with Trip Pro

Morbidity and Mortality Associated with Geriatric Ankle Fractures: A Medicare Part A Claims Database Analysis. The purpose of this study was to examine the incidence of adverse events in elderly patients who required inpatient admission after sustaining an ankle fracture and to consider these data in relation to geriatric hip fracture and other geriatric patient admissions.A retrospective cohort study of patients admitted with an ankle fracture, a hip fracture, or any other diagnosis (...) and 0.557 for patients with ankle fracture.Even after selecting for admitted patients and accounting for both age and comorbidity, geriatric patients with ankle fractures were found to have a lower one-year morbidity compared with geriatric patients who had sustained a hip fracture or alternative admitting diagnoses. Geriatric patients with ankle fractures are likely healthier and more active in ways that are not captured by simply accounting for age and comorbidity. These findings may support more

2015 The Journal of Bone and Joint Surgery. American Volume

19. Operative Versus Nonoperative Treatment of Geriatric Ankle Fractures: A Medicare Part A Claims Database Analysis. (Abstract)

Operative Versus Nonoperative Treatment of Geriatric Ankle Fractures: A Medicare Part A Claims Database Analysis. The incidence of ankle fractures is increasing in the geriatric population, and several studies suggest them to be the third most common extremity fracture in this age group. Previous work has reflected relatively low complication rates during operative treatment. Little is known, however, about the association between these injuries and overall mortality, nor whether operative (...) intervention has any effect on mortality. We hypothesized that geriatric ankle fractures would be correlated with an elevated mortality rate and that operative intervention would be associated with a reduced mortality when compared to nonoperative management.Following Institutional Review Board approval we retrospectively assessed all relevant 2008 part A inpatient claims from the Medicare database. We queried diagnosis codes for ankle fractures, and then excluded any patients whose age was less then 65

2015 Foot & Ankle International

20. Evaluation of one-year mortality after geriatric ankle fractures in patients admitted to nursing homes. (Abstract)

Evaluation of one-year mortality after geriatric ankle fractures in patients admitted to nursing homes. The incidence of geriatric ankle fractures will undoubtedly increase as the population continues to grow. Many geriatric patients struggle to function independently after such injury and often require placement into nursing homes. The morbidity and mortality associated with nursing homes is well documented within the field of orthopaedic surgery. However, there is currently no study examining (...) the mortality associated with nursing home placement following hospitalization for an ankle fracture. Therefore, the purpose of this study was to determine if geriatric patients admitted to nursing homes following an ankle fracture experience elevated mortality rates.Patients were identified using diagnosis codes for ankle fractures from all 2008 part A Medicare claims, and those admitted to nursing homes were identified using a Minimum Data Set (MDS). The Medicare database was also analyzed for specific

2015 Injury

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