Treatment strategies for complex ankle fractures—current developments summarized in a narrative review

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Abstract

Background and Objective

Ankle fractures occur frequently in patients throughout all ages. Due to the many pitfalls associated with their treatment, complex ankle and especially tibial pilon fractures remain a challenge for surgeons. As there is still need for improvement in treating complex ankle fractures and treatment options are steadily increasing this review aims to summarize current practice and aims to highlight current developments by reviewing the literature.

Methods

We conducted a thorough search of PubMed database in December 2022 to identify relevant articles on complex ankle and tibial pilon fractures. Articles in English and German were included in this study.

Key Contents and Findings

Complication rates, especially wound infection are still high, emphasizing the need for careful preoperative planning. Soft tissue management is crucial to reduce complication rates and will often dictate the treatment plan utilized. Open reduction and internal fixation (ORIF) remains the treatment of choice. Nevertheless, in select cases alternative methods such as external fixation, tibiotalocalcaneal nailing or conservative treatment need to be considered as well. Furthermore, additional treatment options such as arthroscopically assisted surgery might help to improve functional outcome after complex ankle fractures. The incidence of complex ankle fractures in geriatric patients keeps rising with our aging population. This group of patients demands particular care and further high-quality studies are needed to warrant best results.

Conclusions

However, more randomized controlled trials are need in order to enhance evidence of newly developed treatment options.

Related collections

Most cited references 101

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Population-based epidemiology of 9767 ankle fractures.

Peter Larsen, Rasmus Elsoe, Svend E Ostgaard (2018)

The purpose was to provide up-to-date information concerning the incidence of ankle fractures in a large and complete population including all age groups, spanning a decade, and report the distribution of fractures, trauma mechanism and patient baseline demographics.

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Increasing number and incidence of low-trauma ankle fractures in elderly people: Finnish statistics during 1970-2000 and projections for the future.

P Kannus, M Palvanen, S Niemi … (2002)

To increase knowledge about recent trends in the number and incidence of various low-trauma injuries among elderly people, we selected, from the National Hospital Discharge Register, all patients > or =60 years of age who were admitted to hospitals in Finland (5 million population) for primary treatment of a first low-trauma ankle fracture during 1970-2000. In each year of the study, the age-adjusted and age-specific incidence of fracture was expressed as the number of patients per 100,000 persons. The predicted numbers and incidence rates of fractures until the year 2030 were calculated using a regression model. For the study period, the number and incidence of low-trauma ankle fractures in Finnish persons > or =60 years of age rose substantially: the total number of fractures increased from 369 in 1970 to 1545 in 2000, a 319% increase, and the crude incidence increased from 57 to 150, a 163% increase. The age-adjusted incidence of these fractures also rose in both women (from 66 in 1970 to 174 in 2000, a 164% increase) and men (from 38 in 1970 to 114 in 2000, a 200% increase). The regression model indicates that, if this trend continues, there will be about three times more low-trauma ankle fractures in Finland in the year 2030 than there was in 2000. In conclusion, the number of low-trauma ankle fractures in elderly Finns is rising rapidly at a rate that cannot be explained simply by demographic changes and, therefore, potentially effective preventive measures, such as prevention of slippings, trippings, and falls in elderly people, and use of ankle supports, should be urgently studied. Copyright 2002 Elsevier Science Inc.

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Anatomy and classification of the posterior tibial fragment in ankle fractures.

Daniel Klika, Ivo Trešl, Jan Bartonícek … (2015)

The aim of this study was to analyze the pathoanatomy of the posterior fragment on the basis of a comprehensive CT examination, including 3D reconstructions, in a large patient cohort.

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Author and article information

Journal

Journal ID (nlm-ta): Ann Transl Med

Journal ID (iso-abbrev): Ann Transl Med

Journal ID (publisher-id): ATM

Title: Annals of Translational Medicine

Publisher: AME Publishing Company

ISSN (Print): 2305-5839

ISSN (Electronic): 2305-5847

Publication date (Electronic): 15 August 2023

Publication date (Print): 25 October 2023

Volume: 11

Issue: 11

Electronic Location Identifier: 387

Affiliations

[1 ]Department of Trauma Surgery, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar , Munich, Germany;

[2 ]deptDepartment of Orthopedics, Balgrist University Hospital , University of Zurich , Zurich, Switzerland

Author notes

Contributions: (I) Conception and design: O Mair, M Crönlein; (II) Administrative support: M Hanschen, P Biberthaler, M Crönlein; (III) Provision of study materials or patients: P Pflüger, M Hanschen, P Biberthaler, M Crönlein; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Olivia Mair, MD. Department of Trauma Surgery, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Ismaninger Strasse 22, 81675 Munich, Germany. Email: OliviaAnna.Mair@ 123456mri.tum.de .

Article

Publisher ID: atm-11-11-387

DOI: 10.21037/atm-23-1173

PMC ID: 10632576

PubMed ID: 37970612

SO-VID: e3a4d9e7-6c59-4cb8-8dab-9a2c21bfe76f

License:

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0.

History

Date received : 07 March 2023

Date accepted : 26 July 2023

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