Lower extremity fractures pose challenges due to prolonged healing times and limited assessment methods. Integrating wearable sensors with machine learning can help overcome these challenges by providing objective assessment and predicting fracture healing. In this retrospective study, data from a gait monitoring insole on 25 patients with closed lower extremity fractures were analyzed. Continuous underfoot loading data were processed to isolate steps, extract metrics, and feed them into three white-box machine learning models. Decision tree and Lasso regression aided feature selection, while a logistic regression classifier predicted days until fracture healing within a 30-day range. Evaluations via 10-fold cross-validation and leave-one-out validation yielded stable metrics, with the model achieving a mean accuracy, precision, recall, and F1-score of approximately 76%. Feature selection revealed the importance of underfoot loading distribution patterns, particularly on the medial surface. Our research facilitates data-driven decisions, enabling early complication detection, potentially shortening recovery times, and offering accurate rehabilitation timeline predictions.

Even after successful surgery for acute ankle fractures, many patients continue having complaints. A possible explanation is the presence of concomitant chondral lesions. The aim of this study is to investigate the accuracy of MRI compared to that of arthroscopy in the assessment of chondral lesions in acute ankle fractures. In this prospective single-center study, patients presenting with acute ankle fractures over a period of three years were identified. A preoperative MRI was performed within a maximum of 10 days after trauma. During surgery, ankle arthroscopy was also performed. The International Cartilage Repair Society (ICRS) cartilage lesion classification was used to grade the detected chondral lesions. To localize the chondral lesions, the talar dome was divided into eight zones and the tibial/fibular articular surfaces into three zones. In total, 65 patients (28 females) with a mean age of 41.1 ± 15 years were included. In the MRI scans, 70 chondral lesions were detected (69.2% of patients) affecting mostly the tibial plafond (30%) and mostly graded as ICRS 3. The mean lesion area measured was 20.8 mm2. In the arthroscopy, 85 chondral lesions were detected (70.8% of patients) affecting mostly the medial surface of the talar dome (25.9%) and mostly graded ICRS 3. The mean lesion area measured was 43.4 mm2. The highest agreement between the two methods was observed in the size estimation of the chondral lesions. The present study shows the reduced accuracy of MRI when compared to arthroscopy in the assessment of traumatic chondral lesions in the setting of acute ankle fractures especially regarding lesion size. MRI remains an essential instrument in the evaluation of such lesions; however, surgeons should take this discrepancy into consideration, particularly the underestimation of chondral lesions\' size in the preoperative planning of surgical treatment and operative technique.

BACKGROUND: There are many options for the surgical treatment of pronation external rotation (PER) type IV ankle fractures, including the use of fibular plates and screws, the aim of this study was to investigate the biomechanical stability and safety of different internal fixation methods for PER type IV ankle fractures via finite element analysis.
METHODS: A three-dimensional finite element model of the ankle joint and the whole foot of a healthy 26-years-old adult male was established and validated based on computed tomography images of his lower limb, and a computer-aided design was used to produce a PER type IV ankle fracture and plate and screw model. Four different internal fixation modes were simulated, including a (all ankle fixation-utilizing a fibular plate and screws for comprehensive stabilization of the ankle), b (inferior tibiofibular joint fixation + all ankle fixation), c (inferior tibiofibular joint fixation + unfixed anterior ankle), and d (inferior tibiofibular joint fixation + unfixed anterior and posterior ankles). The results of the four different fixation methods were compared via finite element analysis, and the von Mises stresses. The displacements of the four different fixation methods were analyzed as the output indices.
RESULTS: There were no significant differences between the results of using fibular plates and screws and the displacement of fracture breaks among the four internal fixation modalities. The von Mises stress in the tibiotalar joint, median ankle, posterior ankle, and anterior ankle was minimized in the working condition of d, d, b, and d respectively. The von Mises stress in the fibular plate and screws was minimized in the working condition of a. The von Mises stress in the distal fibula was minimized in the working condition of a. However, the stress was mainly concentrated at the attachment point of the inferior tibiofibular anterior ligament, and in the working condition with inferior tibiofibular joint fixation, the stress was significantly concentrated in the inferior tibiofibular joint screw in all the fibular plates and screws.
CONCLUSIONS: The results of this study demonstrate the feasibility of using finite element analysis to compare the biomechanical stability and safety of four configurations of fibular plates and screws for treating PER type IV ankle fractures. All four modalities provided comparable biomechanical stability and safety, showing no significant differences. However, the current limitations of the finite element analysis methodology preclude specific clinical inferences. Further refinement of the methodology in future studies is necessary to enable reliable clinical applications.

BACKGROUND: Acute injuries to the tibiofibular syndesmosis, often associated with high ankle sprains or malleolar fractures, require precise diagnosis and treatment to prevent long-term complications. This case report explores the use of needle arthroscopy as a minimally invasive technique for the repair of tibiofibular syndesmosis injuries.
METHODS: We report on a 40-year-old male patient who presented with a trimalleolar fracture and ankle subluxation following a high ankle sprain. Due to significant swelling and poor soft tissue quality, initial management involved external stabilization. Subsequently, needle arthroscopy was employed to assess and treat the tibiofibular syndesmosis injury. The procedure, performed under spinal anesthesia and fluoroscopic control, included nanoscopic evaluation of the ankle joint and reduction of the syndesmosis using a suture button. Follow-up assessments showed significant improvement in pain levels, range of motion, and functional scores. At 26 weeks post-procedure, the patient achieved full range of motion and pain-free status. Needle arthroscopy offers a promising alternative for the management of acute tibiofibular syndesmosis injuries, combining diagnostic and therapeutic capabilities with minimal invasiveness.
CONCLUSIONS: This technique may enhance clinical outcomes and reduce recovery times, warranting further investigation and integration into clinical practice.

UNASSIGNED: Ankle fracture surgeries among diabetic are common and can have fatal consequences and serious adverse outcomes. A target hemoglobin A1c (HbA1c) level <8% in all elective surgeries for patients with diabetes is suggested to minimize poor outcomes. We investigated the postoperative outcomes and complications among patients who underwent ankle fracture surgery using HbA1c level as a predictor value.
UNASSIGNED: This retrospective cohort study was conducted at King Abdulaziz Medical City between January 2016 and December 2022 on all patients with diabetes who underwent open reduction and internal fixation and who had a documented HbA1c level. Radiological outcomes and complications were noted along with the levels of HbA1c and analyzed statistically.
UNASSIGNED: A total of 44 patients were included in the study: 29 women (65.9%) and 15 (34.1%) men. The most frequent ankle fracture type was bimalleolar (54.5%). HbA1c was elevated (54.5%) in patients. A significantly higher proportion of patients who had <8% HbA1c level had radiological union compared to patients who had ≥8% HbA1c level (p = 0.036). Patients who had elevated HbA1c level had more complications although it did not reach statistical significance (p > 0.05). Multivariate regression analysis showed that age and HbA1c level were the significant factors for an uncomplicated and successful ankle surgery.
UNASSIGNED: Poor postoperative outcomes and complications are more common among patients with elevated HbA1c. This suggests that an elevated HbA1c level is associated with a poor treatment outcome. Determination of HbA1c levels may predict potential problems post ankle fracture surgery and improve management outcomes.
UNASSIGNED: تعتبر العمليات الجراحية لكسور الكاحل بين مرضى السكري شائعة ويمكن أن يكون لها عواقب وخيمة ونتائج سلبية خطيرة. تم اقتراح مستوى السكر التراكمي مستهدف <8٪ في جميع العمليات الجراحية الاختيارية لمرضى السكري لتقليل النتائج السيئة. نحن نهدف إلى دراسة نتائج ومضاعفات ما بعد الجراحة بين المرضى الذين خضعوا لعملية جراحية لكسر الكاحل باستخدام مستوى السكر التراكمي كقيمة تنبؤية.
UNASSIGNED: كانت هذه دراسة أترابية بأثر رجعي أجريت في مدينة الملك عبد العزيز الطبية بين يناير 2016 وديسمبر 2022 على جميع مرضى السكري الذين خضعوا للرد المفتوح والتثبيت الداخلي والذين لديهم مستوى موثق لنسبة مستوى السكر التراكمي. وقد لوحظت النتائج والمضاعفات الإشعاعية جنبا إلى جنب مع مستويات مستوى السكر التراكمي وتم تحليلها إحصائيا.
UNASSIGNED: تم تضمين أربعة وأربعين مريضا في الدراسة، 29 امرأة (65.9٪) و 15 (34.1٪) رجلا. كان نوع كسر الكاحل الأكثر شيوعا هو كسر الكاحل ثنائي الجانب (54.5٪). كان نسبة مستوى السكر التراكمي مرتفعة (54.5٪) من المرضى. كانت هناك نسبة أعلى بكثير من المرضى الذين لديهم مستوى مستوى السكر التراكمي أقل من 8% لديهم اتحاد إشعاعي مقارنة بالمرضى الذين لديهم مستوى مستوى السكر التراكمي ≤ 8%. لوحظ أن المرضى الذين لديهم مستوى مرتفع من مستوى السكر التراكمي لديهم مضاعفات أكثر على الرغم من أنها لم تصل إلى دلالة إحصائية. أظهر تحليل الانحدار متعدد المتغيرات أن العمر ومستوى السكر التراكمي كانا من العوامل المهمة لإجراء جراحة الكاحل غير المعقدة والناجحة.
UNASSIGNED: تعد النتائج والمضاعفات السيئة بعد العملية الجراحية أكثر شيوعا بين المرضى الذين يعانون من ارتفاع نسبة مستوى السكر التراكمي. يشير هذا إلى أن ارتفاع مستوى مستوى السكر التراكمي يرتبط بنتيجة علاج سيئة. قد يؤدي تحديد مستويات مستوى السكر التراكمي إلى التنبؤ بالمشاكل المحتملة بعد جراحة كسر الكاحل وتحسين نتائج الإدارة.

UNASSIGNED: Ankle fractures require temporary fixation to allow swelling to subside prior to surgery; this is typically achieved using calcaneal distraction or cast immobilization. We compared the results of these methods in the treatment of Danis-Weber type C ankle fractures.
UNASSIGNED: This retrospective study analyzed the data of 86 patients with Danis-Weber type C ankle fractures, of whom 40 underwent calcaneal distraction and 46 underwent cast immobilization. Clinical measures including preoperative detumescence time, daily swelling value, skin condition, and pain, SF-36 Health Survey (SF-36) score and ankle scores were compared between the two groups.
UNASSIGNED: Baseline characteristics did not differ significantly between the groups. Calcaneal distraction resulted in a lower preoperative detumescence time (6.22 ± 0.64 vs. 8.94 ± 0.82 days) and lower daily swelling values compared with cast immobilization, leading to a lower skin necrosis rate. Resting pain scores were significantly lower in the calcaneal distraction group than in the cast immobilization group at various postoperative time points (P < 0.05). Ankle function scores were higher in the calcaneal distraction group than in the cast immobilization group at 12 months postoperatively (P < 0.05), indicating improved outcomes. Additionally, the SF-36 quality of life scores of patients undergoing calcaneal distraction were notably superior to those in the cast immobilization group.
UNASSIGNED: Calcaneal distraction is superior to cast immobilization in reducing soft tissue swelling, alleviating pain, and enhancing ankle function recovery in patients with Danis-Weber type C ankle fractures. Early calcaneal distraction upon hospital admission is recommended to optimize surgical outcomes.

BACKGROUND: The recovery of limb function after ankle fracture surgery is a gradual process. The main purpose of implementing early functional exercise, joint mobility, muscle contraction function, passive ankle flexion and extension exercises, or physical factor therapy techniques is to achieve the rapid recovery of normal physiological limb function. However, currently the most effective rehabilitation training method is staged limb functional exercise, which promotes rapid recovery of limb function while preventing adverse consequences caused by overwork or insufficient training. Staged limb functional exercise divides the rehabilitation process into multiple stages, each of which has specific training objectives and contents. This method helps patients gradually restore limb function. Nevertheless, some patients still exhibit poor limb function after standardized exercise. Therefore, a functional evaluation should be performed to analyze the impact of staged functional training after ankle fracture surgery.
OBJECTIVE: To perform a functional evaluation and determine the influencing factors of staged functional training in patients with ankle fracture.
METHODS: A retrospective study enrolled 150 patients who underwent surgical treatment for ankle fracture from May 2020 to May 2022 at our hospital. Univariate and multivariate linear regression analyses were performed on general data, functional exercise compliance scale for orthopedic patients, Social Support Rating Scale (SSRS), American Orthopedic Foot and Ankle Score (AOFAS) Ankle-Hindfoot Score, and pain factors [serum bradykinin (BK), prostaglandin E2 (PGE2), 5-hydroxytryptamine (5-HT)].
RESULTS: Based on the AOFAS Ankle-Hindfoot Scale, the cases were divided into the excellent function (n = 111) and ordinary function (n = 39) groups. Univariate analysis revealed that monthly family income, education level, diabetes mellitus, functional exercise compliance scale of orthopedic patients score, SSRS, BK, PGE2, and 5-HT significantly influenced limb function after ankle fracture (P < 0.05); Multiple linear regression analysis showed that the functional exercise compliance scale score, SSRS, BK, PGE2, and 5-HT were independent risk factors affecting functional performance after staged functional exercise (P < 0.05).
CONCLUSIONS: Exercise compliance, SSRS, and pain level are the independent risk factors affecting functional performance after staged functional training following ankle surgery. Clinical nursing care after ankle surgery should include analgesic and health education measures to ensure optimal recovery of limb function.

Objectives: Patients with ankle fractures associated with diabetes experience more complications following standard open reduction-internal fixation (ORIF) than those without diabetes. Augmented fixation strategies, namely extended ORIF and hindfoot nails (HFNs), may offer better results and early weightbearing in this group. The aim of this study was to define the population of patients with diabetes undergoing primary fixation for ankle fractures. Secondarily, we aimed to assess the utilisation of standard and augmented strategies and the effect of these choices on surgical outcomes, including early post-operative weightbearing and surgical complications. Methods: A national multicentre retrospective cohort study was conducted between January and June 2019 in 56 centres (10 major trauma centres and 46 trauma units) in the United Kingdom; 1360 patients with specifically defined complex ankle fractures were enrolled. The patients\' demographics, fixation choices and surgical and functional outcomes were recorded. Statistical analysis was performed to compare high-risk patients with and without diabetes. Results: There were 316 patients in the diabetes cohort with a mean age of 63.9 yrs (vs. 49.3 yrs. in the non-diabetes cohort), and a greater frailty score > 4 (24% vs. 14% (non-diabetes cohort) (p < 0.03)); 7.5% had documented neuropathy. In the diabetes cohort, 79.7% underwent standard ORIF, 7.1% extended ORIF and 10.2% an HFN, compared to 87.7%, 3.0% and 10.3% in the non-diabetes cohort. Surgical wound complications after standard-ORIF were higher in the diabetes cohort (15.1% vs. 8.7%) (p < 0.02), but patients with diabetes who underwent augmented techniques showed little difference in surgical outcomes/complications compared to non-diabetes patients, even though early-weightbearing rates were greater than for standard-ORIF. Conclusions: Ankle fractures in diabetes occur in older, frailer patients, whilst lower-than-expected neuropathy rates suggest a need for improved assessment. Augmented surgical techniques may allow earlier weightbearing without increasing complications, in keeping with modern guidelines in ankle fracture management.

暂无摘要。

暂无摘要。