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to pain, pathological fractures, immobility, decreased functioning, and hypercalcaemia. Over half of patients experience clinical symptoms for which treatment is required, 3 of whom only a minority are surgically treated. 4 In the long bones
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(range: 51.4–91.9 years old) ( Table 1 ). Five patients presented multiple lesions requiring nailing: 52 IM nail fixations were performed. Indications to treatment were (i) impending fracture (21 cases) or pathologic fracture (30 cases) due to long bone
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with impending or actual pathological fractures. 5 Those impending or actual pathological fractures regularly require surgical treatment in order to prevent or stabilize fractures. Surgical procedures used to stabilize impending or actual
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finding the primary tumour site, but should be the last procedure in the diagnostic work-up because it weakens the affected bone and can lead to a pathological fracture. Approximately 20% of patients with bone metastases are referred with an actual
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until a pathologic fracture occurs. The treatment aims to prevent the pathologic fractures, restore the cortical thickness, and contain the recurrence. Multiple treatments have been proposed ranging from observation only to open curettage, and no
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), secondary osteoarthritis, tumor volume, distance from the joint cartilage, reoperation, follow-up time, Campanacci grade, and pathological fracture. Evaluation of the knee osteoarthritis stage was performed using the Kellgren and Lawrence classification
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Department of Orthopaedic Surgery, International Knee and Joint Centre, Abu Dhabi, UAE
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inadequate reduction of the articular step-off, secondary loss of reduction and material cut-out. 2 – 17 Thirdly, use of TKA might be indicated for pathological fractures of the distal femur and/or tibia in cases with poor bone stock or profound condylar
Department of Emergency Medicine, Emergency University Hospital, Bucharest, Romania
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Department of Orthopaedics and Traumatology, Emergency University Hospital Bucharest, Romania
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Department of Orthopaedics and Traumatology, Emergency University Hospital Bucharest, Romania
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Department of Emergency Medicine, Emergency University Hospital, Bucharest, Romania
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Department of Orthopaedics and Traumatology, Emergency University Hospital Bucharest, Romania
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move the right hip. These symptoms occurred while trying to chase after public transportation. Upon initial radiographic examination of the pelvis, a pathological fracture was observed at the specific location of interest (A). Following further medical
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Introduction
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Fragility ankle fractures are traditionally managed conservatively or with open reduction internal fixation. Tibiotalocalcaneal (TTC) nailing is an alternative option for the geriatric patient. This meta-analysis provides the most detailed analysis of TTC nailing for fragility ankle fractures.
Methods
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A systematic search was performed on MEDLINE, EMBASE, Cochrane Library, and Web of Science, identifying 14 studies for inclusion. Studies including patients with a fragility ankle fracture, defined according to NICE guidelines as a low-energy fracture obtained following a fall from standing height or less, that were treated with TTC nail were included. Patients with a previous fracture of the ipsilateral limb, fibular nails, and pathological fractures were excluded. This review was registered in PROSPERO (ID: CRD42021258893).
Results
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A total of 312 ankle fractures were included. The mean age was 77.3 years old. In this study, 26.9% were male, and 41.9% were diabetics. The pooled proportion of superficial infection was 10% (95% CI: 0.06–0.16), deep infection 8% (95% CI: 0.06–0.11), implant failure 11% (95% CI: 0.07–0.15), malunion 11% (95% CI: 0.06–0.18), and all-cause mortality 27% (95% CI: 0.20–0.34). The pooled mean post-operative Olerud–Molander ankle score was 54.07 (95% CI: 48.98–59.16). Egger’s test (P = 0.56) showed no significant publication bias.
Conclusion
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TTC nailing is an adequate alternative option for fragility ankle fractures. However, current evidence includes mainly case series with inconsistent post-operative rehabilitation protocols. Prospective randomised control trials with long follow-up times and large cohort sizes are needed to guide the use of TTC nailing for ankle fractures.
Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania
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Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania
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Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania
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Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania
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Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania
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Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania
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-old woman with bilateral subtrochanteric pathological fractures secondary to a cervical neoplasm, recently treated on the left side with a cephalointramedullary nail. (B) Postoperative image of the right femur after fracture fixation with a long
