Leyla Tümen

The posterior malleolar fragment (PMF) in ankle fractures can be fixed with closed reduction and percutaneous fixation with an anteroposterior screw (Closed Reduction Internal Fixation – CRIF), or with open reduction using a posterior approach and buttress plating (Open Reduction Internal Fixation – ORIF). The objective of this study was to compare these two techniques with respect to postoperative complications and patient-reported outcome measures (PROMs). In this retrospective study, data were analysed from 106 consecutive ankle fracture cases involving the PMF that were operated between 2021 and 2022 in a single institution. The PMF was managed either via CRIF (n = 43) or via ORIF (n = 63). A comprehensive analysis was conducted, encompassing patient-, fracture-specific characteristics, and treatment modalities.A minimum follow-up period of three months was deemed necessary in order to ascertain the complication rate, which was available for a total of 65 patients. The documented complications included superficial wound healing impairment without surgical revision, deep wound healing impairment necessitating surgical revision, iatrogenic nerve injury, delayed bone union, and revision surgery.In the second part of the study, patients were contacted for a follow-up assessment using the Foot and Ankle Outcome Score (FAOS), the Foot and Ankle Ability Measure (FAAM) and a numerical rating scale for pain (NRS). Thirty-nine patients participated. Analyses revealed significant disparities in the distribution of Bartoníček fracture types between the ORIF and CRIF groups: type II was more prevalent, and types III and IV less common, in the CRIF group (n = 43) than in the ORIF group (n = 63; p = 0.03). The PMFs in the ORIF group were found to be significantly larger (p = 0.006), and the mean surgical time was significantly prolonged in comparison to the CRIF group (p < 0.0001). The placement of a positioning screw was observed to be significantly more prevalent in the CRIF group than in the ORIF group (18 cases [42%] vs. 10 cases [16%], p = 0.003).Following a median follow-up period of eight months (range 3–37 months), the complication rate was found to be higher in the ORIF group (37%) than in the CRIF group (18%), although this difference was not statistically significant (p = 0.116).After a median follow-up period of 21 (14–36) months, the CRIF group patients showed significantly better results in the FAOS subscales activities of daily living and quality of life compared to the patients in the ORIF group (p = 0.049 and p = 0.045, respectively). Furthermore, the self-assessed ankle function compared to the status prior to the fracture, in the sports category of the FAAM, was better in the CRIF than in the ORIF group (p = 0.029).No significant differences were identified in FAOS total score or NRS between the two groups (p = 0.107 and p = 0.236, respectively). ORIF of the PMF reduces the likelihood of additional syndesmotic stabilisation in comparison with CRIF; however, it is associated with increased surgical time while maintaining similar complication rates.

Background: The objective of this study is to investigate the age- and gender-specific frequencies of different pathologies after ankle trauma with negative radiographs in children and adolescents. Methods: We retrospectively analysed the MRIs of 100 patients ≤ 18 years within 30 days after acute primary ankle trauma with negative radiographs. Patients were classified into three age groups: 0–11 years, 12–15 years, and 16–18 years. Results: MRI detected pathological findings in 96 cases (96%): Lateral collateral ligament ( n = 62), deltoid ligament injury ( n = 10), syndesmosis injury ( n = 12), Salter-Harris Type 1 fracture of the distal fibula ( n = 2), bone bruise and marrow oedema ( n = 32), soft tissue oedema and hematoma ( n = 13), joint effusion and hematoma ( n = 8), fracture ( n = 12), osteochondral lesion of the talus ( n = 2). Among LCL injuries, 21 cases (33.9%) affected the ATFL alone, 34 cases (54.8%) involved both the ATFL and CFL, 2 cases (3.2%) affected only the CFL, and 5 cases (8.1%) involved all three ligaments (ATFL, CFL and PTFL).The percentages of lateral collateral ligament and syndesmotic injuries both increased significantly with age (0–11 years: 43%, 12–15 years: 57%, and 16–18 years: 78%, p = 0.019; 0–11 years: 5%, 12–15 years: 5%, and 16–18 years: 24%, p = 0.015). There were no significant differences between the genders for any of the injuries ( p ≥ 0.539). In 24% of cases, injuries detected by MRI resulted in a modification of the clinical management. Conclusions: There is a high rate of injuries missed by radiographs but detected by MRI, with LCL injuries being the most common. The older the patient, the more likely it is that a syndesmotic injury will be detected with an MRI.

Background/Objectives: Scaphoid fractures are notorious for a high rate of nonunion, resulting in chronic pain and impaired wrist function. The decision for surgical intervention often involves extensive imaging and prolonged conservative management, leading to delays in definitive treatment. The effectiveness of such treatment remains a subject of ongoing clinical debate, with no universally accepted predictive tool for surgical success. The objective of this study was to train a deep learning algorithm to reliably identify cases of nonunion with a high probability of subsequent union following operative revision. Methods: This study utilized a comprehensive database of 346 patients diagnosed with scaphoid nonunions, with preoperative and postoperative X-rays available for analysis. A classical logistic regression for clinical parameters was used, as well as a TensorFlow deep learning algorithm on X-rays. The latter was developed and applied to these imaging datasets to predict the likelihood of surgical success based solely on the preoperative anteroposterior (AP) X-ray view. The model was trained and validated over six epochs to optimize its predictive accuracy. Results: The logistic regression yielded an accuracy of 66.3% in predicting the surgical outcome based on patient parameters. The deep learning model demonstrated remarkable predictive accuracy, achieving a success rate of 93.6%, suggesting its potential as a reliable tool for guiding clinical decision-making in scaphoid nonunion management. Conclusions: The findings of this study indicate that the preoperative AP X-ray of a scaphoid nonunion provides sufficient information to predict the likelihood of surgical success when analyzed using our deep learning model. This approach has the potential to streamline decision-making and reduce reliance on extensive imaging and prolonged conservative treatment.

Smoking is the most significant and modifiable risk factor for a range of conditions, including cancer, cardiovascular and respiratory diseases. Furthermore, it significantly reduces bone mass and increases the risk of fragility fractures due to its detrimental effects on bone metabolism and regeneration. Moreover, smoking is a known cause of chronic systemic inflammation, leading to an imbalance of cytokines. Comprehending the pathological mechanisms that underlie cytokine production and its impact on post-surgical healing is essential to prevent post-surgical complications. The present study recruited a total of 1144 patients, including 897 patients, among them non-smokers (N = 413), current smokers (N = 201) and ex-smokers (N = 283). Human proteome profiler arrays were used to screen for smoking-dependent differences in the serum cytokine and protein profiles, after matching samples for age, gender, body mass index (BMI), alcohol use, and diabetes risk. Cytokines and immune checkpoint proteins such as CD28, B7-1, MIG, TGFb2 and IL-1a/b were quantified by ELISA. Our study demonstrates a comprehensive understanding of the relationship between smoking, the development of complications, the systemic immune inflammation index (SII) and cytokine/protein levels. We found that a comparison of non-smokers, former smokers, and active smokers in our study cohort did not exhibit significantly altered cytokine and protein serum levels although other studies reported differences between smokers and non-smokers. We were unable to identify single blood circulating markers that could predict complications in smokers after trauma. However, we found the ratio of women to men to be inverted between non-smokers and active smokers resulting in a ratio of 0.62 in smokers. Furthermore, we demonstrate a higher complication rate, longer hospitalizations and elevated SII values among smokers, indicating an involvement of the immune system.