PMC6230424_01
Prereduction view and CT 3D reconstruction of the ankle fracture. (a) Lateral view of the injured ankle. Note displaced distal tibia. (b) Frontal view. (c) CT 3D reconstruction. Talus "wedging" into the distal tibiofibular joint and displacement of tibia are evident.
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This led to an ankle fracture displacement with disruption of the syndesmosis, trauma to soft tissues and skin, and displacement of the distal end of the tibia through the skin (Figures 1(a) and 1(b)). The three-dimensional CT scanning reconstruction demonstrated displacement of the tibia and wedging of the talus into the distal tibiofibular joint (Figure 1(c)).
Lateral radiograph of the right shin and foot. Anterior dislocation of the talus (thick white arrow) and proximal fibular fracture (thin white arrow) are seen.
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The lateral radiograph of the right shin and foot revealed anterior dislocation of the talus (Figure 2). Furthermore, a fracture of one of the shin bones just distal of the knee joint was also observed (Figure 2).
Anteroposterior radiographs of the right shin and foot and the knee joint. (a) Anteroposterior radiograph of the right shin and foot. Talus "wedged" into the ankle syndesmosis (long thick white arrow), fracture of the medial malleolus (short thick white arrow), and proximal fibular fracture (thin white arrow) are seen. (b) Anteroposterior radiograph of the right knee joint. Proximal fibular fracture is indicated with a thin white arrow.
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The anteroposterior radiographs of the right shin and knee joint demonstrated fracture dislocation of the right medial malleolus (Figure 3(a)) and fracture dislocation of the proximal third of the fibula (Figures 3(a) and 3(b)). Furthermore, the "wedging" of the talus in the ankle syndesmosis (Figure 3(a)) was seen as well.
Posttreatment anteroposterior radiographs of the right shin and ankle and lateral radiograph of the right ankle. (a) Anteroposterior radiograph of the right shin and foot. (b) Anteroposterior radiograph of the right ankle. (c) Lateral radiograph of the right ankle.
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Fracture dislocation of the right medial malleolus was fixed with two cannulated compression screws (Figure 4(a)), while the syndesmosis was supported by two cannulated compression screws (Figures 4(a)-4(c)). The right anterior talofibular ligament was repaired using a suture anchor (Figure 4(a)).
3 months posttreatment: anteroposterior and lateral radiograph images, radiographs after the removal of the syndesmosis screw fixation images, CT scanning of the ankle, and images of the patient standing on his feet. (a) Anteroposterior radiograph of the right ankle. (b) Lateral radiograph of the right ankle. (c) The astragalus contusion is indicated with the arrow. (d) The Dupuytren fracture and dislocation was ameliorated. (e) Anteroposterior radiograph of the right ankle after the removal of the syndesmosis screw fixation images. (f) Lateral radiograph of the right ankle after the removal of the syndesmosis screw fixation images. Images of the patient standing on his feet. (g) Anteroposterior image of the patient standing on his feet. (h) Posteroanterior image of the patient standing on his feet. (i) Lateral image from the left of the patient standing on his feet. (j) Lateral image from the right of the patient standing on his feet.
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The 3-month follow-up visit confirmed the healing of the right syndesmosis, and the anteroposterior and lateral radiograph images showed that these fractures' and dislocations' healing process was good (Figures 5(a)-5(d)); the screw fixation supporting the right ankle syndesmosis was removed (Figures 5(e) and 5(f)).
12 months posttreatment: the ankle CT scanning and anteroposterior and lateral radiographs images. (a-f) Ankle CT scanning images of the right ankle. (h) Anteroposterior radiograph of the right ankle. (i) Lateral radiograph of the right ankle.
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At the 12-month follow-up visit after surgery, the radiography examination demonstrated that fractures and dislocations were restored well and healed (Figure 6).
12 months posttreatment: images of the patient standing on his feet. (a) Anteroposterior image of the patient standing on his feet. (b) Posteroanterior image of the patient standing on his feet. (c) Lateral image of the patient standing on his left feet. (d) Lateral image of the patient standing on his right feet. (e) Function of the patient flexion and extension of his feet.
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While not all sequelae of the ankle fracture disappeared, as, for example, astragalus contusion was still evident, the good functions and satisfied gesture of walking were restored (Figure 7), and the overall outcome was improving after 1-year follow-up.
PRISMA diagram of systematic literature review.
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The functionality of the right ankle was restored to a greater degree at the three-month mark (Figure 8). From the 3065 publications found using the aforementioned keywords, only 31 were found suitable after title screening (Figure 8).