Sascha Halvachizadeh (Zurich / CH), Roman Pfeifer (Zurich / CH), Yannik Kalbas (Zurich / CH), Simone Schuerrle (Zurich / CH), Felix Karl Ludwig Klingebiel (Zurich / CH), Paolo Cinelli (Zurich / CH), Hans-Christoph Pape (Zurich / CH)
Abstract text (incl. references and figure legends)
Introduction
The local soft tissue status (STS) guides surgical treatment strategies of fractures fixation. The aim of this study was to assess the physical properties of STS in lateral malleolar fractures that led to either temporal (TEMP) or definitive surgical strategy.
Methods
prospective double-blinded cohort study. Adult patients with closed lateral malleolar fracture eligible, if required surgical treatment.Exclusion: Previous injuries to the lower extremity, acute deep venous thrombosis, skin diseases, delayed presentation. primary outcome was the treatment strategy. Examination: circumference and bone-skin distance on plain radiograph. Physical properties assessment of the STS included optical measures of local perfusion and tactile measures of mechanical characteristics. Measurements were taken on admission and prior decision of treatment strategy. The contralateral not-injured ankle served as control.
Results
Forty patients at a mean age of 41 (±17.6) years were included. The circumference at admission was significantly higher when compared with the healthy site (28.6 ± 3.6cm versus 24.3 ± 2.7cm, p < 0.001). The local perfusion (blood flow 109.6, SD 39.8 A.U. vs. 81.9, SD 15.5, p = 0.0051), and dynamic stiffness of the skin (679.4 N/m, SD 147 N/m vs 469.9N/m, SD 117.9 N/m, p < 0.001) were significantly higher at the injured site. During TEMP, the local blood flow was higher when compared with definitive surgery (109.6, SD 39.8 vs. 94.5, SD 13.0, p = 0.023). The dynamic stiffness of the soft tissue was significantly higher during TEMP (679.4 N/m, SD 147.0 N/m vs. 573.0 N/m, SD 93.8 N/m, p < 0.001)
Conclusion
Altered physical properties of the STS following injury include optical perfusion and dynamic stiffness at the surface. These changes might be indicative for the treatment strategy. The assessment tools could be implemented in routine clinical practice guiding decision making for either temporal or definitive surgical treatment strategies.
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None of the authors have any conflicts to declare