Objectives: Ankle fractures are common in the elderly. However, their association with osteoporosis remains controversial. This systematic review aims to determine the relationship between ankle fracture and bone mineral density (BMD), and to investigate the risk of subsequent fractures after ankle fracture. Methods: MEDLINE and Scopus publications were searched from inception to March and April 2019, respectively. Articles were selected by 2 independent reviewers for cross-sectional, cohort, or casecontrol studies comparing BMD or subsequent fracture risk in low-energy ankle fractures patients with that of the normal population. Data extraction was performed by 2 investigators. Discrepancies were resolved with the third reviewer. Quality assessment was conducted using the modified NewcastleOttawa Scale. Results: Overall, 19 articles were included. The quality assessment showed a generally low-to-moderate risk of bias among studies, mainly due to potential confounders and inadequate follow-up. Of 13 studies exploring BMD in ankle fractured-patients, lower central and peripheral BMD was found in 3 and 2 studies, respectively. The risk of subsequent fracture was examined in 11 studies with relative risks ranging from 0.7 to 4.59. An increased risk of any subsequent fractures in women, both genders, and men was found in 5, 2, and 1 articles, respectively. Conclusions Despite the lack of clear association with BMD, the contribution of ankle fracture to increased subsequent fracture risk and its associated microarchitectural changes cannot be overlooked.Moreover, its potential role as an early predictor of future fracture may promote secondary prevention.Further studies with longer follow-up and stricter confounder control are recommended.

PURPOSE: The effect of sagittal plane angle of the tibial tunnel on the severity of tibial intra-articular aperture expansion caused by iatrogenic re-reaming in anterior cruciate ligament (ACL) reconstruction using a modified transtibial technique is unknown. The purpose of this study was to compare the severity of intra-articular aperture widening at different angles (40°, 45°, and 50°) of the tibial guide (TG). MATERIALS AND METHODS: Ninety-seven patients who underwent modified transtibial ACL reconstruction were randomly allocated to TG 40°, 45°, and 50° groups. Intra-articular tibial aperture width (TW) and tibial tunnel length (TTL) were measured intraoperatively using an arthroscopic ruler and a depth gauge. RESULTS: The TG 50° group had significantly greater tibial aperture widening than the TG 40° group. There was a significant difference among TG 40°, 45°, and 50° groups and the percentage of knees with TTL <35 mm was 8%, 9% and 3%, respectively. There were 2 females with TTL <35 mm in TG 40° and 45° groups each. The average mediolateral length of the tibial plateau was 75 mm. CONCLUSIONS: This study shows that the TG angle of 40° would reduce the severity of intra-articular aperture widening of the tibial tunnel compared to 45° or 50° in modified transtibial ACL reconstruction.
Anterior Cruciate Ligament Reconstruction ; Anterior Cruciate Ligament ; Female ; Humans ; Knee

PURPOSE: The purpose of this review is to compare the clinical and radiological outcomes between open and closed wedge distal femoral varus osteotomy (DFO). METHODS: A literature search of online databases (MEDLINE, EMBASE, and Cochrane Library database) was made in addition to manual search of major orthopedic journals. Data were searched from the time period of January 1990 to October 2016. A modified Coleman Methodology Score system was used to assess the methodologic quality of the included studies. A total of 20 studies were included in the review. All studies were level IV evidence. RESULTS: Comparative analysis of open and closed wedge DFO did not demonstrate clinical and radiological differences. The survival rates were also similar. Five studies (56%) on open wedge DFO mentioned the need for either bone grafting or substitute for osteotomy gap filling and reported higher incidences of reoperation for plate removal than the closed wedge DFO studies. CONCLUSIONS: The present systematic review showed similar performance between open and closed wedge DFO. Outcomes including survival rates were not statistically significantly different. However, additional bone grafting or substitutes were often needed to prevent delayed union or nonunion for open wedge techniques. Additional operations for plate removal were commonly required due to plate irritation in both techniques.
Arthritis ; Bone Transplantation ; Femur ; Incidence ; Knee ; Orthopedics ; Osteotomy ; Reoperation ; Survival Rate