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Letters to the Editor to:

Scientific Articles:
Nirmal C. Tejwani, Toni M. McLaurin, Michael Walsh, Siraj Bhadsavle, Kenneth J. Koval, and Kenneth A. Egol
Are Outcomes of Bimalleolar Fractures Poorer Than Those of Lateral Malleolar Fractures with Medial Ligamentous Injury?
J Bone Joint Surg Am 2007; 89: 1438-1441 [Abstract] [Full text] [PDF]
*Letters to the Editor: Submit a response to this article

Electronic letters published:

[Read Letter to the Editor] Dr. Tejwani responds to Dr. Mereddy.
Nirmal C Tejwani, M.D.   (13 November 2007)
[Read Letter to the Editor] Are Bimalleolar Fracture Outcomes Poorer Than Lateral Malleolar Fractures with Medial Lig. Injury?
Praveen K R Mereddy, Santoshkumar Hakkalamani, Simon R. Platt   (22 October 2007)

Dr. Tejwani responds to Dr. Mereddy. 13 November 2007
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Nirmal C Tejwani, M.D.,
Associate Professor of Orthopaedics
NYU Hospital for Joint Diseases, New York, NY

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Re: Dr. Tejwani responds to Dr. Mereddy.

nirmal.tejwani{at}med.nyu.edu Nirmal C Tejwani, M.D.

Thank you for your interest in our paper.(1) Following are the responses to your queries.

1. The average time interval between injury and surgery was not looked at for this study. All patients underwent surgery after swelling had decreased as seen by appearance of wrinkles and after resolution of blisters. We are unable to comment on the outcome based on the time to surgery as we do not have this data available.

2. No patient had post-operative talar shift or loss of reduction necessitating surgery for re-reduction.

3. We do not remove, nor recommend, routine removal of syndesmotic screws.

4. The hardware removal rate was higher in the bimalleolar group, 13 versus 8 patients. All of these were at patient request; we are unable to say whether this is because there are more implants, since most hardware removal was requested for lateral plates.

I hope we have answered your questions. Please feel free to contact us if you have any further questions.

Reference:

1. Tejwani NC, McLaurin TM, Walsh M, Bhadsavle S, Koval KJ, Egol KA. Are outcomes of bimalleolar fractures poorer than those of lateral malleolar fractures with medial ligamentous injury? J Bone Joint Surg Am. 2007;89:1438-1441.
Are Bimalleolar Fracture Outcomes Poorer Than Lateral Malleolar Fractures with Medial Lig. Injury? 22 October 2007
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Praveen K R Mereddy,
Research Fellow
Wirral University Teaching Hospital, Upton, Wirral, Merseyside, UK,
Santoshkumar Hakkalamani, Simon R. Platt

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Re: Are Bimalleolar Fracture Outcomes Poorer Than Lateral Malleolar Fractures with Medial Lig. Injury?

mpkr3{at}yahoo.com Praveen K R Mereddy, et al.

To The Editor:

We read the article, "Are Outcomes of Bimalleolar Fractures Poorer Than Those of Lateral Malleolar Fractures with Medial Ligamentous Injury?"(1) with interest and appreciate the effort involved in conducting this prospective study. However, we have some additional questions:

What was the average time interval between injury and surgery? Was there a delay in performing surgery on any of the patients because of associated swelling and blisters? If so, does this affect their functional outcome?(2)

Was there any difficulty in fracture reduction in the group with lateral malleolus fracture and deltoid ligament injury? Did any of these patients have a talar shift post-operatively? At what stage were the syndesmotic screws removed?

In the complications the authors mention that the implant removal rate was higher in the bimalleolar fracture group. Could this be explained by the fact that the potential for implant related symptoms would be doubled with the implants on both medial and lateral sides?

The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

References:

1. Tejwani NC, McLaurin TM, Walsh M, Bhadsavle S, Koval KJ, Egol KA. Are outcomes of bimalleolar fractures poorer than those of lateral malleolar fractures with medial ligamentous injury? J Bone Joint Surg Am 2007;90:1438-1441.

2. Høiness P, Strømsøe K. The influence of the timing of surgery on soft tissue complications and hospital stay. A review of 84 closed ankle fractures. Ann Chir Gynaecol. 2000;89(1):6-9.