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Ankle trauma

Michelle L Delco, John G Kennedy, Lawrence J Bonassar, Lisa A Fortier
The diagnosis of ankle osteoarthritis (OA) is increasing as a result of advancements in non-invasive imaging modalities such as magnetic resonance imaging, improved arthroscopic surgical technology and heightened awareness among clinicians. Unlike OA of the knee, primary or age-related ankle OA is rare, with the majority of ankle OA classified as post-traumatic (PTOA). Ankle trauma, more specifically ankle sprain, is the single most common athletic injury, and no effective therapies are available to prevent or slow progression of PTOA...
October 20, 2016: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Steven F Shannon, Matthew T Houdek, Cody C Wyles, Brandon J Yuan, William W Cross, Joseph R Cass, Stephen A Sems
OBJECTIVE: The purpose of this study was to evaluate which primary wound closure technique for ankle fractures affords the most robust perfusion as measured by laser-assisted indocyanine green angiography (LA-ICGA): Allgöwer-Donati or vertical mattress. DESIGN: Prospective, randomized. SETTING: Level 1 Academic Trauma Center. PATIENTS/PARTICIPANTS: Thirty patients undergoing open reduction internal fixation (ORIF) for ankle fractures were prospectively randomized to Allgöwer-Donati (n=15) or vertical mattress (n=15) closure...
October 7, 2016: Journal of Orthopaedic Trauma
Hannah A Blair, James E Frampton
Methoxyflurane (Penthrox(®)) is a halogenated ether first used clinically as a volatile inhalational anaesthetic. It has been used as an analgesic in Australia and New Zealand for the past 30 years. In the UK and Europe, methoxyflurane has been approved for the emergency relief of moderate to severe trauma pain in conscious adult patients. Methoxyflurane is self-administered using a hand-held inhaler. This article reviews the pharmacological properties of methoxyflurane and its clinical efficacy and tolerability in these patients...
October 13, 2016: Clinical Drug Investigation
David J Keene, Dipesh Mistry, Julian Nam, Elizabeth Tutton, Robert Handley, Lesley Morgan, Emma Roberts, Bridget Gray, Andrew Briggs, Ranjit Lall, Tim Js Chesser, Ian Pallister, Sarah E Lamb, Keith Willett
BACKGROUND: Close contact casting (CCC) may offer an alternative to open reduction and internal fixation (ORIF) surgery for unstable ankle fractures in older adults. OBJECTIVES: We aimed to (1) determine if CCC for unstable ankle fractures in adults aged over 60 years resulted in equivalent clinical outcome compared with ORIF, (2) estimate cost-effectiveness to the NHS and society and (3) explore participant experiences. DESIGN: A pragmatic, multicentre, equivalence randomised controlled trial incorporating health economic evaluation and qualitative study...
October 2016: Health Technology Assessment: HTA
Marie-Lyne Nault, Melissa Marien, Jonah Hébert-Davies, G Yves Laflamme, Vincent Pelsser, Dominique M Rouleau, Nayla Gosselin-Papadopoulos, Stéphane Leduc
BACKGROUND: Despite the common occurrence of syndesmotic injuries in ankle trauma, the distal tibiofibular relationship remains poorly understood. The aim of this study was to evaluate the anatomical impact of ankle sagittal positioning on the tibiofibular relationship in intact ankles by using a validated magnetic resonance imaging (MRI)-based measurement system. METHODS: In this radiologic study, 34 healthy volunteers underwent a series of ankle MRIs with the ankle stabilized in 3 positions: neutral position (NP), dorsiflexion (DF), and plantarflexion (PF)...
October 12, 2016: Foot & Ankle International
Keith Willett, David J Keene, Dipesh Mistry, Julian Nam, Elizabeth Tutton, Robert Handley, Lesley Morgan, Emma Roberts, Andrew Briggs, Ranjit Lall, Timothy J S Chesser, Ian Pallister, Sarah E Lamb
Importance: Ankle fractures cause substantial morbidity in older persons. Surgical fixation is the contemporary intervention but is associated with infection and other healing complications. Objective: To determine whether initial fracture treatment with close contact casting, a molded below-knee cast with minimal padding, offers outcome equivalent to that with immediate surgery, with fewer complications and less health resource use. Design, Setting, and Participants: This was a pragmatic, equivalence, randomized clinical trial with blinded outcome assessors...
October 11, 2016: JAMA: the Journal of the American Medical Association
Raymond W Liu, Katherine K Xie
BACKGROUND: It is unclear whether isolated gastroc/soleus tightness can increase the risk of lower extremity injury in an otherwise healthy child. QUESTIONS/PURPOSES: (1) Is there a difference in gastroc/soleus tightness, as represented by ankle dorsiflexion with the knee extended, in children presenting with upper versus lower extremity complaints? (2) Is there a difference in gastroc/soleus tightness in children presenting with atraumatic versus traumatic lower extremity complaints? METHODS: We performed a cross-sectional study of 206 consecutive walking age children presenting to a county orthopedic clinic with new upper or lower extremity complaints...
October 2016: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
Patricia Ribinik, Paul Calmels, Patrick Dehail, Alain Yelnik
OBJECTIVE: To describe a clinical care pathway for patients who underwent lower limb bone joint injury, taking into account patients' needs, PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes. MATERIAL/PATIENTS AND METHODS: This clinical care pathway is designed upon the expertise of the Sofmer-Fedmer signatory group, after analysis of literature, French rules and recommendations. It is ratified by the Sofmer scientific council...
September 2016: Annals of Physical and Rehabilitation Medicine
Ewout S Veltman, Ernst Ja Steller, Philippe Wittich, Jort Keizer
A case of complicated lateral subtalar dislocation is presented and the literature concerning this injury is reviewed. Subtalar joint dislocations are rare and often the result of a high-energy trauma. Complications include avascular necrosis of the talus, infection, posttraumatic osteoarthritis requiring arthrodesis and chronic subtalar instability. Negative prognostic factors include lateral and complicated dislocations, total talar extrusions, and associated fractures. A literature search was performed to identify studies describing outcome after lateral subtalar joint dislocation...
September 18, 2016: World Journal of Orthopedics
Christopher R Hood, Stephanie Eldridge, Matthew Tran, Jason R Miller
INTRODUCTION AND OBJECTIVES: There are several various accessory ossicles and sesamoid bones that can be seen throughout the foot and ankle, with reported incidence of 21.2% and 9.6%, respectively. Accessory ossicles and sesamoid bones usually remain asymptomatic until an inciting event (trauma, overuse) occurs and can then cause pain or degenerative changes. They can also be found in routine imaging. One of these confusing findings are lesser metatarsal sesamoids, which are a rare occurrence...
September 2016: Journal of the American Podiatric Medical Association
Jessie Biles, Alan A Garner
INTRODUCTION: Although harness suspension trauma has been documented since the 1960s, especially in the mountaineering setting, there is little robust medical research into the area. Helicopter hoist rescue shares similar risks and is reserved for those cases that cannot be accessed safely by other routes, where extrication may be hazardous or will take an unreasonable amount of time. The single sling or chest harness used for hoist rescue is a single harness around the upper torso and is easier and quicker to apply than a stretcher...
September 2016: Aerospace Medicine and Human Performance
Paul J Switaj, Daniel Fuchs, Mohammed Alshouli, Avinash G Patwardhan, Leonard I Voronov, Muturi Muriuki, Robert M Havey, Anish R Kadakia
BACKGROUND: A lateral approach with open reduction and internal fixation with a plate is a very effective technique for the majority of distal fibular fractures. However, this open approach for ankle fixation may be complicated by wound dehiscence and infection, especially in high-risk patients. An alternative to plating is an intramedullary implant, which allows maintenance of length, alignment, and rotation and which allows for decreased soft tissue dissection. While there has been clinical data suggesting favorable short-term outcomes with these implants, there is no current biomechanical literature investigating this technology in this particular fracture pattern...
2016: Journal of Orthopaedic Surgery and Research
Axel Somersalo, Juha Paloneva, Hannu Kautiainen, Eija LÖNnroos, Mikko HEinÄNen, Ilkka Kiviranta
Background and purpose - The association between mortality and lower extremity fractures (other than hip fractures in older individuals) is unclear. We therefore investigated mortality in adults of all ages after lower extremity fractures that required inpatient care. Patients and methods - Diagnosis code (ICD10), procedure code (NOMESCO), and 7 additional characteristics of patients admitted to the trauma ward at Central Finland Hospital were collected between 2002 and 2008 (n = 3,567). Patients were followed up until the end of 2012...
September 12, 2016: Acta Orthopaedica
I K Kundu, N K Datta, A Z Chowdhury, K P Das, M M Tarik, M A Faisal
Fracture of tibial shaft is the commonest site of long bone fractures due to its superficial location involving young or middle-age people. Proper management is an important issue regarding the future effective movements. In this study patients were grouped in closed Intra medullary interlocking nailing and locking compression plating. Post-operative follow up at 2 weeks, 6 weeks, 12 weeks and 3 months thereafter up to 6 months were done. Each of the patients was evaluated clinically and radiologically by tucker criteria of Tuker et al...
July 2016: Mymensingh Medical Journal: MMJ
Kaitlin C Neary, Matthew A Mormino, Hongmei Wang
BACKGROUND: In stress-positive, unstable supination-external rotation type 4 (SER IV) ankle fractures, implant selection for syndesmotic fixation is a debated topic. Among the available syndesmotic fixation methods, the metallic screw and the suture button have been routinely compared in the literature. In addition to strength of fixation and ability to anatomically restore the syndesmosis, costs associated with implant use have recently been called into question. PURPOSE: This study aimed to examine the cost-effectiveness of the suture button and determine whether suture button fixation is more cost-effective than two 3...
September 6, 2016: American Journal of Sports Medicine
Michael H Theodoulou, Laura Bohman
Posterior ankle pain can occur for many reasons. If it is produced by forced plantarflexion of the foot, it is often a result of impingement from an enlarged posterior talar process or an os trigonum. This condition may present in an acute or chronic state. Management is initially nonoperative, but surgical treatments are available. This condition is often seen in athletes, so procedures that limit surgical trauma and allow early return to activity are ideal. An arthroscopic approach for this disorder produces good outcomes with limited complications...
October 2016: Clinics in Podiatric Medicine and Surgery
Sean T Grambart
Osteochondral fractures of the ankle are typically caused by traumatic injuries of the ankle. Repetitive trauma can lead to further cartilage damage with subsequent increasing size of the lesion, ultimately leading to severe cartilage disorder and degenerative arthritis of the ankle. Arthroscopic bone marrow stimulation has been shown to be a highly successful option for patients with small osteochondral lesions. Studies show a higher failure rate for larger lesions and cystic changes that disrupt the subchondral plate...
October 2016: Clinics in Podiatric Medicine and Surgery
D P J Smeeing, R M Houwert, M C Kruyt, O A J van der Meijden, F Hietbrink
OBJECTIVE: The postoperative care regimes of ankle fractures are studied for over 30 years and recommendations have shifted only slightly in the last decades. However, study methodology might have evolved. The aim of this study was to evaluate the changes in time in the design, quality and outcome measures of studies investigating the postoperative care of ankle fractures. METHODS: The MEDLINE and EMBASE database were searched for both RCTs and cohort studies. The original studies were divided into decades of publication over the last 30 years...
September 1, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Ki-Won Young, Young-Uk Park, Jin-Su Kim, Hun-Ki Cho, Ho-Sik Choo, Jang-Ho Park
BACKGROUND: The talus has a very complex anatomical morphology and is mainly fractured by a major force caused by a fall or a traffic accident. Therefore, a talus fracture is not common. However, many recent reports have shown that minor injuries, such as sprains and slips during sports activities, can induce a talar fracture especially in the lateral or posterior process. Still, fractures to the main parts of the talus (neck and body) after ankle sprains have not been reported as occult fractures...
September 2016: Clinics in Orthopedic Surgery
Robert J Wetzel, Laurence B Kempton, Edwin S Lee, Michal Zlowodzki, Todd O McKinley, Walter W Virkus
OBJECTIVES: We hypothesized that negligible surgical material cost variation exists between traumatolgists for treatment of bimalleolar ankle and bicondylar tibial plateau fractures. DESIGN: Retrospective medical record review. SETTING: Academic Level 1 Trauma Center; 2-year period. PATIENTS/PARTICIPANTS: Common Procedure Terminology (CPT) codes for open treatment of bimalleolar ankle and bicondylar tibial plateau fractures identified patients...
August 23, 2016: Journal of Orthopaedic Trauma
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