Impact of Previous Ankle Injuries on Professional Footballers' Preseason Functional Ankle Assessment

@#Introduction: Football is the most popular sport and is widely played around the globe, with approximately 400 million players in 208 countries. Lower extremity injuries showed the highest incidence, with ankle injuries being the most prevalent after hip and knee injuries. The purpose of this study was to describe the characteristics of the players who reported previous ankle injuries during pre-competition medical assessment (PCMA) during the 2022 seasons of the Malaysian professional club. In addition, the study also investigated the effect of previous injuries on current ankle function. Materials and methodsː This was a retrospective crosssectional study using secondary data from the preseason PCMA data from a professional club that competed in Malaysia. The ankle range of motion, anterior drawer test, and functional ankle assessments including the Biodex athlete single leg stability test and ankle joint muscle strength were performed during the PCMA. Results: A total of 45 footballers reported previous history of ankle injuries to the left (n=9), right (n=20), or both ankles (n=16). Footballers with prior ankle injuries exhibited significantly less ankle inversion (p = 0.008) and a larger proportion of positive ADT tests in the injured ankle (x² (1, N=90) =7.76, p=0.005) compared to the non-injured side. there was no significant difference in other ankle range of motion, ankle stability index, or ankle muscular strength between previously injured and uninjured ankles. Conclusionsː During preseason screening, half of the footballers in this study reported previous history of ankle injury, putting them at risk of having future ankle injuries. Aside from inversion and the anterior drawer test, no significant differences in range of motion, stability index, or muscle strength were discovered. However, as injury causation is multifactorial, preventive measures should be taken to reduce the risk of injury.

A calf tissue flap combined with antibiotic-loaded calcium sulfate for foot and ankle osteomyelitis / 中华创伤骨科杂志

Objective:To evaluate the efficacy of a calf tissue flap combined with antibiotic-loaded calcium sulfate (artificial bone or mixed iliac bone graft) in the treatment of foot and ankle osteomyelitis.Methods:A retrospective study was conducted to analyze the 11 cases of foot and ankle osteomyelitis which had been treated at Department of Hand and Microsurgery, The Third Hospital of Baoji from October 2018 to October 2021. There were 8 males and 3 females, aged (42.3±23.7) years. The chronic hypotoxic osteomyelitis was repaired and reconstructed after thorough debridement at one stage with a calf tissue flap combined with antibiotic-loaded calcium sulfate artificial bone to fill the cavity and cover the wound. The acute infected trauma was repaired and reconstructed after thorough debridement at the second stage with a calf tissue flap combined with antibiotic-loaded calcium sulfate artificial bone to fill the cavity and cover the wound only after the acute infection was controlled by local dressing, drainage or negative pressure therapy and systemic anti-infection treatment at the primary stage. The flap size ranged from 3.5 cm × 2.0 cm to 12.0 cm × 6.0 cm. Four cases were treated by a peroneal artery perforator flap combined with antibiotic-loaded calcium sulfate artificial bone, 3 cases by a flap with peroneal artery perforator and peroneal nerve trophic vessel combined with antibiotic-loaded calcium sulfate artificial bone, 3 cases by a posterior tibial artery perforator flap combined with antibiotic-loaded calcium sulfate artificial bone, and one by a peroneus longus muscle flap combined with antibiotic-loaded calcium sulfate artificial bone. Postoperatively, the flap survival, bone union time, ankle function and complications were observed; the therapeutic efficacy was evaluated by comparing infection control indexes at the final follow-up [clinical manifestations like local redness, swelling, pain, ulceration, and exudation, and white blood cell count (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and calcitoninogen (PCT)].Results:All the flaps survived except for one which developed necrosis at the distal 1/3 of the flap but responded to dressing change. All the patients were followed up for (22.6±11.5) months. The 6-month follow-up revealed that all the flaps were fine in shape and texture. Re-examinations showed that WBC, CRP, ESR and PCT were normal or close to normal, the local skin was free of redness, swelling or ulceration, and protective sensation was restored to varying degrees. X-ray at (12.1±2.3) months showed that lesions disappeared, bony union was achieved, the ankle joint regained basic flexion and extension, and the affected limb also regained weight-bearing and walking functions in all the patients but one whose X-ray at 18 months showed poor bony union but no other symptoms or signs.Conclusion:In the treatment of foot and ankle osteomyelitis, a calf tissue flap combined with antibiotic-loaded calcium sulfate artificial bone can promote bone healing and restore the function of the foot and ankle because it not only fills the cavity and covers the wound but also effectively controls the infection.

Chronic syndesmosis injury: What can we do? / 国际外科学杂志

Chronic syndesmosis injury is of great difficulty in foot and ankle trauma with a high post-traumtaic arthritis morbidity, deformity and disability rate, which is always caused by a delayed management or improper initial surgical treatment, and need an active intervention. Currently, various of treatment technique for chronic syndesmosis injury has been described, however, the optimal strategy should be determined by patient′s classification, symptoms, activity demands and severity of arthritis to maximally relieve the symptoms, preserve functions and improve the life quality. This article will overview the diagnosis and management of chronic syndesmosis injury in this article.

The Effect of Ankle Brace on Biomechanics of the Lower Extremity During Landing: A Systematic Review and Meta Analysis / 医用生物力学

Objective To examine the effects of ankle brace on biomechanics of the lower extremity during landing, so as to provide a theoretic support to choose ankle brace for people with different sports levels. Methods The key words (ankle brace OR ankle braces OR ankle bracing OR ankle support) AND (landing OR land OR jump OR hopped OR hopping) AND (biomechanics OR kinematics OR kinetics OR electromyography OR neuromuscular) in Chinese and English were searched from different electronic databases (CNKI, Web of Science, EBSCO, PubMed and other databases), for a period of Jan. 2000 to Dec. 2020. Cochrane was used to evaluate the quality of eligible studies. For meta analysis, subgroup analysis was used to assess the impact of ankle braces on ankle biomechanics.Results Thirteen studies with a total of 222 participants were included for mata analysis in this study. The semi-rigid ankle brace reduced the peak of ankle inversion by 25.8% compared with the elastic ankle brace (SMD=-0.562, P<0.001). Moreover, the elastic ankle brace reduced ankle plant flexion during landing among athletes (SMD=-3.42, P=-0.021). As for collagiate students, both elastic ankle and semi-rigid ankle decreased the ankle inversion (elastic ankle brace: 35.4%, SMD=-1.000, P=-0.013; semi-rigid ankle brace: 31.11%, SMD=-0.881, P<0.001) and ankle plant flexion (elastic ankle brace:23.30%, SMD=-1.381, P<0.001;semi-rigid ankle brace: 36.33%, SMD=-1.605, P<0.001).Conclusions Both ankle braces can prevent ankle sprain for athletes (basketball, volleyball, running) who experience training more than 5 years. The elastic ankle brace can limit the inversion and plantar flexion, while the semi-rigid ankle brace can merely decrease the ankle inversion. Therefore, athletes are more suitable for the elastic ankle brace. As for collegiate students without training history, both ankle brace can decrease the ankle inversion and plantar flexion. The elastic ankle brace has greater restriction on inversion, while the semi-rigid ankle brace has more restriction on plantar flexion. Therefore, the elastic ankle brace should be utilized if collegiate students have calcaneofibular ligament injury, while the semi-rigid ankle brace is more suitable for collegiate students who have a history of anterior talofibular ligament injury.

Clinical efficacy of posterolateral approach combined with anteromedial approach in treatment of trimalleolus fracture / 中华创伤骨科杂志

Objective:To investigate the clinical efficacy of posterolateral approach combined with anteromedial approach in the treatment of trimalleolus fracture.Methods:A retrospective analysis was performed of the 20 patients who had been admitted to The Second Department of Orthopedics, The First People's Hospital of Tianshui for trimalleolus fractures from January 2016 to August 2020. They were 16 men and 4 women, aged from 20 to 70 years (average, 49.6 years). The lateral malleolus, posterior malleolus and medial malleolus were treated with reduction and internal fixation using the posterolateral approach combined with the anteromedial approach. Postoperative complications were observed, and the foot function was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and pain visual analog scale (VAS).Results:In this cohort, the operation time ranged from 85 to 115 minutes, averaging 88.4 minutes and the intraoperative blood loss from 50 to 600 mL, averaging 120 mL. All patients were followed up for 12 to 20 months (mean, 14.5 months). The fracture healing time ranged from 3.2 to 5.4 months, averaging 3.8 months. Follow-ups observed no such complications as infection or necrosis of surgical incision, failure of internal fixation, nonunion, or malunion. The AOFAS ankle-hindfoot score at 12 months after operation (87.8±6.4) was significantly higher than that before operation (32.3±4.9) ( t=29.454, P<0.001); as for VAS, one case scored 0, 13 cases 1 to 3 points and 6 cases 4 points. Conclusion:In the treatment of trimalleolus fracture, a combination of posterolateral approach and anteromedial approach can lead to definitely positive efficacy because of a significant reduction in operation time, intraoperative bleeding and postoperative complications.

Comparison of suture anchor and simple suture for acute injury to lateral ankle ligament: mid-to long-term outcomes / 中华创伤骨科杂志

Objective:To compare the mid-to long-term clinical outcomes between suture anchor and simple suture for acute injury to lateral ankle ligament (cauda equina tear near the insertion).Methods:This retrospective study included 146 patients (professional and semi-professional athletes) who had been treated for acute injury to lateral ankle ligament (cauda equina tear near the insertion) at Department of Sports Medicine, The Third Hospital Affiliated to Peking University from June 2007 to May 2017.They were 101 males and 45 females, with an age of (27.1±10.3) years (from 12 to 62 years). Depending on ligament repair techniques, the patients were divided into a suture anchor group of 81 cases subjected to reconstruction of the torn ligament with a 1.8 mm suture anchor, and a simple suture group of 65 cases subjected to direct suture of the torn ligament with a braided thread. The 2 groups were compared in terms of visual analog scale (VAS) pain scores, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and Tegner scores at preoperation and the last follow-up, time and level of postoperative motion recovery, proportion of limited joint motion, incidence of re-sprain and patient satisfaction.Results:There was no significant difference in the preoperative general data between the 2 groups, showing they were comparable ( P>0.05). The mean follow-up duration was (46.1±14.1) months (from 36 to 132 months). The VAS pain score, AOFAS ankle-hindfoot score and Tegner score at the last follow-up were significantly improved than those before operation in all the patients ( P<0.05). Postoperatively, there was no significant difference between the 2 groups in VAS pain score, AOFAS ankle-hindfoot score, Tegner score, incidence of re-sprain or proportion of limited joint motion ( P> 0.05). The suture anchor group was significantly better than the simple suture group in the level of postoperative motion recovery (92%±13% versus 89%±13%) and time of postoperative motion recovery [(4.2±1.1) months versus (4.6±1.0) months] ( P<0.05). Conclusions:Ligament repair, either by suture anchor or by simple suture, is a reliable procedure for patients with high sports demands after severe acute injury to the lateral ankle ligament. Compared with simple suture, suture anchor may accelerate postoperative motion recovery to the pre-injury level.

Características de lesões em atletas adolescentes de basquete / Characteristics of injuries in adolescent basketball athletes

INTRODUÇÃO: O basquetebol é um esporte de contato físico que envolve movimentos complexos como pular, girar e mudar de direção, que frequentemente causam lesões. OBJETIVOS: Este estudo tem como objetivo compreender as características das lesões em atletas adolescentes de basquete. MÉTODOS: Este estudo usa um método descritivo com uma abordagem de estudo transversal, usando um questionário baseado na web (Formulários Google) que consiste em perguntas fechadas para examinar a história, tipos, fatores e tratamentos das lesões sofridas pelos adolescentes atletas de basquete do Centro de Treinamento Esportivo de Estudantes (Pusat Pelatihan Olahraga Pelajar ou PPOP) do DKI Jakarta. Os sujeitos são 14 atletas do sexo masculino e feminino, com idade média de 15,9 ± 1,1 anos, altura média de 172,29 ± 9,33 centímetros e peso médio de 65,71 ± 10,06 quilogramas. O instrumento de pesquisa é um questionário distribuído online na forma de Formulários Google. Um teste de validade foi realizado no questionário usando Aikens. Os dados dos resultados do questionário foram analisados por meio de uma análise percentual das respostas a cada questão. RESULTADOS: Os resultados revelaram que 76% dos atletas sofreram lesões em membros inferiores, sendo a lesão mais frequente na articulação do tornozelo (45%). Além disso, os atletas também afirmaram que as entorses / torções são o tipo de lesão mais experiente (42%). Os treinamentos ocorreram quando 79% dos atletas experimentaram as lesões, enquanto os outros 21% as vivenciaram durante as partidas. CONCLUSÕES: Os resultados deste estudo não podem generalizar os achados, pois envolveu apenas 14 participantes, o que também é uma limitação deste estudo, mas esses achados relatam que a maior lesão que ocorre durante o exercício é a articulação do tornozelo, por isso os autores sugerem fazer um aquecimento adequado. Antes de iniciar uma sessão de treinamento ou durante uma sessão de treinamento competitivo, prevenir lesões é a melhor abordagem para os atletas reduzirem sua ocorrência.

INTRODUCTION: Basketball is a physical contact sport that involves complex movements such as jumping, spinning, and changing directions, all of which frequently cause injuries. OBJECTIVES: This study aims to understand the characteristics of injuries on adolescent basketball athletes. METHODS: This study uses a descriptive method with a cross-sectional study approach using a web-based questionnaire (Google Forms) consisting of close-ended questions to examine the history, types, factors, and treatments of the injuries experienced by the adolescent basketball athletes at the Student Sports Training Center (Pusat Pelatihan Olahraga Pelajar or PPOP) of DKI Jakarta. The subjects are 14 male and female athletes with an average age of 15.9±1.1 years old, an average height of 172.29±9.33 centimeters, and an average weight of 65.71±10.06 kilogram. The research instrument is a questionnaire distributed online in the form of Google Forms. A validity test was conducted on the questionnaire using Aikens. Data Questionnaire result data were analyzed using a percentage analysis on the answers to each question in the questionnaire. RESULTS: The results revealed that 76% of the athletes experienced injuries in the lower limb, with the most frequent injury in the ankle joint (45%). Furthermore, the athletes also stated that sprains/twists are the most experienced type of injury (42%). The training sessions were when 79% of the athletes experienced their injuries, whereas the other 21% experienced them during the matches. CONCLUSIONS: The results of this study cannot generalize the findings because it only involved 14 participants, which is also a limitation of this study, but these findings report that the greater injury that occurs during exercise is the ankle joint, so the authors suggest doing an adequate warm-up. Before starting a training session or during a competitive training session, preventing i

A 4-year epidemiological injury analysis in a Japanese male professional basketball team in terms of racial differences in injury patterns / Journal of Rural Medicine

Objective: To analyze injury patterns in a male Japanese professional basketball team of this new league, with a particular focus on the difference between injuries of Asian and non-Asian players.Patients and Methods: During four basketball seasons, we analyzed all injuries in a B2 league team. We investigated the injury rate (IR), game injury rate (GIR), practice injury rate (PIR), pathology, and body area of each injury. Player demographics and injuries were collected from a database, which was updated by the team’s athletic trainer.Results: In total, 47 injuries in 51 players during the 4-year seasons were included. The IRs overall, in Asian, and in non-Asian players were 4.42, 4.37, and 3.11/1000 player hours (PH), respectively. The GIR (47.16/1000 PH overall, 4.37 in Asian, and 3.11 in non-Asians) was significantly higher than the PIR (1.50/1000 PH overall, 1.66 in Asian, and 0.84 in non-Asian; P<0.001 in all groups). Injuries of the upper body occurred only in Asian players (n=17; 51%, P=0.022). Most injuries occurred in the lower extremities than in other body parts (n=30; 64%, P<0.001), for which Asian and non-Asian players showed similar tendencies. Ankle sprains were the most common acute injury (n=7; 15%, P=0.007), while joint problems were the most common chronic injury (n=7; 15%, P=0.046).Conclusion: In this Japanese basketball team, the GIR of Asian, non-Asian, and overall players was higher than that of PIR. Injuries of the upper body were more frequent in Asian players than in non-Asian players in this league. Ankle sprains were the most common injury in both groups, while acute skin injuries occurred predominantly in Asian players. Prevention programs should be developed for injuries of the upper body in Asian players and those with lower extremity injuries.

The Time of Return to Play after Surgery for Chronic Lateral Ankle Instability in Athletes: A Systematic Review / 대한스포츠의학회지

PURPOSE: The study aimed to assess the average time to return to play following surgery for chronic lateral ankle instability in athletes.METHODS: A literature search was conducted (1976 to 2019) by two independent reviewers using the Medline, Embase, and Cochrane library databases. Articles were retrieved by an electronic search using individual keywords (“lateral ankle instability,” “surgery,” “operation,” “return to sport,” “return to play”) and their combinations. Studies that met the inclusion criteria were assessed for pertinent data.RESULTS: Six randomized controlled trials were included in this analysis. The mean follow-up period was 44.8 months (range, 31.8–58.1 months) in 219 patients (male, 126; female, 113). The mean age was 23.2 years (range, 18.2–28.2 years). Different criteria for returning to sports were used in each paper. In the papers included in this study, different methods and definitions were used for the postoperative recovery method for lateral ankle instability injury. The average time until return to play was 16.53 weeks.CONCLUSION: There are limitations to the application of different surgical techniques and data from different athletes for chronic lateral ankle instability. However, these results suggest that sports physicians evaluate the surgical outcome and may be utilized as reference data for informing the athletes about their time until return.

Pasos básicos para la realización de la artroscopia de tobillo / Basic steps for the ankle arthroscopy

La artroscopia de tobillo es un procedimiento quirúrgico muy empleado actualmente en personas con afecciones de esta articulación. Teniendo en cuenta lo anterior se realizó el presente estudio con el objetivo de actualizar los pasos básicos para su realización y profundizar en los aspectos más importantes relacionados con el tema, entre los cuales figuran: anatomía, indicaciones quirúrgicas, instrumental necesario, métodos de distracción, portales y recorrido artroscópicos, así como complicaciones relacionadas con el proceder. Entre otras ventajas, permite diagnosticar gran número de enfermedades que afectan la articulación del tobillo y brindar un tratamiento oportuno.

The ankle arthroscopy is a very used surgical procedure at present in people with disorders of this joint. Keeping this in mind the present study was carried out with the objective of updating the basic steps for its use and to deepen in the more important aspects related to the topic, among which there are: anatomy, surgical indications, necessary tools, distraction methods, arthroscopic portals and route, as well as complications related to the procedure. Among other advantages, it allows to diagnose great number of diseases which affect the ankle joint and to offer an opportune treatment.

Injury Frequency in Handball Players: A Descriptive Study of Injury Pattern in São Paulo State Regional Teams

Abstract Aim: To assess the frequency of injuries among male and female handball athletes, identifying injured anatomic parts, injury diagnostics, their severity and type. Methods: The participants were composed of 122 handball players from São Paulo state teams, being 63 male (21.2±5.3 years) and 59 female (19.9±5.3 years) athletes who were interviewed using the "Champion Profile" questionnaire. The injuries were sorted by type: acute or overuse; and severity (major, moderate, slight, minor), given by the period of absence from team activities (training sessions and matches), and our results are presented as descriptive statistics. Results: The majority of injuries was found in the lower limbs, both in female (69.6%) and male (47.4%) players, as well as the knee was the most commonly injured anatomic part, representing 33.7% and 20.8% of the total number of injuries for the respective genders. We found a higher number of major injuries in female (35.8%) and male (20.8%) players when compared to the other severity categories. The acute injuries were more common among the total sample (48%) when compared to overuse injuries (22.7%), while a sprain was the most commonly diagnosed injury. Conclusion: It was observed that Brazilian handball players demonstrated an important number of major and acute injuries, forcing them to abstain from training sessions and matches, which can lead to both team and athlete performance losses. Furthermore, we suggest the inclusion of preventive training to reduce the frequency of injuries in handball athletes.

Two posteromedial approaches in treatment of posterior pilon fractures of Klammer type Ⅲ / 中华创伤骨科杂志

Objective To observe operative results of 2 posteromedial approaches in the treatment of posterior pilon fractures of Klammer type Ⅲ.Methods From January 2015 to December 2016,19 patients with posterior pilon fracture (Klammer type Ⅲ) were treated via the posteromedial approach.They were 12 men and 7 women,aged from 21 to 61 years (mean,37.4 years).Straight posteromedial incision was used in 11 cases and curved posteromedial incision in the other 8 cases.The 2 groups were compared in terms of postoperative wound complication,infection,bone union,visual analogue scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) scores.Results Follow-up ranged from 6 to 29 months (mean,11.8 months).All the fractures united after 6 to 15 months (mean,10.7 months).In the straight incision group,the VAS scores at the final follow-up ranged from 0 to 3 points,averaging 1.1 points;the AOFAS scores ranged from 83 to 100 points,averaging 90.8 points.In the curved incision group,the VAS scores at the final follow-up ranged from 0 to 3 points,averaging 1.3 points;the AOFAS scores ranged from 80 to 100 points,averaging 90.1 points.In one case in the curved incision group,the posteromedial wound failed to heal but scar healing was achieved after dressing change for 4 months.Conclusion The posteromedial approach,whether straight or curved,can provide good exposure for posterior pilon fractures of Klammer type Ⅲ,which is conductive to reduction and fixation of the fracture.

Paratrooper's Ankle Fracture: Posterior Malleolar Fracture

BACKGROUND: We assessed the frequency and types of ankle fractures that frequently occur during parachute landings of special operation unit personnel and analyzed the causes. METHODS: Fifty-six members of the special force brigade of the military who had sustained ankle fractures during parachute landings between January 2005 and April 2010 were retrospectively analyzed. The injury sites and fracture sites were identified and the fracture types were categorized by the Lauge-Hansen and Weber classifications. Follow-up surveys were performed with respect to the American Orthopedic Foot and Ankle Society ankle-hindfoot score, patient satisfaction, and return to preinjury activity. RESULTS: The patients were all males with a mean age of 23.6 years. There were 28 right and 28 left ankle fractures. Twenty-two patients had simple fractures and 34 patients had comminuted fractures. The average number of injury and fractures sites per person was 2.07 (116 injuries including a syndesmosis injury and a deltoid injury) and 1.75 (98 fracture sites), respectively. Twenty-three cases (41.07%) were accompanied by posterior malleolar fractures. Fifty-five patients underwent surgery; of these, 30 had plate internal fixations. Weber type A, B, and C fractures were found in 4, 38, and 14 cases, respectively. Based on the Lauge-Hansen classification, supination-external rotation injuries were found in 20 cases, supination-adduction injuries in 22 cases, pronation-external rotation injuries in 11 cases, tibiofibular fractures in 2 cases, and simple medial malleolar fractures in 2 cases. The mean follow-up period was 23.8 months, and the average follow-up American Orthopedic Foot and Ankle Society ankle-hindfoot score was 85.42. Forty-five patients (80.36%) reported excellent or good satisfaction with the outcome. CONCLUSIONS: Posterior malleolar fractures occurred in 41.07% of ankle fractures sustained in parachute landings. Because most of the ankle fractures in parachute injuries were compound fractures, most cases had to undergo surgical repairs.

Diagnostic value of MR imaging in acute injury of ankle without radiological abnormalities / 局解手术学杂志

Objective To evaluate the value of MRI in acute ankle distortion without evidence of fracture. Methods The MRI appear-ances of 21 cases with acute trauma in the ankles were retrospectively analyzed,focusing on the presence or absence injuries of lateral collat-eral ligamentous complex,bone and osteochondral lesions,MRI was performed within 48 h of trauma. Results Bone bruise was observed in 15 patients. There were injuries of the lateral ligaments in 4 cases and the medial ligaments in 1 case. Injury of the osteochondral lesion was in 5 cases and Achilles tear was in 3 cases. Conclusion MRI have diagnostic value for acute ankle injury.

Finite element modeling and mechanical analysis on supination-external rotation ankle injury / 医用生物力学

Objective To simulate the supination-external rotation ankle injury and establish a 3D finite element model of the ankle. Methods Based on CT images of the normal human ankle joint, the 3D model of the ankle with ligaments was established. The supination-external rotation ankle injuries with four different degrees of Lauge-Hanson were analyzed by finite element method. Distributions of the ankle joint stress and tibial articular surface pressure were obtained. Results The maximum stress was at the anterior tibiofibular ligament attachment point of the tibial under supination-external rotation loading. When the anterior tibiofibular ligament was ruptured, the maximum stress was at the interosseous membrane. After the interosseous membrane was ruptured, the high stress was at the posterior ligament of the ankle. When the posterior tibiofibular ligament was ruptured, the high stress was at the deltoid ligament. The high pressure was at the distal fibula or the rear of tibial articular surface. Conclusions The established ankle-foot 3D numerical model can be used for the mechanical analysis of supination-externalrotation ankle injury. The calculated distributions of the ankle stress and the tibial articular surface pressure were in agreement with the description of Lauge-Hanson classification.

Mini-invasive surgical treatment of acute Achilles tendon rupture by Achillon / 中华创伤骨科杂志

Objective To evaluate the clinical efficacy of Achillon,a novel guide for Achilles tendon suture produced by Newdeal Ltd in France,in the mini-invasive surgical treatment of acute Achilles tendon rupture. Methods Between December 2010 and March 2011,7 patients(7 feet) with acute Achilles tendon rupture were treated in our department.They were 5 males (5 feet) and 2 females (2 feet),with an average age of 34.2 years (range,21 to 53 years).The interval between injury and operation ranged from 1 to 11 days(3.8 days on average).A longitudinal incision approximately 2.0-3.5 cm in length was made around the ruptured Achilles tendon for minimally invasive repair after insertion of the Achillon.Postoperative rehabilitation was carried out. Results All the wounds healed at the first stage.All patients were followed up for 5 to 11 months, with an average of 7.2 months. All patients regained normal weight-bearing walking 3 months after operation without any re-rupture. According to the ankle-hindfoot scoring system of American Orthopaedic Foot and Ankle Society (AOFAS),they scored 93.2 points.By the visual analogue scale(VAS),they scored 1.2 points at the operation site. Conclusion The surgical treatment of acute Achilles tendon rupture with Achillon has advantages of mini-invasion,a low rate of incision problems and quick function recovery.

Ankle Syndesmotic Injury / 대한족부족관절학회지

Ankle injuries may involve the distal tibiofibular syndesmosis and can be associated with a variable degree of trauma to the soft tissue and osseous structures that play an important role in ankle joint stability. Ankle syndesmotic injury may occur solely as a soft tissue injury or in association with variable ankle fractures. Ankle syndesmotic injury does not necessarily lead to ankle instability; however, the coexistence of deltoid ligament injury critically destabilizes the ankle joint. The prevalence of these injuries may be higher than previously reported. The diagnosis of syndesmotic injury as not always easy because isolated ankle sprains may be missed in the absence of a frank diastasis and syndesmotic instability may be unnoticed in the presence of bimalleolar ankle fractures. Controversies arise at almost every phase of treatment includings : type of fixation(screw size, type of implant), number of cortices required for fixation and of need for hardware removal. Regardless of controversies, the most important goal should be restore and maintain the normal tibiofibular relationship to allow for healing of the ligamentous structures of the syndesmosis.

The Utility of Emergency Ultrasound for Diagnosing Wrist and Ankle Injuries

PURPOSE: Ultrasound is of proven accuracy in abdominal and thoracic trauma and may be useful for diagnosing extremity injury in situations where radiography is not available, such as disasters and military and space applications. However, the diagnosis of fractures is suggested by history and physical examination and is typically confirmed with radiography. As a alternative to radiography, we prospectively evaluated the utility of extremity ultrasound performed by trained residents of emergency medicine (EM) one patient with wrist and ankle extremity injuries. METHODS: Initially, residents of EM performed physical examinations for fractures. The emergency ultrasound (EM US) was performed by trained residents, who used a portable ultrasound device with a 10- to 5-MHz linear transducer, on suspected patients before radiography examination. The results of emergency ultrasound and radiography and the final diagnosis were recorded, and correlations among them were determined by using Kappa`s test. RESULTS: Thirty-nine patients were enrolled in our study. The average age was 36.6+/-19.3 years. There were radius Fx. (n=21), radius-ulna Fx. (n=1), ulna Fx. (n=1), and contusion (n=2) injuries among the wrist injury and lat.-med. malleolar Fx. (n=13), lat. malleolar Fx. (n=6), and med. malleolar Fx. (n=3) injuries among the ankle injury. Comparing EM US with radiography, we found the sensitivity, specificity, positive predictive value, and negative predictive value of EM US for Fx. diagnosis to be 100%, 66.7%, 97.3%, 100% and those of radiography to be 97.2%, 100%, 100%, and 75%, respectively. Kappa`s test for a correlation between the Fx. diagnosis of EM US and the final diagnosis of Fx was performed, and Kappa`s value was 0.787 (P = 0.004). CONCLUSION: EM US for Fx. can be performed quickly and accurately by EM residents with excellent accuracy in remote locations such as disaster areas and in military and aerospace applications. EM US was as useful as radiography in our study and had a high correlation to the final diagnosis of Fx. Therefore, ultrasound should performed on patients with extremity injury to determine whether extremity evaluation should be added to the FAST (focused abdominal sonography trauma) examination.

A Clinical Study of Ankle Injuries / 대한정형외과학회잡지

Ankle injuries include not only disruption of bony architecture of ankle joint but also significant ligamentous and soft tissue injuries as well. Since ligamentous injury frequently has more serious implication than fracture, it is important that be recognized and included in the plan of treatment. The goal of treatment of ankle fracture is the establishment of the normal ankle joint. To obtain the this goal, the fracture should be reduced as accurately as possible (by open or closed), the fracture fragment must be retained in position until healing is secure, ligamentous structure should be repaired when indicated, and joint motion should be restored. The following clinical results shown by analysls of 108 cases of ankle injuries experienced in the Department of Orthopaedic Surgery, Capital Armed Forces General Hospital, from Jan. 1977 to June 1979. 1. The main cause of the injuries was falling from a height and the other causes were direct violence, traffic accident, and injuries in order. 2. All but one of the fractures could be classified in the manner described by Lauge-Hansen and the type of supination-external rotation was most common type in this series. 3. Ninty-two (85.1%) patients were treated by open reduction and internal fixation of both malleoli and sixteen by closed method. 4. The average period of cast immobilization was 8 weeks after closed reduction and that of open reduction was 6 weeks. 5. The good clinical results were achieved in 95 petients and the better results were obtained in fracturers treated in operative interventions.