Assessing the effect of prophylactic ankle taping on ankle and knee biomechanics during landing tasks in healthy individuals: A cross-sectional observational study

ABSTRACT BACKGROUND: Current research supports the fact that prophylactic ankle taping (AT) is effective in preventing ankle injuries in amateur and elite sports athletes. OBJECTIVE: This study aimed to investigate the effect of AT on balance, knee valgus during drop jump and single-leg countermovement jump (SL-CMJ) landings, and ankle range of motion (ROM) restriction in healthy participants. DESIGN AND SETTING: A cross-sectional observational study was conducted at the Universidad Europea de Madrid, Madrid, Spain. METHODS: Participants: Thirty-nine healthy individuals participated in this study and performed the movements under two conditions (with and without tape). Outcome measurements: ankle ROM, balance, SL-CMJ height, flight time, ground time, and knee valgus. Before any intervention, a random process was developed with a 1:1 allocation ratio, and the participants were assigned to groups A (tape-no tape) and B (no tape-tape). RESULTS: Significant differences between tape and no-tape moments were observed for drop jump knee valgus flexion (P = 0.007), with an increase in knee valgus in participants with ankle taping. Similarly, the Y-balance testshowed a significant decrease in all variables (P = 0.001 and), ankle dorsiflexion (P = 0.001) in participants with ankle taping. CONCLUSIONS: AT is effective for immediate ankle ROM restriction. However, an increase in knee valgus during drop jump task and a decrease in lower limb balance were observed during drop jump task. Based on these results, it can be concluded that AT application in healthy individuals should not be recommended as it results in increase in injury risk factors.

Fractura triplanar de tibia distal: Reporte de un caso y revisión de la literatura / Triplanar fracture of proximal tibia: A case report and literature review

Las fracturas triplanares de tibia distal, son fracturas complejas caracterizadas por afectación multiplanar, clasificándose como Salter Harris tipo IV, en el periodo de cierre fisiario. Son poco frecuentes, representando el 5-15% de las fracturas pediátricas. El mecanismo de lesión que ocurre con mayor frecuencia, consiste en supinación y rotación externa. La tomografía computarizada es actualmente el Gold Standard para el diagnóstico de este tipo de fractura, nos permite evaluar todos los planos, siendo la radiografía simple insuficiente para el diagnóstico ya que puede pasar desapercibida. Paciente de 14 años de edad con fractura triplanar en 2 partes de tibia distal, con resolución quirúrgica. Nuestro caso es un ejemplo de una fractura triplanar de tibia distal, la cual es de baja frecuencia, difícil diagnostico e interpretación. Presentamos imágenes preoperatorias, intraoperatorias y postoperatorias del manejo de esta lesión, obteniendo resultados satisfactorios clínicos, funcionales y en estudios de imágenes. Es indispensable lograr una reducción anatómica de la superficie articular para lograr una evolución satisfactoria. Se recomienda una tomografía computarizada para diagnosticar y manejar esta lesión de manera adecuada. El seguimiento postoperatorio es crucial para el manejo de este paciente, ya que se espera una discrepancia en la longitud de las extremidades y/o deformidad(AU)

Triplane fractures of the distal tibia are complex fractures characterized by multiplane effects. They are classified in the Salter-Harris system as type IV in the period of physeal closure. These fractures are rare and represent 5-15% of pediatric fractures. The most common mechanism of injury is supination and external rotation. Computed tomography is currently the Gold Standard for the diagnosis of this type of fracture since it allows us to evaluate all planes, while plain radiography is insufficient because the fracture can go unnoticed. The objective is to report the clinical case of a 14-year-old patient with triplanar fracture in 2 parts of the distal tibia with surgical resolution. This case is an example of a triplanar fracture of the distal tibia, which is of low frequency, and difficult to diagnose and interpret. Preoperative, intraoperative and postoperative images of the management of this lesion are presented, obtaining satisfactory clinical, functional and imaging study results. It is essential to achieve an anatomical reduction of the joint surface to achieve a satisfactory evolution. A CT scan is recommended to properly diagnose and manage this injury. Postoperative follow-up is crucial for the management of this patient, as a limb length discrepancy and/or deformity is expected(AU)

Anatomical reconstruction of the deltoid ligament and medial migration calcaneal osteotomy for treatment of post-traumatic chronic medial ankle instability / 中华创伤骨科杂志

Objective:To evaluate the clinical effects of anatomical reconstruction of the deltoid ligament and medial migration calcaneal osteotomy in the treatment of chronic ankle instability after trauma.Methods:A retrospective study was conducted to analyze of the clinical data of 16 patients with chronic post-traumatic instability of the medial malleolus who had been treated at The Eighth Department of Orthopedics, Foshan Hospital of Traditional Chinese Medicine from December 2015 to February 2017. There were 14 males and 2 females with an age of (28.1±4.2) years. Seven left sides and 9 right sides were affected; the time from injury to operation was (8.9±2.4) months. Before operation, X-rays (anteroposterior, lateral and Saltzman views) and MRI of weight-bearing ankle were taken. All patients were treated by anatomical reconstruction of the deltoid ligament using the autologous semitendinosus and medial migration osteotomy of the calcaneus. The time for injury healing and occurrence of complications were recorded. The talus tilt angle, Meary angle, hindfoot valgus angle, visual analogue scale (VAS), and the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot function score were compared between the preoperation and the last follow-up. The Sefton evaluation for efficacy in ankle ligament reconstruction was used to assess stability of the ankle joint.Results:Of this cohort, 14 patients were followed up for (16.4±4.9) months after operation and 2 patients lost to follow-up. The 14 patients all returned to normal physical activities 3 months after operation. All incisions healed at the first stage with no infection. One patient experienced pain at the site for harvest of the semitendinosus but the symptoms were relieved after rehabilitation treatment like massage and physical therapy. At the last follow-up, the talus tilt angle [1.0 (0.0, 2.0)°], Meary angle (1.4°±4.2°), hindfoot valgus angle (3.2°±2.4°), VAS score [0.5 (0.0, 1.0) points], and AOFAS ankle-hindfoot score [(89.2±6.1) points] were all significantly improved compared with the preoperative values [8.3°±1.8°, 0.8°±3.8°, 9.9°±3.4°, (5.7±2.5) points, and (49.6±9.8) points] (all P<0.05). According to the Sefton evaluation, the stability of the ankle joint was excellent in 9 cases, good in 4 cases, and fair in 1 case. Conclusion:In the treatment of chronic ankle instability after trauma, anatomical reconstruction of the deltoid ligament and medial migration calcaneal osteotomy is safe and effective, resulting in limited complications.

Research progress of cell transplantation in the treatment of osteochondral lesions of the talus / 中华创伤杂志

Osteochondral lesions of the talus (OLT) frequently manifest following ankle joint trauma, causing ankle pain, swelling and impaired mobility, thereby significantly impeding daily activities of the patients. Presently, clinical treatment approaches encompass both conservative management and surgical intervention. Conservative management endeavors to alleviate symptoms, while patients experiencing persistent symptoms resort to surgical intervention. Commonly employed surgical treatments encompass bone marrow stimulation, autologous osteochondral transplantation, and allogeneic osteochondral transplantation. Bone marrow stimulation is employed as a therapeutic approach for the management of smaller OLT, demonstrating favorable short-term effectiveness; however, the long-term prognosis remains uncertain. Autologous osteochondral transplantation is a viable option for larger OLT lesions, albeit it carries the potential of complications at the donor site. Conversely, allogenic osteochondral transplantation exhibits a diminished success rate. In recent times, the utilization of cell transplantation techniques has garnered escalating interest in the treatment of OLT due to their capacity to regenerate cartilage resembling hyaline and their diverse range of cellular origins. The authors reviewed the progress of cell transplantation in the treatment of OLT, providing a reference for the clinical treatment.

Multi-slice CT imaging characteristics of distal tibiofibular syndesmosis in healthy adults / 中华创伤杂志

Objective:To measure the morphological parameters of distal tibiofibular syndesmosis in healthy adults using multi-slice CT (MSCT) so as to provide a reference for the diagnosis of distal tibiofibular syndesmosis injury.Methods:The ankle MSCT imaging data in 110 normal adults were retrieved from the image report database of Cangzhou People′s Hospital from May 2019 to May 2021, including 56 males and 54 females; aged 18-60 years [(38.2±11.0)years]. There were 51 patients with imaging on the right ankle and 59 on the left ankle. Picture archiving and communication system (PACS) was used to measure parameters at 10 mm above the articular surface of the distal tibia on MSCT, including the anterior tibiofibular space (L1), posterior tibiofibular space (L2), middle tibiofibular space (L3), depth of fibula in notch (L4), distance of anterior tibiofibular edge (L5), distance of posterior tibiofibular edge (L6), anterior tibiofibular syndesmosis angle (A1), and fibular rotation angle (A2), and the measurements were compared by sex, age and side. The positive rate of "tibiofibular line" was observed. The morphological classification of distal tibiofibular syndesmosis was performed.Results:There was no significant difference in L1-L6, A1 and A2 among different age and side (all P>0.05). No significant difference was found in L4, L5, A1 and A2 between males and females ( P>0.05), but L1, L2, L3 and L6 were larger in males than in females ( P<0.05 or 0.01). The positive rate of "tibiofibular line" was 80.4% (45/56) in males compared to 74.1% (40/54) in females ( P>0.05), 77.2% (44/57) in the youth compared to 77.4% (41/53) in the middle-aged, and 78.0% (46/59) in the left ankle compared to 76.5% (39/51) in the right ankle (all P>0.05). Morphological classification of distal tibiofibular syndesmosis was crescent in 61 patients (55.5%), trapezoid in 14 (12.7%), I-shaped in 3 (2.7%), M-shaped in 17 (15.5%), V-shaped in 10 (9.1%), Г-shaped in 5 (4.5%). Conclusions:When L1, L2, L3 and L6 are used as references in the diagnosis of adult distal tibiofibular syndesmosis injury, gender factors rather than age or side factors should be considered. Males have wider distal tibiofibular space than females, with the fibula more forward. The "tibiofibular line" has a high positive rate and is not affected by gender, age or sides, providing a new idea for the diagnosis of distal tibiofibular syndesmosis injury and anatomical reduction. There are many variations in the morphology of distal tibiofibular syndesmosis, so it is easy to be misdiagnosed as the separation of distal tibiofibular syndesmosis on X-ray, which should be noted.

Volumetric measurement to diagnose syndesmotic injury in Danis-Weber B type ankle fractures / 国际外科学杂志

Objective:To investigate the change of syndesmotic volume via CT scan in Danis-Weber B type ankle fracture, aiming to provide a non-invasive diagnostic method for Danis-Weber B type ankle fracture combined with syndesmotic injury.Methods:Retrospective analysis was performed on 48 patients with Danis-Weber B type ankle fractures in Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to March 2022, including 30 males and 18 females, aging (43.71±19.41) years. Ankle CT scans and three-dimensional reconstructions were performed before surgery and at the last follow-up, measuring the syndesmotic volume between the tibiotalar joint and 1, 3 and 5 cm above the ankle and compared with each other. Intraoperative exploration was used as the gold standard for the syndesmotic injury. Based on the results of exploration of the syndesmotic injury, patients were divided into simple ankle fracture group (fracture group, 25 cases) and ankle fracture combined with syndesmotic injury group (fracture + ligament group, 23 cases). The sensitivity and specificity of this diagnostic method were statistically evaluated. The assessments at the last follow-up were performed to value the clinical effect of surgery. The metric data conforming to the normal distribution were expressed as mean ± standard deviation ( ± s), and the t-tests were used for comparison between groups. The measurement data of skewed distribution were expressed as quartile M( Q1, Q3), and nonparametric tests were used for intergroup comparison. Counting data were expressed as number of cases and percentage (%), and Chi-square test were used for intergroup comparison. Results:In the fracture group, there were no statistically significant differences of the syndesmotic volume at 1, 3, and 5 cm above the ankle joint before surgery and at the last follow-up ( P=0.219, 0.269, 0.103). On the contrary, the volume above were statistically significant in the fracture + ligament group ( P<0.001). There were statistically significant differences in syndesmotic volume between the two groups at 1, 3, and 5 cm above the ankle joint preoperatively ( P=0.005, 0.004, 0.038). By contrast, there were no statistical differences between the two groups postoperatively ( P=0.082, 0.155, 0.249). For the sensitivity and specificity of Danis-Weber B type ankle fractures combined with syndesmotic injury, they were 92% and 67% at 1 cm above the ankle joint, 69% and 87% at 3 cm above the ankle joint, and 62% and 87% at 5 cm above the ankle joint, respectively. The last follow-up clinical function score indicated a good surgical outcome. Conclusions:Volumetric measurement via CT scan is one of the diagnostic methods for evaluating Danis-Weber B type ankle fracture combined with syndesmotic injurys. Open resection internal fixation combined with elastic fixation of the ankle fracture combined with syndesmotic injurys can significantly reduce the lower tibiofibular volume, and the efficacy is definite.

Acute ankle injuries: association between sprain severity and ancillary findings

ABSTRACT Objective To correlate the significance of osseous, chondral, tendon, and ligamentous injuries with anatomical variations in low-grade versus high-grade acute ankle sprains. Methods We retrospectively identified the magnetic resonance imaging findings of acute ankle sprains (<15 days). Participants with a history of previous sprains, arthritis, tumors, infections, or inflammatory conditions were excluded. Images were independently evaluated by two musculoskeletal radiologists and assessed for osseous, chondral, tendon, and ligamentous injuries and anatomical variations. Participants were divided into low-grade versus high-grade sprain groups, according to the presence of a complete tear in at least one component of the lateral ligament complex. Results The final study group comprised 100 magnetic resonance images (mean age, 36 years), the majority of males (54%), the right ankle (52%), and a mean sprain duration of 5 days. Participants with high-grade sprains presented with increased rates of medial malleolus edema (p<0.001), moderate and large articular effusions (p=0.041), and shorter calcaneonavicular distance (p=0.008). Complete tears of the anterior talofibular ligament and calcaneofibular ligaments were observed in 100% and 51.2% of the participants in the High-Grade Group, respectively. The deltoid ligament complex was partially torn in this group (55.8% versus 8.8%, p<0.001). Extensor tendon retinaculum lesions occurred significantly more frequently in this group (41.9%) compared to the overall study population (23%) (p<0.001). Conclusion Participants with high-grade ankle sprains presented with shorter calcaneonavicular distances and increased rates of medial malleolus edema, deltoid complex partial tears, extensor retinaculum lesions, and articular effusion.

Problems and strategies for the prevention of ankle injuries in soccer / Problemas e estratégias para a prevenção de lesões do tornozelo no futebol / Problemas y estrategias para la prevención de lesiones de tobillo en el fútbol

ABSTRACT Introduction: The most significant reasons for the frequent ankle injuries in soccer players are the great rivalry and the multiple efforts required by the sport. Objective: Explore the actual scenario of sports injuries in the ankle joint in soccer players, raising adequate prevention strategies. Methods: 22 professional soccer players were randomly divided into experimental and control groups. A controlled experiment lastingsix6 weeks was developed. The experimental group added complementary ankle training in the daily training, while the control group had no changes, according to the usual training plan. Rear (PL) and frontal (AT) balance indexes, functional movement assessment (FMS,) and ankle injury cause (CAI) were collected, analyzed, and compared before and after the intervention. Results: After training, the experimental group's PL score increased from 106.81±5.33 to 117.69±6.44; AT score increased from 61.94±6.17 to 70.36±5.37; CAI score increased from 22.33±3.58 to 25.38±3.18. Total FMS test score increased from 15.36±1.38 to 18.84±1.99, with trunk flexions standing out (from 2.10±0.43 to 2.57±0.37). On the other hand, the changes in the control group were not statistically significant. Conclusion: The presented complementary ankle training effectively prevented injuries in soccer players and can be applied to reduce sports complications in players in training. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: As razões mais significativas para as frequentes lesões no tornozelo em jogadores de futebol são a grande rivalidade e os múltiplos esforços requisitados pelo esporte. Objetivo: Explorar o quadro atual das lesões esportivas na articulação do tornozelo em jogadores de futebol, levantando estratégias de prevenção adequadas. Métodos: Um total de 22 jogadores profissionais de futebol foram divididos aleatoriamente em grupo experimental e de controle. Um experimento controlado com duração de 6 semanas foi desenvolvido. No treinamento diário, o grupo experimental acrescentou um treinamento complementar do tornozelo, enquanto o grupo de controle não teve alterações, de acordo com o plano de treinamento habitual. Foram coletados, analisados e comparados os índices de equilíbrio traseiro (PL) e frontal (AT), a avaliação funcional do movimento (FMS) e a causa das lesões no tornozelo (CAI) antes e após a intervenção. Resultados: Após o treinamento, a pontuação PL do grupo experimental aumentou de 106,81±5.33 para 117,69±6.44; a pontuação AT aumentou de 61.94±6.17 para 70,36±5,37; a pontuação CAI aumentou de 22,33±3,58 para 25,38±3,18. A pontuação total do teste FMS aumentou de 15,36±1,38 para 18,84±1,99, destacando-se as flexões do tronco (de 2,10±0,43 para 2,57±0,37). Por outro lado, as alterações do grupo controle não foram estatisticamente significativas. Conclusão: O treinamento complementar para o tornozelo apresentado mostrou-se eficaz na prevenção de lesões em jogadores de futebol e pode ser aplicado para reduzir as complicações esportivas dos jogadores em treinamento. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: Las razones más significativas de las frecuentes lesiones de tobillo en futbolistas son la gran rivalidad y los múltiples esfuerzos que requiere este deporte. Objetivo: Explorar el panorama actual de las lesiones deportivas en la articulación del tobillo en futbolistas, planteando estrategias de prevención adecuadas. Métodos: Un total de 22 futbolistas profesionales fueron divididos aleatoriamente en grupos experimental y control. Se desarrolló un experimento controlado de 6 semanas de duración. En el entrenamiento diario, el grupo experimental añadió un entrenamiento complementario del tobillo, mientras que el grupo control no tuvo cambios, según el plan de entrenamiento habitual. Se recogieron, analizaron y compararon los índices de equilibrio posterior (PL) y frontal (AT), la valoración del movimiento funcional (FMS) y la causa de lesión de tobillo (CAI) antes y después de la intervención. Resultados: Tras el entrenamiento, la puntuación PL del grupo experimental aumentó de 106,81±5,33 a 117,69±6,44; la puntuación AT aumentó de 61,94±6,17 a 70,36±5,37; la puntuación CAI aumentó de 22,33±3,58 a 25,38±3,18. La puntuación total del test FMS aumentó de 15,36±1,38 a 18,84±1,99, destacando las flexiones de tronco (de 2,10±0,43 a 2,57±0,37). Por otro lado, los cambios del grupo de control no fueron estadísticamente significativos. Conclusión: El entrenamiento complementario de tobillo presentado demostró ser eficaz en la prevención de lesiones en futbolistas y puede aplicarse para reducir las complicaciones deportivas en jugadores en formación. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Analysis of causes and prevention of ankle injuries in college basketball / Análise das causas e prevenção contra lesões no tornozelo no basquetebol universitário / Análisis de las causas y la prevención de las lesiones de tobillo en el baloncesto universitario

ABSTRACT Introduction: Basketball is a combative sport, very popular among college students. However, it requires many periods of running, interspersed with emergency breaks, tackling, and other actions prone to ankle injuries. Objective: Investigate the causes of ankle joint injuries in college basketball, raising countermeasures to prevent these sports injuries. Methods: 413 college students who regularly participate in basketball games at 10 colleges and universities were selected as research objects. The causes of ankle joint injuries in the process of this sport were investigated through questionnaires, and the main causes of injuries were analyzed using statistical methods. Results: The causes of ankle joint injuries in college basketball include subjective and objective factors. Subjective factors include inadequate psychological preparation, warm-up exercise, cushioning, and excessive exercise, among others listed; objective factors mainly contemplate local injury and accidental injury. Conclusion: The participation of college students in basketball is beneficial to improve their physical health, requiring effective measures to prevent possible ankle injuries, both related to subjective and objective aspects. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: o basquetebol é uma modalidade esportiva combativa, muito popular entre os universitários. No entanto, necessita de muitos períodos de corrida, intercalados por pausas emergenciais, enfrentamentos e outras ações propensas a lesões no tornozelo. Objetivo: Investigar as causas de lesões nas articulações do tornozelo no basquetebol universitário, levantando contramedidas para prevenir essas lesões desportivas. Métodos: O total de 413 estudantes universitários que participam regularmente em jogos de basquetebol em 10 faculdades e universidades foram selecionados como objetos de pesquisa. As causas das lesões nas articulações do tornozelo no processo desse esporte foram investigadas através de questionários, sendo analisadas as principais causas das lesões através de métodos estatísticos. Resultados: as causas das lesões nas articulações do tornozelo dentro do basquetebol universitário incluem principalmente fatores subjetivos e objetivos. Os fatores subjetivos incluem a preparação psicológica inadequada, o exercício de aquecimento inadequado, o amortecimento inadequado, o exercício excessivo, entre outros listados; os fatores objetivos contemplam principalmente a lesão local e a lesão acidental. Conclusão: A participação dos estudantes universitários no basquetebol é benéfica para melhorar a sua saúde física, requerendo medidas eficazes para prevenir possíveis lesões no tornozelo, tanto as relacionadas aos aspectos subjetivos como objetivos. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: El baloncesto es una modalidad deportiva combativa, muy popular entre los estudiantes universitarios. Sin embargo, requiere muchos periodos de carrera, intercalados con pausas de emergencia, enfrentamientos y otras acciones propensas a las lesiones de tobillo. Objetivo: Investigar las causas de las lesiones de la articulación del tobillo en el baloncesto universitario, planteando contramedidas para prevenir estas lesiones deportivas. Métodos: Se seleccionaron como objeto de investigación un total de 413 estudiantes universitarios que participaban regularmente en partidos de baloncesto en 10 colegios y universidades. Las causas de las lesiones de la articulación del tobillo en el proceso de este deporte se investigaron mediante cuestionarios, y las principales causas de las lesiones se analizaron mediante métodos estadísticos. Resultados: Las causas de las lesiones de la articulación del tobillo en el baloncesto universitario incluyen principalmente factores subjetivos y objetivos. Los factores subjetivos incluyen una preparación psicológica inadecuada, un ejercicio de calentamiento inadecuado, una amortiguación inadecuada, un ejercicio excesivo, entre otros enumerados; los factores objetivos contemplan principalmente la lesión local y la lesión accidental. Conclusión: La participación de los estudiantes universitarios en el baloncesto es beneficiosa para mejorar su salud física, requiriendo medidas eficaces para prevenir posibles lesiones de tobillo, tanto las relacionadas con aspectos subjetivos como objetivos. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Prevention and rehabilitation of ankle sprain in soccer training / Prevenção e reabilitação de entorse de tornozelo no treinamento de futebol / Prevención y rehabilitación del esguince de tobillo en el entrenamiento de fútbol

ABSTRACT Introduction In soccer training, many impacts in running and defense make ankle sprain a very common sports injury; therefore, prevention and rehabilitation management of ankle sprain is particularly important. Objective Explore the strategy of preventing and rehabilitating ankle sprain in soccer training. Methods 10 athletes with ankle sprain were selected and randomly divided into the experimental and control group. Both groups received rehabilitation training, the control group received only manual therapy, and the experimental group received active and passive rehabilitation management. The indices relevant to ankle rehabilitation were analyzed daily: active extension and flexion angle, in addition to the degree of joint edema. Results By the third day, the experimental group's recovery rate was significantly higher. By the end of the seventh day, the active plantar flexion angle in the control group was 28.0133, while in the experimental group, it was 32.0512. As for the degree of joint swelling on day 5, the experimental group was 2.2059 and 1.0057 in the control group. The control group only achieved this level of recovery in the experimental group on the seventh day. Conclusion Using comparative analysis, the rehabilitation strategy associated with the active and passive techniques proposed in this article showed a better performance than the traditional protocol. Studies are suggested popularizing rehabilitation combined with active training with passive traction. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução No treinamento do futebol, um grande número de impactos na corrida e na defesa fazem da entorse do tornozelo uma lesão esportiva muito comum, portanto, a prevenção e o manejo da reabilitação da entorse do tornozelo são particularmente importantes. Objetivo Explorar a estratégia de prevenção e reabilitação da entorse de tornozelo no treinamento de futebol. Métodos 10 atletas com entorse de tornozelo foram selecionados e divididos aleatoriamente em grupo experimental e controle. Ambos grupos receberam treinamento de reabilitação, o grupo controle recebeu apenas terapia manual e o grupo experimental recebeu um manejo ativo e passivo da reabilitação. Os índices relevantes à reabilitação do tornozelo foram analisados diariamente, dentre eles: ângulo de extensão e flexão ativa além do grau de edema articular. Resultados Até o terceiro dia, a taxa de recuperação do grupo experimental foi significativamente maior e ao final do sétimo dia, o ângulo ativo de flexão plantar no grupo controle foi de 28,0133 enquanto no grupo experimental foi de 32,0512. Quanto ao grau de inchaço articular ao quinto dia, no grupo experimental foi de 2,2059 e 1,0057 no grupo controle. Esse nível de recuperação do grupo experimental somente foi atingido pelo grupo controle ao sétimo dia. Conclusão Por meio de análise comparativa, a estratégia reabilitação associada a ativos e passivos propostos neste artigo evidenciou melhor desempenho frente ao protocolo tradicional. Sugere-se estudos para a popularização da reabilitação combinada ao treinamento ativo com tração passiva. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción En el entrenamiento de fútbol, un gran número de impactos en la carrera y la defensa hacen que el esguince de tobillo sea una lesión deportiva muy común, por lo que la gestión de la prevención y la rehabilitación del esguince de tobillo son especialmente importantes. Objetivo Explorar la estrategia de prevención y rehabilitación del esguince de tobillo en el entrenamiento de fútbol. Métodos Se seleccionaron 10 atletas con esguince de tobillo y se dividieron aleatoriamente en grupo experimental y grupo de control. Ambos grupos recibieron entrenamiento de rehabilitación, el grupo de control sólo recibió terapia manual y el grupo experimental recibió gestión de rehabilitación activa y pasiva. Se analizaron diariamente los índices relevantes para la rehabilitación del tobillo, entre ellos: la extensión activa y el ángulo de flexión, además del grado de edema articular. Resultados Al tercer día, la tasa de recuperación del grupo experimental fue significativamente mayor y al final del séptimo día, el ángulo de flexión plantar activo en el grupo de control era de 28,0133 mientras que en el grupo experimental era de 32,0512. En cuanto al grado de inflamación articular en el día 5, en el grupo experimental fue de 2,2059 y de 1,0057 en el grupo de control. Este nivel de recuperación en el grupo experimental sólo lo alcanzó el grupo de control al séptimo día. Conclusión A través del análisis comparativo, la estrategia de rehabilitación asociada a las técnicas activas y pasivas propuestas en este artículo evidenció un mejor desempeño que el protocolo tradicional. Se sugieren estudios para la popularización de la rehabilitación combinada con el entrenamiento activo con tracción pasiva. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Clinical observation of contralateral needling combined with Maitland ankle mobilization for chronic ankle sprain / 针灸推拿医学（英文版）

Objective: To observe the efficacy of contralateral needling combined with Maitland ankle mobilization in the treatment of chronic ankle sprain.Methods: A total of 106 patients with chronic ankle sprain were included in the study. They were numbered according to their order of visit, with odd numbers assigned to the control group and even numbers assigned to the observation group, with 53 cases in each group. Patients in the control group were treated with Maitland ankle mobilization, while those in the observation group were given additional contralateral needling treatment. After treatment, we observed the indicators including, ankle circumference, range of motion (ROM) of dorsiflexion, ROM of plantar flexion, thickness of ankle ligaments, and the changes in Baird-Jackson ankle score, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and visual analog scale (VAS) score to compare the efficacy between the two groups. Results: After treatment, the total effective rate of the observation group was 94.3％ and was significantly higher than that of the control group (81.1％), indicating statistical significance (P<0.05). After treatment, the ankle circumference of both groups decreased, and the ROM of dorsiflexion and the ROM of plantar flexion increased (P<0.05). The changes in the observation group were more significant, indicating inter-group statistical significance (P<0.05). After treatment, the thickness of the anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament, as well as the VAS scores decreased in both groups; the changes in the observation group were more significant, indicating inter-group statistical significance (P<0.05). After treatment, the Baird-Jackson ankle score and the AOFAS ankle- hindfoot score increased in both groups, and the scores in the observation group were higher than those in the control group, indicating inter-group statistical significance (P<0.05). Conclusion: The efficacy of contralateral needling combined with Maitland ankle mobilization in the treatment of chronic ankle sprain is superior to that of Maitland ankle mobilization alone.

Ankle Sprain in Young Athletes: A 2-Year Retrospective Study at a Multisport Club / Entorse no tornozelo em jovens atletas: Um estudo retrospectivo de 2 anos em um clube multiesportivo

Abstract Objective The present study aimed to analyze ankle sprains in young athletes of basketball, futsal, artistic gymnastics, trampoline, tennis, judo, and volleyball over 2 seasons. Methods Data of 529 athletes in the 1st year and of 495 athletes in the 2nd year of analysis were investigated from the injury record database of a sports club. The following data were considered: the demographic characteristics (age, body mass, height, and sex), the mechanism (contact or noncontact), the severity, the moment at which the injury occurred, and the recurrence. Also, the incidence rate, the injury risk of the first ankle sprain, and the incidence rate ratio between sports were calculated. Results The athletes sustained 124 ankle sprains in the 2 years of analysis. The majority occurred during training (76.6%) and lead to absence from sports practice (75.8%). The injury recurrence was low: 2 athletes (1.6%) had a recurrence in the same year and 5 (4.0%) in the following year. The incidence rate (0.79 to 12.81 per 1,000 hours) and the injury risk (1.14 to 19.44%) varied among sports. Volleyball, basketball, and futsal presented the highest injury rate incidence. Tennis, gymnastics, and trampoline showed the lowest injury rate incidence. Judo showed an incidence rate different from those of basketball and volleyball in the 1st year and similar to those of other sports in the 2nd year. Conclusion Ankle sprain greatly impacted sports practice and presented characteristics that differ among the investigated sports. These findings may contribute to developing preventive injury programs.

Resumo Objetivo O presente estudo teve como objetivo analisar entorses no tornozelo em jovens atletas de basquete, futsal, ginástica artística, trampolim, tênis, judô e vôlei ao longo de duas temporadas. Métodos Foram investigados dados de 529 atletas no 1° ano e 495 atletas no 2° ano de análise a partir do banco de dados de registros de lesões de um clube esportivo. Foram considerados os seguintes dados: as características demográficas (idade, massa corporal, altura e sexo), o mecanismo (contato ou não contato), a severidade, o momento em que ocorreu a lesão e a recorrência. Além disso, foram calculadas a taxa de incidência, o risco de lesão da primeira entorse no tornozelo e a razão da taxa de incidência entre os esportes. Resultados Os atletas sofreram 124 entorses no tornozelo nos 2 anos de análise. A maioria ocorreu durante o treinamento (76,6%) e levou à interrupção da prática esportiva (75,8%). A recorrência da lesão foi baixa: 2 atletas (1,6%) tiveram recorrência no mesmo ano e 5 (4,0%) no ano seguinte. A taxa de incidência (0,79 a 12,81 por 1.000 horas) e o risco de lesão (1,14 a 19,44%) variaram entre os esportes. Vôlei, basquete e futsal apresentaram a maior incidência de lesões. Tênis, ginástica e trampolim apresentaram a menor incidência de lesões. O judô apresentou uma taxa de incidência diferente das do basquete e do vôlei no 1° ano e semelhante às dos outros esportes no 2° ano. Conclusão A entorse no tornozelo impactou muito a prática esportiva e apresentou características que diferem entre os esportes investigados. Esses achados podem contribuir para o desenvolvimento de programas de prevenção de lesões.

Posterior malleolus fracture fixation in ankle injuries: A clinical study

Introduction: Posterior Malleolar fractures are relatively rare and a part of complex ankle injuries. Trimalleolar fractures affect the stability of the weight-bearing ankle joint. Management of posterior malleolar fractures is a challenge. Aims: This study aimed to examine the radiological and clinical outcomes of the management of posterior malleolar fractures in adults. Settings and Design: This is an original research retrospective study Materials and Methods: Eleven patients underwent fixation of ankle fractures with fixation of posterior malleolus as needed using screws or plates. Surgical outcomes were examined in follow-up with an average follow-up of 21 months using the American Orthopedic Foot and Ankle Score (AOFAS) score and with radiological correlation at each follow-up. Results: In our series, 27% of patients had 44B type injury and 73% of patients had 44C type injury as per AO/ OTA classification. The average AOFAS score was 90.45 for the series and the score for patients treated with direct reduction of the fragment was better than for those treated with indirect reduction. The average score for patients managed with screws was better than for those treated with plates in our series. 82% of patients showed excellent to good outcomes with one patient having an infection and one patient having moderate to severe pain. Conclusion: Anatomical reduction of posterior malleolar fragment leads to better long-term functional outcomes and a stable ankle joint with early mobilization.

Functional training rehabilitation in a latin dance injury / Reabilitação com treinamento funcional em lesão ocasionada por dança latina / Rehabilitación con entrenamiento funcional en lesión causada por danza latina

ABSTRACT Introduction: Latin dance is an emerging sport with rapid popularization in China. Along with the increase of world competitions in Latin dance, its rules are in constant progress demanding high motor coordination and balance skills from the athlete. In an attempt to keep up with the quality required by international competitions, rehabilitation must also be innovated. Objective: Explore the application of functional rehabilitation training to ankle injuries in Latin dance dancers. Methods: 65 athletes from a Latin dance club were selected as subjects and divided into research and control groups, with 33 and 32, respectively. The control group received the same daily training, while the study group was added a specific protocol involving rehabilitation with functional training. Functional indices were categorized, subjective analysis and pain were collected before and after the intervention. Results: The results showed that the pain score of the study group went from 5.71±0.49 to 2.21±0.19, while the control group started with 5.69±0.41 ending at 4.78±0.31 after training. There was no significant difference in the visual analog pain scale score between the two groups before training (P > 0.05). Conclusion: Functional training rehabilitation can improve the rate of exercise in ankle injuries on Latin dance practitioners. Evidence Level II; Therapeutic Studies - Investigating the result.

RESUMO Introdução: A dança latina é um esporte emergente com rápida popularização na China. Juntamente com o aumento das competições mundiais de dança latina, suas regras de estão em constante progresso exigindo altas habilidades de coordenação motora e equilíbrio do atleta. A reabilitação também deve ser inovada para acompanhar a qualidade requerida pelos padrões das competições internacionais. Objetivo: Explorar a aplicação do treinamento de reabilitação funcional em lesões no tornozelo de dançarinos da dança latina. Métodos: 65 atletas de um clube de dança latina foram selecionados como sujeitos e divididos em grupos de pesquisa e grupos de controle, com 33 e 32, respectivamente. O grupo de controle recebeu o mesmo treinamento cotidiano, enquanto ao grupo de estudo foi acrescentado um protocolo específico envolvendo reabilitação com treinamento funcional. Índices funcionais foram categorizados e análise subjetiva e dor também foi coletada antes e após a intervenção. Resultados: Os resultados mostraram que a pontuação da dor do grupo de estudo foi de 5,71±0,49 para 2,21±0,19, enquanto o grupo de controle iniciou com 5,69±0,41 finalizando em 4,78±0,31 depois do treinamento. Não houve diferença significativa na pontuação da escala visual analógica de dor entre os dois grupos antes do treinamento (P > 0,05). Conclusão: A reabilitação com treinamento funcional pode melhorar a taxa de reabilitação para exercícios no público praticante de dança latina com lesões no tornozelo. Nível de evidência II; Estudos Terapêuticos - Investigação de Resultados.

RESUMEN Introducción: El baile latino es un deporte emergente con una rápida popularización en China. Junto con el aumento de las competiciones mundiales de bailes latinos, sus reglas están en constante progreso exigiendo al atleta una gran coordinación motora y habilidades de equilibrio. La rehabilitación también debe ser innovadora para estar a la altura de la calidad exigida por las normas de las competiciones internacionales. Objetivo: Explorar la aplicación del entrenamiento de rehabilitación funcional en las lesiones de tobillo en los bailarines de danza latina. Métodos: Se seleccionaron 65 atletas de un club de baile latino como sujetos y se dividieron en grupos de investigación y de control, con 33 y 32, respectivamente. El grupo de control recibió el mismo entrenamiento diario, mientras que al grupo de estudio se le añadió un protocolo específico de rehabilitación con entrenamiento funcional. Se clasificaron los índices funcionales y también se recogió el análisis subjetivo y el dolor antes y después de la intervención. Resultados: Los resultados mostraron que la puntuación de dolor del grupo de estudio pasó de 5,71±0,49 a 2,21±0,19, mientras que el grupo de control empezó con 5,69±0,41 y terminó con 4,78±0,31 después del entrenamiento. No hubo diferencias significativas en la puntuación de la escala analógica visual del dolor entre los dos grupos antes del entrenamiento (P > 0,05). Conclusión: La rehabilitación con entrenamiento funcional puede mejorar el índice de rehabilitación para el ejercicio en practicantes de baile latino con lesiones de tobillo. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.

Effects of neuromuscular treatment on postural balance in athletes recovering from the ankle injury / Efeitos do tratamento neuromuscular sobre o equilíbrio postural em atletas na reabilitação de lesão do tornozelo / Efectos del tratamiento neuromuscular sobre el equilibrio postural en atletas en la rehabilitación de lesiones del tobillo

ABSTRACT Introduction: Posture is directly related to body balance, and both have great importance in movement. Body posture is affected by several human body factors in space, and neuromuscular athletes' rehabilitation methods should be designed for an optimal return of postural stability. Objective: Explore the effects of neuromuscular treatment on postural balance rehabilitation of athletes' ankle injuries. Methods: 20 athletes with functional ankle instability were randomized into experimental and control groups. The experimental group received neuromuscular treatment. The control group maintained standard muscle strength and joint activity rehabilitation exercises. The effects of two rehabilitative procedures were compared by Cumberland ankle instability assessment questionnaire, T-type agility test, and Sargent vertical jump test. Results: Agility after exercise was significantly lower than those before exercise by 0.8 versus 1s; there was no significant difference between the two groups before the experiment. Agility test results of the experimental group were significantly lower than those of the control group (2s). Sargent's vertical jump test results were significantly different from those before the exercise (P < 0.01). Conclusion: The postural balance showed good recovery with the neuromuscular treatment and the rehabilitation method of the athletes after the ankle injury. Evidence Level II; Therapeutic Studies - Investigating the result.

RESUMO Introdução: A postura está diretamente relacionada ao equilíbrio corporal e ambos têm grande importância no movimento. A postura corporal é afetada por vários fatores do corpo humano no espaço e os métodos de reabilitação neuromuscular em atletas devem ser delineados para um retorno otimizado da estabilidade postural. Objetivo: Explorar os efeitos do tratamento neuromuscular sobre o equilíbrio postural na reabilitação de lesão no tornozelo de atletas. Métodos: 20 atletas com instabilidade funcional do tornozelo foram divididos aleatoriamente em grupo experimental e grupo controle. O grupo experimental recebeu tratamento neuromuscular, enquanto o grupo controle permaneceu com exercícios de reabilitação de força muscular e atividade articular padrão. Os efeitos de dois procedimentos de reabilitação na instabilidade funcional do tornozelo foram comparados pelo questionário de avaliação da instabilidade do tornozelo de Cumberland, teste de agilidade do tipo T e teste de salto vertical de Sargent. Resultados: Os resultados do teste t de agilidade após o exercício foram significativamente menores do que os anteriores ao exercício em 0,8 contra 1s; não houve diferença significativa entre os dois grupos antes do experimento. Os resultados dos testes de agilidade do grupo experimental foram significativamente inferiores aos do grupo controle (2s). Os resultados do teste de salto vertical de Sargent foram significativamente diferentes daqueles anteriores ao exercício (P < 0,01). Conclusão: O equilíbrio postural apresentou boa recuperação com o tratamento neuromuscular e com o método de reabilitação dos atletas após a lesão do tornozelo. Nível de evidência II; Estudos Terapêuticos - Investigação de Resultados.

RESUMEN Introducción: La postura está directamente relacionada con el equilibrio corporal y ambos tienen gran importancia en el movimiento. La postura corporal se ve afectada por varios factores del cuerpo humano en el espacio y los métodos de rehabilitación neuromuscular en los deportistas deben diseñarse para un retorno óptimo de la estabilidad postural. Objetivo: Explorar los efectos del tratamiento neuromuscular sobre el equilibrio postural en la rehabilitación de lesiones de tobillo en atletas. Métodos: 20 atletas con inestabilidad funcional del tobillo fueron divididos aleatoriamente en un grupo experimental y un grupo de control. El grupo experimental recibió un tratamiento neuromuscular, mientras que el grupo de control permaneció con ejercicios estándar de rehabilitación de la fuerza muscular y la actividad articular. Se compararon los efectos de dos procedimientos de rehabilitación sobre la inestabilidad funcional del tobillo mediante el cuestionario de evaluación de la inestabilidad del tobillo de Cumberland, la prueba de agilidad tipo T y la prueba de salto vertical de Sargent. Resultados: Los resultados de la prueba t de agilidad después del ejercicio fueron significativamente inferiores a los de antes del ejercicio en 0,8 frente a 1s; no hubo diferencias significativas entre los dos grupos antes del experimento. Los resultados de la prueba de agilidad del grupo experimental fueron significativamente inferiores a los del grupo de control (2s). Los resultados de la prueba de salto vertical de Sargent fueron significativamente diferentes de los obtenidos antes del ejercicio (P < 0,01). Conclusión: El equilibrio postural mostró una buena recuperación con el tratamiento neuromuscular y con el método de rehabilitación de los atletas tras la lesión del tobillo. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.

Lesões desportivas em atletas recreacionais amadores de taekwondo / Lesões em atletas recreacionais de taekwondo / Sports injuries in amateur recreational Taekwondo athletes

RESUMO As modalidades esportivas de combate (MEC) são muito frequentes em megaeventos esportivos e, dentre elas, destaca-se o taekwondo, que prioriza o contato direto entre os participantes principalmente a partir de chutes e socos, e proporciona ambiguidade na relação saúde-desporto, pois sua prática pode ser lesiva. O objetivo do estudo foi quantificar a prevalência de lesões em atletas recreacionais de taekwondo, oriundas de treinos ou competições, e testar sua associação a fatores intrínsecos e extrínsecos. Trata-se de estudo observacional descritivo, de natureza retrospectiva, que empregou inquérito de morbidade referida para registro dos agravos. As informações quanto à lesão desportiva foram registradas considerando os últimos seis meses de 2018. Participaram atletas com idade entre 12 e 25 anos, de ambos os sexos, praticantes de taekwondo na cidade de Pelotas, no Rio Grande do Sul. A prevalência de lesões desportivas em praticantes recreacionais de taekwondo na cidade de Pelotas é 26,2% (n=11), sem diferenças significantes entre sexos. O principal motivo de prática é o condicionamento para saúde (35,7%); o principal mecanismo de lesão foi chute atacando (45,4%), seguido de impacto ao realizar defesa (27,3%); o tipo de lesão mais frequente foi entorse (27,3%), seguido de contusão (18,2%); e os segmentos corporais mais lesionados foram joelho (36,4%) e tornozelo (36,4%). A prevalência de lesões desportivas em praticantes recreacionais de taekwondo da cidade de Pelotas é inferior à encontrada na literatura, e isto pode decorrer da natureza da prática, dado que eles são atletas recreacionais amadores, com a prática direcionada ao condicionamento para a saúde.

RESUMEN Las modalidades deportivas de combate (MDC) son muy comunes en los megaeventos deportivos y, entre ellos, destaca el taekwondo, el cual prioriza el contacto directo entre los participantes principalmente a través de patadas y golpes, y proporciona ambigüedad en la relación salud-deporte, ya que su práctica puede ser perjudicial. El objetivo del estudio fue cuantificar la prevalencia de lesiones en atletas recreativos de taekwondo, desde entrenamientos o competiciones, y probar su asociación con factores intrínsecos y extrínsecos. Este es un estudio observacional descriptivo, de tipo retrospectivo, que utilizó una encuesta de morbilidad reportada para registrar las condiciones. La información sobre lesiones deportivas se registró teniendo en cuenta los últimos seis meses de 2018. Los participantes eran atletas de entre 12 y 25 años, de ambos sexos, practicantes de taekwondo en la ciudad de Pelotas, en Rio Grande Do Sul (Brasil). La prevalencia de lesiones deportivas en practicantes recreativos de taekwondo en la ciudad de Pelotas es del 26,2% (n = 11), sin diferencias significativas entre sexos. La razón principal de la práctica de los participantes es el acondicionamiento de la salud (35,7%); el principal mecanismo de lesión fue el ataque de patada (45,4%) seguido de impacto al realizar la defensa (27.3%); el tipo de lesión más frecuente fue el esguince (27,3%) seguido de contusión (18,2%), y los segmentos corporales más lesionados fueron la rodilla (36,4%) y el tobillo (36,4%). La prevalencia de lesiones deportivas en practicantes recreativos de taekwondo en la ciudad de Pelotas es menor que la que se encuentra en la literatura, y esto puede deberse a la naturaleza de la práctica, dado que son atletas aficionados recreativos, con la práctica dirigida al acondicionamiento para la salud.

ABSTRACT Combat sports are very common in sport mega-events. Taekwondo is a combat sport that prioritizes direct contact between participants, specially by kicks and punches, and provides ambiguity in the health-sport relationship, as its practice could be harmful. This study aimed to quantify the prevalence of injuries in amateur Taekwondo athletes, from training or competitions, and assess their association with intrinsic and extrinsic factors. This is a descriptive, observational, and retrospective study that assessed injuries by a reported morbidity inquiry. Information on sports injuries considered the last six months of 2018. Participants were athletes aged from 12 to 25 years old, of both sexes, practicing Taekwondo in the city of Pelotas, Rio Grande do Sul, Brazil. The prevalence of sports injuries in amateur Taekwondo athletes in Pelotas was 26.2% (n=1), without significant differences between sexes. The main reason for the practice was physical conditioning (35.7%). The main mechanism of injury was kick when attacking (45.4%), followed by impact when defending (27.3%). The most frequent type of injury was sprain (27.3%). followed by contusion (18.2%), and the most injured body parts were knees (36.4%) and ankles (36.4%). The prevalence of sports injuries in amateur Taekwondo athletes in Pelotas was lower than the one found in the literature, and it may be due to the nature of the practice, as they are recreational amateur athletes aiming to improve physical conditioning.

Association between coping with past ankle sprain, and current physical activity levels and sedentary times among senior soccer players in Japan / 体力科学

This cross-sectional study examines the association between coping with past ankle sprain, and current physical activity levels and sedentary times. It included a total of 1,464 male soccer players, who participated in the 6th Senior Soccer Festival in Shizuoka in 2017. A self-administered questionnaire was conducted on the day of the festival and 567 subjects responded (38.7% response rate). Participants answered questions regarding the coping with past ankle sprain, such as whether they had first aid treatment (yes/no), the type of initial treatment facilities (6 categories), and their most frequented facilities (5 categories). Additionally, the International Physical Activity Questionnaire Short Form was used to obtain information on current physical activity level and sedentary time. We compared the mean values of physical activity levels and sedentary times with the first aid treatment, initial treatment facilities and most frequented facilities answers, respectively. The mean age was 64.7 years. Physical activity level was associated with first aid treatment (yes: 3860.3 Metabolic equivalents (METs)/min/week; no: 3082.0 METs/min/week) (p=0.033). Sedentary time was also associated with first aid treatment (yes: 265.4 min/day; no: 321.3 min/day) (p=0.014). Initial treatment facilities and most frequented facilities were not associated with physical activity levels or sedentary times. Our study showed that those who had received first aid treatment had high physical activity levels and low sedentary time.

Mid-term effects of surgery for sub-acute injury to distal tibiofibular syndesmosis associated with ankle fracture / 中华创伤骨科杂志

Objective:To evaluate the mid-term efficacy of surgery for sub-acute injury to distal tibiofibular syndesmosis associated with ankle fracture.Methods:From July 2014 to October 2019, 14 patients were treated at Foot & Ankle Section, Department of Orthopaedics, Shanghai Sixth People’s Hospital for sub-acute injury to distal tibiofibular syndesmosis associated with ankle fracture.There were 11 males and 3 females, aged from 17 to 61 years (mean, 35.9 years).According to Danis-Weber classification, 6 cases were type B and 8 type C; according to Lauge-Hansen classification, 7 cases belonged to supination-external rotation, one to pronation-abduction, and 6 to pronation-external rotation (Maisonneuve fracture in 4).The syndesmosis injury was treated by fixation with distal tibiofibular screws in 11 cases, by Tightrope elastic fixation in one, by hybrid fixation with distal tibiofibular screws and Tightrope in one, and by distal tibiofibular fusion in one.Postoperative complications were recorded.Their visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society ankle-hindfoot scores (AOFAS-AH) were compared between preoperation and the last follow-up.Results:The 14 patients were followed up for 24 to 85 months (mean, 46.8 months). Of the 9 patients whose distal tibiofibular screws had been removed (including one with hybrid fixation), wound infection occurred in one after removal of all the internal fixation, distal tibiofibular widening in 2, ankle degeneration in 5 and fibular nonunion in one. Of the other 3 patients whose distal tibiofibular screws had not been removed, screw breakage happened in 2, screw loosening in one and distal tibiofibular widening in one. The VAS scores were significantly improved from preoperative 6.8±0.9 to 1.4±1.3 at the last follow-up; the AOFAS-AH scores were increased significantly from preoperative 35.3±6.3 to 86.8±11.7 at the last follow-up (both P<0.001). According to AOFAS-AH scores, 8 cases were excellent, 4 good and 2 moderate. Conclusion:Surgery for sub-acute injury to distal tibiofibular syndesmosis associated with ankle fracture can restabilize the distal tibiofibular syndesmosis and ankle joint, reduce pain and improve ankle function, leading to fine mid-term efficacy.

Curative effect of distal tibiofibular screw fixation combined with ligament repair for the treatment of ankle fracture accompanied with distal tibiofibular syndesmosis injuries / 中华创伤杂志

Objective:To investigate the clinical efficacy of distal tibiofibular screw fixation combined with ligament repair for the treatment of ankle fracture accompanied with distal tibiofibular syndesmosis injuries.Methods:A retrospective cohort analysis was made on clinical data of 72 patients with ankle fracture accompanied with distal tibiofibular syndesmosis injuries admitted to 909th Hospital of Joint Service Support Force of PLA from September 2017 to September 2020, including 38 males and 34 females, aged 19-65 years [(42.5±12.2)years]. The fracture was type B in 30 patients, type C 1 in 29 and type C2 in 13 according to Danis-Weber classification. A total of 36 patients were treated by distal tibiofibular screw fixation combined with ligament repair (fixation+repair group) and 24 patients by distal tibiofibular screw fixation (fixation group). Operation time, intraoperative blood loss and hospital stay were recorded. Visual analogue scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot score and ankle range of motion (ROM) were determined at 1, 3 months postoperatively and at the final follow-up. Complications were documented. Results:All patients were followed up for 12-22 months [(15.9±2.2)months]. There were no significant differences in operation time, intraoperative blood loss and hospital stay between the two groups (all P>0.05). VAS in fixation+repair group was (3.1±1.0)points and (2.1±0.6)points at 1, 3 months postoperatively, significantly lower than (3.9±0.8)points and (2.6±0.8)points in fixation group (all P<0.05), but the score showed no significant difference between the two groups at the final follow-up ( P>0.05). AOFAS score in fixation+repair group was (64.7±4.0)points, (73.2±3.4)points and (87.2±3.4)points at 1, 3 months postoperatively and at the final follow-up, significantly higher than (60.1±4.9)points, (70.2±1.9)points and (84.1±2.6)points in fixation group (all P<0.05). There was no significant difference in the ROM between the two groups at 1 month postoperatively ( P>0.05), but the ROM at 3 months postoperatively and at the final follow-up in fixation+repair group [(44.4±2.9)° and (52.3±2.5)°, respectively] was significantly higher than that in fixation group [(41.4±2.7)° and (50.1±2.7)°, respectively] (all P<0.05). There was 1 patient with internal fixation loosening in fixation+repair group, with the incidence of complications of 3% (1/36). While the incidence of complications was significantly lhigher in fixation group [17%(6/36)], including 2 patients with re-separation of distal tibiofibular syndesmosis, 2 with internal fixation loosening and 2 with internal fixation breakage ( P<0.05). Conclusion:Compared with distal tibiofibular screw fixation, distal tibiofibular screw fixation combined with ligament repair for the treatment of ankle fracture accompanied with distal tibiofibular syndesmosis injuries is effective to early relieve ankle pain, improve ankle function and ROM, and reduce occurrence of complications.

Efficacy of modified posterolateral approach combined with medial approach in open reduction and internal fixation of trimalleolar ankle fracture / 中华创伤杂志

Objective:To compare the clinical results of modified posterolateral approach combined medial approach versus traditional posterolateral approach combined with medial approach in open reduction and internal fixation of trimalleolar ankle fracture.Methods:A retrospective cohort study was used to analyze the clinical data of 46 patients with trimalleolar ankle fracture admitted to the First Affiliated Hospital of Naval Military Medical University from June 2013 to June 2019, including 14 males and 32 females, at age of 19-71 years [(49.2±14.9)years]. There were 33 patients with supination-external rotation type IV ankle fracture and 13 with pronation-external rotation type IV ankle fracture according to Lauge-Hansen classification. Open reduction and internal fixation was performed through the modified posterolateral approach combined with medial approach in 25 patients (modified approach group), and through the traditional posterolateral approach combined with medial approach in 21 patients (traditional approach group). The visual analogue score (VAS) at 3 days and 1 week after surgery, fracture healing time, range of ankle flexion and extension and Baird-Jackson score at the final follow-up and postoperative complications (numbness of the affect limb, wound necrosis, etc.) were compared between the two groups.Results:All patients were followed up for 11-21 months [(14.8±2.2)months]. There was no statistical difference in VAS or fracture healing time at 3 days after surgery between the two groups (all P>0.05). The VAS was 3.0 (3.0, 4.0)points in modified approach group at 1 week after surgery, significantly lower than 4.0 (3.0, 5.0)points in traditional approach group ( P<0.05). At the final follow-up, there was no statistical difference in range of ankle plantarflexion between the two groups ( P>0.05), but range of ankle dorsiflexion was significantly greater in modified approach group [(11.8±2.8)°] than that in traditional approach group [(8.1±3.5)°] ( P<0.01). At the final follow-up, Baird-Jackson score was not statistically different between the two groups ( P>0.05). There were 4 patients with numbness and 2 with wound necrosis in traditional approach group, but no numbness or wound necrosis occurred in modified approach group ( P<0.01). Conclusion:Both the modified posterolateral approach combined with medial approach and traditional posterolateral approach combined with medial approach can achieve good clinical results in open reduction and internal fixation of trimalleolar ankle fractures, but the former has advantages of better pain relief, better recovery of ankle dorsiflexion and less complications.