Comparison of plate versus screw internal fixation in the treatment of posterior malleolar fracture: A systematic review and meta-analysis.

BACKGROUND: Treatment of posterior malleolar fracture with plate or screw fixation is still controversial. Plate fixation is considered to have better stability but more soft tissue damage; screw fixation is less invasive and may yields lesser blood loss and surgery time. We conducted this meta-analysis to explore intraoperative and postoperative efficacy between plate and screw fixation in posterior malleolar fractured patients. METHODS: PubMed, Cochrane, Embase, Scopus and Chinese National Knowledge Infrastructure databases were searched in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Random-effects model and 95% confidence intervals was used. The outcomes of interest were surgery time, blood loss, length of hospital stay, American Orthopedic Foot and Ankle Score (AOFAS), bone healing time, full weight bearing time, off bed ambulation time, Visual Analogue Scale (VAS), complication rate, and rate of use of syndesmosis screw etc. RESULTS: One randomized clinical trial and fifty-two retrospective cohort studies with a total of 3757 patients (1956 in screw group and 1801 in plate group) were included in the systematic review. Compared to screw group, plate group yielded significantly longer surgery time, more intraoperative blood loss, but shorter length of hospital stay, better AOFAS, better Baird Jackson score, better AOFAS and Baird Jackson excellent-good rate, shorter bone healing time, shorter time enabling full weight bearing, shorter time enabling off bed ambulation, lesser postoperative pain, lesser complication rate, lesser loosening rate, lesser malunion rate, and lesser postoperative osteoarthritis. CONCLUSIONS: Plate fixation is a favorable alternative to screw fixation in posterior malleolar fractured patients. Although plate fixation was at risk of longer surgery time and more blood loss, it provided better postoperative functional outcome, shorter healing, weight bearing and off bed ambulation time and lesser pain compared to screw fixation.

"Fragment Width Ratio" as a Predictor of Nonunion for Femoral Shaft Fracture With Third Fragments.

Previous studies have reported that large fracture fragment with displacement might cause nonunion of femoral shaft fractures. We therefore intended to delineate significant risk factors for developing a nonunion predisposed by a major fracture fragment. We analyzed 61 patients who were operated on using interlocking nails for femoral shaft fractures from 2009 to 2018. We classified patients with modified Radiographic Union Scale for Tibia fractures scores of less than 11 or needing reoperations by 1 year postoperatively as nonunion. We thereafter measured parameters of the displaced fracture fragment and fracture site to identify the significant difference between the union and non-union groups. We also applied the receiver operating characteristic curve to demonstrate a threshold value for the fragment width (FW) ratio. Among 61 patients with complete follow-up, no significant difference was found regarding length, displacement, and angulation of fragments between patients with and without union. Except for higher mean FW (P=.03) and the FW ratio (P=.01) in patients with nonunion, the logistic regression analysis demonstrated that FW ratio significantly affected union (P=.018; odds ratio, 0.21; 95% CI, 0.001-0.522). Although a fracture fragment greater than 4 cm with displacement greater than 2 cm was reported to significantly cause nonunions, our study showed that an FW ratio greater than 0.55 instead of fragment size or displacement was predictive for the occurrence of nonunion adjoining to the fracture site. Fixation of the third fracture fragment should not be ignored for preventing a nonunion. More attention should be paid to achieve a better fixation for a major fracture fragment with an FW ratio greater than 0.55 to avoid the development of non-union following the use of interlocking nail for femoral shaft fracture. [Orthopedics. 2023;46(3):169-174.].

[Critical Care Nursing in Targeted Temperature Management (TTM) After Cardiac Arrest].

Targeted temperature management (TTM) is a complex and sophisticated intensive-care procedure that is included in the American Heart Association guidelines for treating patients who remain unconscious after resuscitation from cardiac arrest. TTM has been demonstrated to reduce brain injury associated with reperfusion after resuscitation and to improve the neurological prognosis in patients with cardiac arrest. The TTM process may be divided into four phases: induction, maintenance, rewarming, and normothermia. The critical element in TTM is the quick lowering and slow raising of body temperature, which should be fine-tuned to maintain temperature stability and minimize variation. Caregivers should monitor the physiological changes caused by core body temperature change closely and manage possible complications such as shivering, hypo- and hyper-glycemia, electrolyte imbalance, skin injury, arrhythmia, and infection. Based on contemporary evidence and clinical experience, this article provides critical care nurses a summary and key points of each stage of TTM when used to take care of resuscitated patients after cardiac arrest. We hope this work may help improve patient safety and quality of care during the TTM procedure.

Comparing efficacy of a single intraarticular injection of platelet-rich plasma (PRP) combined with different hyaluronans for knee osteoarthritis: a randomized-controlled clinical trial.

BACKGROUND: Intraarticular plasma-rich platelet (PRP) and hyaluronic acid (HA) have each been shown to be effective for treating knee osteoarthritis (OA). Evidence supporting the combination therapy is controversial. This study aimed to investigate the efficacy of a single intraarticular PRP injection combined with different HAs in patients with knee OA. METHODS: In this prospective randomized-controlled trial, 99 patients with Kellgren-Lawrence grade 2 knee OA with average knee pain ≥ 30 mm on a 0-100 mm pain visual analog scale (VAS) were randomized into two groups. The PRP + Artz group received a single intraarticular HA (Artz, 2.5 ml, 10 mg/ml) followed by 3 ml PRP (n = 50). The PRP + HYAJOINT Plus group received a single intraarticular cross-linked HA (HYAJOINT Plus, 3 ml, 20 mg/ml) followed by 3 ml PRP (n = 49). All patients were evaluated before and at 1, 3 and 6 months after injections. The primary outcome was the VAS pain reduction from baseline at 6 months. Secondary outcome measures included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne index, single leg stance (SLS) test and patient satisfaction. RESULTS: Ninety-five patients were analyzed by intention-to-treat analysis. Both groups improved significantly in VAS pain, WOMAC, Lequesne index and SLS at 1, 3 and 6 months post intervention (p < 0.05). Between-group comparisons showed no significant differences at most follow-up time points, except better improvements in Lequesne index at 1 month (p = 0.003) and WOMAC-stiffness score at 6 months (p = 0.020) in the PRP + Artz group, and superiority in SLS at 1, 3 and 6 months in the PRP+ HYAJOINT Plus group (p < 0.001, p = 0.003 and p = 0.004). Additional Johnson-Neyman analyses showed that among the patients with baseline WOMAC-pain score > 8.5, WOMAC-function score > 21.7 and WOMAC-total score > 32.0, respectively, those treated with PRP + HYAJOINT Plus injections had better effects in WOMAC-pain, WOMAC-function and WOMAC-total scores than those treated with PRP + Artz at 3 months postinjection (p < 0.05). Both groups reported high satisfaction. No serious adverse events occurred during the study. CONCLUSIONS: A single PRP injection combined with Artz or HYAJOINT Plus is effective and safe for 6 months in patients with knee OA. Both injection regimens are potential treatment options for knee OA. Further studies are needed to confirm these results. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov (NCT04931719), retrospectively. Date of registration 18/6/2021. NAME OF TRIAL REGISTRY: Comparing efficacy of single PRP combined with different hyaluronans for knee osteoarthritis. LEVEL OF EVIDENCE: Therapeutic Level 1.

Efficacy and Safety of a Single Intra-articular Injection of Platelet-rich Plasma on Pain and Physical Function in Patients With Ankle Osteoarthritis-A Prospective Study.

Ankle osteoarthritis (OA) can cause disabling symptoms, and some patients prefer to be treated with minimally invasive procedures. The aim was to evaluate the efficacy and safety of a single intraarticular injection of platelet-rich plasma (PRP) for patients with ankle OA. In a prospective study done in a university-affiliated tertiary care medical center, 44 patients with symptomatic ankle OA for at least 6 months were recruited. Patients received a single injection of PRP (3 mL) into symptomatic ankles. The primary outcome was the change from baseline in the visual analog scale (VAS) pain (0-10 cm) at 6 months. Secondary outcomes included the Ankle Osteoarthritis Scale (AOS) score, American Orthopedic Foot and Ankle Society (AOFAS) hindfoot-ankle score, single-leg stance test (SLS), rescue analgesics consumption and patient satisfaction. Thirty-nine participants (88.64%) completed the study. Significantly improvement in the VAS and AOS was noted at 1-, 3-, and 6-month follow-ups (p < .001). The mean VAS pain decreased significantly from 4.1 ± 1.7 at baseline to 2.2 ± 1.9, 1.7 ± 1.5, and 1.8 ± 1.6 at 1, 3, and 6 months (p < .001). The mean total AOS score reduced by 1.5, 2.2, and 2.1 from baseline respectively postinjection (p < .001). The mean AOFAS hindfoot-ankle score improved from 80.3 points at baseline to 87.2, 91.6, and 89.7 points at 1, 3, and 6 months (p < .001). SLS tests improved significantly (p < .001) at each follow-up. Acetaminophen consumption dropped significantly (p < .001) and no serious adverse events occurred. The study showed promise for a single intraarticular injection of PRP in the treatment of ankle OA.

Usefulness of Therapeutic Hypothermia to Improve Survival in Out-of-Hospital Cardiac Arrest.

BACKGROUND: In recent years, therapeutic hypothermia (TH) has been used to improve outcomes in patients with out-of-hospital cardiac arrest (OHCA). Despite these recommendations, many centers are still hesitant to implement such hypothermia protocols. In this study, we assessed the effects of TH for OHCA patients. METHODS: A total of 58 OHCA patients who had return of spontaneous circulation after OHCA presumed to be due to cardiac causes were enrolled. Twenty-three patients underwent TH, which was performed using a large volume of ice crystalloid fluid infusions in the emergency room and conventional cooling blankets in the ICU to maintain a body temperature of 32-34 °C for 24 hours using a tympanic thermometer. Patients in the control group received standard supportive care without TH. Hospital survival and neurologic outcomes were compared. RESULTS: There were no significant differences between the groups in patient characteristics, underlying etiologies and disease severity. In the 23 patients who received TH, 17 were alive at hospital discharge. In the 35 patients who received supportive care, only 11 were alive at hospital discharge (73.91% vs. 31.43%, p = 0.0015). Approximately 52% of the patients in the TH group had good neurologic outcomes (12 of 23) compared with the 20% (7 of 35) of the patients in the supportive group (p = 0.01). CONCLUSIONS: TH can improve the outcomes of OHCA patients. Further large-scale studies are needed to verify our results.

Efficacy of intraarticular botulinum toxin A and intraarticular hyaluronate plus rehabilitation exercise in patients with unilateral ankle osteoarthritis: a randomized controlled trial.

BACKGROUND: There was an increasing requirement for novel treatments of osteoarthritis (OA). The aim was to compare the efficacy of intraarticular Botulinum toxin type A (BoNT-A) and intraarticular hyaluronate plus rehabilitation exercise in patients with ankle OA. METHODS: This was a prospective, randomized, assessor-blinded study with a 6-month follow-up period, conducted in the outpatient rehabilitation department at a university-affiliated tertiary care medical center. Seventy-five patients with symptomatic ankle OA (Kellgren-Lawrence grade 2) were randomized to receive either a single 100-unit BoNT-A injection into the target ankle (n = 38) or a single hyaluronate injection plus 12 sessions of rehabilitation exercise (30 minutes/day, 3 times/week for 4 weeks) (n = 37). The primary outcome measure was the Ankle Osteoarthritis Scale (AOS). Secondary outcome measures included American Orthopedic Foot and Ankle Society (AOFAS) Ankle/Hindfoot Score, visual analog scale (VAS) for ankle pain, single leg stance test (SLS), Timed "Up-and-Go" test (TUG), consumption of rescue analgesics and global patient satisfaction. RESULTS: There were no significant between-group differences in total AOS scores, pain subscale and disability subscale scores (adjusted mean difference AMD = -0.2, 95% CI = (-0.5, 0.2), p = 0.39; AMD = -0.1, 95% CI = (-0.5, 0.3), p = 0.57; AMD = -0.2, 95% CI = (-0.6, 0.2), p = 0.36). The 2 groups showed no significant differences in AOFAS, VAS, SLS, TUG scores and consumption of rescue analgesics at each follow-up visit, except that the hyaluronate group improved more in SLS than the BoNT-A group at 1-month follow-up. Patients' satisfaction rate was high, with no serious adverse events. There was no difference in adverse events between the two groups (p = 1.00). CONCLUSIONS: Treatment with intraarticular BoNT-A or hyaluronate injection plus rehabilitation exercise was associated with improvements in pain, physical function and balance in patients with ankle OA. These effects were rapid at 2 weeks and might last for at least 6 months. There was no difference in effectiveness between the two interventions. TRIAL REGISTRATION: The trial was registered at clinical trials.gov (Registry number NCT01760577).

The effect of three weekly intra-articular injections of hyaluronate on pain, function, and balance in patients with unilateral ankle arthritis.

BACKGROUND: Ankle arthritis can cause substantial pain and functional limitation. Previous studies have indicated that five weekly intra-articular injections of hyaluronate were safe and effective in the treatment of ankle osteoarthritis. The purpose of this study was to evaluate the effect and safety of three weekly injections of hyaluronate in patients with unilateral ankle arthritis. METHODS: Fifty patients who had had unilateral ankle pain for at least six months and were classified radiographically as having Kellgren-Lawrence grade-2 or 3 ankle arthritis were recruited for a prospective study. Patients received three weekly intra-articular injections of hyaluronate. The primary outcome was the change in the Ankle Osteoarthritis Scale score at six months after the third injection. Secondary outcomes included the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score, four clinical tests of balance, consumption of rescue analgesics, and global patient satisfaction. RESULTS: Forty-six participants completed the study. A significant reduction in the mean Ankle Osteoarthritis Scale score was noted at one, three, and six months after the third injection (p < 0.05 for each follow-up visit compared with baseline). The mean AOFAS Ankle-Hindfoot Score improved from 60.5 points at baseline to 73.5, 75.5, and 76.7 points at one, three, and six months of follow-up, respectively (p < 0.05). The patients demonstrated significant improvement on all four balance tests at each follow-up visit (p < 0.05 for each test compared with baseline). Acetaminophen consumption dropped significantly following treatment (p < 0.05). The patients' satisfaction rate was high, and no serious adverse events were reported. CONCLUSIONS: This study suggests that three weekly injections of hyaluronate are well-tolerated and can provide pain relief and improve function and balance in patients with unilateral ankle arthritis. Larger controlled trials with longer follow-up are necessary to verify the effects of hyaluronate in the treatment of ankle arthritis.

Calcaneal osteotomy preoperative planning system with 3D full-sized computer-assisted technology.

In this study, we developed a CT-based computer-assisted pre-operative planning and simulating system for the calcaneal osteotomy by integrating different software's function. This system uses the full-scaled 3D reverse engineering technique in designing and developing preoperative planning modules for the calcaneal osteotomy surgery. The planning system presents a real-sized three-dimensional image of the calcaneus, and provides detailed interior measurements of the calcaneus from various cutting planes. This study applied computer-assisted technology to integrate different software's function to a surgical planning system. These functions include 3-D image model capturing, cutting, moving, rotating and measurement for relevant foot anatomy, and can be integrated as the user's function. Furthermore, the system is computer-based and computer-assisted technology. Surgeons can utilize it as part of preoperative planning to develop efficient operative procedures. This system also has a database that can be updated and extended and will provide the clinical cases to different users for experienced based learning.

Surgical treatment of acute acromioclavicular joint injuries using a modified Weaver-Dunn procedure and clavicular hook plate.

Various surgical procedures have been described for the treatment of complete acromioclavicular joint dislocation, but no consensus exists on the optimal therapy. The aim of each type of procedure is to stabilize the clavicle by substitution of the ruptured coracoclavicular ligaments. Treatment modalities have changed with increasing understanding of the nature of the problem and the biomechanics of the joint. This article presents a method consisting of a modified Weaver-Dunn procedure and a clavicular hook plate for the operative management of acute acromioclavicular joint injuries.We performed a retrospective study of 46 patients who had undergone a modified Weaver-Dunn procedure with a clavicular hook plate for acute acromioclavicular joint injuries between July 2002 and December 2006. Average follow-up was 36.6 months (range, 24-46 months). There was 1 skin-deep infection, 1 dislocation of the hook, and 2 redislocations of the acromioclavicular joint. Thirteen patients had some calcification between the clavicle and the coracoid process, which did not cause loss of motion or other symptoms. All but 1 patient returned to work, and all but 1 returned to their preoperative activity level. The mean Constant score was 88.2 points. The mean Disabilities of the Arm, Shoulder, and Hand (DASH) score was 12.2 points.Treatment of acute acromioclavicular joint injuries using a modified Weaver-Dunn procedure and a clavicular hook plate showed good short-term clinical results with a low complication rate. Further investigation and long-term results are needed to confirm these preliminary findings.

Full-scale 3D preoperative planning system for calcaneal osteotomy with a multimedia system.

UNLABELLED: This study presents a new computer-assisted surgical planning and simulating system that employs a multimedia environment for calcaneal osteotomy surgery. The system uses a full-scale computer-assisted engineering technique for designing and developing preoperative planning modules. The planning system not only presents a real-sized 3-dimensional (3D) image of the calcaneus, but also provides detailed interior measurements of the calcaneus from various cutting planes. The multimedia user interface integrates the function of different software programs in order to plan and simulate the operation. These functions include 3D image model capturing, sectioning, translocation, rotating, and measuring relevant foot anatomy, all of which can be integrated and used for surgical planning, as well as for future study and discussion. Furthermore, because the system is computer based with a multimedia user interface, surgeons can use it to explore the optimal operative procedure. The system also has a databank that can be updated and expanded, and can be used to provide clinical cases to different users for education and training. LEVEL OF CLINICAL EVIDENCE: 5.

Hyaluronic acid as a treatment for ankle osteoarthritis.

Viscosupplementation refers to the concept of synovial fluid replacement with intra-articular injections of hyaluronic acid (HA) for the relief of pain associated with osteoarthritis (OA). Intra-articular viscosupplementation was approved by the Food and Drug Administration (FDA) in 1997. It is currently indicated only for the treatment of pain associated with knee OA. However, OA can occur in several of the weight-bearing joints of the foot and ankle. Ankle OA produces chronic disability that directly impacts the quality of life. There is only limited published literature relating to the use of HA in the ankle. This paper will review the authors' experience, indications, clinical outcomes, and complications of viscosupplementation therapy in patients with ankle OA.

Classification and mass production technique for three-quarter shoe insoles using non-weight-bearing plantar shapes.

We have developed a technique for the mass production and classification of three-quarter shoe insoles via a 3D anthropometric measurement of full-size non-weight-bearing plantar shapes. The plantar shapes of fifty 40-60-year-old adults from Taiwan were categorized and, in conjunction with commercially available flat or leisure shoe models, three-quarter shoe-insole models were generated using a CAD system. Applying a rapid prototype system, these models were then used to provide the parameters for manufacturing the shoe insoles. The insoles developed in this study have been classified into S, M and L types that offer user-friendly options for foot-care providers. We concluded that these insoles can mate tightly with the foot arch and disperse the pressure in the heel and forefoot over the foot arch. Thus, practically, the pressure difference over the plantar region can be minimised, and the user can experience comfort when wearing flat or leisure shoes.

Giant cell tumor of the EDL tendon sheath: an unusual cause of hallux valgus.

Hallux valgus is a lateral deviation of the proximal phalanx of the first metatarsophalangeal joint. It is a common disorder in adults. The etiologic factors include modern shoes, rheumatoid arthritis, pes planus, metatarsus primus varus, and trauma. Tumors causing hallux valgus deformities are unusual. We report a 50-year-old female with a hallux valgus deformity caused by a giant cell tumor of the second EDL tendon sheath. Surgical excision of the tumor and corrective osteotomy produced a permanent cure. This unusual cause of a hallux valgus deformity should increase awareness of tumors as a possible cause of foot deformities.

Efficacy of intra-articular hyaluronic acid in patients with osteoarthritis of the ankle: a prospective study.

OBJECTIVE: To investigate the efficacy, safety and the duration of treatment effectiveness of intra-articular hyaluronic acid (Artz, Japan) in patients with ankle osteoarthritis (OA). METHOD: As a prospective clinical trial, 93 patients with unilateral ankle pain for at least 6 months and radiographically classified as Kellgren-Lawrence grade I or II ankle OA were included. After five weekly intra-articular Artz injections, the Ankle Osteoarthritis Scale (AOS), the American Orthopaedic Foot and Ankle Society (AOFAS) ankle/hindfoot score, ankle sagittal range of motion (ROM), patients' global satisfaction, local adverse events and consumption of rescue analgesics were analyzed. RESULTS: Seventy-five patients completed the study. Significant improvement in AOS and AOFAS ankle/hindfoot scores was noted at 1 week, 1 month, 3 months and 6 months post the fifth injection (P < 0.001 compared with baseline). The mean reduction of AOS score was 1.9, 2.6, 2.5 and 2.6 at each following visit (P < 0.001). The mean AOFAS ankle/hindfoot score improved from 64 points at baseline to 75, 78, 78, and 78 points at 1 week, 1 month, 3 months and 6 months, respectively, post the fifth injection (P < 0.001). Ankle sagittal ROM did not improve significantly (P > 0.05). The majority of patients reported satisfaction at 1 week (100%), 1 month (100%), 3 months (90.7%) and 6 months (86.7%) follow-up. Local adverse events occurred in 6.7% of patients. Acetaminophen consumption dropped significantly following treatment (P < 0.001). CONCLUSION: Five weekly intra-articular injections of Artz provide pain relief and functional improvements in patients with Kellgren-Lawrence grades I and II ankle OA. The clinical effect was rapid at 1 week and may last for 6 months or more.

Hyaluronate improves pain, physical function and balance in the geriatric osteoarthritic knee: a 6-month follow-up study using clinical tests.

OBJECTIVE: To investigate the effects of intraarticular hyaluronic acid (HA) (Artzal, Seikagaku Corp., Japan) in geriatric participants with unilateral knee osteoarthritis (OA). METHOD: This was a prospective, observer-blind study with 6 months follow-up done in the setting of an outpatient rehabilitation department in a university-affiliated tertiary care medical center. Sixty-eight patients, aged 65 years or above, with symptoms and radiographic evidence of unilateral knee OA for at least 6 months were recruited. Patients received five weekly intraarticular injections of Artzal into symptomatic knees. Fifty-six participants completed the study. Fifty age-, body mass- and gender-matched healthy individuals were selected as control. Visual analog scale (VAS), Lequesne index and four balance tests including single-leg stance test (SLS), function reach test (FRT), timed "Up-and-Go" test (TUG) and Berg balance scale (BBS) were assessed before injection and at each follow-up visit in the OA group. Four balance tests were obtained on healthy participants for data comparison. RESULTS: Before Artzal injections, the OA group showed significantly worse VAS, Lequesne index and four balance tests scores than did the control group (P < 0.001). Significant improvement in all outcome measures were noted at 1 week, 1, 3 and 6 months post the fifth injection compared with baseline before injection. Local adverse events were reported in four patients (7.1%). CONCLUSION: Significant improvement in pain, physical function and balance tests was demonstrated after five weekly Artzal injections in geriatric patients with knee OA. The effect had rapid onset at 1 week and may last for 6 months.

Comparison of plain MRI and MR arthrography in the evaluation of lateral ligamentous injury of the ankle joint.

BACKGROUND: The purpose of this study was to determine the efficacy of plain magnetic resonance imaging (MRI) and magnetic resonance (MR) arthrography for detecting collateral ligamentous injury of the ankle joint. METHODS: Fifty patients (October 2001 to November 2003) suffering from ankle disability who underwent plain MRI and MR arthrographic studies were enrolled in this study. The diagnostic criteria for ligament disruption on plain MRI included nonvisualization, disruption, waviness of the ligament, or coexistent avulsion fracture. The MR arthrographic findings of ligament disruption were based on leakage of gadolinium contrast medium anterior to the anterior talofibular (ATaF) ligament following ATaF ligament disruption, and the contrast medium filling into the common peroneal tendon sheath after calcaneofibular (CF) ligament disruption. The 2 modalities were interpreted respectively and blindly. RESULTS: Seventeen patients received surgical intervention. There were 14 patients who had a torn ATaF ligament and 6 patients who suffered from CF ligament disruption proved by surgery. Limited detection of preoperative plain MRI survey, which showed 12 patients had torn ATaF and 2 patients had torn CF ligament, was noted. However, most patients with ligamentous injury were correctly diagnosed by MR arthrography preoperatively (only 1 case of CF injury was missed). The plain MRI alone had a higher incidence of false negative and false positive detection. MR arthrography was also valuable for evaluating the coexisting intra-articular pathologies of the ankle joint. CONCLUSION: For evaluating ankle disability, using plain MRI alone is not adequate for correctly detecting lateral collateral ligamentous injury of the ankle joint. MR arthrography improves the sensitivity and the accuracy for ATaF and CF ligament injuries. It also helps in assessing coexisting pathologic lesions of ankle joints, especially impingement syndromes and osteochondral lesions, and provides more information for therapeutic decision making.

Treatment of distal tibial metaphyseal fractures: Plating versus shortened intramedullary nailing.

BACKGROUND: Fractures in the distal tibial metaphysis are more complicated to treat than diaphyseal fractures. We compared treatment with plating to treatment with shorted intramedullary (IM) nailing. METHODS: Patients with AO type 43A fractures were treated with plate fixation (group A, n=14) or shortened IM nailing (group B, n = 13). We compared postoperative radiographic deformities, functional results (Iowa ankle scores), and symptoms (Olerud and Molander ankle scores). RESULTS: All fractures had healed at final follow-up (mean, 33 month). Mean union times were 27.8 week (range, 18-36 week) in group A and 22.6 week (range, 18-30 week) in group B (P<0.05). Mean postoperative valgus angulations were larger in group B (3.7 degrees ) than in group A (0.5 degrees ) (P<0.05). However, malunions did not differ between groups (P<0.05). Functional results and postoperative symptoms were similar. CONCLUSIONS: Both plate fixation and shortened IM nailing were effective for treating distal tibial metaphyseal fractures.

Coralline hydroxyapatite and laminectomy-derived bone as adjuvant graft material for lumbar posterolateral fusion.

OBJECT: The purpose of this study was to evaluate the effectiveness of coralline hydroxyapatite (CHA) and laminectomy-derived bone as an adjuvant graft material when combined with autogenous iliac bone graft (AIBG) in posterolateral fusion (PLF). METHODS: This prospective, case-control study involved 58 patients who underwent lumbar instrumentation-augmented PLF for degenerative spinal stenosis-induced segmental instability between July 2000 and June 2001. The patients were divided into three groups. Laminectomy bone and AIBG were placed in the right intertransverse process space in Group 1 (20 patients), CHA and AIBG were placed in Group 2 (19 patients), and laminectomy bone and CHA were placed in Group 3 (19 patients). Pure autogenous iliac cancellous bone graft was placed in the left intertransverse process space in all three groups of patients. Successful fusion was determined by two spine surgeons after examining the plain, anteroposterior, bilateral oblique, and lateral flexion-extension radiographs. If the examiners did not agree on fusion status, fine-cut computerized tomography scans of the fusion mass were used to make the final decision. The chi-square test was used to compare the fusion rate at different time intervals among the three groups. CONCLUSIONS: Pure AIBG placed in left intertransverse process space was associated with the best fusion rate. After 6 months, CHA produced a comparable result to laminectomy-derived bone when combined with AIBG. When laminectomy bone was mixed with CHA, the combination failed to yield a satisfactory fusion rate (57.9%) even 1 year after surgery if no AIBG was added.