RESUMO
Chronic ankle instability is a disabling condition, often occurring as a result of traumatic ankle injury. A paucity of published data is available documenting chronic ankle instability in the pediatric population. Much of the data has been confined to the adult population. We present 2 cases of chronic ankle instability, 1 in a 12-year-old and 1 in a 9-year-old patient. Unlike the typical adult etiology, the cause of instability was a dysfunctional lateral ligamentous complex as a consequence of bony avulsion of the tip of the fibula. Both patients had sustained a twisting injury to the ankle. The fractures failed to unite. The nonunion resulted in dysfunction of the anterior talofibular ligament with consequent chronic ankle instability. At the initial clinical assessment, magnetic resonance imaging was requested for both patients. In patient 1 (12 years old), the fracture was fixed with 2 headless screws and was immobilized in a plaster cast for 6 weeks. In patient 2 (9 years old), because of the small size of the avulsed fragment, fixation was not possible. A modified Gould-Broström procedure was undertaken, facilitating repair of the avulsed fragment using anchor sutures.
Assuntos
Fíbula/lesões , Fratura Avulsão/cirurgia , Fraturas não Consolidadas/complicações , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Articulação do Tornozelo , Parafusos Ósseos , Criança , Doença Crônica , Feminino , Fíbula/diagnóstico por imagem , Seguimentos , Fixação Interna de Fraturas/métodos , Fratura Avulsão/complicações , Fratura Avulsão/diagnóstico por imagem , Fraturas não Consolidadas/diagnóstico por imagem , Fraturas não Consolidadas/cirurgia , Humanos , Instabilidade Articular/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/fisiopatologia , Imageamento por Ressonância Magnética/métodos , Medição de Risco , Âncoras de Sutura , Resultado do TratamentoRESUMO
BACKGROUND: We wanted to assess the number of unnecessary radiographs done for acute knee injury patients and the accuracy of the Pittsburgh decision rules. MATERIAL AND METHODS: A retrospective observational study was done to look at the acute knee injury patients presented to a district general hospital Accident and Emergency Department from August 2011 till August 2013. We assessed the following parameters: sex, age, mechanism of injury, weight-bearing status and incidence of fractures in patients subjected to plain radiograph. A prospective study was then done from April 2014- August 2014 following implementation of the Pittsburgh decision rules. RESULTS: 24% of the patients had knee X-ray, compared to 72.12% in the first cycle. 36.8% had fracture, compared to 6.1% first cycle, with 66.7 % reduction in x-rays. Pittsburgh decision rules sensitivity was 100% and specificity 85.3%, positive predictive value 45.8% and accuracy 87%. CONCLUSIONS: 1. The Pittsburgh decision rules is highly sensitive, specific and accurate in determining the need of X-ray in acute knee Injuries. 2. We found that the Pittsburgh decision rules performs well in our hospital, which coincides with previously published literature.