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1: Osteoporos Int. 2003 Nov 5 [Epub ahead of print].
The fracture liaison service: success of a program for the evaluation and
management of patients with osteoporotic fracture.
McLellan AR, Gallacher SJ, Fraser M, McQuillian C.
Western Infirmary, Glasgow, UK.
Introduction: Fracture care often represents the first opportunity for
management of osteoporosis; however, many patients do not receive any
after a fracture. In Glasgow, Scotland, fewer than 10% of fracture patients
underwent bone mineral density (BMD) testing. In an effort to better meet the
needs of fracture patients by providing routine assessment and, where
treatment for osteoporosis after their fracture, a novel service (The
Liaison Service) was designed and implemented in two separate National Health
Service trusts in Glasgow. Methods: An agreed-upon standard of care for men
women 50+ years of age with fractures was established in collaboration with
orthopedic surgeons and primary care physicians. The Fracture Liaison Service
assumes responsibility for fracture case-finding and for assessing and
performing diagnostic evaluations (including axial DXA), and making specific
treatment recommendations for the secondary prevention of osteoporotic
fractures. Results: During the first 18 months of operation, more than 4,600
patients with fractures of the hip, wrist, humerus, ankle, foot, hand, and
sites were seen by the Fracture Liaison Service's osteoporosis specialist
nurses. Nearly three quarters of these patients were considered for BMD
treatment was recommended for approximately 20% of the patients without need
BMD testing. Overall, 82.3% of patients who had BMD testing were found to be
osteopenic or osteoporotic at the hip or spine. Conclusions: The Fracture
Liaison Service has successfully identified and evaluated most patients with
fractures. Only those patients who declined were not evaluated. The ultimate
success of the program will be measured by the subsequent fracture experience
these patients, but clear improvements in diagnosing and treating low bone
mineral density in patients with fracture have already been demonstrated.
PMID: 14600804 [PubMed - as supplied by publisher]
2: Osteoporos Int. 2003 Nov 4 [Epub ahead of print].
Radiocalcium absorption is reduced in postmenopausal women with vertebral and
most types of peripheral fractures.
Nordin BE, O'Loughlin PD, Need AG, Horowitz M, Morris HA.
Division of Clinical Biochemistry, Institute of Medical and Veterinary
Frome Road, 5000, Adelaide, South Australia, Australia.
Intestinal calcium absorption accounts for 60% of the variance in calcium
balance and is therefore a potentially very important determinant of bone
status. Whether measured by the balance technique or with radiocalcium, it is
known to be significantly reduced in postmenopausal women with vertebral and
fractures. By contrast, there is very little information about calcium
absorption in other types of postmenopausal fracture. We now report a series
549 untreated, Caucasian postmenopausal women in whom we recorded prevalent
fractures, measured radiocalcium absorption, and obtained radiographs of the
lateral thoracic and lumbar spine. Of these women, 172 had no prevalent
fractures, showed normal spine radiographs, and served as controls; 72 had
or more peripheral fractures but normal spine radiographs; 147 had one or
wedged or crushed vertebrae but no peripheral fractures; and 158 had a
of peripheral fracture and one or more fractured vertebrae. Age-adjusted
radiocalcium absorption was significantly lower in the two groups with spinal
fractures than in the controls ( P<0.001) but not in the group with
fractures only. It was also lower in the cases with more than two spinal
fractures than in those with two or less ( P<0.001). In respect of peripheral
fractures, the greatest age-adjusted absorption deficit was found in
of the humerus (35%) followed by hip (32%), spine (21%), wrist (19%), and rib
17% (all significant but not significantly different from each other). Lesser
deficits in tibia, ankle and foot fractures were not significant but type 2
errors could not be excluded. We conclude that impaired calcium absorption is
particularly associated with those fractures for which osteoporosis is a
significant risk factor.
PMID: 14598024 [PubMed - as supplied by publisher]
3: Foot Ankle Int. 2003 Oct;24(10):771-4.
Investigation of incidence of superficial peroneal nerve injury following
Redfern DJ, Sauve PS, Sakellariou A.
Frimley Park Hospital NHS Trust, Portsmouth Road, Frimley, Surrey, UK.
The aim of this study was to investigate the incidence of superficial
nerve (SPN) injury following ankle fracture and to establish whether this
differed between those treated by open reduction and internal fixation (ORIF)
and those treated nonoperatively in a cast. Two hundred eighty patients who
been treated for an ankle fracture either surgically (ORIF group) or
nonoperatively (cast group) were identified. Patients were invited for
assessed using the AOFAS scoring system, and examined for any evidence of SPN
injury. The surgical approach was documented and all fractures were
according to the Weber classification. A total of 120 patients returned for
review; 56 patients from the ORIF group and 64 patients from the cast group.
mean time from injury to review was 2 years (range, 12-36 months). Overall,
patients (15%) had a symptomatic SPN injury and these patients had a
significantly lower AOFAS score. In the cast group, 9% of patients had
symptoms from an SPN injury, compared to 21% of patients in the ORIF group (p
.05). No evidence of SPN injury was found in those who had a posterolateral
approach to the ankle. Surgeons should be aware that the SPN is at risk
lateral approach to the fibula and that injury to this nerve can frequently
identified as a cause of chronic ankle pain.
PMID: 14587991 [PubMed - in process]
4: Acta Orthop Traumatol Turc. 2003;37(4):299-303.
[Treatment of trimalleolar fractures. Is osteosynthesis needed in posterior
malleolar fractures measuring less than 25% of the joint surface?]
[Article in Turkish]
Katioz H, Bombaci H, Gorgec M.
Department of Orthopedics and Traumatology (Ortopedi ve Travmatoloji
Haydarpasa Numune Training and Research Hospital, Uskudar, Istanbul, Turkey.
OBJECTIVES: We evaluated the effect of posterior malleolar fractures, which
measured less than 25% of the joint surface, on the results of ankle
METHODS: The study included 44 patients (21 females, 23 males; mean age 44
years; range 17 to 76 years) who underwent surgical treatment for Weber types
or C ankle fractures. Fibula fractures were associated with deltoid ligament
ruptures in 12 patients, and with medial malleolar fractures in 32 patients.
Sixteen patients and 28 patients with and without posterior malleolar
respectively, were evaluated as separate groups according to the Phillips'
criteria for comparison of clinical, anatomical, and arthritic scores. The
follow-up was 29.5 months (range 18 to 64 months). RESULTS: There were no
significant differences between the two groups with regard to clinical and
anatomical scores. Although the mean arthritic score was higher in patients
a posterior malleolar fracture, it did not reach significance (p>0.05).
CONCLUSION: Our data show that satisfactory results can be achieved in
malleolar fractures measuring less than 25% of the joint surface when an
acceptable reduction is performed even without osteosynthesis.
PMID: 14578650 [PubMed - in process]
5: J Bone Joint Surg Am. 2003 Oct;85-A(10):1893-900.
Outcomes after treatment of high-energy tibial plafond fractures.
Pollak AN, McCarthy ML, Bess RS, Agel J, Swiontkowski MF.
Department of Orthopaedics, University of Maryland School of Medicine,
21201, USA.
BACKGROUND: Although a number of investigators have documented clinical
and complications associated with tibial plafond, or pilon, fractures, very
have examined functional and general health outcomes associated with these
fractures. Our purpose was to assess midterm health, function, and impairment
after pilon fractures and to examine patient, injury, and treatment
characteristics that influence outcome. METHODS: A retrospective cohort
of pilon fractures treated at two centers between 1994 and 1995 was
Patient, injury, and treatment characteristics were recorded from patient
interviews and medical record abstraction. Study participants returned to the
initial treatment centers for a comprehensive evaluation of their health
The primary outcomes that were measured included general health, walking
ability, limitation of range of motion, pain, and stair-climbing ability. A
secondary outcome measure was employment status. RESULTS: Eighty (78%) of 103
eligible patients were evaluated at a mean of 3.2 years after injury. General
health, as measured with the Short Form-36 (SF-36), was significantly poorer
than age and gender-matched norms. Thirty-five percent of the patients
substantial ankle stiffness; 29%, persistent swelling; and 33%, ongoing pain.
sixty-five participants who had been employed before the injury, twenty-eight
(43%) were not employed at the time of follow-up; nineteen (68%) of the
twenty-eight reported that the pilon fracture prevented them from working.
Multivariate analyses revealed that presence of two or more comorbidities,
married, having an annual personal income of less than 25,000 US dollars, not
having attained a high-school diploma, and having been treated with external
fixation with or without limited internal fixation were significantly related
poorer results as reflected by at least two of the five primary outcome
measures. CONCLUSIONS: At more than three years after the injury, pilon
fractures can have persistent and devastating consequences on patients'
and well-being. Certain social, demographic, and treatment variables seem to
contribute to these poor outcomes.
PMID: 14563795 [PubMed - in process]
6: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2003 Sep;17(5):367-9.
[Operative treatment of displaced talar neck fractures with absorbable lag
[Article in Chinese]
Liu LF, Cai JF, Liang J.
Traumatic Orthopedic Department, General Hospital of Jinan Military Command,
Jinan, Shandong, P. R. China 250031.
OBJECTIVE: To study a new kind of operation for displaced talar neck
METHODS: From April 1996 to March 2001, 9 talar neck fractures were treated
internal fixation of absorbable lag screw with a medial approach and cut of
medial malleolus to expose the fractures. A non-weight-bearing below-knee
was applied for 6 to 12 weeks after operation. Once union of the fracture
is apparent, the patient should remain non-weight bearing in a removable
short-leg and keep exercise every day. RESULTS: All the patients received
follow-up from 15 to 60 months with an average of 28 months. The fractures
healed from 20 to 42 weeks. The excellent and good rate of function was 77.8%
(7/9) according to American Orthopedic Foot and Ankle Society Score(AOFAS).
case had the complication of superficial infection of wound and skin edge
necrosis after operation, which was Hawkins type III. Late complication
two cases of avascular necrosis(AVN). Among them, one AVN of Hawkins type II
caused by early weight-bearing five weeks after operation and gained the fair
score. The other AVN of Hawkins type III was inefficient to conservative
and proceeded ankle fusion in the end. The AOFAS of the patient was bad.
CONCLUSION: Treatment of talar neck fractures by internal fixation of
lag screw with a medial approach is an ideal method. It can gain a
result by the operation, strict postoperative care and rehabilitation.
PMID: 14551931 [PubMed - in process]
7: Foot Ankle Int. 2003 Sep;24(9):724; author reply 724-6.
RE: Method for manual reduction of displaced intra-articular fracture of the
calcaneus: technique, indications and limitations, Omoto H, Nakamura K, Foot
Ankle Int. 22(11):874-879, 2001.
Kim DH, Berkowitz MJ.
Publication Types:
PMID: 14524525 [PubMed - in process]
8: J Reconstr Microsurg. 2003 Jul;19(5):295-8.
Gracilis muscle split into two free flaps.
Schoeller T, Meirer R, Gurunluoglu R, Piza-Katzer H, Wechselberger G.
University Hospital Innsbruck, Leopold-Franzens University, Innsbruck,
A case is presented in which the gracilis muscle was transversely split into
free flaps for coverage of two separate defects in a patient with a
multi-segment fracture of the metatarsal bones and the ankle joint.
PMID: 14506576 [PubMed - in process]
9: J Orthop Trauma. 2003 Sep;17(8):549-54.
Correction of tibial malunion and nonunion with six-axis analysis deformity
correction using the Taylor Spatial Frame.
Feldman DS, Shin SS, Madan S, Koval KJ.
Department of Orthopaedic Surgery, NYU-Hospital for Joint Diseases, 301 East
17th Street, New York, NY 10003, USA.
OBJECTIVE: To determine the effectiveness of six-axis analysis deformity
correction using the Taylor Spatial Frame for the treatment of posttraumatic
tibial malunions and nonunions. DESIGN: Retrospectively reviewed, consecutive
series. Mean duration of follow-up was 3.2 years (range 2-4.2 years).
Tertiary referral center for deformity correction. PATIENTS/PARTICIPANTS:
Eighteen patients were included in the study (11 malunions and 7 nonunions).
deformities were posttraumatic in nature. The mean number of operations
the application of the spatial frame was 2.6 (range 1-6 operations). All
patients completed the study. INTERVENTION: Six-axis analysis deformity
correction using the Taylor Spatial Frame (Smith & Nephew, Memphis, TN) was
for correction of posttraumatic tibial malunion or nonunion. Nine patients
bone grafting at the time of frame application. One patient with a tibial
plafond fracture simultaneously had deformity correction and an ankle fusion
a mobile atrophic nonunion. Two patients had infected tibial nonunions that
treated with multiple debridements, antibiotic beads, and bone grafting at
time of spatial frame application. A rotational gastrocnemius flap was used
cover a proximal third tibial defect in one patient. The average length of
the spatial frame was worn, time to healing, was 18.5 weeks (range 12-32
MAIN OUTCOME MEASUREMENTS: Assessment of deformity correction in six axes,
and ankle range of motion, incidence of infection, and return to preinjury
activities. RESULTS: Of the 18 patients treated with the Taylor Spatial
with adjunctive bone graft as necessary, 17 achieved union and significant
correction of their deformities in six axes (ie, coronal angulation and
translation, sagittal angulation and translation, rotation, and shortening).
Fifteen patients returned to their preinjury activities at last follow-up.
CONCLUSION: Six-axis analysis deformity correction using the Taylor Spatial
Frame is an effective technique to treat posttraumatic malunions and
of the tibia, with several advantages over previously used devices.
PMID: 14504575 [PubMed - in process]
10: Orthop Clin North Am. 2003 Jul;34(3):445-59.
Ankle and foot disorders in skeletally immature athletes.
Chambers HG.
Department of Orthopedic Surgery, University of California at San Diego, San
Diego, CA, USA.
As one of the most commonly injured areas in the immature athlete, the foot
ankle has many disorders. Knowledge of congenital and developmental
abnormalities and possible injury patterns enables the clinician to correctly
diagnose these disorders. Physical examination and appropriate use of imaging
technology provide confirmation of the initial impression. As children and
adolescents participate in sports with greater intensity, there is a higher
incidence of overuse injuries that may have long-term implications.
Publication Types:
Review, Tutorial
PMID: 12974494 [PubMed - indexed for MEDLINE]
11: Arthroscopy. 2003 Sep;19(7):E8-11.
Arthroscopic resection of an extra-articular tenosynovial giant cell tumor
the ankle region.
Spahn G, Bousseljot F, Schulz HJ, Bauer T.
Clinic of Arthroscopy and Joint Surgery, Eisenach, Germany.
This report describes the case of a 31-year-old man with a tenosynovial giant
cell tumor in the left ankle region. The tumor developed over a period of 5
months. A conservatively treated fracture of the leg in the patient's history
was important. The presurgical magnetic resonance imaging (MRI) examination
allowed a specific diagnosis and the exclusion of infiltrative properties of
tumor. The tumor was excised using an exclusively arthroscopic technique. The
procedure included treatment of intra-articular pathologies and the removal
of 2
loose bodies. The excision was complete and no recurrence or complication was
seen in 5 months' follow-up. In view of the possible recurrence (in about 50%
patients) and the unknown development of malignant tumors, arthroscopic
can be advantageous. This procedure includes small scars and lower risks of
infection and necrosis. Therefore, arthroscopic treatment of soft tissue
near the ankle joint may by an alternative to open excision.
PMID: 12966401 [PubMed - in process]
12: Clin Orthop. 2003 Sep;(414):37-44.
Open ankle fractures in patients with diabetes mellitus.
White CB, Turner NS, Lee GC, Haidukewych GJ.
Mayo Clinic, Rochester, MN 55905, USA.
Complications after surgical treatment of closed ankle fractures in patients
with diabetes previously have been well documented. The purpose of this study
was to evaluate the union rate, infection rate, and soft tissue complication
rate in open ankle fractures in patients with diabetes. Between January 1,
and December 31, 2000, 14 open ankle fractures in 13 patients with diabetes
treated. The mean followup was 19 months (range, 6-84 months). All patients
followed up until union, amputation, or for at least 6 months. Nine of 14
extremities (64%) had wound healing complications. Ultimately, five patients
(six extremities; 42%) had below the knee amputation. Only three of 14
in three patients healed without complications. Open ankle fractures in
with diabetes are limb-threatening injuries with high amputation and
rates despite contemporary techniques of open reduction and internal
intravenous antibiotics, and emergent irrigation and debridement.
PMID: 12966274 [PubMed - indexed for MEDLINE]
13: Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 2003 Sep;175(9):11937.
Rapid musculoskeletal magnetic resonance imaging using integrated parallel
acquisition techniques (IPAT)--initial experiences.
Romaneehsen B, Oberholzer K, Muller LP, Kreitner KF.
Klinik und Poliklinik fur Radiologie, Johannes Gutenberg-Universitat Mainz.
PURPOSE: To investigate the feasibility of using multiple receiver coil
for time saving integrated parallel imaging techniques (iPAT) in traumatic
musculoskeletal disorders. MATERIAL AND METHODS: 6 patients with traumatic
derangements of the knee, ankle and hip underwent MR imaging at 1.5 T. For
signal detection of the knee and ankle, we used a 6-channel body array coil
was placed around the joints, for hip imaging two 4-channel body array coils
two elements of the spine array coil were combined for signal detection. All
patients were investigated with a standard imaging protocol that mainly
consisted of different turbo spin-echo sequences (PD-, T (2)-weighted TSE
and without fat suppression, STIR). All sequences were repeated with an
integrated parallel acquisition technique (iPAT) using a modified sensitivity
encoding (mSENSE) technique with an acceleration factor of 2. Overall image
quality was subjectively assessed using a five-point scale as well as the
ability for detection of pathologic findings. RESULTS: Regarding overall
quality, there were no significant differences between standard imaging and
imaging using mSENSE. All pathologies (occult fracture, meniscal tear, torn
interpositioned Hoffa's cleft, cartilage damage) were detected by both
techniques. iPAT led to a 48 % reduction of acquisition time compared with
standard technique. Additionally, time savings with iPAT led to a decrease of
pain-induced motion artifacts in two cases. CONCLUSION: In times of
cost pressure, iPAT using multiple coil elements seems to be an efficient and
economic tool for fast musculoskeletal imaging with diagnostic performance
comparable to conventional techniques.
Publication Types:
Evaluation Studies
PMID: 12964073 [PubMed - indexed for MEDLINE]
14: Am J Orthop. 2002 Jan;31(1 Suppl):18-21.
The bioresorbable syndesmotic screw: application of polymer technology in
Miller SD, Carls RJ.
Department of Orthopaedic Surgery, The Union Memorial Hospital, Baltimore,
Maryland, USA.
A bioresorbable syndesmotic screw was used successfully for fixation in 4
patients, 3 with a bimalleolar Weber type-C ankle fracture and 1 with a
Maisonneuve-type injury. The 5-mm screw consisted of a polyglycolic
acid/polylactic acid copolymer placed in standard fashion at the time of open
reduction and internal fixation. The patients healed without difficulty, and
follow-up radiographs showed anatomic maintenance of the syndesmotic space.
There were no resorption problems. Signs of minimal irritation were noted at
screw-head site in 2 patients at 3 to 4 months after surgery, but the
did not hamper activity or rehabilitation. The screws maintained alignment.
Preliminary results suggest that a larger study to further evaluate the
of this screw is appropriate.
PMID: 12962245 [PubMed - indexed for MEDLINE]
15: Am J Orthop. 2002 Jan;31(1 Suppl):7-10.
Management of ipsilateral distal tibia and ankle fractures.
Henry SL.
Department of Orthopaedic Surgery, University of Kentucky School of Medicine,
Lexington, Kentucky, USA.
This study reviews 24 patients with ipsilateral fractures of the distal tibia
metaphysis and ankle joint. All fractures were evaluated and categorized by
mechanism of injury--that is, bending force versus torsion. All--tibial
fractures in this series were managed by a statically locked intramedullary
with appropriate stabilization of the ankle injury as indicated by the
or injury pattern. This treatment protocol resulted in an excellent clinical
result with only 3 patients requiring a secondary procedure: 2 dynamizations
1 exchanged intramedullary nail. The results indicate that fibular fractures
involving disruption of the syndesmosis or minimally displaced distal fibular
fractures may be treated nonoperatively. Conservative management or minimal
internal fixation may be recommended for minimally displaced fractures of the
medial malleolus or tibial plafond. Displaced fractures of the medial
or distal fibula or fractures in which the syndesmosis has been disrupted are
best treated with standard open reduction and internal fixation following
placement of the intramedullary nail.
PMID: 12962243 [PubMed - indexed for MEDLINE]
16: Foot Ankle Int. 2003 Aug;24(8):642-9.
Pseudo os trigonum sign: missed posteromedial talar facet fracture.
Giuffrida AY, Lin SS, Abidi N, Berberian W, Berkman A, Behrens FF.
Department of Orthopaedics, UMDNJ-New Jersey Medical School, Newark, NJ
BACKGROUND: Posteromedial talar facet fracture (PMTFF) is a rare injury,
sparsely reported in the literature. This article proposes that PMTFF is
left undiagnosed by orthopaedic surgeons and suggests the routine application
advanced radiographic studies (i.e., CT scan) in the recognition of PMTFF. It
also evaluates nonoperative management of PMTFF. METHODS: After obtaining
Institutional Review Board approval, the medical records over a 5-year period
(1997-2001) were retrospectively reviewed from the foot and ankle service of
level 1 trauma center, identifying all cases of PMTFF. Charts were reviewed
relevant data. Results of treatment were assessed during follow-up physical
examination. RESULTS: Six cases of PMTFF were identified over a 5-year
All injuries were associated with medial subtalar joint dislocation. Four of
(66%) patients were not initially diagnosed with PMTFF, but instead
as an os trigonum. The remaining two patients had an established diagnosis of
PMTFF at the time of initial treatment. All had short leg cast immobilization
for medial subtalar dislocation. CT evaluation yielded additional diagnoses
all six patients. All six patients showed a PMTFF. Five patients (83%)
persistent subtalar joint subluxation. Five of six (83%) patients required at
least one additional procedure as a result of an undiagnosed or
treated PMTFF. Four patients underwent subtalar joint fusion, and one patient
underwent tibiotalar calcaneal fusion secondary to concomitant ankle/subtalar
arthritis. The patient who did not undergo recommended fusion continued to be
symptomatic. CONCLUSIONS: Diagnosis of PMTFF necessitates a heightened
suspicion, especially when a medial subtalar joint dislocation is present.
Proper imaging studies, such as coronal CT scan, should be performed after
subtalar dislocation. Timely treatment, in the form of open reduction and
internal fixation for large fragments involving the articular surface or
surgical excision for smaller fragments, is recommended in order to restore
proper anatomy and function of the subtalar joint. This study verifies the
significant morbidity associated with an undiagnosed or nonoperatively
PMID: 12956572 [PubMed - in process]
17: Singapore Med J. 2003 Mar;44(3):155-9.
Clinics in diagnostic imaging (83). Occult tibial condylar fracture.
Singh K, Peh WC.
Department of Diagnostic Radiology, Singapore General Hospital, Outram Road,
Singapore 169608.
A 39-year-old man who presented with right knee pain following trauma was
to have a radiographically-occult fracture of the lateral tibial condyle on
magnetic resonance (MR) imaging. The intra-articular fracture was seen as a
curvilinear area of hypointensity on both T1- and T2- weighted MR images,
surrounding bone bruising. The MR appearances of occult fractures and bone
bruising, and the role of MR imaging in the detection of these injuries in
various other regions, such as the ankle, hip, elbow and wrist, are
PMID: 12953733 [PubMed - indexed for MEDLINE]
18: J Athl Train. 2002 Dec;37(4):463-466.
Longitudinal Split of the Peroneus Brevis Tendon and Lateral Ankle
Treatment of Concomitant Lesions.
Karlsson J, Wiger P.
Sahlgrenska University Hospital, Goteborg, Sweden.
OBJECTIVE: To describe the clinical picture, pathophysiology, and treatment
concomitant lesions of the peroneus brevis tendon and lateral ligament
to the ankle. BACKGROUND: In some cases, chronic lateral ankle instability is
associated with a longitudinal partial tear in the peroneus brevis tendon.
Patients who suffer from this lesion usually have atypical posterolateral
pain combined with signs of recurrent ligament instability ("giving way").
tendon injury is often overlooked because it is combined with the ligament
injury, and the injury mechanisms are similar. DESCRIPTION: Tears or laxity
the superior peroneal retinaculum allow the anterior part of the injured
peroneus brevis tendon to ride over the sharp posterior edge of the fibula,
leading to a longitudinal tear in the tendon. This combined injury should be
suspected in patients with recurrent giving way of the ankle joint and
retromalleolar pain. The diagnosis can be established using either
ultrasonography or magnetic resonance imaging. DIFFERENTIAL DIAGNOSIS:
injury, tenosynovitis, peroneus longus tendon lesion, os peroneum fracture,
distal peroneus brevis tendon tear, or anomalous peroneus tertius tendon.
TREATMENT: The tendon injury and the ligament insufficiency should be
at the same time. CONCLUSIONS: We recommend reconstruction of the superior
peroneal retinaculum, combined with repair of the tendon, using side-to-side
sutures and anatomical reconstruction of the lateral ankle ligaments.
PMID: 12937568 [PubMed - as supplied by publisher]
19: Foot Ankle Int. 2003 Jul;24(7):561-6.
Position of the distal fibular fragment in pronation and supination ankle
fractures: a CT evaluation.
Tang CW, Roidis N, Vaishnav S, Patel A, Thordarson DB.
Department of Orthopaedic Surgery, University of Southern California, Los
Angeles, CA 90033, USA.
BACKGROUND: Although classically the fibula has been reported to be in
rotation after supination-external rotation (SER) or pronation-external
(PER) ankle fractures, a previous CT study demonstrated that what had
traditionally been interpreted as external rotation of the distal fibular
fracture fragment is actually internal rotation of the proximal fibular
fragment. The purpose of this study was to evaluate a series of CT scans in
patients who have suffered type IV SER or PER ankle fractures to assess the
rotational deformity of the fibular fragment. MATERIALS AND METHODS: CT scans
the injured and uninjured extremities were performed on 30 extremities which
sustained either SER (21) or PER (9) injuries. The rotational relationship
between the tibia and fibula was determined by a measured rotational ratio. A
qualitative assessment of the rotational relationship between the tibia and
fibula above, at, and below the fracture site at the level of the mortise was
also performed. The difference in the ratio (calculated by subtracting the
rotation ratio of the normal side from the fracture side) demonstrated
the fractured fibula is externally or internally rotated compared to the
uninjured side. RESULTS: The average rotational ratio difference above the
fracture compared to below the fracture for the SER group demonstrated
significant external rotation (p < .001). The PER fracture also demonstrated
external rotation of the distal fragment compared to the proximal fragment (p
.002). Additionally, qualitative assessment of the relationship demonstrated
obvious change in the rotational relationship in any patient above the
site except one where mild internal rotation of the proximal fragment was
However, at the level of the mortise, all had a normal talofibular rotational
relationship while 24 of 30 had widening of the medial clear space with
rotation clearly evident on 15 of these 24 scans. CONCLUSION: Our study
demonstrated that the distal fibular fragment in both SER and PER fractures
externally rotated relative to both the contralateral normal side and
to the proximal fibular fragment.
PMID: 12921363 [PubMed - indexed for MEDLINE]
20: Osteoporos Int. 2003 Aug 12 [Epub ahead of print].
The association between osteoporotic fractures and health-related quality of
life as measured by the Health Utilities Index in the Canadian Multicentre
Osteoporosis Study (CaMos).
Adachi JD, Ioannidis G, Pickard L, Berger C, Prior JC, Joseph L, Hanley DA,
Olszynski WP, Murray TM, Anastassiades T, Hopman W, Brown JP, Kirkland S,
C, Papaioannou A, Poliquin S, Tenenhouse A, Papadimitropoulos EA.
Department of Medicine, St. Joseph's Hospital, McMaster University, Charlton
Avenue East, Suite 501, L8 N 1Y2, Hamilton, Ontario, Canada.
Osteoporotic fractures can be a major cause of morbidity. It is important to
determine the impact of fractures on health-related quality of life (HRQL). A
total of 3,394 women and 1,122 men 50 years of age and older, who were
for the Canadian Multicentre Osteoporosis Study (CaMos), participated in this
cross-sectional study. Minimal trauma fractures of the hip, pelvis, spine,
body (included upper and lower leg, knee, ankle, and foot), upper body
arm, elbow, sternum, shoulder, and clavicle), wrist and hand (included
hand, and finger), and ribs were studied. Participants with subclinical
vertebral deformities were also examined. The Health Utilities Index Mark II
III Systems were used to assess HRQL. Past osteoporotic fractures varied in
prevalence from 1.2% (pelvis) to 27.8% (lower body) in women and 0.3%
to 29.3% (wrist) in men. Multivariate linear regression analyses [parameter
estimates and corresponding 95% confidence intervals (CI)] indicated that
minimal trauma fractures were negatively associated with HRQL and that this
relationship depends on fracture type and gender. The multi-attribute scores
the Mark II system were negatively related to hip (-0.05; 95% CI: -0.09, 0.01),
lower body (-0.02; 95% CI: -0.03, -0.000), and subclinical vertebral
(-0.02; 95% CI: -0.03, -0.00) for women. The multi-attribute scores for the
III system were negatively related to hip (-0.09; 95% CI: -0.14, -0.03) and
fractures (-0.06; 95% CI: -0.11, -0.00) for women, and rib fractures (-0.06;
CI: -0.12, -0.00) for men. In conclusion, this study demonstrates a negative
association between osteoporotic fractures and quality of life in both women
PMID: 12920507 [PubMed - as supplied by publisher]
21: Eur J Vasc Endovasc Surg. 2003 Aug;26(2):176-8.
A comparison of patients who developed venous leg ulceration before and after
their 50th birthday.
MacKenzie RK, Brown DA, Allan PL, Bradbury AW, Ruckley CV.
Vascular Surgery Unit, Royal Infirmary, Edinburgh, Scotland, UK.
BACKGROUND: although chronic venous ulceration (CVU) is often viewed
as a disease of the elderly, recent epidemiological data suggest that a
significant proportion of patients first develop CVU before middle age. Such
patients may represent a distinct group in terms of aetiology, natural
prognosis and therapeutic options. AIM: to compare patients who developed CVU
before (Group 1) and after (Group 2) their 50th birthday. METHODS: one
and eighteen consecutive patients with "pure" CVU underwent history and
examination, measurement of ankle-brachial pressure index (ABPI) and duplex
ultrasound examination of the affected limb. Pure venous ulcers were defined
those of >4 weeks duration in the presence of venous reflux (>0.5) and in
association with an ankle: brachial pressure index of >0.8. RESULTS: patients
Group 1 (n = 54, 46%) were more likely to be male (32/54 [59%] vs 14/64
[23%], p
< 0.001 chi(2)), to have a higher median (interquartile [IQR]) body mass
(32 [27-39] vs 27 [23-34], p = 0.003, Mann-Whitney U [MWU]), to have a
of deep venous thrombosis (23/54 [43%] vs 16/64 [25%], p = 0.04 chi(2)) and
ipsilateral long bone fracture (13/54 [24%] vs 5/64 [8%], p = 0.01, chi(2)),
have previously undergone venous surgery (27/54 [50%] vs 19/64 [30%] a median
(IQR) of 11.5 (6.5-19) and 10 (2-20) years earlier respectively, and to have
worse disease in terms of the duration of present ulcer (12 (6-36) vs 8.5 [318]
months, p = 0.035 MWU), the total duration of ulcer disease (216 [72-360] vs
[12-120] months, p < 0.001 MWU), and the number of episodes of ulceration (3
[2-7] vs 1 [1-3], p = 0.002 MWU). There was no significant difference between
the two groups in the pattern and severity of venous reflux with 46/54 (85%)
Group 1 and 54/64 (84%) of Group 2 patients having surgically correctable
superficial venous reflux. CONCLUSION: patients who develop CVU before their
50th birthday appear to represent a distinct group in terms of aetiology,
natural history and prognosis. The importance of thrombo-embolic prophylaxis
the prevention, and the detection and correction of superficial venous reflux
the treatment, of such ulcers is re-emphasised.
PMID: 12917834 [PubMed - in process]
22: Magn Reson Imaging Clin N Am. 2003 May;11(2):311-21.
Winter sports injuries. The 2002 Winter Olympics experience and a review of
Crim JR.
Department of Radiology, University Hospital and Clinics, University of Utah
Health Sciences Center, 50 North Medical Drive, Salt Lake City, UT 84132,
Injury patterns at the 2002 Winter Olympics were similar to those in
recreational winter athletes, although injury rates were higher. The high
of injury compared with reported rates in recreational athletes reflect the
intensity of the competition and the high speeds of the athletes. In
rates are artificially elevated because we were not able to count the number
practice runs by each athlete, only the number of races. The highest rates of
injuries resulting in positive MR imaging or plain radiographs were in
snowboarders (28/1000 races), followed by alpine skiers (20/1000). In all of
winter sports, the most commonly injured joint was the knee (37 injuries),
the most common knee injury was the ACL tear. Injuries to the foot and ankle
were second in frequency (15 injuries). It is interesting that three of the
ankle injuries were syndesmosis sprains; this may be an underreported injury
winter sports. There were 12 injuries to the upper extremity, all but two to
shoulder. Back complaints were frequent, but only seven patients had
imaging abnormalities found in the lumbar spine: two stress fractures of the
pedicles, one acute pedicle fracture, one spondylolysis, and four disc
PMID: 12916893 [PubMed - in process]
23: Foot Ankle Clin. 2003 Jun;8(2):361-73, xi.
Use of allografts in the management of ankle arthritis.
Tontz WL Jr, Bugbee WD, Brage ME.
Department of Orthopaedic Surgery, University of California, San Diego, 200
Arbor Drive #8894, San Diego, CA 92103, USA.
Reconstruction of articular cartilage defects of the tibiotalar joint remains
challenge. Although arthrodesis and total ankle arthroplasty are treatment
options, we present fresh tibiotalar allografting as an alternative
The average age of 12 patients who underwent tibiotalar allografting was 43
years. The average follow-up was 21 months. All grafts healed at the
interface. Complications included intraoperative fracture in one patient and
graft collapse that required revision allografting in another. Most patients
were relieved of preoperative pain and were satisfied with the procedure.
Postoperative function was also significantly improved, based on
and physician assessment. Fresh tibiotalar allografting is an exciting and
promising technique in the treatment of articular cartilage defects in young,
active patients.
PMID: 12911247 [PubMed - indexed for MEDLINE]
24: Foot Ankle Clin. 2003 Jun;8(2):317-33.
Supramalleolar osteotomy: indications and technique.
Stamatis ED, Myerson MS.
Department of Orthopaedic Surgery, The Union Memorial Hospital, 3333 North
Calvert Street, #400, Baltimore, MD 21218, USA.
The distal tibial (supramalleolar) osteotomy for the treatment of pathologic
entities of the adult distal tibia and foot and ankle has received limited
attention in the literature. It is technically demanding and requires an
extensive and careful preoperative planning. In our experience, it has been a
useful tool in the surgical armamentarium to reconstruct the normal
environment in malunion preventing any long-term deleterious effects, and to
shift and redistribute loads in the ankle joint to protect the articular
cartilage from further degeneration.
Publication Types:
Review Literature
PMID: 12911244 [PubMed - indexed for MEDLINE]
25: J Orthop Trauma. 2003 Aug;17(7):534-5.
Achilles tendon rupture associated with injury of the calcaneofibular
Sugimoto K, Kasanami R, Iwai M, Takakura Y, Kawate K.
Department of Orthopaedic Surgery, Saiseikai Nara Hospital, Nara, Japan.
A 49-year-old man collided against an infielder when he slid into second base
during a recreational baseball game. He was unable to continue in the game
to diffuse pain and swelling of his hindfoot. A rupture of the Achilles
was diagnosed incidentally on palpation and observation of a positive
squeeze test. Subcutaneous hemorrhage at the lateral aspect of the heel and a
small bone fragment under the lateral malleolus on an anteroposterior plain
radiograph indicated a fracture of the calcaneal wall. At surgery, a complete
rupture of the Achilles tendon and an avulsion of the calcaneofibular
from the calcaneal wall were seen. Both injuries were surgically repaired,
the patient subsequently did well. The mechanism of injury was thought to be
impact hyperdorsiflexion of the ankle with rupture of the Achilles tendon
accompanied by an inversion injury. Using a literature search, it was found
this combination of injuries has not been previously reported.
PMID: 12902795 [PubMed - in process]
26: Physiother Res Int. 2003;8(2):69-82.
Performance after surgical treatment of patients with ankle fractures--14month
Nilsson G, Nyberg P, Ekdahl C, Eneroth M.
Research Department, Lund University Hospital, Department of Physical
Lund University, Sweden.
BACKGROUND AND PURPOSE: Few studies have been published that extensively
evaluate physical outcome after ankle fractures. In addition, there is a lack
knowledge of how physical outcome correlates with subjective assessments of
symptoms and function after ankle fracture. The purpose of the present study
to investigate outcome after surgical treatment of patients with ankle
and to study how well the experience of symptoms and function correlated with
the results of clinical physical tests. METHOD: The study used a
cross-sectional study design. Fifty-four patients, aged 17-64 years, were
evaluated 14 months post-operatively. Evaluation included a questionnaire
containing the Olerud-Molander Ankle Score (OMAS) (Olerud and Molander, 1984)
and some additional questions. Patients were also called for a physical and
radiographic examination. RESULTS: The median OMAS obtained was 75 (range
10-100). Only 10 (19%) of the patients reported complete recovery and 16
scored > or = 90, indicating good function. The results of the following
clinical tests were correlated with OMAS: loaded dorsal extension; ankle
circumference; number of toe and heel rises; and single-limb stance. Those
showed poorer results in physical outcome on the affected side had lower
No ankles with clear mechanical instability were found, although almost half
patients experienced functional instability that, in turn, was associated
decreased total OMAS. CONCLUSIONS: Both subjectively scored function and
physical performance after surgically treated ankle fractures indicated poor
results. One reason for this might be insufficient rehabilitation.
PMID: 12879729 [PubMed - in process]
27: J Am Podiatr Med Assoc. 2003 Jul-Aug;93(4):336-9.
Syndesmotic rupture without ankle fracture. A report of two cases in
professional football players.
Endean T, King W, Martin HR.
Department of Sports Medicine, Palo Alto Medical Foundation, Palo Alto, CA
94301, USA.
Two patients with syndesmotic rupture without fracture are presented to
demonstrate that ligamentous injury to the distal syndesmosis can occur as an
isolated injury. In both cases diagnosis was delayed owing to a negative
radiograph on the day of injury. Comprehensive follow-up is imperative to
correctly diagnose this injury pattern.
PMID: 12869606 [PubMed - indexed for MEDLINE]
28: J Am Podiatr Med Assoc. 2003 Jul-Aug;93(4):292-7.
Medial malleolar stress fractures. Literature review, diagnosis, and
Kor A, Saltzman AT, Wempe PD.
Kaiser Permanente, Temple Hills, MD 20748-2557, USA.
Medial malleolar stress fractures are relatively uncommon injuries that can
quite debilitating and disabling. This article discusses the symptoms,
diagnostic aids, pathomechanics, and management of medial malleolar stress
fractures. Using three cases, the authors illustrate nonoperative versus
operative treatments in an athlete and the influence of an in-season versus
off-season injury. A percutaneous cannulated screw fixation procedure is
described that allowed an athlete to return to competition 24 days after
sustaining a displaced medial malleolar stress fracture.
Publication Types:
Review, Tutorial
PMID: 12869598 [PubMed - indexed for MEDLINE]
29: Gynecol Obstet Fertil. 2003 Jun;31(6):543-5.
[Reflex sympathetic dystrophy involving the ankle in pregnancy:
and therapeutic management]
[Article in French]
Sergent F, Mouroko D, Sellam R, Marpeau L.
Clinique gynecologique et obstetricale, hopital Charles-Nicolle, CHU de
1, rue de Germont, 76031 Rouen cedex, France.
We report the case of a multigravida presenting in the first trimester of
pregnancy with reflex sympathetic dystrophy involving both ankles.
location of reflex sympathetic dystrophy in pregnancy is classically the hip
times out of 10). Symptoms develop mostly with primipara in the third
of pregnancy or in post-partum. Fracture is the major risk of reflex
dystrophy. Peculiarities of reflex sympathetic dystrophy's treatment in the
course of pregnancy are evoked. The end of the pregnancy can be shortened
the aim of stabilizing disease even to activate its healing. Pathophysiologic
mechanisms of reflex sympathetic dystrophy in pregnancy seem multiple and
complex. Our observation, by its atypical characteristics, recalls it.
PMID: 12865194 [PubMed - indexed for MEDLINE]
30: Am J Sports Med. 2003 Jul-Aug;31(4):511-7.
The incidence of injuries in elite junior figure skaters.
Dubravcic-Simunjak S, Pecina M, Kuipers H, Moran J, Haspl M.
Department of Physical Medicine and Rehabilitation, Sveti Duh General
Zagreb, Croatia.
BACKGROUND: There has been rapid growth in the technical and physiologic
made on skaters who perform more and more difficult jumps, spins, lifts,
and free skating movements. PURPOSE: To investigate the frequency of injuries
and overuse syndromes in elite junior skaters. STUDY DESIGN: Questionnaire.
METHODS: During four consecutive Junior World Figure Skating Championships
the Croatia Cup, we interviewed 236 female and 233 male skaters by
to determine the frequency of injuries and overuse syndromes. RESULTS:
Fifty-nine of the female skaters (25%) and 65 of the male skaters (27.9%)
reported sustaining acute injuries; 101 female (42.8%) and 106 male (45.5%)
skaters reported overuse syndromes. Low back pain was reported by 19 female
23 male skaters. The most frequent acute injury was ankle sprain. In singles
female skaters, the most frequent overuse injury was stress fracture (19.8%),
followed by jumper's knee (14.9%). In singles male skaters, jumper's knee
(16.1%) was the most frequent injury, followed by Osgood-Schlatter disease
(14.2%). More than 50% of injuries in young singles figure skaters involved
overuse syndromes. Pairs skaters and ice dance skaters had a higher risk of
acute injury than overuse syndrome because of falls from lifts and throw
CONCLUSIONS: Programs to improve postural alignment, flexibility, and
especially during the asynchronous period of bone and soft tissue
should be instituted to prevent and reduce overuse syndromes.
PMID: 12860537 [PubMed - in process]
31: J Bone Joint Surg Am. 2003 Jul;85-A(7):1321-9.
Uncemented STAR total ankle prostheses. Three to eight-year follow-up of
fifty-one consecutive ankles.
Anderson T, Montgomery F, Carlsson A.
Department of Orthopaedics, Malmo University Hospital, Sweden.
BACKGROUND: The feasibility of replacing the ankle joint has been a matter of
speculation for a long time. In recent years, the designs of ankle prostheses
have been improved, and three designs, all used without bone cement,
dominate the market. However, documentation of the clinical results of the
of these prostheses is sparse. We reviewed the intermediate-term results of
fifty-one consecutive Scandinavian Total Ankle Replacements (STAR). METHODS:
Between 1993 and 1999, fifty-one consecutive ankles were replaced with an
uncemented, hydroxyapatite-coated STAR total ankle prosthesis. Clinical
examination for the present study was performed by one surgeon who had not
part in the operations. Standardized radiographs were used. Complications and
failures were recorded, and patient satisfaction and functional outcome
were determined for all patients with an unrevised implant. RESULTS: Twelve
ankles had to be revised. Seven were revised because of loosening of at least
one of the components; two, because of fracture of the meniscus; and three,
other reasons. A component was exchanged in seven of the twelve revisions,
whereas the ankle was successfully fused in the other five. An additional
ankles had radiographic signs of loosening. The thirty-nine unrevised ankles
(thirty-seven patients) were examined after thirty-six to ninety-seven months
(median, fifty-two months). The patient was satisfied with the result after
thirty-one of the ankle replacements, somewhat satisfied after two, and not
satisfied after six. The median Kofoed score increased from 39 points before
surgery to 70 points at the time of the follow-up examination. A median
follow-up score of 74 points was recorded when the system described by Mazur
al. and the AOFAS (American Orthopaedic Foot and Ankle Society) system were
used. The median range of motion was approximately the same preoperatively
postoperatively. The estimated five-year survival rate, with revision for any
reason as the end point, was 0.70. When radiographic loosening of either
component was used as the end point, the estimated five-year radiographic
survival rate was significantly better for the last thirty-one ankles treated
the series (p = 0.032). CONCLUSIONS: Total ankle replacement may be a
alternative to arthrodesis, provided that the components are correctly
positioned and are of the correct size. However, the risks of loosening and
failure are still higher than are such risks after total hip or total knee
PMID: 12851358 [PubMed - indexed for MEDLINE]
32: J Bone Joint Surg Am. 2003 Jul;85-A(7):1185-9.
Lower-extremity function for driving an automobile after operative treatment
ankle fracture.
Egol KA, Sheikhazadeh A, Mogatederi S, Barnett A, Koval KJ.
Department of Orthopaedic Surgery, New York University-Hospital for Joint
Diseases, New York 10003, USA.
BACKGROUND: The purpose of this study was to determine when patients recover
ability to safely operate the brakes of an automobile following operative
of an ankle fracture. METHODS: A computerized driving simulator was developed
and tested. Eleven healthy volunteers were tested once to establish normal
values (Group I), and a group of thirty-one volunteers with a fracture of the
right ankle were tested at six, nine, and twelve weeks following operative
repair (Group II). The subjects were tested with a series of driving
(city, suburban, and highway). Scores on the Short Form Musculoskeletal
Assessment were recorded at six, nine, and twelve weeks and were compared
the results of the driving test. We investigated the effect of the time of
visit and of the testing condition on the braking times. RESULTS: The total
braking time was 1079 msec for Group I and 1330, 1172, and 1160 msec for
II at six, nine, and twelve weeks, respectively, postoperatively (p =
The total braking time consistently improved for each of the driving
at each successive data point (p = 0.05). The increase in the total braking
at six weeks meant an increase in the distance traveled by the automobile
braking of 22 ft (6.7 m) at 60 mph (96.6 km/hr), and the increase at nine
meant an increase of 8 ft (2.4 m) at 60 mph. The functional outcome improved
each successive visit, although no significant association was found between
functional scores and normalization of total braking time. CONCLUSION: By
weeks, the total braking time of patients who have undergone fixation of a
displaced right ankle fracture returns to the normal, baseline value.
PMID: 12851340 [PubMed - indexed for MEDLINE]
33: J Orthop Trauma. 2003 Jul;17(6):421-9.
High-velocity gunshot wounds of the tibial plafond managed with Ilizarov
external fixation: a report of 13 cases.
Yildiz C, Atesalp AS, Demiralp B, Gur E.
OBJECTIVE: To report the results of using Ilizarov fixation for the treatment
open tibial plafond fractures caused by high-velocity gunshot injuries.DESIGN
Retrospective review of consecutive patients. SETTING: Military academic
hospital. PATIENTS: Using the AO classification, three type C1, five type C2,
and five type C3 open tibial plafond fractures due to high-velocity gunshot
injuries were treated with irrigation, debridement, primary closure, and
Ilizarov fixation. Eleven of the fractures were type IIIA, and the remaining
were type IIIB according to the Gustilo-Anderson classification. There were
multiple traumas in one case. METHODS: Plafond fractures were treated by
Ilizarov technique in all 13 cases. In three of the cases, additional osseous
transport to eliminate a skeletal defect was performed. MAIN OUTCOME
Results were evaluated according to Bone's clinical grading system. RESULTS:
Average follow-up was 38.4 months (range 26 to 50 months). Callus began to
in 21 to 35 days (average 27.9 days). The fractures united in 126 to 154 days
(average 137.6 days), and the apparatus was removed from the limb at that
There were six good, three fair, and four poor results. Minimal skin necrosis
around the wound was seen in four cases, wound infection and purulent
were seen in two cases, and angular deformity was seen in two cases. Delayed
union and reflex sympathetic dystrophy were not seen in any cases. Although
tibiotalar narrowing was seen in four cases, no cases required tibiotalar
arthrodesis or subsequent bony reconstruction at the time of their most
follow-up. The average residual ankle range of motion was plantar flexion
degrees and dorsiflexion 11.5 degrees. CONCLUSIONS: Early aggressive
of nonviable tissues, stabilization with an Ilizarov external fixator, and
either primary or delayed primary closure followed by early ankle range of
motion and weight bearing is an alternative treatment method of these
PMID: 12843727 [PubMed - indexed for MEDLINE]
34: Clin Orthop. 2003 Jul;(412):131-8.
Outcome after single technique ankle arthrodesis in patients with rheumatoid
Kennedy JG, Harty JA, Casey K, Jan W, Quinlan WB.
Department of Orthopaedics, Hospital for Special Surgery, New York, NY 10021,
The established treatment for severe rheumatoid arthritis in the ankle is
arthrodesis. Numerous reports in the literature describe outcomes in patients
with degenerative and posttraumatic arthrosis and rheumatoid disease. This
led to results that are difficult to interpret. In addition, in the few
that have evaluated patients with rheumatoid disease many techniques of
arthrodesis are reported, further confounding assessment of one fusion
One technique of 20 ankle fusions in patients with rheumatoid disease was
evaluated. A modified Wagner arthrodesis was used through a transfibular
approach using parallel compression screws. The scoring systems of Mazur et
Moran et al, and the Short-Form-36 were used to evaluate the outcome. The
time to followup was 3 years 10 months. Eighteen of 20 fusions obtained a
talocrural union (90%). No correlation was found between the scores of Mazur
al and Moran et al. Correlation was achieved between the scores for the Short
Form-36 and Moran et al. The modified Wagner ankle arthrodesis is a simple,
reliable, reproducible technique with a 90% union rate. The value of the
technique has been confirmed in patients with rheumatoid arthritis by
the outcome using a scoring system that is validated and relevant to this
Publication Types:
Clinical Trial
PMID: 12838063 [PubMed - indexed for MEDLINE]
35: Ulus Travma Derg. 2003 Apr;9(2):145-8.
Management of Lisfranc's fracture-dislocation.
Pehlivan O, Akmaz I, Solakoglu C, Rodop O.
Gulhane Military Medical Academy, Haydarpasa Training Hospital, Department of
Orthopaedics and Traumatology, Istanbul, Turkey.
Lisfranc's joint injuries are rare and complex. A car driver who sustained a
traffic accident, was admitted because of partial dorsolateral
fracture-dislocation of the Lisfranc's joint. The diagnosis was made by
examination and radiographs. Reduction and pin fixation were performed under
general anesthesia. At the end of the ninth month, range of motion of the
and ankle was full, with no pain on daily activities.
PMID: 12836115 [PubMed - indexed for MEDLINE]
36: Curr Sports Med Rep. 2003 Jun;2(3):125-35.
Sideline management of fractures.
Hutchinson M, Tansey J.
University of Illinois at Chicago, Department of Orthopedics, Sports Medicine
Services, 209 Medical Sciences South, 901 South Wolcott, Chicago, IL 60612,
Athletes have the potential to sustain a myriad of injuries, ranging from
strains and overuse to fractures and dislocations. The team physician and
sideline medical professionals must be keenly aware of the risk potential,
have an emergency plan in place to address any potential injuries. Bone
can range from unstable, open fractures to overuse and stress fractures.
and players may challenge recommendations regarding not only treatment, but
return-to-play issues. The fundamental guideline must always be what is safe
the athlete. Decisions must be individualized for each athlete, anatomic
and injury. If the athlete is not at significant risk to himself, the
is healed or can be protected, and the athlete can function at his previous
level with a protective device, he may be able to return to sport.
PMID: 12831651 [PubMed - indexed for MEDLINE]
37: Rev Esp Anestesiol Reanim. 2003 Apr;50(4):192-6.
[Pulmonary embolism after placement of an Esmarch bandage for ankle surgery]
[Article in Spanish]
Paez Hospital M, Herrero Gento E, Buisan Garrido F.
Servicio de Anestesiologia, Reanimacion y Terapeutica del Dolor, Hospital
Clinico Universitario de Valladolid, Avd. Ramon y Cajal, 3 47005 Valladolid.
We report the case of a woman scheduled for surgical fixation of an ankle
fracture who developed a pulmonary embolism during application of an Esmarch
compression bandage for exsanguination of the limb. Tracheal intubation and
mechanical ventilation were needed to reanimate the patient and surgery had
be postponed 15 days. Orthopedic surgery, pneumatic tourniquets for providing
bloodless field and other risk factors contribute to the development of
pulmonary embolism, which is often fatal. Accurate diagnosis by plasma Ddimer
determination and imaging (perfusion scintigraphy, vascular Doppler
echocardiography and pulmonary angiography) is discussed, along with
approaches to consider when managing pulmonary embolism.
PMID: 12825308 [PubMed - indexed for MEDLINE]
38: Alcohol Alcohol. 2003 Jul-Aug;38(4):357-9.
Case report: managing fractures in non-compliant alcoholic patients--a
challenging task.
Charalambous CP, Zipitis CS, Kumar R, Hirst P, Paul AS.
Department of Trauma and Orthopaedics, Manchester Royal Infirmary,
AIMS: To investigate whether there are extractable conclusions for limb
management in dependent alcoholics. METHODS: We discuss four cases of
alcoholics who presented in our department over a 12-month period, and who
developed significant complications owing to non-compliance with treatment.
RESULTS: Initial treatment, although appropriate, failed because of
non-compliance. This led to further admissions, wound infections and surgery
enable cure. CONCLUSIONS: Our case reports indicate that for upper limb
fractures of the middle third of the humerus, non-operative treatment or
internal fixation with out-patient detoxification is appropriate. Lower limb
fractures, on the other hand, should be dealt with by external fixation and
in-patient detoxification. It is imperative that the alcohol dependence is
addressed if we are to decrease non-compliance.
PMID: 12814904 [PubMed - indexed for MEDLINE]
39: Foot Ankle Int. 2003 May;24(5):392-7.
Peroneus longus ligamentoplasty for chronic instability of the distal
tibiofibular syndesmosis.
Grass R, Rammelt S, Biewener A, Zwipp H.
Klinik fur Unfall-und Wiederherstellungschirurgie, Universitatsklinikum C. G.
Carus der Technischen Universitat Dresden, Fetscherstr. 74, D-01307 Dresden,
The distal tibiofibular syndesmosmotic ligament complex is important for
stability and congruency of the ankle joint. Syndesmotic lesions in the ankle
fracture-dislocations are well recognized and classified systematically.
insufficiency of the syndesmosis leads to a lateral shift of the talus and
eversion stress permits a pathological rotation of the talus. There is also
retroversion of the distal fibula representing a painful deformity. Little
experience exists with surgical reconstruction of the syndesmosis. This
describes a new ligamentoplasty with a split peroneus longus tendon graft
mimics the normal anatomic conditions of the syndesmotic complex in 16
with symptomatic chronic syndesmotic insufficiency after pronation-external
rotation and pronation abduction injuries to the ankle joint.
no infections or hematomas were seen. One patient had asymptomatic breakage
the syndesmosis screw; one patient had a 10 degree decrease of dorsiflexion
the ankle because of a partial anterior tibiofibular synostosis. Fifteen of
patients had pain relief at a mean follow-up period of 16.4 months (range,
months); all patients had relief of the chronic swelling of the ankle and the
giving way. The mean Karlsson score at follow-up was 88 (range, 70-100)
It may be concluded that peroneus longus ligamentoplasty in a preliminary
resulted in reliable ankle stability and considerable pain relief in patients
with chronic syndesmotic instability.
PMID: 12801194 [PubMed - indexed for MEDLINE]
40: J Ultrasound Med. 2003 Jun;22(6):635-40.
Sonographic diagnosis of talar lateral process fracture.
Copercini M, Bonvin F, Martinoli C, Bianchi S.
Departement de Radiologie, Division de Radiodiagnostic et de Radiologie
Interventionnelle, Hopital Cantonal Universitaire de Geneve, Geneva,
The frequency of fractures of the lateral process of the talus (LPT) has
markedly increased because of the expansion of snowboard activity. These
are difficult to diagnose, because they have aspecific signs, and standard
radiographs do not show the fractures in 50% of cases. Sonography is used
and more in the assessment of ankle trauma, but it is rarely performed for
detection of bone fractures. We report a case of a patient in which
directly showed an LPT fracture.
PMID: 12795560 [PubMed - in process]
41: Plast Reconstr Surg. 2003 Jun;111(7):2223-9.
Bone reconstruction of the lower extremity: complications and outcomes.
Pelissier P, Boireau P, Martin D, Baudet J.
Service de Chirurgie Plastique, Hopital Pellegrin-Tondu, Bordeaux, France.
A study was performed to analyze the results and final outcomes of bone
reconstruction of the lower extremity. Twenty-six patients presented with
IIIB open fractures, nine with type IIIC open fractures, and 15 with chronic
osteomyelitis. Seven patients underwent primary amputation, and
was attempted for 43 patients. The mean bone defect size was 7.7 cm (range, 3
20 cm). Bone reconstruction was achieved with conventional bone grafts in 16
cases, in association with either local (13 cases) or free (three cases)
Vascularized bone transfer was performed in 24 cases, with either
groin flaps (10 cases), soleus-fibula flaps (12 cases), or osteocutaneous
lateral arm flaps (two cases). For three patients, bone reconstruction was
performed with a technique that combines the induction of a membrane around a
cement spacer with the use of an autologous cancellous bone graft. Infections
were observed to be responsible for prolonged hospital stays and treatment
failures. The cumulative rates of sepsis were 4.6 percent at 1 week after
and 62.8 percent at 2 months. Vascular complications were also related to
infections and were responsible for four secondary amputations. One patient
asked for secondary amputation because of a painful nonfunctional lower limb.
Bone healing occurred in 37 of 43 cases, and the average time to union was
months, with an average of 8.7 procedures. The mean lengths of stay were 49
for conventional bone grafts and 62 days for vascularized bone grafts. All of
the 50 patients were able to walk, with an average time of 14 months. All of
patients with amputations underwent prosthetic rehabilitation. Patients
complained about the reconstructed limb (62.8 percent). Joint stiffness was
present in 40 percent of the cases. Other long-term complications were pain
(nine cases), lack of sensation (five cases), infection (five cases), and
pseudarthrosis (one case). However, all of the patients with successful
reconstructions preferred their salvaged leg to an amputation. Of 41 patients
who were working before the injury, 26 returned to work.
Publication Types:
Evaluation Studies
PMID: 12794463 [PubMed - indexed for MEDLINE]
42: Top Magn Reson Imaging. 2003 Apr;14(2):179-97.
Magnetic resonance imaging of sports injuries of the ankle.
Morrison WB.
Department of Radiology, Thomas Jefferson University Hospital, Philadelphia,
Pennsylvania 19107, USA.
Basic sports-related injuries of the ankle include ligament tear, tendon
degeneration and tear, bone bruise, fracture, impingement, osteochondral
and plantar fasciitis. This article discusses the magnetic resonance imaging
appearance of these injuries.
Publication Types:
Review, Tutorial
PMID: 12777889 [PubMed - indexed for MEDLINE]
43: Clin Podiatr Med Surg. 2003 Apr;20(2):335-59.
Progressive post-traumatic ankle arthrosis treated with total ankle joint
replacement: a case review.
Janis LR, Wilke B, Beasley BD, Ploot E, Lam AT.
Grant Podiatric Surgical Residency Program, Department of Medical Education,
Grant Medical Center, 111 S. Grant Avenue, Columbus, OH 43215, USA.
This article discusses the joint degeneration progression associated with
post-traumatic arthrosis of the ankle. A representative case study of this
debilitating condition was outlined, and treatment with total ankle joint
replacement was presented. Although ankle arthrodesis continues to be a
option following the progression of severe post-traumatic osteoarthritis,
ankle replacement is maturing as a viable option for this condition.
Publication Types:
Review, Tutorial
PMID: 12776985 [PubMed - indexed for MEDLINE]
44: Clin Orthop. 2003 May;(410):267-73.
Multicentric giant cell tumor of bone: a case report and review of the
Taylor KF, Yingsakmongkol W, Conard KA, Stanton RP.
Alfred I. duPont Institute, Wilmington, DE, USA.
Multicentric giant cell tumor of bone is the rare variant of a lesion that is
relatively common in a skeletally mature population. An otherwise healthy
13-year-old boy presenting with this entity was followed up for 6 years.
this period, the patient was diagnosed with and treated for six individual
lesions. One recurrence required resection, Ilizarov bone lengthening, and
subsequent ankle arthrodesis. He remains fully active and free of distant
Publication Types:
Review, Tutorial
PMID: 12771839 [PubMed - indexed for MEDLINE]
45: Injury. 2003 Jun;34(6):454-9.
Calcaneal fractures in adolescents. CT classification and results of
Buckingham R, Jackson M, Atkins R.
Bristol Royal Infirmary, Bristol, UK.
The morphology of calcaneal fractures in 9 adolescents (mean age 13.4 years)
with 10 fractures were classified using plain films and computed tomography
scans. The patterns were found to be similar to those in adults.All except
of the fractures (which was not significantly displaced) were treated with
reduction and internal fixation. In all cases it was possible to achieve
anatomic reduction and rigid internal fixation. Seven patients had
long-term clinical results. One patient with pending litigation scored
and one patient with an ipsilateral fracture of the talar neck scored 'fair'.
This patient had mild limitation of ankle movement, all others had full ankle
movement. Five had unrestricted subtalar movement, in two it was mildly
and in three it was moderately limited (50-80%). There was no evidence of
abnormality of the physes on follow up X-rays. We conclude that operative
treatment of this fracture yields good results.
PMID: 12767793 [PubMed - indexed for MEDLINE]
46: Nurs Stand. 2003 May 7-13;17(34):22.
Comment on:
Nurs Stand. 2002 Oct 23;17(6):37-46; quiz 47-8.
One step at a time.
Hayes J.
Shrewsbury School.
Publication Types:
PMID: 12764972 [PubMed - indexed for MEDLINE]
47: Ann Emerg Med. 2003 Jun;41(6):854-8.
Fracture of the lateral process of the talus associated with snowboarding.
Chan GM, Yoshida D.
Department of Emergency Medicine, Bellevue Hospital Center, New York
School of Medicine, New York, NY 10016, USA.
Snowboarding is one of the fastest-growing winter sports and is associated
a relatively high rate of ankle injuries. Presented is a patient who, after
falling while snowboarding, complained of lateral ankle pain and was
misdiagnosed with an ankle sprain. Further workup revealed a lateral process
the talus fracture, an injury that is rare outside of snowboarding. A lateral
process of the talus fracture should be suspected when there is a history of
inversion with dorsiflexion and there is tenderness over the lateral process
the talus. Results of plain films are negative up to 40% of the time, and
therefore a computed tomographic scan is the imaging modality of choice.
Treatment includes immobilization and not bearing weight for 4 to 6 weeks for
nondisplaced fractures or open reduction and fixation for displaced
Up to two thirds of patients with lateral process of the talus fractures
chronic pain. Early recognition may decrease this relatively high rate of
PMID: 12764342 [PubMed - indexed for MEDLINE]
48: Foot Ankle Clin. 2003 Mar;8(1):131-47, ix.
Complications of open reduction and internal fixation of ankle fractures.
Leyes M, Torres R, Guillen P.
Section of Foot and Ankle Surgery, Clinica Cemtro, Madrid, Spain.
This article discusses the complications after open reduction and internal
fixation of ankle fractures. Complications are classified as perioperative
(malreduction, inadequate fixation, and intra-articular penetration of
hardware), early postoperative (wound edge dehiscence, necrosis, infection
compartment syndrome), and late (stiffness, distal tibiofibular synostosis,
degenerative osteoarthritis, and hardware related complications). Emphasis is
placed on preventive measures to avoid such complications.
Publication Types:
Review, Tutorial
PMID: 12760580 [PubMed - indexed for MEDLINE]
49: Unfallchirurg. 2003 May;106(5):359-66.
[The role of the tibiofibular syndesmotic and the deltoid ligaments in
stabilizing Weber B type ankle joint fractures--an experimental
[Article in German]
Richter J, Schulze W, Clasbrummel B, Muhr G.
Chirurgische Universitatsklinik, Bergmannsheil, Bochum.
The purpose of the present biomechanical investigation was to check the
functional importance of the syndesmosis ligaments and of the deltoid
for ankle fracture type B according to the AO-Weber classification. We
constructed a special fixation clamp, with 12 fresh and unembalmed lower legs
being tested for lateral shift (mm) and ten for tibiotalar rotation. All
specimens were exposed in the same neutral position.Transverse loads (F(y))
varied between 0 and 150 N, axial loads (F(z)) between 0, 300, 600 and 1,000
and rotational loads (F(r)) between 2.4 and 4.9 Nm. All series were repeated
according to supination-eversion (SE) injury patterns of the Lauge-Hansen
classification. Syndesmotic ligaments and the fibula were incrementally
sectioned from anterior to posterior. Type SE I consisted of an isolated
incision of the anterior syndesmosis ligament. Type SE II had an additional
oblique fracture of the fibula at the height of the tibiofibular syndesmosis.
type SE III injuries, in addition to the fibular fracture, a complete rupture
the syndesmosis ligaments was present, and for type SE IV lesions the deltoid
ligaments were incised.The transverse load-displacement curve was s-shaped in
all uninjured joints,with the highest gradient between 10 and 20 N with no
compression. Without axial compression in cases of F(y)=25 N transverse
the mean talus translation was 0.51 mm. Following type II injuries, the
talus translation was 0.68 mm (not significant) and rose to an average of
mm ( P <0.01) in type III injuries. After additional incision of the deltoid
ligaments, the ankle joint subluxed permanently when more than 5-10 N
loads were applied. Axial loads of 300 N or more resulted in a considerable
reduction in talus translations, indicating increased stability and
within the joint complex. In this way, the vertical loading of the ankle
always contributed to joint stability. The average internal tibiotalar
reached with a torque of 2.4 Nm was 3.52 degrees and with 4.9 Nm 5.15 degrees
when no axial compression was applied.External rotation measured -6.36
and -8.62 degrees, respectively. Following the experimental protocol,
significant increases were noted for external rotation at SE II degrees
( P =0.003) and for internal rotation at SE III degrees ( P =0.03) injuries.
data support the proposition that the deltoid ligaments and the posterior
syndesmosis play a key role in the stability of ankle fractures for
supination-eversion injuries. If these structures remain intact, conservative
and early functional treatment are recommended in patients with minimal (<2
or no fracture displacement. This concept is confirmed by the literature
with clinical mid- and long-term follow-up studies.
PMID: 12750808 [PubMed - in process]
50: Foot Ankle Int. 2003 Apr;24(4):368-71.
Primary fusion as salvage following talar neck fracture: a case report.
Thomas RH, Daniels TR.
St. Michael's Hospital, Toronto, Ontario, Canada.
For a 29-year-old man with a three-week-old Hawkins Type IV talar neck
intra-operative reduction and fixation were not possible due to soft tissue
contractures and severe comminution. A primary talonavicular and subtalar
arthrodesis with the use of iliac crest bone graft was performed.
follow-up at 16 months demonstrated solid fusions, no avascular necrosis of
talus and a functional range of motion at the ankle. He was not capable of
returning to his job of roof maintenance.
PMID: 12735383 [PubMed - indexed for MEDLINE]
51: Foot Ankle Int. 2003 Apr;24(4):338-44.
Malunion following trimalleolar fracture with posterolateral subluxation of
talus--reconstruction including the posterior malleolus.
Weber M, Ganz R.
Department of Orthopaedic Surgery, University of Bern, Inselspital, 3010
Malunion after a malleolar fracture can include a displaced posterior
with associated posterolateral subluxation of the talus. Corrective osteotomy
including the posterior malleolus was performed in four patients. Joint
congruity was obtained in every case. The patients were followed for 46 to 80
months postoperatively. They all experienced an improvement in pain and three
four patients were unlimited in their walking capacity. Mild to moderate
residual symptoms were frequent. The symptoms were attributed to the damage
the cartilage and soft-tissues both from the initial injury and from
weightbearing on the incongruous joint. Discrete, non-progressive osteophytes
were seen in all patients. Delay in reconstruction did not preclude a good
result, although early reoperation is felt to be preferable.
PMID: 12735377 [PubMed - indexed for MEDLINE]
52: Med J Malaysia. 2002 Dec;57(4):426-32.
Vascular trauma in Penang and Kuala Lumpur Hospitals.
Lakhwani MN, Gooi BH, Barras CD.
Penang Adventist Hospital, Penang.
OBJECTIVES: The nature of vascular trauma varies greatly between continents
across time. The aim of this study was to prospectively analyse the
demographics, pathology, management and clinical outcomes of vascular
in two urban Malaysian hospitals and review of international literature on
vascular trauma. From this information, preliminary management and preventive
implications will be described. METHODS: Eighty-four consecutive cases of
requiring vascular surgery were prospectively analysed over three years at
Hospital Kuala Lumpur and Hospital Pulau Pinang, Malaysia. Extensive patient
demographic and injury data, including the mechanism of injury, associated
injuries, angiographic findings, operative details and post-operative
complications, were systematically gathered. RESULTS: Most vascular injuries
were incurred by males (76/84), with 37% (28/76) of them aged between 21 and
years. Malays were most frequently injured (n = 36) followed by Chinese and
Indians. Road traffic accidents (n = 49) substantially outnumbered all other
causes of injury. Lower limb injuries (n = 57) occurred more than twice as
as upper limb injuries (n = 27). Complete arterial transections (n = 43) and
intimal injuries (n = 27) were more common than arterial lacerations (n = 10)
and pseudoaneurysms (n = 4). The most frequently damaged vessels were the
popliteal/tibioperoneal trunk (n = 33). All patients received urgent Doppler
ultrasound assessment and, where possible, ankle-brachial systolic index
measurement. Of all patients, 40 received an angiogram, haemodynamic
making this investigation impractical in others. Primary arterial repair was
most frequently employed surgical procedure (n = 54) followed by autogenous
reverse long saphenous vein (LSV) interposition graft (n = 14), embolectomy
(n =
5) and PTFE interposition graft (n = 3). The most common post-operative
complication was wound infection (n = 11). Amputation, as a last resort, was
required in 13 cases following either primary or autogenous reverse LSV
complicated by sepsis or critical ischaemia. CONCLUSIONS: Vascular trauma,
especially in conjunction with severe soft tissue, nerve or orthopaedic
carries colossal physical, psychological, financial and social costs.
nerve and venous injury portended poor outcome in this study. Whilst
trauma was a common association, the concurrence of occult vascular trauma
soft tissue injury without fracture emphasises the crucial importance of
thorough and rapid clinical vascular assessment, investigation and surgical
intervention. Fasciotomy, especially for the lower limb, is important for the
prevention of compartment syndrome and its, limb-threatening sequelae.
preventive road safety promotion and interventions, with attention to highrisk
groups (young males and motorcyclists), is urgently required.
PMID: 12733167 [PubMed - indexed for MEDLINE]
53: J Bone Joint Surg Br. 2003 Apr;85(3):431-4.
Extra-articular extrusion of an osteochondral fragment of the talar dome.
Herscovici D Jr, Infante AF Jr, Scaduto JM.
Orthopaedic Trauma Service, Tampa General Hospital, Tampa, Florida, USA.
Osteochondral fractures of the talus are uncommon. They are classified
to Berndt and Harty, as progressing in severity through four stages. This
classification, however, does not address extra-articular extrusion of the
osteochondral fragment. We report an osteochondral lesion of the talar dome
which presented as an extruded extra-articular fragment in a closed injury of
the ankle. This type of lesion may offer a continuation to the four original
stages. Clinicians should be aware that this pattern of fracture can occur,
thus allow a more accurate diagnosis and the provision of some aid in the
treatment of these injuries.
PMID: 12729124 [PubMed - indexed for MEDLINE]
54: J Bone Joint Surg Br. 2003 Apr;85(3):334-41.
Total ankle replacement. The results in 200 ankles.
Wood PL, Deakin S.
Wrightington Hospital for Joint Disease, Wigan, England, UK.
Between 1993 and 2000 we implanted 200 cementless, mobile-bearing STAR total
ankle replacements. None was lost to follow-up for reasons other than the
of a patient. The mean follow-up was for 46 months (24 to 101). A
requiring further surgery developed in eight ankles and 14 were revised or
fused. The cumulative survival rate at five years was 92.7% (95% CI 86.6 to
98.8) with time to decision to revision or fusion as an endpoint. The most
frequent complications were delayed wound healing and fracture of a
These became less common with experience of the operation. The radiological
appearance of the interface of the tibial implant was significantly related
its operative fit and to the type of bioactive coating.
PMID: 12729104 [PubMed - indexed for MEDLINE]
55: J Bone Joint Surg Am. 2003 May;85-A(5):820-4.
Foot and ankle fractures in elderly white women. Incidence and risk factors.
Hasselman CT, Vogt MT, Stone KL, Cauley JA, Conti SF.
University of Pittsburgh, Pennsylvania, USA.
BACKGROUND: Although foot and ankle fractures are among the most common
nonspinal fractures occurring in older women, little is known about their
epidemiology. This study was designed to determine the incidence of and risk
factors for foot and ankle fractures in a cohort of 9704 elderly, nonblack
enrolled in the multicenter Study of Osteoporotic Fractures. METHODS: At
first clinic visit, between 1986 and 1988, the women provided information
regarding lifestyle, subjective health, and function. Bone mineral density
measured in the proximal and distal parts of the radius and in the calcaneus.
The women were followed for a mean of 10.2 years, during which time 301 of
had a foot fracture and 291 had an ankle fracture. The fractures were
with use of a modification of the Orthopaedic Trauma Association's
RESULTS: The incidence of foot fractures was 3.1 per 1000 woman-years, and
incidence of ankle fractures was 3.0 per 1000 woman-years. The most common
fracture was an isolated fibular fracture (prevalence, 57.6%), and the most
common foot fracture was a fracture of the fifth metatarsal (56.9%). Women
sustained an ankle fracture had been slightly younger at the time of study
enrollment than the women who did not sustain such a fracture (71.0 compared
with 71.7 years), they had a higher body mass index (27.6 compared with
and they were more likely to have fallen within the twelve months prior to
filling out the original questionnaire (38.1% compared with 29.7%). The
appendicular bone mineral density was not significantly different between
two groups of subjects. Women who sustained a foot fracture had a lower bone
mineral density in the distal part of the radius (0.345 g/cm (2) compared
0.363 g/cm (2) ) and a lower calcaneal bone mineral density (0.394 g/cm (2)
compared with 0.404 g/cm (2) ) than the women without a foot fracture, they
less likely to be physically active (62.3% compared with 67.8%), and they
more likely to have had a previous fracture after the age of fifty (45.5%
compared with 36.8%) and to be using either long or short-acting
benzodiazepines. CONCLUSIONS: Overall, foot fractures appeared to be typical
osteoporotic fractures, whereas ankle fractures occurred in younger women
with a
relatively high body mass index.
Publication Types:
Multicenter Study
PMID: 12728031 [PubMed - indexed for MEDLINE]
56: Orthopedics. 2003 Apr;26(4):415-8.
Diabetic neuroarthropathy (Charcot joints): the importance of recognizing
chronic sensory deficits in the treatment of acute foot and ankle fractures
diabetic patients.
Graves M, Tarquinio TA.
Department of Orthopedic Surgery and Rehabilitation, University of
Medical Center, 2500 N State St, Jackson, MS 39216, USA.
Patients with diabetic neuropathy are at a higher risk of developing
complications, especially Charcot arthropathy. Early diagnosis and
is the key to optimizing outcome. Therefore, diabetic patients with a lower
extremity injury should be screened with sensory testing using a 5.07
PMID: 12722914 [PubMed - indexed for MEDLINE]
57: Am Fam Physician. 2003 Apr 1;67(7):1438.
Comment on:
Am Fam Physician. 2002 Sep 1;66(5):785-94.
Differentiating foot fractures from ankle sprains.
Hatch RL.
Publication Types:
PMID: 12722843 [PubMed - indexed for MEDLINE]
58: Br J Plast Surg. 2003 Jan;56(1):66-9.
Use of Integra to resurface a latissimus dorsi free flap.
Moore C, Lee S, Hart A, Watson S.
Department of Burns and Plastic Surgery, Glasgow Royal Infirmary, Glasgow,
The successful use of Integra to cover a muscle flap as a secondary
reconstructive procedure is presented.
PMID: 12706160 [PubMed - indexed for MEDLINE]
59: Acta Orthop Traumatol Turc. 2003;37(2):133-7.
[Clinical results of tibial pilon fractures treated by open reduction and
internal fixation]
[Article in Turkish]
Kalenderer O, Gunes O, Ozcalabi IT, Ozluk S.
Izmir SSK Tepecik Egitim Hastanesi II. Ortopedi ve Travmatoloji Klinigi.
OBJECTIVES: We evaluated the results of pilon fractures treated by open
reduction and internal fixation. METHODS: The study included 18 patients
age 36 years; range 19 to 56 years) with pilon fractures. According to the
and Allgower's classification, there were three type I, nine type II, and six
type III fractures. Five fractures were open including three of GustiloAnderson
type II, and two fractures of type III. The results were assessed using the
Burwell-Charnley criteria. The mean follow-up was 54 months (range 9 to 86
months). RESULTS: According to the Burwell-Charnley criteria, the results
good in 12 patients (66%), fair in three patients (17%), and poor in three
patients (17%). The most common complication was posttraumatic degenerative
arthritis, followed by wound infection (22%), Sudeck atrophy (22%), delayed
union (17%), and angulation (11%). CONCLUSION: Early anatomical reduction, a
stable fixation, early mobilization, and delayed weight-bearing seem to
long-term results of treatment in pilon fractures caused by high energy
Publication Types:
Evaluation Studies
PMID: 12704252 [PubMed - indexed for MEDLINE]
60: J Foot Ankle Surg. 2003 Mar-Apr;42(2):99-104.
Early weight bearing after posterior malleolar fractures: An experimental and
prospective clinical study.
Papachristou G, Efstathopoulos N, Levidiotis C, Chronopoulos E.
Second Department of Orthopaedics, National and Kapodistrian University, St
Hospital, N. Ionia, Athens, Greece.
The distribution of axial load to the lower end of the tibia at different
positions of the ankle joint for the anterior, middle, and posterior part of
joint was studied in both photoelastic models and fractured ankle joints in
cadaveric specimens. Synthetic models were used to simulate both normal ankle
joints and ankles with fractures of the posterior lip of the tibia. Tests
performed with the ankle at dorsiflexed, neutral-flexed, and plantarflexed
positions of the ankle joint. The clinical portion of the study evaluated 15
patients with fracture of the posterior malleolus that comprised 0% to 33% of
the articular surface. All patients had open reduction and internal fixation
through a posterolateral or posteromedial approach, and were allowed full
bearing in a cast within 7 days of surgery. In the simulated models, the
posterior one fourth of the ankle joint remains unloaded in the majority of
cases. The stresses are greatly increased when the load is doubled and are
mainly distributed to the 2 central quadrants. With additional axial load,
fourth quadrant sustained little increase in the load bearing. All patients
had an uneventful recovery. By the second postoperative month, they were able
walk normally and had a painless range of motion of the ankle. By the third
month, all patients were able to undertake their daily activities, and all
fractures were consolidated. The clinical relevance of this study is early
weight bearing, after open reduction internal fixation of posterior malleolar
fracture of the ankle joint, facilitates recovery, promotes fracture union,
allows the patient to assume normal activity by the third month after
(The Journal of Foot & Ankle Surgery 42(2):99-104, 2003)
PMID: 12701079 [PubMed - in process]
61: Int Orthop. 2003;27(2):98-102. Epub 2002 Dec 11.
Lisfranc injuries: patient- and physician-based functional outcomes.
O'Connor PA, Yeap S, Noel J, Khayyat G, Kennedy JG, Arivindan S, McGuinness
Department of Orthopaedic Surgery, Cork University Hospital, Wilton, Ireland.
The purpose of this study was to assess functional outcome of patients with a
Lisfranc fracture dislocation of the foot by applying validated patient- and
physician-based scoring systems and to compare these outcome tools. Of 25
injuries sustained by 24 patients treated in our institution between January
1995 and June 2001, 16 were available for review with a mean follow-up period
36 (10-74) months. Injuries were classified according to Myerson. Outcome
instruments used were: (a) Medical Outcomes Study 36-Item Short Form Health
Survey (SF-36), (b) Baltimore Painful Foot score (PFS) and (c) American
Orthopedic Foot and Ankle Society (AOFAS) mid-foot scoring scale. Four
had an excellent outcome on the PFS scale, seven were classified as good,
fair and two poor. There was a statistically significant correlation between
PFS and Role Physical (RP) element of the SF-36.
PMID: 12700933 [PubMed - indexed for MEDLINE]
62: Instr Course Lect. 2003;52:647-59.
The surgical management of pediatric fractures of the lower extremity.
Flynn JM, Skaggs DL, Sponseller PD, Ganley TJ, Kay RM, Leitch KK.
Children's Hospital of Philadelphia, University of Pennsylvania,
Pennsylvania, USA.
The majority of pediatric fractures of the lower extremity can and should be
treated with closed reduction, immobilization, and close follow-up. However,
there is an ongoing debate in the orthopaedic community regarding the exact
of surgical management in the treatment of pediatric fractures. In the past 2
decades, surgical management of certain fractures provided markedly better
results than closed management. In certain cases, such as those requiring
anatomic realignment of the physis or articular surface, there are clear
indications for surgical management. Increasingly, however, surgical
is being used to maintain optimal alignment, to allow early motion, or to
facilitate mobilization of children with a lower extremity fracture. For many
types of fractures, both nonsurgical and surgical methods have yielded good
results and have vocal advocates. Certain technical advances, such as the use
flexible intramedullary fixation and bioreabsorbable implants, have further
increased enthusiasm for surgical management of pediatric fractures of the
Publication Types:
Review, Tutorial
PMID: 12690889 [PubMed - indexed for MEDLINE]
63: Liver Transpl. 2003 Apr;9(4):373-6.
The safety and outcome of joint replacement surgery in liver transplant
Levitsky J, Te HS, Cohen SM.
Center for Liver Diseases, Gastroenterology Division, University of Chicago
Hospitals, Chicago, IL.
A small group of patients may require total hip arthroplasty, total knee
arthroplasty, or other joint replacement surgery after OLT for osteoporotic
fractures, osteonecrosis, and osteoarthritis. Although arthroplasty is safe
the general population, its safety in liver transplant recipients is unclear.
The aim of the study was to determine the safety and outcome of joint
replacement surgery in our liver transplant recipients. A retrospective
was performed on all liver transplant recipients who had total joint
arthroplasty at a single teaching institution between 1986 and 2002. Data
regarding major intraoperative and postoperative complications was obtained
the medical charts and a hospital-based computer system. Of over 1,200 liver
transplant recipients, we identified 7 patients who underwent 12 total
arthroplasties (8 knee, 3 hip, 1 ankle). Joint replacements were performed
electively for osteonecrosis (5 of 12) and osteoarthritis (5 of 12), whereas
hip arthroplasties were performed emergently for fractures. All patients with
osteonecrosis or hip fracture had been treated with prolonged
There were no deaths or major complications in the intraoperative and
postoperative periods. On long-term follow-up, no patients have had pain,
dislocation, or infection in the postsurgical joint. No joint revision
has been required. In conclusion, a small number of stable liver transplant
recipients at our institution underwent joint replacement surgery without
short-term or long-term complications. Our study suggests that joint
surgery may be safely and successfully performed in this population, although
larger, randomized, prospective trials are needed to confirm our findings.
PMID: 12682889 [PubMed - in process]
64: Singapore Med J. 2002 Nov;43(11):566-9.
Riding motorcycles: is it a lower limb hazard?
Lateef F.
Department of Emergency Medicine, Singapore General Hospital, 1 Hospital
Outram Road, Singapore 169608.
The morbidity and mortality among motorcyclists involved in road traffic
accidents (RTA) in Singapore is high. Due to their relatively small size,
represent a vulnerable group of road-users. Many reports from studies
overseas have shown that both lower limb and head injuries appear to be
among motorcyclists. OBJECTIVES: To study the characteristics of lower limb
injuries among motorcyclists involved in RTA, who present to the Department
Emergency Medicine of an urban, tertiary, teaching hospital for treatment.
METHODS: The study was conducted prospectively from 1 July 2000 to 30 June
Demographic data was collected together with details of the type of injuries,
mechanism involved, management and disposition. SPSS (Chicago, Inc.) was
utilised for data management and statistical analysis. RESULTS: Of the 1,809
motorcyclists studied, 1,056 (58.3%) sustained lower limb injuries, 328
had head injuries and 256 (14.2%), sustained facial injuries. The mean age
26.4 +/- 7.2 years and males made up the majority of the patients (1,733,
95.8%). Helmet usage was 100%.The commonest type of lower limb injury was
fractures (531, 50.3%).The most common type of fracture was that of the shaft
the tibia and fibula (231, 43.5%), followed by fractures around the ankle
35.0%). For those with more than one body region injured, head injury was
to be not commonly associated with lower limb injuries. The commonest
of injury was collision with another vehicle, while approaching a turn (769,
42.5%).There were 96 motorcyclists (5.3%) who had clinical evidence of
consumption on their breath at presentation. There were 533 (29.5%) patients
were admitted for in-patient management and the mean duration of stay was 4.8
+/- 4.5 days.Amongst those with lower limb injuries, the admission rate was
30.5% (322 of 1,056) and the mean duration of hospitalisation was 5.3 +/- 3.9
days. CONCLUSION: Lower limb injuries represent the commonest form of injury
among motorcyclists involved in RTA. Improved training via motorcycle rider
education, better design of future motorcycles and protective footwear may
to reduce this problem.
PMID: 12680525 [PubMed - indexed for MEDLINE]
65: J Orthop Trauma. 2003 Apr;17(4):241-9.
Complications following management of displaced intra-articular calcaneal
fractures: a prospective randomized trial comparing open reduction internal
fixation with nonoperative management.
Howard JL, Buckley R, McCormack R, Pate G, Leighton R, Petrie D, Galpin R.
Canadian Orthopedic Trauma Society, Calgary, Alberta, Canada.
OBJECTIVE: To report on all complications experienced by patients with
intra-articular calcaneal fractures (DIACFs) following nonoperative
or open reduction internal fixation (ORIF). DESIGN: Prospective, randomized,
multicenter study. SETTING: Four level I trauma centers. PATIENTS: The
population consisted of consecutive patients, age 17 to 65 at the time of
injury, presenting to 1 of the centers with DIACFs between April 1991 and
December 1998. INTERVENTIONS: Patients were randomized to the nonoperative
treatment group or to operative reduction using a lateral approach to the
calcaneus. MAIN OUTCOME MEASUREMENTS: Follow-up for patients was at 2 weeks,
weeks, 3 months, 12 months, 24 months, and once greater than 24 months
injury. At each follow-up interval, patients were assessed for the
of major and minor complications. After a minimum of 2-year follow-up,
were asked to fill out a validated visual analogue scale questionnaire (VAS)
a general health review (SF-36). RESULTS: There were 226 DIACFs (206
in the ORIF group with 57 of 226 (25%) fractures (57 of 206 patients [28%])
having at least 1 major complication. Of 233 fractures (218 patients)
nonoperatively managed, 42 (18%) (42 of 218 patients [19%]) developed at
least 1
major complication (indirectly resulting in surgery). CONCLUSION:
occur regardless of the management strategy chosen for DIACFs and despite
management by experienced surgeons. Complications are a cause of significant
morbidity for patients. Outcome scores in this study tend to support ORIF for
calcaneal fractures. However, ORIF patients are more likely to develop
complications. Certain patient populations (WCB and Sanders type IV)
developed a
high incidence of complications regardless of the management strategy chosen.
Publication Types:
Clinical Trial
Multicenter Study
Randomized Controlled Trial
PMID: 12679683 [PubMed - indexed for MEDLINE]
66: Emerg Med (Fremantle). 2003 Apr;15(2):126-32.
Validation of the Ottawa Ankle Rules in Australia.
Broomhead A, Stuart P.
Emergency Department, Lyell McEwin Health Service, Adelaide,
OBJECTIVE: This study was a prospective validation of the Ottawa Ankle Rules
(OAR) in Australia following appropriate education in the use of the rules.
METHODS: The OAR were applied to consecutive patients 18 years and over
presenting with acute ankle and foot injuries to the ED of an urban teaching
hospital. RESULTS: Three hundred and thirty-three patients had 366 injuries.
There were 43 fractures in 265 ankle injuries and 14 fractures in 101 foot
injuries. Sensitivity was 100% for ankle (95% confidence interval (CI): 92100)
and midfoot fractures (95% CI: 77-100). Specificity was 15.8% (95% CI: 11-21)
for ankle fractures and 20.7% (95% CI: 13-31) for midfoot fractures.
The OAR had a sensitivity of 100% for ankle and midfoot fractures when used
both junior and senior physicians.
Publication Types:
Validation Studies
PMID: 12675622 [PubMed - indexed for MEDLINE]
67: J Bone Joint Surg Am. 2003 Apr;85-A(4):604-8.
Effect of fibular plate fixation on rotational stability of simulated distal
tibial fractures treated with intramedullary nailing.
Kumar A, Charlebois SJ, Cain EL, Smith RA, Daniels AU, Crates JM.
University of Tennessee-Campbell Clinic, Memphis, Tennessee 38104, USA.
BACKGROUND: The effect of an intact fibula on rotational stability after a
distal tibial fracture has, to the best of our knowledge, not been clearly
defined. We designed a cadaver study to clarify our clinical impression that
fixation of the fibula with a plate increases rotational stability of distal
tibial fractures fixed with a Russell-Taylor intramedullary nail. METHODS:
matched pairs of embalmed human cadaveric legs and sixteen fresh-frozen human
cadaveric legs, including one matched pair, were tested. To simulate
5-mm transverse segmental defects were created at the same level in the tibia
and fibula, 7 cm proximal to the ankle joint in each bone. The tibia was
stabilized with a 9-mm Russell-Taylor intramedullary nail that was statically
locked with two proximal and two distal screws. Each specimen was tested
fibular fixation as well as with fibular fixation with a six-hole semitubular
plate. A biaxial mechanical testing machine was used in torque control mode
an initial axial load of 53 to 71 N applied to the tibial condyle. Angular
displacement was measured in 0.56-N-m torque increments to a maximal torque
4.52 N-m (40 in-lb). RESULTS: Initially, significantly less displacement (p <
= 0.05) was produced in the specimens with fibular plate fixation than in
without fibular plate fixation. The difference in angular displacement
the specimens treated with and without plate fixation was established at the
first torque data point measured but did not increase as the torque was
increased. No significant difference in the rotational stiffness was found
between the specimens treated with and without plate fixation after
of the second torque data point (between 1.68 and 4.48 N-m). CONCLUSIONS:
Fibular plate fixation increased the initial rotational stability after
tibial fracture compared with that provided by tibial intramedullary nailing
alone. However, there was no difference in rotational structural stiffness
between the specimens treated with and without plate fixation as applied
was increased.
PMID: 12672833 [PubMed - indexed for MEDLINE]
68: Clin Orthop. 2003 Apr;(409):260-7.
Syndesmotic disruption in low fibular fractures associated with deltoid
Ebraheim NA, Elgafy H, Padanilam T.
Department of Orthopaedic Surgery, Medical College of Ohio, Dowling Hall 3065
Arlington Avenue, Toledo, OH 43614-5807, USA.
Low fibular fractures that were associated with deltoid ligament disruption
inferior tibiofibular syndesmotic disruption were studied. All of the
had a Type B Weber fibular fracture associated with a deltoid ligament
It was difficult to detect the syndesmosis disruption on the initial
of the anteroposterior and mortise radiographs obtained preoperatively
there was no obvious talar shift on the plain radiograph. Careful evaluation
the plain radiograph and determination of all the recommended measurements
necessary to diagnose the syndesmotic disruption. However, the syndesmotic
disruption was easily recognizable on axial computed tomography scans when
comparing the injured and the noninjured sides. Axial computed tomography
also showed a shallow incisura fibularis in all patients and in three cases
revealed anterior fibular subluxation that was not appreciated on the plain
radiographs obtained preoperatively. On the basis of the current study using
level of the fibular fracture as a guideline for application of the
screw as suggested by some authors may not be accurate. There are several
factors that should be considered including the depth of the incisura
posterior malleolus fractures, deltoid ligament injury, and subluxation of
fibula. The surgeon's impression in the operating room of syndesmosis
should be considered as the best guideline in the application of syndesmosis
fixation rather than depending on the level of the fibular fracture.
PMID: 12671510 [PubMed - indexed for MEDLINE]
69: Clin Orthop. 2003 Apr;(409):241-9.
Salvage of distal tibia metaphyseal nonunions with the 90 degrees cannulated
blade plate.
Chin KR, Nagarkatti DG, Miranda MA, Santoro VM, Baumgaertner MR, Jupiter JB.
Department of Orthopaedics, Massachusetts General Hospital and Harvard
School, Boston, MA, USA.
Nonunion of distal tibia metaphyseal fractures after trauma is a major
Treating these nonunions is made more challenging by the presence of
ipsilateral tibiotalar arthrosis. The current study examined the use of the
degrees cannulated blade plate as an alternative method of stable internal
fixation for 13 distal tibia metaphyseal nonunions and simultaneous fusion of
three arthritic tibiotalar joints in 13 patients (seven males and six
with an average age of 42.4 years (range, 21-73 years). Each patient had an
average of three prior procedures (range, 2-6). Patients were followed up for
average of 34.2 months (range, 24-55 months). All 13 patients achieved
radiographic and clinical union an average of 15.6 weeks (range, 12-20 weeks)
from the date of the definitive procedure. There were two broken screws, but
secondary procedures were required to obtain fusion. All patients were
ambulatory without support at the last followup. The implant proved effective
for stable internal fixation of distal tibia metaphyseal nonunions alone or
simultaneous fusion of the tibiotalar joint.
PMID: 12671508 [PubMed - indexed for MEDLINE]
70: Acta Orthop Belg. 2003;69(1):42-8.
Tibiocalcaneal Marchetti-Vicenzi nailing in revision arthrodesis for
posttraumatic pseudarthrosis of the ankle.
De Smet K, De Brauwer V, Burssens P, Van Ovost E, Verdonk R.
Department of Orthopaedic Surgery, Ghent University Hospital, De Pintelaan
B-9000 Gent, Belgium.
The authors conducted a retrospective study of 7 patients treated with
tibiotalocalcaneal Marchetti-Vicenzi nailing (one anterograde and six
nails). All these patients had developed pseudarthrosis after previous
arthrodesis for posttraumatic ankle fractures. The results were evaluated
clinically and radiographically at a median time of four years. Fusion
in three patients, in one of them only after removal of the proximal locking
screw. Of the remaining four patients, one achieved consolidation after
replacement of the Marchetti-Vicenzi nail by another intramedullary nail, two
were lost to follow-up after replacement by external or internal fixation,
the last patient developed pseudarthrosis again. At least nine additional
interventions were necessary in six patients, including one amputation for
intractable pain and severe soft-tissue damage due to the trauma. None of the
patients had excellent or good results. The majority was unsatisfied with
type of intramedullary nailing. Therefore our study was terminated
Revision ankle fusion for nonunion or malunion after external or internal
fixation has a high complication rate. Further study is mandatory to prevent
resolve remaining problems.
PMID: 12666290 [PubMed - indexed for MEDLINE]
71: J Orthop Sci. 2003;8(2):236-8.
Fracture of the distal end of the fibula through a persistent physis in an
with fracture of the medial malleolus.
Yamamoto N, Nagoya S, Obata M, Yamashita T.
Department of Orthopaedic Surgery, Sapporo Medical University School of
Medicine, Minami 1-jo, Nishi 16-chome, Chuo-ku, Sapporo 060-8543, Japan.
A 26-year-old woman was injured in a motor vehicle accident and sustained a
bimalleolar fracture of the right ankle. Radiographs revealed a shearing
fracture of the medial malleolus and a gap in the distal end of the right
that resembled epiphysiolysis in children. Fracture of the distal end of the
fibula through a persistent physis was suspected. Histological examination of
material obtained from the fracture site during surgery revealed remnants of
hyaline cartilage. We believe that the fracture occurred at a persistent
of the distal end of the fibula.
PMID: 12665964 [PubMed - indexed for MEDLINE]
72: J Orthop Sci. 2003;8(2):166-9.
Percutaneous plating for unstable tibial fractures.
Oh CW, Park BC, Kyung HS, Kim SJ, Kim HS, Lee SM, Ihn JC.
Department of Orthopedic Surgery, Kyungpook National University Hospital, 50,
2-Ga, SamDok-Dong, Chung-Gu, Daegu, Korea 700-721.
Twenty-four unstable tibial fractures were stabilized with a narrow limited
contact-dynamic compression plate inserted using a percutaneous plating
technique under fluoroscopic guidance. The major indication for this
was a tibial fracture for which intramedullary nailing would be difficult.
were 16 proximal or distal metaphyseal fractures and 5 segmental fractures in
adults and 3 mid-shaft fractures in adolescents who still had an open physis.
the 24 fractures, 22 healed without a second procedure; the two failures
included one that required an early bone graft for severe comminution and
another with a superficial infection that healed after early removal of the
plate. There were no other infections. There were three cases of screw
but they did not require a further procedure. At the final follow-up, one
patient had healed with 5 degrees varus alignment and another with 10 degrees
external rotation. All the patients had good knee or ankle function. We are
confident that the percutaneous plating technique to treat unstable tibial
fractures for which intramedullary nailing would be difficult will prove to
an alternative stabilization method, as it avoids the risk of infection or
tissue compromise.
PMID: 12665952 [PubMed - indexed for MEDLINE]
73: Knee Surg Sports Traumatol Arthrosc. 2003 Mar;11(2):112-5. Epub 2003 Jan
Arthroscopy-assisted reduction and percutaneous fixation of a multiple
Gigante A, Marinelli M, Verdenelli A, Lupetti E, Greco F.
Istituto di Patologia e Clinica dell'Apparato Locomotore, Polo
Didattico-Scientifico, Via Tronto, 10, 60020 Torrette, Italy.
Glenoid fractures are rare. The traditional method for treating them is open
reduction and internal fixation in arthrotomy. Arthroscopic reduction with
percutaneous fixation is used in selected fractures (of tibial plateau,
distal radius). We describe the surgical technique adopted to treat a
Y-shaped articular glenoid fracture using arthroscopy and percutaneous
PMID: 12664204 [PubMed - indexed for MEDLINE]
74: Swiss Surg. 2003;9(1):19-25.
[Kirschner wire transfixation of syndesmosis rupture--an alternative
of type B and C malleolar fractures]
[Article in German]
Missbach-Kroll A, Meier L, Meyer P, Burckhardt A, Eisner L.
Chirurgische Klinik, Ratisches Kantons- und Regionalspital Chur, Loestrasse
CH-7000 Chur.
After completing ORIF of the lateral malleolus, the standard technique for
fixation of the syndesmosis involves placement of a 3.5 mm locking screw
the fibula to the tibia. Alternative there is a possibility to make the
transfixation with two 1.6 mm Kirschner wires introduced obliquely across the
distal tibiofibular syndesmosis. No early removing of the implant is
This retrospective study was conducted on a total of 50 cases of Weber type B
C malleolar fractures with syndesmotic rupture between 1988 and 1996. In 45
patients (90%) there is no complication seen for the transfixation, but in
patients a Kirschner wire dislocation was observed. We were able to review 36
these patients after a median follow-up of 8.3 years (range 5-12 years). The
results were evaluated using objective, subjective and roentgenographic
criteria. Subjective rating had 29 patients (81%) with very good or good
results. Good radiological results were found in 29 patients (81%).
of this results the Kirschner wires transfixation is a technical simple
with good or very good results.
Publication Types:
Evaluation Studies
PMID: 12661428 [PubMed - indexed for MEDLINE]
75: Acta Orthop Traumatol Turc. 2003;37(1):9-18.
[Results of the Ilizarov method in the treatment of pseudoarthrosis of the
[Article in Turkish]
Ozturkmen Y, Dogrul C, Karli M.
SSK Istanbul Egitim Hastanesi 1. Ortopedi ve Travmatoloji Klinigi, Istanbul.
OBJECTIVES: We evaluated the results of the Ilizarov method in the treatment
pseudoarthrosis of the lower extremities. METHODS: Forty-six patients (34
12 women; mean age 38.6 years; range 28 to 69 years) were treated by the
Ilizarov method for femoral (n=8, 17%) and tibial (n=38, 83%)
The mean duration of the disease was 1.6 years (range 6 months to 4.8 years).
Pseudoarthrosis was hypertrophic in seven patients (16%) and atrophic in 39
patients (84%). The mean number of previous operations was 1.4 (range 0 to
the mean bone loss was 7.4 cm (range 3 to 12 cm); the mean shortening was 6.8
(range 0 to 12 cm); the mean size of the defect was 5.2 cm (range 3 to 12
Applications were monofocal in 30 patients (66%) and bifocal in 16 patients
(34%). The mean follow-up was 22.6 months (range 9 to 54 months). RESULTS:
occurred in all patients (92%) but four (2 monofocal, 2 bifocal). The fixator
was applied for a mean of 208 days (range 93 to 750 days), which was 162 days
(range 98 to 296 days) for monofocal, and 286 days (range 140 to 496 days)
bifocal applications. According to the Paley's criteria, the results for bone
healing and function were excellent in 26 and 25 patients, good in 12 and 14
patients, fair in four and three patients, and poor in four patients,
respectively. Pin tract infections developed in 28 patients, and reflex
sympathetic dystrophy in three patients. Refracture occurred after the
of the frame in three patients who received bifocal treatment. One patient
developed transient peroneal nerve palsy with drop foot. Equinus rigidity of
ankle was seen in four patients. Cancellous bone grafting was performed in
patients (25%) in whom delayed healing was observed at the target site
segmental bone transport. Three patients had union with a residual deformity
more than 7 degrees. In the monofocal group, none of the patients had a
shortening of more than 1 cm. Following bifocal applications, no bone defects
were observed; the mean residual length discrepancy was 1. 5 cm (range 0 to 4
cm), and the healing index was 52 days/cm. CONCLUSION: The Ilizarov technique
may simultaneously be successful in the treatment of joint contractures,
angular, rotational, and translational deformities, shortening, and bone
Publication Types:
Evaluation Studies
PMID: 12655190 [PubMed - indexed for MEDLINE]
76: Foot Ankle Int. 2003 Feb;24(2):172-5.
Avulsion fractures of the medial tubercle of the posterior process of the
Kim DH, Berkowitz MJ, Pressman DN.
Department of Orthopedics, Denver, CO 80205, USA.
Avulsion fracture of the medial tubercle of the posterior process of the
occurs after forceful dorsiflexion-pronation of the ankle. We evaluated five
patients who had sustained this fracture while participating in sporting
activities. Two patients were correctly diagnosed acutely and treated with
immobilization and limited weightbearing. Avulsion fractures in the remaining
three patients went undiagnosed acutely. This group was treated with delayed
operative excision for persistent posteromedial ankle pain. The patients were
evaluated at a mean follow-up of 35 months using the AOFAS Ankle-Hindfoot
The two patients diagnosed and treated acutely achieved excellent results.
three patients with missed fractures did poorly, yet achieved comparable
after late excision. Our results suggest that prompt diagnosis and
management yields reliably good outcomes. Untreated avulsion fractures
predictably do poorly. For these patients, late excision can provide
functional and symptomatic improvement.
PMID: 12627627 [PubMed - indexed for MEDLINE]
77: Foot Ankle Int. 2003 Feb;24(2):158-63.
Injury characteristics and the clinical outcome of subtalar dislocations: a
clinical and radiographic analysis of 25 cases.
Bibbo C, Anderson RB, Davis WH.
Department of Orthopaedic Surgery, Marshfield Clinic, Marshfield, WI 54449,
The objective of this study was to determine the mechanisms of injury and
pattern of associated foot and ankle injuries and systemic injuries
with subtalar dislocations, and, correlate these data with the radiographic
clinical/functional outcome of patients after subtalar dislocation. RESULTS:
Twenty-five patients with a subtalar dislocation were identified over a seven
year period. The mean patient age was 38 years. Males (n=19) comprised 76% of
patients, with a mean age of 36 years. High energy mechanisms (motor vehicle
accidents, falls) accounted for 68% of subtalar dislocations. Although high
energy mechanisms showed a strong trend toward open subtalar dislocations,
association was not statistically significant (p=0.0573, Fisher's exact
Closed dislocations predominated (75%). Left and right-sided dislocations
nearly equally distributed, even among motor vehicle accidents. Medial
dislocations predominated (65%): these were not influenced by mechanism of
injury and did not result in statistically lower AOFAS ankle/hindfoot scores.
Subtalar dislocation was irreducible (requiring open reduction) in 32%, with
higher energy mechanisms of injury being statistically associated with an
irreducible subtalar dislocation (p=0.0261, Fisher's exact test). Block to
reduction was evenly distributed among soft tissue elements (posterior tibial
tendon, flexor hallucis longus tendon, capsule, extensor retinaculum) and
osseous elements. Eighty-eight percent of patients incurred concomitant
to the foot and ankle (95% of which were closed injuries), namely, the ankle
talus. Systemic injuries occurred in 88% of patients. At a mean follow-up of
five years, the mean AOFAS score of the subtalar dislocation side was
significantly lower (mean=71 vs. 93, p=0.0007, unpaired Student's t-test). No
statistical relation was found between the number of associated extremity
injuries and AOFAS score (Spearman correlation coefficient, r=(-)0.236,
p=0.331). Radiographic follow-up demonstrated 89% of ankles with radiographic
changes (31% symptomatic); however, the majority of these patients (61%) had
associated ankle injury. The subtalar joint demonstrated radiographic changes
89% of patients, with 63% being symptomatic; 75% of patients with subtalar
changes incurred a fracture about the subtalar joint at the time of
Four patients went on to subtalar fusion at an average of 8.8 months
post-dislocation. The midfoot showed radiographic changes in 72% of patients,
with only 15% of these patients being symptomatic. All patients with midfoot
symptoms were well controlled by nonsurgical measures.
PMID: 12627624 [PubMed - indexed for MEDLINE]
78: Unfallchirurg. 2003 Feb;106(2):161-5.
[Simultaneous reimplantation of both lower legs--5-year follow-up (case
[Article in German]
Schmidhammer R, Dorninger L, Huber W, Haller H, Kropfl A.
Unfallkrankenhaus der AUVA, Linz, Austria.
We are reporting the case of a 29 year old male in whom we performed
reimplantaton of both lower legs following trauma inflicted by a railroad
boxcar. Five years after this accident, the patient's walk is almost normal
both deep sensitivity and two point discrimination on the soles of his feet
sufficient.The patient can walk, run and stand very well on one leg, both on
even and on uneven ground.He returned to his job with the railroad 8 months
after his accident. Originally the patient was employed as a railroad
and is now an office employee. His private life is normal and he enjoys
and dancing. In our opinion, sufficient function of the tibial nerve in the
reconstructed extremity is important for clinically satisfactory long-term
results. Both the Mangled Extremity Severity Score (MESS) and the NISSSA are
helpful in making the decision on whether to primarily amputate or
Gustillo IIIC cases. Good long-term results as well as general cost reduction
are achievable following reconstruction of extremities.Amputation of an
extremity can be predicted with 100% certainty when MESS is 9 or more.Primary
shortening and secondary lengthening of an extremity is a good method of
treating Gustillo III C fractures.
PMID: 12624689 [PubMed - indexed for MEDLINE]
79: Clin Orthop. 2003 Mar;(408):286-91.
Distal tibia metaphyseal fractures treated by percutaneous plate
Oh CW, Kyung HS, Park IH, Kim PT, Ihn JC.
Kyungpook National University Hospital, Taegu, Korea.
Twenty-one patients with fractures of the distal tibial metaphysis, some with
minimal displacement in the ankle, were treated by percutaneous plate
osteosynthesis with a narrow limited contact-dynamic compression plate. Using
the classification by the Arbeitsgemeinschaft fur Osteosynthesefragen and
Orthopaedic Trauma Association, 17 fractures had no articular involvement,
whereas four included intraarticular extension. At final followup (mean, 20
months), all the fractures healed without second procedures and the mean
time was 15.2 weeks. One patient had malalignment of the limb with 10 degrees
internal rotation, but there were no angular deformities greater than 5
or any shortening greater than 1 cm. All patients had excellent or
ankle function. There were no infections or any soft tissue compromise.
Percutaneous plate osteosynthesis is a safe and worthwhile method of managing
such fractures, which avoids some of the complications associated with
conventional open plating methods.
PMID: 12616072 [PubMed - indexed for MEDLINE]
80: Clin Orthop. 2003 Mar;(408):82-5.
Antibiotic therapy in gunshot wound injuries.
Simpson BM, Wilson RH, Grant RE.
Division of Orthopaedic Surgery, Howard University Hospital, Washington, DC,
Protocols for antibiotic prophylaxis in the treatment of fractures caused by
gunshots have not been delineated clearly in the literature to date. The
review of the literature reveals that antibiotic therapy for treatment of
fractures is predicated on the muzzle velocity of the weapon used to inflict
fracture. General consensus has been reached regarding the requirement of at
least 24 hours of intravenous antibiotic treatment in fractures caused by
high-velocity weapons in conjunction with the appropriate wound and fracture
care. Similarly, in fractures caused by shotguns, thorough wound debridement
24- to 48-hour administration of intravenous antibiotics is necessary.
in fractures caused by low-velocity weapons, there is not a preponderance of
evidence showing that there is a distinct advantage to using antibiotic
prophylaxis in these injuries. Special clinical consideration must be given
regarding the use of antibiotics in fractures caused by gunshots that are
intraarticular and those about the hand, foot, and ankle.
Publication Types:
Review, Tutorial
PMID: 12616042 [PubMed - indexed for MEDLINE]
81: Spinal Cord. 2003 Mar;41(3):172-7.
Use of the ring fixator in the treatment of fractures of the lower extremity
long-term paraplegic and tetraplegic patients.
Meiners T, Keil M, Flieger R, Abel R.
Spinal Cord Center, Werner Wicker Clinic, 34537 Bad Wildungen, Germany.
STUDY DESIGN: Retrospective study. OBJECTIVES: To examine the value of
fracture stabilization by means of the ring fixator in fractures of the lower
extremity in the presence of chronic paralysis caused by transverse lesions
the spinal cord. SETTING: A specialist center for the treatment of spinal
injuries in Germany. METHODS: Clinical examination of the lower extremities
side-for-side comparison, radiological investigation of the fractures,
survey. PATIENTS: In 21 patients with chronic spinal cord lesions, 22
of the lower extremities were treated with the ring fixator. RESULTS: At
follow-up a mean of 41.5 months after fracture healing it could be shown that
movement in the knee and ankle joints on the same side as the fracture was
restricted by more than 10 degrees in any of our patients. No losses
activities of daily living were reported, and 19 of the 21 patients were
satisfied with the result achieved with this technique. After four of the 22
operations there were complications. Malalignments were visible
following five of the fractures. CONCLUSIONS: In osteoporosis-induced
of the lower extremities in chronically paraplegic and tetraplegic patients,
fracture stabilization with the ring fixator, with fewer complications and
better results in terms of joint mobility, is superior to the conservative
treatment so far given preference in the literature. It should be offered as
alternative to conservative treatment in the case of pathological fractures.
PMID: 12612620 [PubMed - indexed for MEDLINE]
82: Pflege Z. 2001 Nov;54(11):829-30.
[Learning in nursing care: support in a crisis]
[Article in German]
Kela N, Kela P.
PMID: 12607459 [PubMed - indexed for MEDLINE]
83: Am J Forensic Med Pathol. 2003 Mar;24(1):51-4.
A variant of incaprettamento (ritual ligature strangulation) in East Timor.
Pollanen MS.
Forensic Pathology Unit, Office of the Chief Coroner, and the Department of
Pathobiology and Laboratory Medicine, University of Toronto, Toronto,
Incaprettamento is a ritualized form of ligature strangulation often
with the Italian Mafia. The hallmarks include ligature strangulation and
of the body in a highly stereotyped fashion. The bindings include tying the
wrists and ankles together, with the body in the prone position (similar to
"hogtying"), and an additional ligature encircling the neck and attached to
bindings of the extremities. The binding of the body may be performed after
death is inflicted by ligature strangulation, or it may be associated with
self-strangulation, as shown by the arrangement of ligatures and the position
the body. A case with great similarities to incaprettamento, in which the
was exhumed from a grave in East Timor, is described in detail. However, in
addition to prone-position binding and a hyoid fracture, chopping wounds of a
knee and blunt trauma to the posterior torso were found. The implication of
these wounds is discussed in relation to incaprettamento.
PMID: 12604999 [PubMed - indexed for MEDLINE]
84: Orthopedics. 2003 Feb;26(2):131; author reply 131.
Comment on:
Orthopedics. 2002 Apr;25(4):427-30.
Ankle fixation.
George RC.
Publication Types:
PMID: 12597214 [PubMed - indexed for MEDLINE]
85: J Biomech Eng. 2002 Dec;124(6):750-7.
The axial injury tolerance of the human foot/ankle complex and the effect of
Achilles tension.
Funk JR, Crandall JR, Tourret LJ, MacMahon CB, Bass CR, Patrie JT, Khaewpong
Eppinger RH.
Automobile Safety Laboratory, Department of Mechanical, Aerospace, and
Engineering, University of Virginia, 1011 Linden Avenue, Charlottesville, VA
22902, USA.
Axial loading of the foot/ankle complex is an important injury mechanism in
vehicular trauma that is responsible for severe injuries such as calcaneal
tibial pilon fractures. Axial loading may be applied to the leg externally,
the toepan and/or pedals, as well as internally, by active muscle tension
applied through the Achilles tendon during pre-impact bracing. The objectives
this study were to investigate the effect of Achilles tension on fracture
and to empirically model the axial loading tolerance of the foot/ankle
Blunt axial impact tests were performed on forty-three (43) isolated lower
extremities with and without experimentally simulated Achilles tension. The
primary fracture mode was calcaneal fracture in both groups. However,
initiated at the distal tibia more frequently with the addition of Achilles
tension (p < 0.05). Acoustic sensors mounted to the bone demonstrated that
fracture initiated at the time of peak local axial force. A survival analysis
was performed on the injury data set using a Weibull regression model with
specimen age, gender, body mass, and peak Achilles tension as predictor
variables (R2 = 0.90). A closed-form survivor function was developed to
the risk of fracture to the foot/ankle complex in terms of axial tibial
The axial tibial force associated with a 50% risk of injury ranged from 3.7
for a 65 year-old 5th percentile female to 8.3 kN for a 45 year-old 50th
percentile male, assuming no Achilles tension. The survivor function
here may be used to estimate the risk of foot/ankle fracture that a blunt
impact would pose to a human based on the peak tibial axial force measured by
anthropomorphic test device.
PMID: 12596644 [PubMed - indexed for MEDLINE]
86: BMJ. 2003 Feb 22;326(7386):417.
Comment in:
BMJ. 2003 Feb 22;326(7386):405-6.
BMJ. 2003 May 24;326(7399):1147; author reply 1147.
Accuracy of Ottawa ankle rules to exclude fractures of the ankle and midfoot:
systematic review.
Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G.
Horten Centre, Zurich University, Postfach Nord, CH-8091 Zurich, Switzerland.
OBJECTIVE: To summarise the evidence on accuracy of the Ottawa ankle rules, a
decision aid for excluding fractures of the ankle and mid-foot. DESIGN:
Systematic review. DATA SOURCES: Electronic databases, reference lists of
included studies, and experts. REVIEW METHODS: Data were extracted on the
population, the type of Ottawa ankle rules used, and methods. Sensitivities,
not specificities, were pooled using the bootstrap after inspection of the
receiver operating characteristics plot. Negative likelihood ratios were
for several subgroups, correcting for four main methodological threats to
validity. RESULTS: 32 studies met the inclusion criteria and 27 studies
reporting on 15 581 patients were used for meta-analysis. The pooled negative
likelihood ratios for the ankle and mid-foot were 0.08 (95% confidence
0.03 to 0.18) and 0.08 (0.03 to 0.20), respectively. The pooled negative
likelihood ratio for both regions in children was 0.07 (0.03 to 0.18).
these ratios to a 15% prevalence of fracture gave a less than 1.4%
of actual fracture in these subgroups. CONCLUSIONS: Evidence supports the
ankle rules as an accurate instrument for excluding fractures of the ankle
mid-foot. The instrument has a sensitivity of almost 100% and a modest
specificity, and its use should reduce the number of unnecessary radiographs
Publication Types:
Review, Academic
PMID: 12595378 [PubMed - indexed for MEDLINE]
87: Pediatr Emerg Care. 2003 Feb;19(1):6-9.
Midfoot injury in children related to mini scooters.
Bibbo C, Davis WH, Anderson RB.
Department of Orthopaedic Surgery, Marshfield Clinic, Wisconsin, USA.
The remarkable rise in popularity of mini scooters has been accompanied by an
increase in the number of foot and ankle injuries. We have observed unique
pediatric foot injuries related to the use of mini scooters. An association
be present linking the design of the mini scooter and the riding practices of
children. We report on two unique midfoot injuries in children occurring with
mini scooter use and discuss how these foot injuries may be related to
design and children's riding practices. Safety guidelines aimed at the
prevention of foot and ankle injuries while riding mini scooters are
PMID: 12592105 [PubMed - indexed for MEDLINE]
88: Int Orthop. 2003;27(1):30-5. Epub 2002 Sep 05.
Fracture dislocations of Lisfranc's joint treated with closed reduction and
percutaneous fixation.
Perugia D, Basile A, Battaglia A, Stopponi M, De Simeonibus AU.
Universita Tor Vergata, Via G.A. Plana, 13, 00197, Rome, Italy.
We reviewed 42 patients (mean age 37.7+/-14.2 years) with closed fracture
dislocations of Lisfranc's joint treated with percutaneous screw fixation.
follow-up was 58.4+/-17.3 months. The aim was to compare dislocations in
which a
perfect anatomical reduction had been reached with dislocations in which
reduction was only near anatomical. The mean American Orthopaedic Foot and
Society score for all patients was 81.0+/-13.5. There were no significant
differences in outcome scores between patients with perfect anatomical
and patients with near anatomical reduction. However, patients with combined
fracture dislocations obtained statistically better scores than patients with
pure dislocations.
PMID: 12582806 [PubMed - indexed for MEDLINE]
89: Am J Orthop. 2003 Jan;32(1):46-8.
Use of a vertical transarticular pin for stabilization of severe ankle
Scioscia TN, Ziran BH.
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh,
Pennsylvania, USA.
Transarticular pin fixation has been used successfully to stabilize severe
fractures. This technique is most commonly used as provisional fixation until
internal fixation is appropriate. In addition, transarticular pin fixation
be a supplement in cases involving persistent tibiotalar instability after
internal fixation and can provide sole definitive fixation of arthritic and
osteoporotic ankles. In this article, we describe the surgical technique,
results, and review when transarticular pin fixation may be appropriate. We
believe that all orthopedic surgeons should know this technique--especially
those treating cases of complex orthopedic trauma.
PMID: 12580352 [PubMed - indexed for MEDLINE]
90: Am J Orthop. 2003 Jan;32(1):35-7.
Plantar ganglion cyst associated with stress fracture of the third
McAllister DR, Koh J, Bergfeld JA.
Department of Orthopaedic Surgery, Center for Health Sciences, University of
California, Los Angeles, California, USA.
Ganglion cysts of the foot and ankle occur relatively infrequently.
stress fractures occur in a variety of athletes who subject their lower
extremities to repetitive loading. In this article, we report the case of a
professional football player with a plantar forefoot ganglion cyst associated
with a stress fracture of the third metatarsal. After the cyst resolved with
aspiration, the stress fracture healed with conservative, nonsurgical
PMID: 12580349 [PubMed - indexed for MEDLINE]
91: J Trauma. 2003 Feb;54(2):379-90.
The orthoplastic approach for management of the severely traumatized foot and
Heitmann C, Levin LS.
Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Duke
University Medical Center, Durham 27710, USA.
Publication Types:
Review, Tutorial
PMID: 12579071 [PubMed - indexed for MEDLINE]
92: Osteoporos Int. 2003 Jan;14(1):69-76.
Disability after clinical fracture in postmenopausal women with low bone
density: the fracture intervention trial (FIT).
Fink HA, Ensrud KE, Nelson DB, Kerani RP, Schreiner PJ, Zhao Y, Cummings SR,
Nevitt MC.
MD, MPH, VA Medical Center, One Veterans Drive, Box 11G, Minneapolis, MN
Relatively little is known about outcomes following clinical osteoporotic
fractures at nonhip, nonvertebral skeletal sites. To address this issue, we
prospectively assessed post-fracture disability at multiple skeletal sites in
population of 909 older (aged 55-81 years), community-dwelling women with low
femoral neck bone mineral density who had experienced a fracture while
in the Fracture Intervention Trial (FIT). FIT is a randomized, double-masked,
placebo-controlled trial that was designed to determine the effect of
alendronate on fracture incidence, and the current study was conducted as a
secondary analysis of FIT data. Following incident clinical fractures, FIT
participants were followed prospectively for assessment of site-specific,
fracture-related disability. Measures of disability were self-reported days
hospitalized or confined to bed because of the fracture ('bed days') and days
reduced usual activities because of the fracture ('limited activity days').
fracture types evaluated, those of the hip resulted in the highest percentage
subjects with any bed days or limited activity days after fracture (94% with
bed days and 100% with any limited activity days), though the mean number of
days and limited activity days appeared highest after lumbar vertebral
(25.8 mean bed days and 158.5 mean limited activity days). Substantial
disability also was reported after fractures of thoracic vertebrae, humerus,
distal forearm, ankle and foot. Within fracture types, post-fracture
was highly variable, ranging from none to more than 6 months.
PMID: 12577187 [PubMed - indexed for MEDLINE]
93: J Bone Joint Surg Am. 2003 Feb;85-A(2):287-95.
Tibial plafond fractures. How do these ankles function over time?
Marsh JL, Weigel DP, Dirschl DR.
Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics,
College of Medicine, Iowa City 52242, USA.
BACKGROUND: The intermediate outcome of fractures of the tibial plafond
with current techniques has not been reported, to our knowledge. The purpose
this study, performed at a minimum of five years after injury, was to
the effect of these fractures on ankle function, pain, and general health
and to determine which factors predict favorable and unfavorable outcomes.
METHODS: Fifty-six ankles (fifty-two patients) with a tibial plafond fracture
were treated with a uniform technique consisting of application of a
hinged transarticular external fixator coupled with screw fixation of the
articular surface. Thirty-one patients with thirty-five involved ankles
between five and twelve years after the injury for a physical examination,
assessment of ankle pain and function with the Iowa Ankle Score and Ankle
Osteoarthritis Scale, assessment of general health status with the Short
(SF-36), and radiographic examination of the ankle. RESULTS: Arthrodesis had
been performed on five of the forty ankles for which the outcome was known at
minimum of five years after the injury. Other than removal of prominent
(two patients), no other surgical procedure had been performed on any
The average Iowa Ankle Score was 78 points (range, 28 to 96 points). The
on the SF-36 and Ankle Osteoarthritis Scale demonstrated a long-term negative
effect of the injury on general health and on ankle pain and function when
compared with those parameters in age-matched controls. The degree of
osteoarthrosis was grade 0 in three ankles, grade 1 in six, grade 2 in
and grade 3 in six. The majority of patients had some limitation with regard
recreational activities, with an inability to run being the most common
complaint (twenty-seven of the thirty-one patients). Fourteen patients
jobs because of the ankle injury. Fifteen ankles were rated by the patient as
excellent; ten, as good; seven, as fair; and one, as poor. Nine patients with
previously recorded ankle scores had better scores after the longer follow-up
interval. The patients perceived that their condition had improved for an
average of 2.4 years after the injury. CONCLUSIONS: Although tibial plafond
fractures have an intermediate-term negative effect on ankle function and
and on general health, few patients require secondary reconstructive
and symptoms tend to decrease for a long time after healing.
PMID: 12571307 [PubMed - indexed for MEDLINE]
94: J Bone Joint Surg Am. 2003 Feb;85-A(2):205-11.
Use of a cast compared with a functional ankle brace after operative
of an ankle fracture. A prospective, randomized study.
Lehtonen H, Jarvinen TL, Honkonen S, Nyman M, Vihtonen K, Jarvinen M.
Medical School, University of Tampere, Finland.
BACKGROUND: Controversy continues with regard to the optimal postoperative
after open reduction and internal fixation of an ankle fracture. The
of this study was that postoperative treatment of an ankle fracture with a
that allows active and passive range-of-motion exercises would improve the
functional recovery of patients compared with that after conventional
with a cast. Thus, the purpose of this prospective, randomized study was to
compare the long-term subjective, objective, and functional outcome after
conventional treatment with a cast and that after use of functional bracing
the first six weeks following internal fixation of an ankle fracture.
One hundred patients with an unstable and/or displaced Weber type-A or B
fracture were treated operatively and then were randomly allocated to two
groups: immobilization in a below-the-knee cast (fifty patients) or early
mobilization in a functional ankle brace (fifty patients) for the first six
postoperative weeks. The follow-up examinations, which consisted of
and objective (clinical, radiographic, and functional) evaluations, were
performed at two, six, twelve, and fifty-two weeks and at two years
postoperatively. RESULTS: There were no perioperative complications in either
study group, but eight patients who were managed with a cast and thirty-three
patients who were managed with a brace had postoperative complications, which
were mainly related to wound-healing. Two patients in the group treated with
cast had deep-vein thrombosis. All fractures healed well in both groups. The
difference between the two groups with respect to the complication rate was
significant (p = 0.0005). No significant differences between the study groups
were observed in the final subjective or objective (clinical) evaluation. At
two-year follow-up examination, the average score (and standard deviation)
according to the ankle-rating scale of Kaikkonen et al. was 85 +/- 9 points
the group treated with a cast and 83 +/- 10 points for the group treated with
brace, and the average ankle score according to the system of Olerud and
Molander was 87 +/- 8 points and 87 +/- 9 points, respectively. CONCLUSIONS:
long-term functional outcome after postoperative treatment of an ankle
with a cast and that after use of a functional brace are similar. Although
mobilization with use of a functional ankle brace may have some theoretical
beneficial effects, the risk of postoperative wound complications associated
with this treatment approach is considerably increased compared with that
conventional cast treatment. Thus, the postoperative protocol of treatment
a functional brace requires refinement before it can be generally advocated
use after operative treatment of an ankle fracture.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 12571295 [PubMed - indexed for MEDLINE]
95: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2002 May;16(3):209-11.
[Orthopaedic applications for biodegradable and absorbable internal fixation
[Article in Chinese]
Liu JG, Ma WH, Xu XX.
Department of Orthopaedics, First Clinical Hospital of Jilin University,
Changchun Jilin, P. R. China 130021.
OBJECTIVE: To illustrate the effect and complication of orthopedic
for biodegradable and absorbable internal fixation of fractures, and to
the existent problem and research aspect currently. METHODS: The recent
literatures on orthopedic applications and study of biodegradable and
internal fixation for fractures were reviewed. The effect of biodegradable
materials on bone healing was summarized. RESULTS: It is good for the
of fracture fixation and result of treatment. The biodegradable and
internal fixation fractures had no adverse effect on bone healing.
There will be more widespread application for biodegradable and absorbable
materials in orthopedics, but the intensive research should be carried out to
prevent its complication.
Publication Types:
Review, Tutorial
PMID: 12569701 [PubMed - indexed for MEDLINE]
96: J Foot Ankle Surg. 2003 Jan-Feb;42(1):45-7.
Recurrent ankle sprains secondary to nonunion of a lateral malleolus
Faraj AA, Alcelik I.
Orthopaedic Surgery Department, Airedale General Hospital, Steeton, West
Yorkshire, England.
A case of an adult man with symptoms of chronic recurrent ankle sprains
secondary to nonunion of a fracture of the tip of the lateral malleolus is
presented. The nonunion was debrided, bone grafted, and internally fixed by
using the tension band wire technique. The fracture healed and the patient
experienced no further episodes of ankle sprain.
PMID: 12567368 [PubMed - indexed for MEDLINE]
97: Med Princ Pract. 2003 Jan-Mar;12(1):47-50.
Primary ankle fusion using blair technique for severely comminuted fracture
the talus.
Hantira H, Al Sayed H, Barghash I.
Al-Razi Orthopaedic Hospital, Safat, Kuwait.
OBJECTIVE: We report a case of a severely comminuted fracture of the body of
talus treated by primary Blair tibiotalar fusion. CLINICAL PRESENTATION AND
INTERVENTION: A very severely comminuted open fracture of the body of the
was treated on the same day of injury by debridement and tibiotalar fusion
the Blair fusion technique. CONCLUSION: Blair fusion may be indicated in
of severely comminuted fractures of the talar body. It has the advantage of
giving a near-normal appearance to the foot, producing less shortening and
allowing motion to remain at the talonavicular and anterior subtalar joints.
Copyright 2003 S. Karger AG, Basel
PMID: 12566969 [PubMed - indexed for MEDLINE]
98: J Orthop Sci. 2003;8(1):20-5.
Ankle arthrodesis combined with tibial lengthening using the Ilizarov
Sakurakichi K, Tsuchiya H, Uehara K, Kabata T, Yamashiro T, Tomita K.
Department of Orthopaedic Surgery, School of Medicine, Kanazawa University,
Takara-machi, Kanazawa 920-8641, Japan.
We report our experience using the Ilizarov method to perform combined ankle
arthrodesis and tibial lengthening in six patients (mean age 47 years; range
25-66 years). The average distraction length was 4.1 cm (range 1.1-6.8 cm),
the mean period of follow-up was 36 months (range 26-44 months). Three
had active infection of the ankle. Four patients had undergone previous
two of which were primary ankle arthrodeses. We performed
compression-distraction in three patients and bone transport in three. In the
compression-distraction group, the mean length gained was 1.9 cm, the mean
external fixation index (EFI) was 144 days/cm, and the mean external fixation
time was 246 days. In the bone transport group, the mean length gained was
cm, the mean EFI was 35.4 days/cm, and the mean external fixation time was
days. All cases achieved a good clinical result with a solid ankle
and no infection, deformity, or need for additional support. The Ilizarov
may be practically applied for ankle arthrodesis, especially in complicated
cases. The EFI and external fixation time tended to increase for patients
with a
length gain of 3 cm or less.
PMID: 12560881 [PubMed - indexed for MEDLINE]
99: Knee Surg Sports Traumatol Arthrosc. 2003 Jan;11(1):46-9. Epub 2002 Nov
Improvement in technique for arthroscopic ankle fusion: results in 15
Kats J, van Kampen A, de Waal-Malefijt MC.
Department of Orthopedics, University Hospital Nijmegen, Postbox 9101, 6500
Nijmegen, The Netherlands.
We retrospectively assessed time until consolidation, complications, and
functional results according to Morgan from the clinical charts and
of 15 arthroscopic ankle fusions. In 11 patients unilateral distraction and
crossed screw placement over the fusion area through tibia and fibula were
(group A); in 4 patients a technique of bilateral distraction and parallel
placement from the dorsal side of the tibia into the neck of the talus was
(group B). In group A there were two cases of insufficient compression at the
arthrodesis site, three cases of suboptimal compression, and five cases of
malposition of the screws. In all cases in group B good compression and
was achieved, and no case of malpositioning of screws occurred. There was
nonunion in 3 of 11 patients in group A and in none of the four patients in
group B. Time until fusion was 23.3 in group A and 12.5 weeks in group B.
Functional results were better in group B. The initial experiences with our
technique of bilateral distraction and parallel screw placement are therefore
promising. Screw placement is easier and optimal compression and fixation are
achieved. We feel that this technique should be considered when performing an
arthroscopic ankle fusion.
PMID: 12548451 [PubMed - indexed for MEDLINE]
100: Aust J Physiother. 2002;48(4):320.
Ottawa Ankle Rules are more sensitive than Dutch in detecting significant
Pope R.
PMID: 12542039 [PubMed - as supplied by publisher]
101: ANZ J Surg. 2002 Oct;72(10):724-30.
Comment in:
ANZ J Surg. 2002 Nov;72(11):775-6.
Ankle fractures: functional and lifestyle outcomes at 2 years.
Lash N, Horne G, Fielden J, Devane P.
Department of Surgery, Wellington School of Medicine, Otago University,
Wellington, New Zealand.
BACKGROUND: Ankle fractures form a high proportion of the total number of
fractures treated in New Zealand. International studies show that there are
mixed functional outcomes with differing fracture types and subsequently
differing lifestyle outcomes. METHODS: Fracture clinic records and
admissions books for Wellington Public Hospital, Capital Coast Health,
-Wellington, were retrospectively reviewed to gain a population of patients
sustained ankle fractures for the period January--December 1998. These
were asked to fill in postal questionnaires detailing their current ankle
function and lifestyle, two years after fracturing their ankle. The patients'
radiographs were reviewed to classify the types of ankle fractures sustained.
RESULTS: Of 141 patients that sustained ankle fractures, 74 were followed up
years after their ankle fracture. All fracture types averaged Olerud-Molander
ankle scores of 71.1. Weber A fractures averaged ankle function scores of 90,
Weber B fractures 80, and Weber C fractures 78. Four patients (5%) achieved
'poor' results, 12 (16%) patients achieved a 'fair' result, 30 (41%) patients
gained a 'good' result, 27 (36%) patients attained 'excellent' results.
Lifestyle outcomes were reflected in the patient's ankle function outcomes (P
0.05). CONCLUSION: Patients who sustain ankle fractures can be expected to be
still experiencing functional difficulties two years post-treatment.
PMID: 12534384 [PubMed - indexed for MEDLINE]
102: Emerg Med J. 2003 Jan;20(1):E2.
Fracture of lateral process of the talus presenting as ankle pain.
Sharma S.
Victoria Infirmary, South Glasgow University Hospitals NHS Trust, Glasgow,
The case is presented of a 27 year old woman with lateral ankle pain after an
inversion injury sustained while dancing. Although initial radiographs failed
identify the fracture, radiographs of the ankle at six weeks showed an
unsuspected fracture of the lateral process of the talus. The fracture was
treated with cast immobilisation for six weeks and the patient is currently
undergoing aggressive physiotherapy. A literature review revealed that
of the lateral process of the talus are frequently overlooked and should be
considered in the differential diagnosis of patients with acute and chronic
ankle pain as an early diagnosis and treatment prevent long term
PMID: 12533394 [PubMed - in process]
103: Emerg Med J. 2003 Jan;20(1):E1.
Comminuted fracture of the talus not visible on the initial radiograph.
Burton T, Sloan J.
Department of Accident and Emergency Medicine, General Infirmary, Leeds, UK.
AUTHOR:e-mail address please Fractures of the talus are rare injuries and
fractures of the body of the talus are particularly rare. Diagnosis of these
fractures is also difficult as initial radiographs may be normal,
with osteochondral talar dome fractures. Long term morbidity is common after
fractures of the talus. A case is presented of a patient with a comminuted
fracture of the body of the talus with non-diagnostic initial standard ankle
radiographs. Accident and emergency doctors should be aware of this injury,
be suspicious that patients with an appropriate mechanism of injury and
pronounced pain may require further investigation despite normal standard
radiographs, as an occult fracture of the talus may be present.
PMID: 12533393 [PubMed - in process]
104: Clin Biomech (Bristol, Avon). 2003 Jan;18(1):19-27.
Semi-rigid vs rigid glass fibre casting: a biomechanical assessment.
White R, Schuren J, Konn DR.
Department of Orthopaedics, Grampian Gait and Movement Analysis Centre,
University of Aberdeen/Grampian University Hospitals Trust, Scotland,
OBJECTIVES: To determine if semi-rigid synthetic casts provide any measurable
advantages compared to rigid synthetic casts. BACKGROUND: Glass fibre
are now commonly applied immediately post-injury to provide rigid
of the limb, for both weight bearing and non-weight bearing casts. However,
composite casts that have inherent flexibility are also available and it is
claimed they provide some functionality. METHODS: Five members of the
orthopaedic department each applied a rigid and a semi-rigid below elbow
(Colles) and a below knee walking cast to a single volunteer subject. Joint
immobilisation and functional movement was assessed using electrogoniometry
limb support using pressure transducers. RESULTS: Semi-rigid Colles casts
provided slightly greater immobilisation at the wrist while allowing full
function and greater support to the forearm during hand movements. Similarly,
semi-rigid below knee walking casts produced greater immobilisation at the
while allowing more forefoot movement and were less of an impediment to
CONCLUSIONS: Semi-rigid casting techniques have measurable advantages
to rigid synthetic casts and represent a further development in the
management of fractures and soft tissue injuries. RELEVANCE: Semi-rigid
is a relatively new technique that can reduce some of the problems of rigid
immobilisation and could potentially shorten the rehabilitation phase
injury. Information about the performance of these casts to assess their
in specific applications is very limited.
Publication Types:
Evaluation Studies
PMID: 12527243 [PubMed - indexed for MEDLINE]
105: Swiss Surg. 2002;8(6):285-7.
[Prevention of thromboembolism in conservative ambulatory fracture treatment.
Verification of an out-of-court FMH (Federation Mediation Helvetica) expert
[Article in German]
Hohendorff B, Burckhardt A.
Klinik fur Orthopadische Chirurgie, Kantonsspital Olten, Olten.
In an extra judicial assessment for the Medical Assessment Centre of the FMH
(Federation Mediation Helvetica) a clinical case of a female patient who had
suffered from deep vein thrombosis was reviewed. The patient had been treated
conservatively for a malleolar fracture and had not received any
thrombosis prophylaxis. The question of false treatment had to be discussed.
final conclusion of the judicial assessment is that the medical treatment
with a
physical thrombosis prophylaxis of the patient was correct. Due to the
controversial judgements found in the literature concerning the thrombosis
prophylaxis, a certain insecurity remains for the treating physician. Taking
into account the different risk factors, the indication for a prophylaxis
therefore still be decided on an individual basis.
PMID: 12520850 [PubMed - indexed for MEDLINE]
106: Foot Ankle Clin. 2002 Dec;7(4):755-64, vii.
Experience with the STAR ankle arthroplasty at Wrightington Hospital, UK.
Wood PL.
Wrightington, Wigan and Leigh NHS Trust, Wigan Lancashire, UK.
The STAR prosthesis has been used at Wrightington Hospital since November
and from then until June 2002, 280 replacements have been carried out. The
opinions expressed in this article are based on an ongoing audit of these
Publication Types:
Review, Tutorial
PMID: 12516732 [PubMed - indexed for MEDLINE]
107: Foot Ankle Clin. 2002 Sep;7(3):551-65, ix.
Syndesmosis injuries: acute, chronic, new techniques for failed management.
Mosier-LaClair S, Pike H, Pomeroy G.
Family Orthopedic Associates, 4466 West Bristol Road, Flint, MI 48507, USA.
A syndesmotic injury occurs through tearing, rupture, or bony avulsion of the
syndesmotic ligament complex. The syndesmotic ligament complex consists of
anterior tibiofibular, the posterior tibiofibular, the transverse
and the interosseous ligaments. Without these ligamentous restraints the
tibiofibular joint (DTFJ) widens and can result in an asymmetric ankle
Many cadaveric studies have been performed to evaluate the force required and
amount of DTFJ displacement with progressive sectioning of the syndesmotic
Publication Types:
Review Literature
PMID: 12512409 [PubMed - indexed for MEDLINE]
108: Foot Ankle Clin. 2002 Sep;7(3):495-9.
Absorbable implants in fracture management.
Stroud CC.
Department of Orthopaedic Surgery, Union Memorial Hospital, 3333 North
Street, Baltimore, MD 21218, USA.
The use of absorbable implants has been studied extensively in the clinic and
the laboratory. The limitations of absorbable implants are now well-known and
include a finite life span and strength profile, the possible development of
inflammatory response, and their limitation to use in fractures that do not
require traditional compression techniques. Advantages of these implants
the lack of necessity for removal at a later date, which has cost savings
potential, their ease of use, and their strength, which may be sufficient for
healing in certain situations. The most likely scenarios for the use of these
implants in fracture management of the foot and ankle include syndesmotic
disruptions, dislocations about the midfoot, and fractures of the medial
Publication Types:
Review Literature
PMID: 12512405 [PubMed - indexed for MEDLINE]
109: Acta Orthop Traumatol Turc. 2002;36(3):242-7.
[The results of surgical treatment in ankle fractures]
[Article in Turkish]
Yilmaz E, Karakurt L, Serin E, Bulut M.
Department of Orthopedics and Traumatology (Ortopedi ve Travmatoloji Anabilim
Dali), Medicine Faculty of Firat University, 23200 Elazig, Turkey.
OBJECTIVES: We evaluated the results of surgical treatment for ankle
and the factors that play a role in these results. METHODS: The study
31 patients (20 men, 11 women, mean age 38.2 years) who underwent surgical
treatment for ankle fractures and had an adequate follow-up. According to the
Lauge-Hansen classification, the mechanism of occurrence was supinationexternal
rotation in 13 (42%), pronation-external rotation in two (26%),
pronation-abduction in four (13%), and supination-abduction in four patients
(13%). In two patients (6%), the fractures could not be classified. Most of
fractures occurred with falling in winter months. The majority of fractures
(55%) was of bimalleolar type. The mean follow-up was 26 months. RESULTS:
was obtained in all fractures. According to the objective criteria, the
were good, moderate, and poor in 18 (58%), eight (26%), and five (16%)
respectively. Subjective evaluation yielded good, moderate, and poor results
17 (55%), eight (26%), and six (19%) patients, respectively. The results were
poor especially in pronation-external rotation and fracture-dislocation type
fractures. Two patients (6%) developed degenerative arthritis. CONCLUSION: In
our opinion, the best anatomical reduction may be achieved by surgical
of ankle fractures that present with a talar tilt, fibular shortening, and
injury to the syndesmosis.
Publication Types:
Evaluation Studies
PMID: 12510082 [PubMed - indexed for MEDLINE]
110: Mil Med. 2002 Dec;167(12):1044.
Explosive ordinance disposal team equipment and its use in diagnosing
Midla GS, McGranahan ME.
Operation Enduring Freedom, Task Force Rakkasan, HHC-2-187, APO AE 09355.
A 31-year-old man presented to the Rakkasan battalion aid station, located at
the Qandahar Airport, Afghanistan, with complaints and physical findings
consistent with those that would either support a grade III ankle sprain or
fracture. The battalion aid station is an echelon I level of care. This
does not have radiographic capabilities. With the closest radiology facility
located in Seeb, Oman the 710th Explosive Ordinance Disposal team, which was
operating in the area, was contacted. This unit was able to perform
in a timely manner to help aid in correctly diagnosing the injury.
PMID: 12502182 [PubMed - indexed for MEDLINE]
111: J Foot Ankle Surg. 2002 Nov-Dec;41(6):379-88.
Mechanical characteristics of an absorbable copolymer internal fixation pin.
Pietrzak WS, Caminear DS, Perns SV.
Biomet, Inc., P.O. Box 587, Warsaw, IN 46581, USA.
Absorbable internal fixation is gaining acceptance among foot and ankle
surgeons. While absorbable pins made of poly-L-lactic acid, polyglycolic
or poly-p-dioxanone are generally effective as applied in the foot, their
strength loss profiles and degradation characteristics may not be optimally
matched to the healing process. This study investigated a novel absorbable
oriented copolymer pin, with unique absorption characteristics, made of 82%
poly-L-lactic acid and 18% polyglycolic acid, to determine its suitability
use in fixation in the foot. The pins were incubated in a 37 degrees C buffer
bath that simulated in vivo conditions and were mechanically tested in
four-point bend and shear at time intervals up to 12 weeks. In vitro strength
loss profiles demonstrated peak strength retention (flexural and shear) for
about 8 weeks, with 50% of properties remaining by 12 weeks. The initial
modulus of the pins was approximately 7 GPa. The mathematical relationship
between pin strength and pin diameter was discussed, providing the surgeon
helpful criteria for making an implant selection. The degradation time course
these pins appears to compliment the known healing dynamics of bone, making
a suitable choice for use in foot surgery.
PMID: 12500789 [PubMed - indexed for MEDLINE]
112: J Pediatr Orthop. 2003 Jan-Feb;23(1):55-9.
Valgus deformity after fibular resection in children.
Gonzalez-Herranz P, del Rio A, Burgos J, Lopez-Mondejar JA, Rapariz JM.
Alcala de Henares University, Madrid, Spain.
The authors present a retrospective study of 23 patients in their growing
who underwent resection of more than 2 cm of the fibula. Long-term effects in
the ankle and tibia were analyzed. The patients were radiologically studied
using the contralateral side as control. Representative radiologic findings
distal migration of the fibula head in 75% (but without clinical relevance),
thickening of the external tibial cortex in 20%, talar tilt in 45%, proximal
migration of the lateral malleolus in 55%, and diaphyseal valgus of the tibia
20% of the cases. Incomplete regeneration of fibula was observed in 58% of
cases. Two patients suffered a spiral diaphyseal fracture and another a slow
physeal fracture of the distal tibia. In this study, many radiologic changes
were observed after fibula resection. The authors suggest using
methods after fibula resection when it is possible.
PMID: 12499944 [PubMed - indexed for MEDLINE]
113: Zhonghua Wai Ke Za Zhi. 2002 Nov;40(11):855-7.
Unilateral external fixator combined with simple internal fixation for severe
open tibia-fibular fracture.
Zhang Y, Fang W, Lou C, Lu H, Shi G, Zhao J.
Department of Orthopeadic, Zhuji People's Hospital, Zhejiang 311800, China.
OBJECTIVE: To improve the treatment for severe open tibia-fibular fracture.
METHODS: From 1994 to 2000, 146 patients with severe open tibia-fibular
were treated. According to Gustilo classification, all patients were of type
III. Among them, 96 patients belonged to III A, 36 III B, and 18 III C. One
hundred and eight patients were male and 38 female, aged from 11 to 68 years,
with an average of 31. All patients were treated with unilateral external
fixator combined with simple internal fixation (general screw or Kirschner
wire). Thirty patients were treated with secondary flap operation. Among
19 patients received pedicle gastrocnemius muscle flaps, 9 free vastus
muscle flaps, and 2 free latissimus dorsi muscle flaps. RESULTS: Three
of type IIIB were subjected to amputation because of advanced age and
cerebral or thoraco-abdominal injury. Five patients of type III C had
because of insufficient postoperative blood supply and necrosis. The rupture
other 138 patients was well reduced, and firmly fixed. They were followed up
6 months-6 years, with an average of 2.5 years. The average time of
fracture-union was 27 weeks, and the average time for removal of fixtors was
weeks. The motion of knee joint ranged from 0 to 120 degree in 110 patients;
from 0 to 100 degrees in 25, and from 0 to 90 degrees. The motion of ankle
was approximately normal. CONCLUSIONS: For patients with severe open
tibia-fibular fracture, comprehensive analysis should be made for
of the wounded limb or amputation as for elderly patients with vessel-nerve
injury or with cerebral- thoracoabdominal injury, emergency amputation should
done. Unilateral external fixator combined with simple internal fixation
(general screw or Kirschner wire) for severe open tibia-fibular fracture is
advantageous for a simple and reliable fixation. It is less traumatic.
PMID: 12487864 [PubMed - indexed for MEDLINE]
114: Unfallchirurg. 2002 Dec;105(12):1115-31; quiz 131-2.
[Pilon tibial fractures]
[Article in German]
Hahn MP, Thies JW.
Klinik fur Unfall- und Wiederherstellungschirurgie Zentralkrankenhaus
Sankt-Jurgen-Strasse, Bremen.
PMID: 12486580 [PubMed - indexed for MEDLINE]
115: J Orthop Sci. 2002;7(6):694-7.
Charcot joint-like changes following ankle fracture in a patient with no
underlying disease: report of a rare case.
Kumagai M, Yokota K, Endoh T, Takemoto H, Nagata K.
Department of Orthopaedic Surgery, Kurume University School of Medicine, 67
Asahi-machi, Kurume, Fukuoka 830-0011, Japan.
Charcot joint is a disease that often occurs in patients with diabetes
tabes dorsalis, syringomyelia, chronic alcoholism, leprosy, trauma, or
after fractures and dislocations. The treatment for Charcot joint has various
complications, such as skin lesions, infections, and delayed union. We
our experience with a male patient who developed Charcot joint-like changes
without diabetes mellitus or any other disease after an ankle fracture due to
minor trauma.
PMID: 12486475 [PubMed - indexed for MEDLINE]
116: Arch Orthop Trauma Surg. 2002 Dec;122(9-10):541-3. Epub 2002 Nov 07.
Medial peritalar dislocation.
Pehlivan O, Akmaz I, Solakoglu C, Rodop O.
Gulhane Military Medical Academy, Haydarpasa Training Hospital, Department of
Orthopaedics and Traumatology, Istanbul, Turkey.
In this paper, a case of closed medial subtalar dislocation and accompanying
talar head fracture in a 22-year-old man which occurred while walking on a
downhill road is reported. Closed reduction under general anesthesia was
unsuccessful. The obstacle for closed reduction was determined at surgery for
open reduction and internal fixation as buttonholing of the talar head
the extensor retinaculum. At the 26-month follow-up, he was pain-free in his
daily activities.
PMID: 12483340 [PubMed - indexed for MEDLINE]
117: J Trauma. 2002 Dec;53(6):1094-101; discussion 1102.
Is there a reliable outcome measurement for displaced intra-articular
Kinner BJ, Best R, Falk K, Thon KP.
Department of Surgery, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
BACKGROUND: The treatment of displaced intra-articular calcaneal fractures
remains controversial, because of difficulties in assessing the outcome. The
goal of this study, therefore, was to compare different outcome measurements
with gait analysis, using dynamic pedography. METHODS: Twenty patients with
operatively treated displaced intra-articular calcaneal fractures were
up clinically and radiographically. In addition, foot pressure was measured
using dynamic pedography. RESULTS: No significant difference was found
the two clinical outcome scores used (p = 0.08); both revealed good results.
Dynamic pedography, however, showed a shift of the maximum impact and rolloff
of the foot to the lateral side, as well as a widening of these zones in the
heel and on the sole in 14 of 20 patients. CONCLUSION: These results indicate
that traditional outcome measurements underestimate functional deficits in
patients. Monitoring plantar pressure distribution might therefore be a
tool for assessing foot function in these patients.
Publication Types:
Evaluation Studies
PMID: 12478034 [PubMed - indexed for MEDLINE]
118: Sports Med. 2003;33(1):75-81.
Overview of injuries in the young athlete.
Adirim TA, Cheng TL.
Division of Emergency Medicine, Children's National Medical Center,
DC 20010, USA.
It is estimated that 30 million children in the US participate in organised
sports programmes. As more and more children participate in sports and
recreational activities, there has been an increase in acute and overuse
injuries. Emergency department visits are highest among the school-age to
adult population. Over one-third of school-age children will sustain an
severe enough to be treated by a doctor or nurse. The yearly costs have been
estimated to be as high as 1.8 billion US dollars. There are physical and
physiological differences between children and adults that may cause children
be more vulnerable to injury. Factors that contribute to this difference in
vulnerability include: children have a larger surface area to mass ratio,
children have larger heads proportionately, children may be too small for
protective equipment, growing cartilage may be more vulnerable to stresses
children may not have the complex motor skills needed for certain sports
after puberty. The most commonly injured areas of the body include the ankle
knee followed by the hand, wrist, elbow, shin and calf, head, neck and
Contusions and strains are the most common injuries sustained by young
In early adolescence, apophysitis or strains at the apophyses are common. The
most common sites are at the knee (Osgood-Schlatter disease), at the heel
(Sever's disease) and at the elbow (Little League Elbow). Non-traumatic knee
pain is one of the most common complaints in the young athlete. Patellar
Pain Syndrome (PFPS) has a constellation of causes that include overuse, poor
tracking of the patellar, malalignment problems of the legs and foot
such as pes planus. In the child, hip pathology can present as knee pain so a
careful hip exam is important in the child presenting with an insidious onset
knee pain. Other common injuries in young athletes discussed include anterior
cruciate ligament injuries, ankle sprains and ankle fractures. Prevention of
sports and recreation-related injuries is the ideal. There are six potential
ways to prevent injuries in general: (i) the pre-season physical examination;
(ii) medical coverage at sporting events; (iii) proper coaching; (iv)
hydration; (v) proper officiating; and (vi) proper equipment and
playing conditions.
Publication Types:
Review, Tutorial
PMID: 12477379 [PubMed - indexed for MEDLINE]
119: J Orthop Surg (Hong Kong). 2001 Jun;9(1):39-43.
Foot and ankle injuries occurring in inflatable rescue boats (IRB) during
lifesaving activities.
Ashton LA, Grujic L.
Mona Vale Hospital, Australia.
Inflatable Rescue Boats (IRBs) are utilised by the Surf Life Saving
(SLSA) in Australia to perform rescue operations and in regional competitions
between surf clubs. These activities have resulted in a number of serious
and ankle injuries which reflect the high impact of this activity in heavy
unpredictable surf. We have retrospectively reviewed 12 significant injuries
relating to IRB usage presented to our regional hospital emergency department
over a 3-year period. These include 6 Lisfranc fracture dislocations of the
midfoot, 4 ankle fracture variants, one tibial shaft fracture, and one
rupture of the peroneal retinaculum leading to peroneal tendon dislocation.
Analysis of IRB footstraps in current usage shows they are directly related
the patterns of injury seen. We have recommended modifications to footstraps
handgrips currently in use with the aim of minimising or preventing these
PMID: 12468842 [PubMed - as supplied by publisher]
120: Int Orthop. 2002;26(6):377-80. Epub 2002 Jul 06.
Tibial reconstruction using a non-vascularised fibular transfer.
Morsi E.
Faculty of Medicine, Menoufia University, 25 Elmohtsb Street, Mohrm Bak,
Alexandria, Egypt.
A non-vascularised contralateral fibular transfer was performed on seven
patients with non-union of the tibia and a sclerosed segmental bone defect
following injury. The average follow-up was 2.7 years with a minimum of 2
The operation was successful in achieving fracture union in six patients,
an average time to union of 4.5 months (range: 3-6). Shortening of up to 2.4
was found in two patients and mild residual ankle stiffness in one. This
procedure is successful and simple when compared to microvascular and
PMID: 12466873 [PubMed - indexed for MEDLINE]
121: J Bone Joint Surg Br. 2002 Nov;84(8):1138-41.
Percutaneous screw fixation for fractures of the sesamoid bones of the
Blundell CM, Nicholson P, Blackney MW.
Over a period of one year we treated nine fractures ofhe sesamoid bones of
hallux, five of which were in the medial sesamoid. All patients had symptoms
exercise, but only one had a recent history of injury. The mean age of the
patients was 27 years (17 to 45) and there were six men. The mean duration of
symptoms was nine months (1.5 to 48). The diagnosis was based on clinical and
radiological investigations. We describe a new surgical technique for
percutaneous screw fixation for these fractures using a Barouk screw. All the
patients were assessed before and after surgery using the American
Foot and Ankle Society Hallux Score (AOFAS). There was a statistically
significant improvement in the mean score from 46.9 to 80.7 (p = 0.0003)
fixation of the fracture with a rapid resolution of symptoms. All patients
returned to their previous level of activity by three months. We believe that
this relatively simple technique is an excellent method of treatment in
appropriately selected patients.
PMID: 12463658 [PubMed - indexed for MEDLINE]
122: Foot Ankle Clin. 2002 Jun;7(2):323-50.
Foot and ankle fractures in the industrial setting.
Campbell JT.
Department of Orthopaedic Surgery, Johns Hopkins University, Johns Hopkins
Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224-2780, USA.
Fractures of the ankle and foot are common in the worker. Proper initial
assessment and treatment can result in a functional recovery that is prompt
complete in many cases. Many fractures, however, have a poor long-term
and prolonged recovery. Frank initial discussions with the patient and case
manager can help the system better manage the patient's future.
Publication Types:
Review, Tutorial
PMID: 12462113 [PubMed - indexed for MEDLINE]
123: Osteoporos Int. 2002 Dec;13(12):980-9.
Measurement of bone adjacent to tibial shaft fracture.
Findlay SC, Eastell R, Ingle BM.
Bone Metabolism Group, Section of Medicine, Division of Clinical Sciences,
University of Sheffield, Sheffield, UK.
Delayed union and non-union are common complications after fracture of the
tibial shaft. Response of the surrounding bone as a fracture heals could be
monitored using techniques currently used in the study of osteoporosis. The
of our study were to: (1) evaluate the decrement in bone measurements made
to the fracture using dual-energy X-ray absorptiometry (DXA), quantitative
ultrasound (QUS) and peripheral quantitative computed tomography (pQCT); (2)
compare values for fractured versus non-fractured leg to determine the
of decrement in bone measurements; and (3) calculate short-term precision in
DXA, QUS and pQCT in order to calculate the ratio of decrement to precision
(response ratio, RR) to determine the optimal test for monitoring changes
tibial fracture. The biggest decrement in bone measurements at the
limb of 28 patients with tibial shaft fracture was observed at the pQCT
trabecular sites (distal = 19%, p<0.0001; proximal 5% = 21%, p<0.001;
10% = 28%, p<0.001) and the ultradistal tibia/fibula measured by DXA (19%,
p<0.0001). When comparing Z-scores, the magnitude of decrements at the
ipsilateral limb was bigger for variables measured directly at the tibia,
proximal and distal to the fracture. The magnitude of the decrement in
ultradistal tibia/fibula BMD decreased as the time since fracture increased (
= 0.55). When response ratios are considered, pQCT measurements at the distal
tibia (RR 6-8) and proximal 5% and 10% trabecular sites (RR 5 and 9
respectively) were found to be the most sensitive to change. Therefore, pQCT
the trabecular regions of either the proximal or distal tibia should prove
most sensitive measurement for monitoring changes in bone adjacent to a
shaft fracture.
PMID: 12459941 [PubMed - indexed for MEDLINE]
124: Foot Ankle Int. 2002 Nov;23(11):999-1002.
The role of pulsatile cold compression in edema resolution following ankle
fractures: a randomized clinical trial.
Mora S, Zalavras CG, Wang L, Thordarson DB.
Twenty-four patients with displaced ankle fractures awaiting surgery were
randomized to a study (n=11) or a control group (n=13). In the study group,
patients had a pulsatile cold compression (PCC) device applied to their
and remained at bed rest with the extremity elevated while awaiting surgery.
the control group patients remained in a posterior molded splint instead of
PCC device. Baseline circumferential measurements of the ankle were obtained,
followed by measurements at 24-hour increments to evaluate edema resolution.
addition, patient satisfaction with use of the PCC device was evaluated with
scale ranging from 1 to 4.The median decrease of circumference in the study
group compared to the control group was 0.5 cm vs. 0.1 cm at 24 hours
0.9 cm vs. 0.4 cm at 48 hours (p<0.001), and 1.2 cm vs. 0.5 cm at 72 hours
(p=0.009). The ratio of the decrease in circumference relative to the
circumference of the normal ankle was significantly higher in the PCC group
compared to the control group at all time points. All patients in the PCC
were satisfied with the device (median satisfaction score = 4). The PCC
was well tolerated and resulted in a significantly greater reduction of ankle
circumference at 24, 48, and 72 hours after its application, compared to
splinting and elevation alone.The PCC device facilitates edema resolution
following ankle fractures.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 12449403 [PubMed - indexed for MEDLINE]
125: Foot Ankle Int. 2002 Nov;23(11):992-5.
Evaluation of compression in intramedullary hindfoot arthrodesis.
Berson L, McGarvey WC, Clanton TO.
The Greater Hartford Orthopedic Group, PC, Hartford, CT, USA.
Compression was evaluated in an intramedullary hindfoot arthrodesis cadaver
model using an external fixator and a "second generation" intramedullary
compression nail. Four cadaver specimens were used. Four trials were done
each specimen. Trial 1: manual compression with the 1st generation nail.
2: external fixator for compression with the 1st generation nail. Trial 3:
external fixator for compression with the 2nd generation nail. Trial 4:
nail-mounted compression device with the 2nd generation nail. In Trial 1 it
not possible to obtain or maintain compression. In Trial 2 large values of
compression were obtained with the external fixator, however compression was
maintained after the first generation nails were locked and the fixator was
removed. In Trial 3 large values of compression were obtained with the
fixator, but minimal compression was maintained after the second-generation
nails were locked and the fixator was removed. In Trial 4 large values of
compression were obtained with the compression device and greater than 60% of
the compression was maintained after the nail was locked and the compression
device was released. The study revealed that both the external fixator and
compression device could produce compression. The external fixator is useful
an aid in the O.R. However, in this study significant compression was
only with utilization of the compression device.
PMID: 12449401 [PubMed - indexed for MEDLINE]
126: Arch Orthop Trauma Surg. 2002 Nov;122(8):424-8. Epub 2002 Jun 20.
Percutaneous, arthroscopically-assisted osteosynthesis of calcaneus
Gavlik JM, Rammelt S, Zwipp H.
Department of Trauma and Reconstructive Surgery, University Hospital Carl
Carus, Fetscherstr. 74, 01307 Dresden, Germany.
BACKGROUND: The development of major and minor wound complications is a major
concern in the open reduction and internal fixation of displaced intraarticular
calcaneus fractures. Percutaneous, arthroscopically assisted screw
osteosynthesis was developed to minimize the surgical approach without
inadequate reduction of the subtalar joint. The method was applied in
cases of displaced intra-articular calcaneus fractures with one fracture line
crossing the posterior calcaneal facet (Sanders type II fractures). METHODS:
Between March 1998 and July 2000, 15 patients were treated with that method.
Percutaneous leverage was carried out with a Schanz screw introduced into the
tuberosity fragment (the Westhues maneuver) under direct arthroscopic and
fluoroscopic control. After anatomic reduction was achieved, the fragments
fixed with three to six cancellous screws introduced via stab incisions.
RESULTS: The functional results of 10 patients at a minimum of 1 year followup
are good to excellent, with an average AOFAS ankle-hindfoot score of 93.7
87-100) and an average Maryland Foot Score of 95.8 (range 93-100). Overall
patient comfort and satisfaction were superior to open reduction for similar
fracture patterns, and the in-hospital time could be reduced. CONCLUSIONS:
Percutaneous, arthroscopically assisted osteosynthesis offers exact
of the articular surface and allows anatomical reduction while adhering to
principles of minimally invasive surgery. The short-term results are
while long-term results with greater patient cohorts are awaited.
PMID: 12442176 [PubMed - indexed for MEDLINE]
127: Clin Orthop. 2002 Nov;(404):196-202.
Preoperative hip to ankle radiographs in total knee arthroplasty.
McGrory JE, Trousdale RT, Pagnano MW, Nigbur M.
Naval Medical Center Portsmouth, Portsmouth, VA, USA.
Whether a preoperative long leg radiograph taken with the patient standing
the surgeon reproduce a normal mechanical axis after total knee arthroplasty
unknown. The purpose of the current study was to evaluate whether a
long leg radiograph helps to restore normal limb alignment after total knee
arthroplasty. Ninety-four patients (124 primary total knee arthroplasties)
randomized to either receive or not receive a preoperative long leg standing
radiograph. Patients with previous hip or ankle surgery, femoral or tibial
fracture, deformity of 15 degrees or greater, or those who were obese (body
weight index > 40 kg/m2) were excluded. All arthroplasties were done by one
surgeon. The angle of distal femoral resection varied between 5 degrees and 8
degrees (mean, 6.2 degrees) among patients with long leg radiographs. In
patients without long leg radiographs, the distal femur was cut at 5 degrees.
Long leg radiographs were obtained postoperatively in all patients and the
mechanical axis was assessed, first by whether the mechanical axis fell
the central third of the knee, and second by the distance in millimeters that
the mechanical axis fell from the knee center. No significant difference in
postoperative mechanical axis was detected between the two groups. Eighty-six
percent of the patients with long leg preoperative radiographs and 92% of the
patients without long leg preoperative radiographs had the mechanical axis
through the central (1/3) of the knee. Preoperative hip to ankle long leg
radiographs taken with the patient standing did not significantly help to
a neutral mechanical axis during routine total knee arthroplasty.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 12439260 [PubMed - indexed for MEDLINE]
128: J Orthop Trauma. 2002 Nov-Dec;16(10):709-16.
Trabecular bone strain changes associated with subchondral comminution of the
distal tibia.
McKinley TO, Callendar PW, Bay BK.
Department of Orthopaedic Surgery, University of Iowa Hospital and Clinics,
City, Iowa 52242, USA.
OBJECTIVE: To measure trabecular bone strain changes resulting from three
increasing subchondral bone defects in the distal tibia. DESIGN: Cadaveric
biomechanical model. SETTING: Contact radiographs were made from sagittal
sections of human cadaveric distal tibia under no load and loaded to 400 N.
Digital images, made from contact radiographs of unloaded specimens, were
compared to corresponding digital images of loaded specimens using custom
software that measures trabecular deformation and calculates trabecular bone
strain. INTERVENTION: Twelve specimens were initially loaded intact in
compression. Testing was repeated after creating three increasing circular
subchondral bone defects in the center of a sagittal cross-section of the
tibia. Defects were 10%, 20%, and 30% of the sagittal diameter of the distal
tibia. MAIN OUTCOME MEASURES: Maximum shear strain, maximum principal strain,
and minimum principal strain were measured in six discrete regions in the
trabecular bone in the distal tibia. RESULTS: Small defects (10%) caused
strain elevations. Significant increases in trabecular bone strain were
with medium (20%) and large (30%) defects. Compressive strain increases as
as 1400 microstrain (10 strain) were measured adjacent to and proximal to the
defects with medium and large defects. CONCLUSIONS: Subchondral defects cause
size-dependent elevations in trabecular bone strain in the distal tibia.
and large defects caused rapidly increasing trabecular bone deformation under
PMID: 12439194 [PubMed - indexed for MEDLINE]
129: ANZ J Surg. 2002 Nov;72(11):775-6.
Comment on:
ANZ J Surg. 2002 Oct;72(10):724-30.
The importance of outcome.
Nade S.
Publication Types:
PMID: 12437685 [PubMed - indexed for MEDLINE]
130: Nurs Stand. 2002 Oct 23;17(6):37-46; quiz 47-8.
Comment in:
Nurs Stand. 2003 May 7-13;17(34):22.
Assessment and management of foot and ankle fractures.
Larsen D.
A&E Department, Bromley Hospital, Kent.
Injuries to the foot and ankle are common presentations in A&E, and while
are rarely life-threatening, incorrect diagnosis and management can have
consequences for patients. This article discusses the causes, assessment and
treatment of patients with these fractures.
Publication Types:
Review, Tutorial
PMID: 12434749 [PubMed - indexed for MEDLINE]
131: J Bone Joint Surg Am. 2002 Nov;84-A(11):2111-9.
What's new in orthopaedic trauma.
Wiss DA.
Southern California Orthopaedic Institute, 6815 Noble Avenue, Van Nuys, CA
91405, USA.
Publication Types:
Review, Tutorial
PMID: 12429787 [PubMed - indexed for MEDLINE]
132: J Bone Joint Surg Am. 2002 Nov;84-A(11):2029-38.
Kinematic behavior of the ankle following malleolar fracture repair in a
high-fidelity cadaver model.
Michelson JD, Hamel AJ, Buczek FL, Sharkey NA.
Center for Locomotion Studies, The Pennsylvania State University, 29
Building, University Park, PA 16802, USA.
BACKGROUND: Previous studies involving axially loaded ankle cadaver specimens
undergoing a passive range of motion after fracture have demonstrated
instability patterns consisting of excessive external rotation during plantar
flexion. The present study was designed to expand these studies by using a
in which ankle motion is controlled by physiologically accurate motor forces
generated through phasic force-couples attached to the muscle-tendon units.
METHODS: Eight right unembalmed cadaver feet were tested in a dynamic gait
simulator that reproduces the sagittal kinematics of the tibia while applying
physiological muscle forces to the tendons of the major extrinsic muscles of
foot. Six-degrees-of-freedom kinematics of the tibia and talus were measured
with use of a VICON motion-analysis system. The experimental conditions
all combinations of lateral and medial injury to reproduce the clinical
classifications of ankle fracture. Statistical analysis was performed with
repeated-measures analyses of variance. RESULTS: The talus of the intact
demonstrated coupled external rotation and inversion relative to the tibia as
the ankle plantar flexed. Osteotomy of the fibula, simulating a lateral ankle
fracture, slightly but significantly increased external rotation and
of the talus (p < 0.001), whereas disruption of either the superficial or the
deep deltoid ligament increased talar eversion (p < 0.003) and disruption of
deep deltoid ligament increased internal rotation (p < 0.0001). The aberrant
motions were corrected by repair of the injured structure. CONCLUSIONS: The
predominant coupled rotation of the talus is external rotation associated
plantar flexion. Following progressive ankle destabilization, talar external
rotation and inversion increased. Clinical Relevance: The clinical
decision-making process regarding the treatment of ankle fractures centers on
determination of whether the injury is expected to result in abnormal motion,
which is thought to predispose to the development of arthritis. The present
study demonstrated a remarkable degree of ankle stability during stance phase
even when there was severe disruption of medial and lateral structures. This
finding suggests that a main determinant of clinical outcome after ankle
fracture may be ankle motion during swing phase, when ankle stability is not
augmented by the combination of axial loading and active motor control of
motion. If swing-phase motion is abnormal, then the ankle may be in a
position at the point of heel-strike.
PMID: 12429766 [PubMed - indexed for MEDLINE]
133: Dev Med Child Neurol. 2002 Oct;44(10):695-8.
Fracture prevalence in Duchenne muscular dystrophy.
McDonald DG, Kinali M, Gallagher AC, Mercuri E, Muntoni F, Roper H, Jardine
Jones DH, Pike MG.
Oxford Radcliffe NHS Trust, UK.
The objective of this study was to determine the prevalence, circumstances,
outcome of fractures in males with Duchenne muscular dystrophy (DMD)
neuromuscular clinics. Three hundred and seventy-eight males (median age 12
years, range 1 to 25 years) attending four neuromuscular centres were studied
case-note review supplemented by GP letter or by interview at the time of
attendance. Seventy-nine (20.9%) of these patients had experienced fractures.
Forty-one percent of fractures were in patients aged 8 to 11 years and 48% in
independently ambulant patients. Falling was the most common mechanism of
fracture. Upper-limb fractures were most common in males using knee-anklefoot
orthoses (65%) while lower-limb fractures predominated in independently
and wheelchair dependent males (54% and 68% respectively). Twenty percent of
ambulant males and 27% of those using orthoses lost mobility permanently as a
result of the fracture. In a substantial proportion of males, the occurrence
a fracture had a significant impact on subsequent mobility.
PMID: 12418795 [PubMed - indexed for MEDLINE]
134: J Pediatr Orthop. 2002 Nov-Dec;22(6):754-60.
Treatment of established and anticipated nonunion of the tibia in childhood.
Liow RY, Montgomery RJ.
Middlebrough General Hospital, Cleveland, United Kingdom.
Nonunion in long bone fractures is rare in the skeletally immature patient.
authors report the outcome of a series of patients treated for tibial bone
and nonunion at average follow-up of 66 months. Nine children aged 18 months
17 years were treated. Three patients had established nonunion ranging from 7
months to 6 years, three had bone loss (1-6 cm), and three had fractures in
which nonunion was anticipated (one Gustilo IIIb and two Tscherne III).
Treatment involved wound excision for open fractures, debridement of
devascularized bone, and stabilization with monolateral fixators (two
and circular fixators (seven patients). Five patients had unifocal treatment
four had multifocal treatment (three bone transports). Treatment time ranged
from 3 to 12 months and was not related to the complexity of treatment.
Functional outcome was measured using the Short Musculoskeletal Functional
Assessment, a validated outcome assessment tool. At the latest follow-up
(average 66 months), the mean knee flexion was 134 degrees and mean ankle
was 12 degrees dorsiflexion, 31 degrees plantar flexion. Physeal arrest was
present in three children (limb length discrepancy 2-4 cm), but with no
deformity. Functional outcome revealed a "Dysfunction Index" of 0% to 19%
(average 7%) and a "Bother Index" of 0% to 16% (average 6%). Good function
be obtained following treatment of these severe injuries.
PMID: 12409902 [PubMed - indexed for MEDLINE]
135: Plast Reconstr Surg. 2002 Nov;110(6):1613-4.
Collagen sheets as temporary wound cover in major open fractures before
definitive flap cover.
Venkatramani H, Sabapathy SR.
Publication Types:
PMID: 12409804 [PubMed - indexed for MEDLINE]
136: JBR-BTR. 2002 Aug-Sep;85(4):212-8.
Trauma of the pediatric ankle and foot.
Vanhoenacker FM, Bernaerts A, Gielen J, Schepens E, De Schepper AM.
Department of Radiology, University Hospital Antwerp, Edegem, Belgium.
This article presents a brief overview of the injuries to the ankle and foot
encountered in children and adolescents. Trauma to the ankle or foot may
from acute, chronic, or repetitive forces. The role of the different imaging
modalities in the assessment of ankle and foot trauma in the growing patient
discussed. Plain radiographs remain the mainstay in the diagnosis of most
traumas, whereas CT may be helpful to unravel the complex anatomy of certain
fractures like the triplane or juvenile Tillaux fracture. In the evaluation
chronic injuries, including osteochondrosis dissecans and osteonecrosis, MRI
evolving as the modality of choice.
PMID: 12403392 [PubMed - indexed for MEDLINE]
137: J Foot Ankle Surg. 2002 Sep-Oct;41(5):335-7.
Ilizarov ring fixator for a difficult case of ankle syndesmosis disruption.
Relwani J, Lahoti O, Orakwe S.
Lewisham University Hospital, London, UK.
Syndesmotic stabilization is recommended for tibiofibular diastasis, a
Maisonneuve fracture, or syndesmotic instability after fixation of distal
tibia-fibula fractures. In the case presented, a syndesmotic stabilization
performed with a screw inserted 2 cm above the tibiotalar joint Subsequent
failure occurred due to the weight of the patient and a lack of compliance
the necessary nonweight bearing protocol. The Ilizarov frame was used to
and maintain a stable syndesmosis with a simple two-ring construct which
the patient to bear weight on the injured limb while his syndesmosis healed.
This is not recommend as a routine method of treatment, but is presented as
extended indication of the Ilizarov frame for difficult cases.
PMID: 12400719 [PubMed - indexed for MEDLINE]
138: Foot Ankle Int. 2002 Oct;23(10):917-21.
Functional outcome of patients following open reduction internal fixation for
bilateral calcaneus fractures.
Zmurko MG, Karges DE.
Wayne State University, Detroit Receiving Hospital, Department of Orthopaedic
Surgery, MI, USA.
Treatment of displaced intra-articular calcaneus fractures has historically
controversial, but recent developments have led to resurgence in open
internal fixation (ORIF) for displaced calcaneus fractures. Recent functional
outcome studies comparing operative to nonoperative treatment of unilateral
calcaneus fractures has shown a trend towards improved function with ORIF. No
studies have investigated the functional outcome of patients who have
operative treatment of bilateral displaced calcaneus fractures. The purpose
this study was to review our operative experience with bilateral displaced
intra-articular calcaneal fractures. A retrospective review of medical charts
indicated 13 patients had undergone ORIF for bilateral calcaneus fractures.
patients could be contacted and brought to the clinic for functional
and radiographic CT studies. Functional outcome was assessed by the
Musculoskeletal Functional Assessment Score (MFA) and the American
Foot and Ankle Hindfoot Score (AOFAS). The average follow-up was 56 months.
half of the patients required additional surgeries. The average MFA and AOFAS
scores were 31.1 and 71.8, respectively. Functional outcome decreased for
patients with multiple traumatic fractures and surgical procedures of the
calcaneus. Our results show a diminished functional outcome for patients
sustaining bilateral calcaneus fractures treated with ORIF when compared to
patients managed surgically for unilateral calcaneus fractures, but better
functional outcomes than patients who do not undergo ORIF for unilateral
calcaneus fractures. This diminished function limits work capacity and
to perform daily activities that require standing.
PMID: 12398143 [PubMed - indexed for MEDLINE]
139: J Trauma. 2002 Oct;53(4):686-90.
Skateboard-associated injuries: participation-based estimates and injury
Kyle SB, Nance ML, Rutherford GW Jr, Winston FK.
Epidemiology and Health Statistics, Consumer Product Safety Commission,
Bethesda, Maryland, USA.
BACKGROUND: Skateboarding is a popular recreational activity but has
associated risks. To place this risk in perspective, participation-based
of injury were determined and compared with those of other selected sports.
Skateboard-associated injuries were evaluated over time to determine
participation-based trends in injury prevalence. METHODS: Rates of
skateboard-associated injury were studied for the 12-year period 1987 to 1998
for participants aged 7 years or older. The National Electronic Injury
Surveillance System provided injury estimates for skateboarding and the
additional sporting activities. The National Sporting Goods Association
survey of nationally representative households provided participation
A participation-based rate of injury was calculated from these data sets for
selected sports for the year 1998. RESULTS: The 1998 rate of emergency
department-treated skateboard-associated injuries-8.9 injuries per 1,000
participants (95% confidence interval [CI], 6.2, 11.6)-was twice as high as
in-line skating (3.9 [95% CI, 3.1, 4.8]) and half as high as basketball (21.2
[95% CI, 18.3, 24.1]). The rate of skateboard-associated injuries declined
1987 to 1993 but is again increasing: the 1998 rate was twice that of 1993
[95% CI, 1.6, 7.4] and 8.9 [95% CI, 6.2, 11.6], respectively). Increases
occurred primarily among adolescent and young adult skateboarders. The most
frequent injuries in 1998 were ankle strain/sprain and wrist fracture: 1.2
CI, 0.8, 1.6) and 0.6 (95% CI, 0.4, 0.8) per 1,000, respectively.
Skateboard-associated injuries requiring hospitalization occurred in 2.9% and
were 11.4 (95% CI, 7.5, 17.5) times more likely to have occurred as a result
a crash with a motor vehicle than injuries in those patients not
CONCLUSION: This study is the first to relate skateboarding and other sport
injuries to participation exposures. We found that skateboarding is a
comparatively safe sport; however, increased rates of injury are occurring in
adolescent and young adult skateboarders. The most common injuries are
musculoskeletal; the more serious injuries resulting in hospitalization
typically involve a crash with a motor vehicle. This new methodology that
participation-based injury rates might contribute to more effective injury
control initiatives.
PMID: 12394867 [PubMed - indexed for MEDLINE]
140: N Z Med J. 2002 Sep 27;115(1162):U184.
The Ottawa ankle rules for the use of diagnostic X-ray in after hours medical
centres in New Zealand.
Wynn-Thomas S, Love T, McLeod D, Vernall S, Kljakovic M, Dowell A, Durham J.
Department of General Practice, Wellington School of Medicine and Health
AIMS: The aims of this study were to measure baseline use of Ottawa ankle
(OAR), validate the OAR and, if appropriate, explore the impact of
the Rules on X-ray rates in a primary care, after hours medical centre
METHODS: General practitioners (GPs) were surveyed to find their awareness of
ankle injury guidelines. Data concerning diagnosis and X-ray utilisation were
collected prospectively for patients presenting with ankle injuries to two
hours medical centres. The OAR were applied retrospectively, and the
and specificity of the OAR were compared with GPs clinical judgement in
ordering X-rays. The outcome measures were X-ray utilisation and diagnosis of
fracture. RESULTS: Awareness of the OAR was low. The sensitivity of the OAR
diagnosis of fractures was 100% (95% CI: 75.3 - 100) and the specificity was
(95% CI: 40.5 - 54.5). The sensitivity of GPs clinical judgement was 100%
CI: 75.3 - 100) and the specificity was 37% (95% CI: 30.2 - 44.2).
the OAR would reduce X-ray utilisation by 16% (95% CI: approx 10.8 - 21.3).
CONCLUSIONS: The OAR are valid in a New Zealand primary care setting. Further
implementation of the rules would result in some reduction of X-rays ordered
ankle injuries, but less than the reduction found in previous studies.
Publication Types:
Validation Studies
PMID: 12386663 [PubMed - indexed for MEDLINE]
141: Prehosp Emerg Care. 2002 Oct-Dec;6(4):406-10.
Comment in:
Prehosp Emerg Care. 2002 Oct-Dec;6(4):486-8.
Few emergency medical services patients with lower-extremity fractures
prehospital analgesia.
McEachin CC, McDermott JT, Swor R.
Department of Emergency Medicine, William Beaumont Hospital,Royal Oak, MI
Previous literature has identified prehospital pain management as an
emergency medical services (EMS) function, and few patients transported by
with musculoskeletal injuries receive prehospital analgesia (PA). OBJECTIVES:
To describe the frequency with which EMS patients with lower-extremity and
fracture receive prehospital and emergency department (ED) analgesia; 2) to
describe EMS and patient factors that may affect administration of PA to
patients; and 3) to describe the time interval between EMS and ED medication
administrations. METHODS: This was a four-month (April to July 2000)
retrospective study of patients with a final hospital diagnosis of hip or
lower-extremity fracture who were transported by EMS to a single suburban
community hospital. Data including patient demographics, fracture type, EMS
response, and treatment characteristics were abstracted from review of EMS
ED records. Patients who had ankle fractures, had multiple traumatic
were under the age of 18 years, or did not have fractures were excluded.
RESULTS: One hundred twenty-four patients met inclusion criteria. A basic
support (BLS)-only response was provided to 20 (16.0%). Another 38 (38.4%)
received an advanced life support (ALS) response and were triaged to BLS
transport. Of all the patients, 22 (18.3%) received PA. Patients who received
were younger (64.0 vs. 77.3 years, p < 0.001) and more likely to have a
lower-extremity fracture other than a hip fracture (31.8% vs. 10.7%, p <
Of all patients, 113 (91.1%) received ED analgesia. Patients received
from EMS almost 2.0 hours sooner that in the ED (mean 28.4 +/- 36 min vs. 146
+/- 74 min after EMS scene arrival, p < 0.001). CONCLUSION: A minority of the
study group received PA. Older patients and patients with hip fracture are
likely to receive PA. It is unclear whether current EMS system design may
adversely impact administration of PA. Further work is needed to clarify
patient need or EMS practice patterns result in low rates of PA.
PMID: 12385607 [PubMed - indexed for MEDLINE]
142: Sportverletz Sportschaden. 2002 Sep;16(3):101-7.
[Functional results of dynamic gait analysis after 1 year of hobby-athletes
a surgically treated ankle fracture]
[Article in German]
Losch A, Meybohm P, Schmalz T, Fuchs M, Vamvukakis F, Dresing K, Blumentritt
Sturmer KM.
Universitatsklinikum Gottingen, Abteilung fur Unfallchirurgie, Plastische und
Widerherstellungschirurgie, Germany.
Retrospectively 20 patients with a surgically treated ankle fracture caused
hobby-accidents were examined clinically and radiologically by a score
to Phillips after 12 months postoperatively. Further they have taken part in
dynamical gait analysis at the same time. A group of 20 healthy adults was
as a control group comparable to age, sex, height and weight. Although 19
patients out of 20 have achieved a good result at the score evaluation and
of them was clinically noticed with any pathological gait, gait analysis has
shown a significant slowed gait speed and a decreased stride length. The
reduction of the plantarflexor moment at the injured ankle joint immediately
following heel contact was yet the most remarkable result of the gait
The changes of gait pattern are interpreted as an adapted and internalized
motion pattern caused by pain and behaviour of rest at any time while the
mobilisation-phase was going on. It could not document any significant
correlation between subjective and clinical parameters and parameters
by gait analysis. However, a significant correlation of gait-analysed
was found between the injured and uninjured side. By dynamical gait analysis
is possible to quantify remarkable gait changes, to obtain objective data,
also to demonstrate asymmetrical loading and motion that were not clinically
detectable previously. It follows that it can be relevant to patients with
complaints by leading them to specific physiotherapeutical treatment and gait
training so that they would be able to carry on their sports-activities
Publication Types:
Evaluation Studies
PMID: 12382182 [PubMed - indexed for MEDLINE]
143: Foot Ankle Clin. 2002 Mar;7(1):191-206.
Salvage after complications of total ankle arthroplasty.
Myerson MS, Miller SD.
Department of Orthopaedic Surgery, Union Memorial Orthopaedics, Johnston
Professional Building, #400, 3333 North Calvert Street, Baltimore, MD 21218,
The problems that arise during surgery and after failure of TAA may be
formidable to even the most experienced surgeon. As with any operative
procedure, the consideration of this procedure should be tempered with the
difficulty in salvage. This article is an early summary of some of the
problems with the Agility (DePuy) total joint ankle arthroplasty.
Publication Types:
Review Literature
PMID: 12380389 [PubMed - indexed for MEDLINE]
144: Foot Ankle Clin. 2002 Mar;7(1):107-20.
Arthrodesis as salvage for calcaneal malunions.
Robinson JF, Murphy GA.
Bridger Orthopedic and Sports Medicine, 931 Highland Boulevard, Suite 3210,
Bozeman, MT 59715, USA.
Even with greater emphasis on anatomic reduction, outcomes after calcaneal
fractures continue to be unsatisfactory in many patients. Lateral wall
impingement, subtalar arthrosis with pain and stiffness, nerve compression
syndromes, and hindfoot malalignment all can cause disabling symptoms. If
conservative treatment fails to relieve symptoms, subtalar arthrodesis can
provide a painless, stable hindfoot in most patients. For severe deformity
anterior ankle impingement and loss of the talar angle of declination,
distraction bone block arthrodesis through a posterior approach is preferred.
Publication Types:
Review Literature
PMID: 12380384 [PubMed - indexed for MEDLINE]
145: Anthropol Anz. 2002 Sep;60(3):309-19.
[A severe traffic accident--250 years ago. Medical history presentation]
[Article in German]
Herrmann G, Holck P, Wilhelm H.
Kreiskrankenhaus Grunstadt, Chirurgische Abteilung, Grunstadt/Pfalz.
During a scientific examination in July 1999 both crypts below the St.
Church in Grunstadt, Germany, were opened and 9 coffins from the county
of Leiningen examined. This paper is concentrating on one of these persons:
Georg Hermann (1679-1751), count of Leiningen-Westerburg-Altleiningen, who
during the 18. century the city its barock character. He was also responsible
for the rebuilding of the church. His skeleton revealed interesting
changes. Few years before his death the count had the accident to get run
by a heavy wagon which crushed the distal part of his legs. The fractures
healed, but gave him an ancylotic and shortened left leg, which must have
him a lot of suffering in his last years.
Publication Types:
Historical Article
Personal Name as Subject:
Hermann G
PMID: 12378797 [PubMed - indexed for MEDLINE]
146: J Bone Joint Surg Am. 2002 Oct;84-A(10):1829-35.
Intramuscular and blood pressures in legs positioned in the hemilithotomy
position : clarification of risk factors for well-leg acute compartment
Meyer RS, White KK, Smith JM, Groppo ER, Mubarak SJ, Hargens AR.
Department of Orthopaedic Surgery, University of California at San Diego
Center, San Diego, California 92123-4228, USA.
BACKGROUND: Acute compartment syndrome has been widely reported in legs
positioned in the lithotomy position for prolonged general surgical,
and gynecologic procedures. The orthopaedic literature also contains reports
this complication in legs positioned on a fracture table in the hemilithotomy
position. The purpose of this study was to identify the risk factors for
development of acute compartment syndrome resulting from this type of leg
positioning. METHODS: Eight healthy volunteers were positioned on a fracture
table. Intramuscular pressures were continuously measured with a slit
in all four compartments of the left leg with the subject supine, in the
hemilithotomy position with the calf supported, and in the hemilithotomy
position with the heel supported but the calf free. Blood pressure was
intermittently with use of automated pressure cuffs. RESULTS: Changing from
supine to the calf-supported position significantly increased the
pressure in the anterior compartment (from 11.6 to 19.4 mm Hg) and in the
lateral compartment (from 13.0 to 25.8 mm Hg). Changing from the calfsupported
to the heel-supported position significantly decreased intramuscular pressure
the anterior, lateral, and posterior compartments (to 2.8, 3.4, and 1.9 mm
respectively). The mean diastolic blood pressure in the ankle averaged 63.9
Hg in the supine position, which significantly decreased to 34.6 mm Hg in the
calf-supported position. Changing to the heel-supported position had no
significant effect on the diastolic blood pressure in the ankle (mean, 32.8
Hg). The mean difference between intramuscular pressure and diastolic blood
pressure in the supine position was approximately 50 mm Hg in each of the
compartments. This mean difference significantly decreased to <20 mm Hg in
calf-supported position and then, when the leg was moved into the heelsupported
position, significantly increased to approximately 30 mm Hg in all
CONCLUSIONS: The combination of increased intramuscular pressure due to
compression from the calf support and decreased perfusion pressure due to the
elevated position causes a significant decrease in the difference between the
diastolic blood pressure and the intramuscular pressure when the leg is
in the hemilithotomy position in a well-leg holder on a fracture table.
with a prolonged surgical time, this position may cause an acute compartment
syndrome of the well leg. Leaving the calf free, instead of using a standard
well-leg holder, increases the difference between the diastolic blood
and the intramuscular pressure and may decrease the risk of acute compartment
PMID: 12377915 [PubMed - indexed for MEDLINE]
147: J Bone Joint Surg Am. 2002 Oct;84-A(10):1799-810.
Congenital pseudarthrosis of the tibia: results of technical variations in
charnley-williams procedure.
Johnston CE 2nd.
Texas Scottish Rite Hospital for Children, Dallas, Texas 75219, USA.
BACKGROUND: Results of the Charnley-Williams method of intramedullary
for treatment of congenital pseudarthrosis of the tibia have varied, in part
because of variations in surgical technique. The outcomes of three variations
this procedure were compared to determine which technique was the most likely
result in union. METHODS: The results in twenty-three consecutive patients
congenital pseudarthrosis of the tibia were reviewed at four to fourteen
following initial surgical treatment with an intramedullary rod. Three types
procedures were performed: type A, which consisted of resection of the tibial
pseudarthrosis with shortening, insertion of an intramedullary rod into the
tibia, and tibial bone-grafting combined with fibular resection or osteotomy
insertion of an intramedullary rod into the fibula; type B, which was
to type A except that it did not include fibular fixation; and type C, which
consisted of insertion of a tibial rod and bone-grafting but no fibular
The outcome was classified as grade 1 when there was unequivocal union with
weight-bearing function and maintenance of alignment requiring no additional
surgical treatment; grade 2 when there was equivocal union with useful
with the limb protected by a brace, and/or valgus or sagittal bowing for
additional surgery was required or anticipated; and grade 3 when there was
persistent nonunion or refracture, requiring full-time external support for
and/or instability. RESULTS: Eleven patients (48%) ultimately had a grade-1
outcome; nine, a grade-2 outcome; and three, a grade-3 outcome. The final
outcome was not associated with either the initial radiographic appearance of
the lesion or the age of the patient at the time of the initial surgery. The
results following type-A and B operations were better than those after type-C
procedures. Surgery on an intact fibula resulted in a lower prevalence of
grade-3 outcomes than was found when an intact fibula was not operated on (p
0.05). Transfixation of the ankle joint by the intramedullary rod did not
decrease the prevalence of grade-3 outcomes. CONCLUSIONS: There is little
justification for a type-C operation, as it either resulted in a persistent
nonunion or failed to improve an equivocal outcome in every case. Leaving an
intact fibula undisturbed to maintain stability or length also was not
successful in this series. In addition, the presence of fibular insufficiency
(fracture or a pre-pseudarthrotic lesion) was highly prognostic for
valgus deformity (occurring in ten of twelve cases), whether or not the
eventually healed.
PMID: 12377911 [PubMed - indexed for MEDLINE]
148: J Bone Joint Surg Am. 2002 Oct;84-A(10):1733-44.
Operative compared with nonoperative treatment of displaced intra-articular
calcaneal fractures: a prospective, randomized, controlled multicenter trial.
Buckley R, Tough S, McCormack R, Pate G, Leighton R, Petrie D, Galpin R.
Calfary General Hospital, Calgary, Alberta, Canada.
BACKGROUND: Open reduction and internal fixation is the treatment of choice
displaced intra-articular calcaneal fractures at many orthopaedic trauma
centers. The purpose of this study was to determine whether open reduction
internal fixation of displaced intra-articular calcaneal fractures results in
better general and disease-specific health outcomes at two years after the
injury compared with those after nonoperative management. METHODS: Patients
four trauma centers were randomized to operative or nonoperative care. A
standard protocol, involving a lateral approach and rigid internal fixation,
used for operative care. Nonoperative treatment involved no attempt at closed
reduction, and the patients were treated only with ice, elevation, and rest.
fractures were classified, and the quality of the reduction was measured.
Validated outcome measures included the Short Form-36 (SF-36, a general
survey) and a visual analog scale (a disease-specific scale). RESULTS:
April 1991 and December 1997, 512 patients with a calcaneal fracture were
treated. Of those patients, 424 with 471 displaced intra-articular calcaneal
fractures were enrolled in the study. Three hundred and nine patients (73%)
followed and assessed for a minimum of two years and a maximum of eight years
follow-up. The outcomes after nonoperative treatment were not found to be
different from those after operative treatment; the score on the SF-36 was
and 68.7, respectively (p = 0.13), and the score on the visual analog scale
64.3 and 68.6, respectively (p = 0.12). However, the patients who were not
receiving Workers' Compensation and were managed operatively had
higher satisfaction scores (p = 0.001). Women who were managed operatively
scored significantly higher on the SF-36 than did women who were managed
nonoperatively (p = 0.015). Patients who were not receiving Workers'
Compensation and were younger (less than twenty-nine years old), had a
moderately lower Bohler angle (0 degrees to 14 degrees ), a comminuted
a light workload, or an anatomic reduction or a step-off of < or =2 mm after
surgical reduction (p = 0.04) scored significantly higher on the scoring
after surgery compared with those who were treated nonoperatively.
Without stratification of the groups, the functional results after
care of displaced intra-articular calcaneal fractures were equivalent to
after operative care. However, after unmasking the data by removal of the
patients who were receiving Workers' Compensation, the outcomes were
significantly better in some groups of surgically treated patients.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 12377902 [PubMed - indexed for MEDLINE]
149: J Pediatr Orthop B. 2002 Oct;11(4):298-301.
Isolated congenital pseudoarthrosis of the fibula.
Yang KY, Lee EH.
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
Congenital pseudarthrosis of the limb most commonly involves the tibia,
various combinations of bones including fibula, radius, ulna, clavicle and
humerus have all been described. Isolated congenital pseudarthrosis of the
fibula is a very rare entity with only 12 cases reported in the English
literature. We report three cases of this condition treated in our
The first child had a varus ankle deformity at the age of 4 months. The other
two children presented with valgus ankle deformity after they started to
Two patients were treated conservatively while the third had a distal
tibio-fibular fusion in view of severe valgus deformity. All three patients
showed good early results after 1 to 2 years. We advocate early distal
tibio-fibular fusion to prevent valgus deformity in these children.
PMID: 12370580 [PubMed - indexed for MEDLINE]
150: Am J Emerg Med. 2002 Oct;20(6):502-5.
Painful discrimination: the differential use of analgesia in isolated lower
Kozlowski MJ, Wiater JG, Pasqual RG, Compton S, Swor RA, Jackson RE.
Department of Emergency Medicine, William Beaumont Hospital, A Wayne State
University Affiliated Program, Royal Oak, MI 48067, USA.
Our primary objective was to compare use of analgesia for patients with and
without fracture as a result of isolated lower extremity trauma, in the
emergency department (ED). Our secondary objective was to compare the
practices of emergency physicians (EPs) with that of physician assistants
We performed a prospective, blinded cohort study with the presence of
as the risk factor and provision of any pain medication while in the ED as
primary outcome. Included in the study were all patients who presented to a
90,000 visit suburban teaching hospital with an isolated lower extremity
who received a radiograph of the foot or ankle over a 9-week period. We
patients without trauma, with multiple trauma, admitted, or seen by one of
investigators. Patients admitted and those with multiple trauma were excluded
because these patients had contacts with multiple physicians and it is
they would be able to differentiate which physician prescribed medication and
they were emergency personnel. We defined analgesia as any pain medication at
any dose. One investigator preformed follow-up interviews using a
questionnaire 3 days after the visit. Patients expressed their recollection
their degree of pain using a verbal analog scale of 1 to 10. We report crude
adjusted odds ratios (OR). Of 516 consecutive patients, 111 met exclusion
criteria and 3 had incomplete data. Of the remaining 405, we contacted 384
in an average of 3 +/- 1 days. Patients with and without fractures recalled
their initial degree of pain similarly, with the mean initial pain scores on
verbal analog scale of 6.6 +/- 2.5 versus 6.8 +/- 2.1 respectively. Patients
with a fracture were more likely to receive pain medication while in the ED
v 15% P =.047, OR 1.75 (CI 95% 1.02, 2.99). EPs gave some form of ED
to 29% of patients, as compared with 10% of patients seen by PAs (OR = 3.58
95% 2.05, 6.24). EPs provided a prescription to 44% of patients versus 21% of
patients seen by PAs (OR = 2.91 CI 95% 1.85, 4.57). Our estimated adjusted
for providing analgesia in the ED were: fracture = 2.0 (CI 95% 1.13, 3.58);
3.52 (CI 95% 1.98, 2.99); and for every additional point on the verbal pain
scale: 1.28 (CI 95% 1.11, 1.48). Patients with fracture were more likely to
receive pain, despite reporting identical degree of pain. EPs were more
to provide analgesia than PAs. Copyright 2002, Elsevier Science (USA).
Publication Types:
Evaluation Studies
PMID: 12369020 [PubMed - indexed for MEDLINE]
151: Acta Chir Orthop Traumatol Cech. 2002;69(4):243-7.
[Fracture-dislocations of the ankle joint in adults. Part I: epidemiologic
evaluation of patients during a 1-year period]
[Article in Czech]
Jehlicka D, Bartonicek J, Svatos F, Dobias J.
Ortopedicko-traumatologicka klinika 3. LF UK a FNKV, Praha.
PURPOSE OF THE STUDY: The aim of the study is to present a basic statistical
overview of fracture-dislocations of the ankle in adults in a one-year group
patients. MATERIAL: The analyzed group of patients comprised 232 patients
men, 111 women) treated for fracture-dislocations of the ankle at the
department between 1 January and 31 December 1999. In all patients the physes
were closed. The type of fractures was classified after B. G. Weber. RESULTS:
Type A fractures accounted for 23%, Type B fractures for 65% and Type C
fractures for 12% of all cases. The average age of the injured was 49 years
(range, 16-89), with men prevailing until 5th decade and women predominating
from 6th decade. In 65% of Type A fractures there occurred only the fracture
lateral malleolus, in 31% the fracture involved also medial malleolus and in
it affected also the posterior margin of the distal tibia. In 49% of Weber B
type of fractures the medial malleolus was fractured, in 20% the deltoid
ligament was ruptured and in 31% there occurred no injury on the medial
Avulsion of the posterior margin of the distal tibia occurred in 46%. In 71%
Type C fractures the fracture was located in the lower half of fibula,
Maisonneuve type occurred in 29%. Medial malleolus was fractured in 57%, the
deltoid ligament was ruptured in 36%, in 7% there was no medial injury. The
posterior margin of the distal tibia was avulsed also in 46%. Fracture of the
posterior margin of the distal tibia occurred in Type A in 4%, in Type B in
and in Type C also in 46%. In Types B and C the size of the avulsed posterior
part of the distal tibia covered 1/4 of its articular surface in 75% of
1/3 in 17% and 1/2 in 8% of cases. DISCUSSION: We have found an adequate
of patients for comparison only in the Lindsjo work who evaluated a group of
adult patients treated at his department between the beginning of February
and end of June 1975. Other groups of patients which we studied and which
included some of the parameters that we have examined are not comparable from
the viewpoint of the basic selection of patients as the selection was made in
different way, namely according to the manner of treatment, i.e.
or surgically, or according to the preference of one of the types of the
fractures or the period of follow-up. Also, the so called epidemiological
studies concentrated only on one or two factors (men/women ratio, the cause
injury, the period of the year). In addition, some works also include
in growing individuals. CONCLUSION: Fracture-dislocations affect equally men
women. Men prevail until the age of fifty, women afterwards. The average age
patients was 49 years. Most frequent is Weber B Type, least frequent Weber C.
PMID: 12362627 [PubMed - indexed for MEDLINE]
152: Hosp Med. 2002 Sep;63(9):556-7.
Fractures of the ankle.
Coull R, Williams RL.
UCL Hospitals, London W1N 8AA.
Publication Types:
Review, Tutorial
PMID: 12357861 [PubMed - indexed for MEDLINE]
153: Foot Ankle Int. 2002 Sep;23(9):833-7.
Stress fractures of the ankle and forefoot in patients with inflammatory
Maenpaa H, Lehto MU, Belt EA.
Rheumatism Foundation Hospital, Heinola, Finland.
Twenty-four stress fractures occurring in the metatarsal bones and ankle
were examined in 17 patients with inflammatory arthritides. There were 16
metatarsal, four distal fibular, two distal tibial, and two calcaneus
Radiographic analyses were performed to determine the presence of possible
predisposing factors for stress fractures. Metatarsal and ankle region stress
fractures were analyzed separately. Stress fractures occurred most frequently
the second and third metatarsals. In metatarsal fractures, there was a trend
varus alignment of the ankle to cause fractures of the lateral metatarsal
and valgus alignment of the medial metatarsal bones. Valgus deformity of the
ankle was present in patients with distal fibular fractures in the ankle
group. Calcaneus fractures showed neutral ankle alignment. Malalignment of
ankle and hindfoot is often present in distal tibial, fibular, and metatarsal
stress fractures. Additionally, patients tend to have long disease histories
with diverse medication, reconstructive surgery and osteoporosis. If such
patients experience sudden pain, tenderness, or swelling in the ankle region,
stress fractures should be suspected and necessary examinations performed.
PMID: 12356181 [PubMed - indexed for MEDLINE]
154: Clin Nucl Med. 2002 Oct;27(10):707-10.
A critical appraisal of pinhole scintigraphy of the ankle and foot.
Frater C, Emmett L, van Gaal W, Sungaran J, Devakumar D, Van der Wall H.
School of Clinical Sciences, Faculty of Health Studies, Charles Sturt
University, Wagga Wagga, Australia.
BACKGROUND: Scintigraphy is an established imaging technique for injuries of
ankle and foot that are not apparent on plain radiographs. The scintigraphic
technique has varied, with planar and pinhole images being used. MATERIALS
METHODS: The incremental value of pinhole scintigraphy over planar imaging
studied in 16 patients with established diagnoses. Inter-reporter
reproducibility was also measured. RESULTS: Pinhole scintigraphy improved the
diagnostic specificity in nearly one half of the patients (48%). It did not
contribute substantial information in 46% and led to confusion in the
of one patient. Inter-reporter agreement was good, with a kappa value of
Diagnoses varied from fractures of the talar dome to avulsion fractures of
malleoli and impingement syndromes. CONCLUSIONS: Pinhole images add a
significant incremental value to planar scintigraphy of the foot and ankle.
Although this had been perceived intuitively in the past, it has not been
critically evaluated. The technique has good inter-reporter agreement.
Publication Types:
Evaluation Studies
PMID: 12352112 [PubMed - indexed for MEDLINE]
155: Am Fam Physician. 2002 Sep 1;66(5):785-94.
Comment in:
Am Fam Physician. 2003 Apr 1;67(7):1438.
Am Fam Physician. 2003 Mar 15;67(6):1187-8.
Foot fractures frequently misdiagnosed as ankle sprains.
Judd DB, Kim DH.
Tripler Army Medical Center, Honolulu, Hawaii 96859, USA.
Most ankle injuries are straightforward ligamentous injuries. However, the
clinical presentation of subtle fractures can be similar to that of ankle
sprains, and these fractures are frequently missed on initial examination.
Fractures of the talar dome may be medial or lateral, and they are usually
result of inversion injuries, although medial injuries may be atraumatic.
Lateral talar process fractures are characterized by point tenderness over
lateral process. Posterior talar process fractures are often associated with
tenderness to deep palpation anterior to the Achilles tendon over the
posterolateral talus, and plantar flexion may exacerbate the pain. These
fractures can often be managed nonsurgically with nonweight-bearing status
and a
short leg cast worn for approximately four weeks. Delays in treatment can
in long-term disability and surgery. Computed tomographic scans or magnetic
resonance imaging may be required because these fractures are difficult to
detect on plain films.
Publication Types:
Review, Tutorial
PMID: 12322769 [PubMed - indexed for MEDLINE]
156: Unfallchirurg. 2002 Aug;105(8):740-3.
[Retrograde tibial intramedullary nailing with the Flex Nail--treatment of
tibial fracture in an unusual case]
[Article in German]
Wagner F, Schaudig W, Bauer R.
Abteilung fur Unfall- und Wiederherstellungschirurgie, Chirurgische Klinik,
Klinikum St. Marien, Mariahilfbergweg 7, 92224 Amberg.
We report a case by a 75 year old female patient suffering a third-degree
fracture of the shinbone with a severe damage of the soft tissue. Primary
operation was a temporary fixation with a fixateur externe and a radical
debridement of the soft tissue with vacuum-sealing. Ten days later we did the
definitive surgery. Osteosynthesis was done by a retrograd nailing with the
flexible unreamed humerus nail (Flex-Nail) through the medial ankle. The
of the soft tissue was treated by a muscle flap and meshgraft
Healing of the soft tissue and beginning consolidation of the fracture comes
after 4 months. In our opinion the retrograd inserted Flex-Nail is a good
for treatment of compound fractures of the lower leg in special cases.
PMID: 12243019 [PubMed - indexed for MEDLINE]
157: AJR Am J Roentgenol. 2002 Oct;179(4):949-53.
Sonography of ankle tendon impingement with surgical correlation.
Shetty M, Fessell DP, Femino JE, Jacobson JA, Lin J, Jamadar D.
Department of Radiology, University of Michigan Medical Center, Taubman
2808, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0326, USA.
OBJECTIVE: This report describes sonography of ankle tendon impingement due
osteophytes, fracture fragments, and orthopedic hardware. CONCLUSION:
can be helpful in identifying ankle tendon impingement due to osteophytes,
fracture fragments, and orthopedic hardware. In such cases, dynamic
can aid assessment.
PMID: 12239043 [PubMed - indexed for MEDLINE]
158: Chir Narzadow Ruchu Ortop Pol. 2002;67(3):269-77.
[External fixation of fractures using Dysnastab-S stabilizers for massive
fractures of tibial bone epiphyseal articulations ]
[Article in Polish]
Deszczynski J, Szczesny G, Karpinski J, Deszczynska H, Ziolkowski M.
Klinika Ortopedii i Rehabilitacji, II Wydzial Lekarski, Akademia Medyczna w
Massive ankle fractures lead to joint stiffness and resulting decrease in
of motion. This can be avoided by functional treatment. In cases where severe
soft tissue trauma coexists with bone fractures surgical treatment is limited
and external fixation is the method of choice. Modern external fixation
technique allows for stabilisation and maintaining range of motion in the
affected joint. This paper presents the results of application of the
external fixator. The construction of this fixator allows dorsal and plantar,
reducing postraumatic joint stiffness. It also allows appropriate insight
soft tissues and debridement of devitalised tissues as well as their
surgical reconstruction. In our material (27 cases) treated with the
fixator for an average of 16 weeks a satisfactory bone healing process in all
cases was noted. Appropriate function of the extremity was maintained, with
comparable plantar flexion to the contralateral, not affected joint. Only in
case post operative treatment was complicated by algodystrophy. Our
showed that implementation of modern external stabilisation techniques leads
appropriate fracture healing with full function of the inferior extremity.
PMID: 12238397 [PubMed - indexed for MEDLINE]
159: Bone. 2002 Sep;31(3):430-3.
Increasing number and incidence of low-trauma ankle fractures in elderly
Finnish statistics during 1970-2000 and projections for the future.
Kannus P, Palvanen M, Niemi S, Parkkari J, Jarvinen M.
Accident and Trauma Research Center, President Urho Kaleva Kekkonen Institute
for Health Promotion Research, Tampere, Finland.
To increase knowledge about recent trends in the number and incidence of
low-trauma injuries among elderly people, we selected, from the National
Hospital Discharge Register, all patients > or =60 years of age who were
admitted to hospitals in Finland (5 million population) for primary treatment
a first low-trauma ankle fracture during 1970-2000. In each year of the
the age-adjusted and age-specific incidence of fracture was expressed as the
number of patients per 100,000 persons. The predicted numbers and incidence
rates of fractures until the year 2030 were calculated using a regression
For the study period, the number and incidence of low-trauma ankle fractures
Finnish persons > or =60 years of age rose substantially: the total number of
fractures increased from 369 in 1970 to 1545 in 2000, a 319% increase, and
crude incidence increased from 57 to 150, a 163% increase. The age-adjusted
incidence of these fractures also rose in both women (from 66 in 1970 to 174
2000, a 164% increase) and men (from 38 in 1970 to 114 in 2000, a 200%
increase). The regression model indicates that, if this trend continues,
will be about three times more low-trauma ankle fractures in Finland in the
2030 than there was in 2000. In conclusion, the number of low-trauma ankle
fractures in elderly Finns is rising rapidly at a rate that cannot be
simply by demographic changes and, therefore, potentially effective
measures, such as prevention of slippings, trippings, and falls in elderly
people, and use of ankle supports, should be urgently studied. Copyright 2002
Elsevier Science Inc.
PMID: 12231418 [PubMed - indexed for MEDLINE]
160: Unfallchirurg. 2002 Jul;105(7):643-6.
[New concept in therapy of distal tibial metaphyseal fractures and pilon
fractures with minor dislocations and severe soft tissue damage]
[Article in German]
Gehr J, Friedl W.
Klinikum Aschaffenburg, Abteilung Unfall- Hand- und
Am Hasenkopf 1, 63739 Aschaffenburg.
The treatment of pilon fractures and distal metaphysial tibia fractures
very high standards on the osteosynthesis material regarding the soft tissue
the essential joint reconstruction. The selection of the surgical entrance,
particularly in case of a critical arterial or venous circulation and the
possible irritation of the soft tissue caused by the osteosynthesis material
us to search for alternative osteosynthesis methods. After the elaboration of
pre-clinical study and good first results in the treatment of patella,
and ankle joint fractures by means of the XS-nail the latter is now also
employed for pilon fractures. Within a time period of 8 month 5 fibula
coming with pilon fractures had been treated with the XS-nail. This case
will demonstrate both the technique of treatment and the flexibility of the
PMID: 12219651 [PubMed - indexed for MEDLINE]
161: Unfallchirurg. 2002 Jul;105(7):612-8.
[Retrograde intramedullary nailing of knee para-articular fractures in
paraplegic patients]
[Article in German]
Schmeiser G, Vastmans J, Potulski M, Hofmann GO, Buhren V.
Berufsgenossenschaftliche Unfallklinik Murnau, Prof.-Kuntscher-Str. 8, 82418
INTRODUCTION: Patients with spinal cord lesions suffer injury even by
trauma, especially in the area of the knee joint. Because of lost sensitivity
and proprioception, the treatment of the fracture has to be minimally
but stable enough for physiotherapy. METHODS: There were 18 patients with 20
fractures near the knee: 15 fractures of the supracondylar femur were treated
with a retrograde intramedullary GSH nail and 5 fractures of the proximal
with a new retrograde nailing technique. RESULTS: At review all patients had
good motion range of the knee joint (> 100 degrees), and ankle joint motion
free. CONCLUSION: We saw in this study that the GSH nail is an excellent
for stabilizing supracondylar fractures of the femur in paraplegic patients
because the treatment is minimally invasive and the fracture is stable enough
for physiotherapy. The retrograde nailing of proximal fractures of the tibia
a good alternative method for treatment of patients with spinal cord lesions.
PMID: 12219647 [PubMed - indexed for MEDLINE]
162: Unfallchirurg. 2002 Jul;105(7):595-601.
[Treatment of rare talus dislocation fractures. An analysis of 23 injuries]
[Article in German]
Besch L, Drost J, Egbers HJ.
Klinik fur Unfallchirurgie, Universitatsklinikum Kiel, Arnold-Heller-Strasse
24105 Kiel.
METHODS: Between 1980 and 1996 we treated 23 patients for dislocated
of the talus. The injury was caused by a car accident in 61% and a high fall
22%. Five patients had open wounds (22%), two developed compartment syndrome
the foot (9%) at an early stage, and 11 patients had multiple injuries. We
the classifications of Hawkins and Marti/Weber. All fractures were surgically
treated by fixation with screw osteosynthesis, percutaneous wire
and/or external fixation. Fifteen patients with dislocated fractures of the
talus underwent clinical and radiological follow-up examinations using the
score. RESULTS: Four patients had excellent and three good results. In five
patients with moderate, two with adequate, and one with poor results, we
additional injuries to the ipsilateral foot or leg in 50%. Of those patients,
73% developed peritalar arthrosis and 39% talar necrosis. Due to bony
anatomical reconstruction was unsatisfactory in 48%. CONCLUSIONS: Even
anatomical reduction and sufficient stabilization cannot always decrease the
rate of talar necrosis and peritalar arthrosis.
PMID: 12219644 [PubMed - indexed for MEDLINE]
163: Injury. 2002 Oct;33(8):729-34.
Do type B malleolar fractures need a positioning screw?
Heim D, Schmidlin V, Ziviello O.
Department of Surgery, District Hospital, CH-3714, Frutigen, Switzerland.
Type B malleolar fractures (AO/ASIF classification) are usually stable ankle
joint fractures. Nonetheless, some show a residual instability after internal
fixation requiring further stabilization. How often does such a situation
and can these unstable fractures be recognized beforehand?From 1995 to 1997,
malleolar fractures (three type A, 90 type B, 18 type C) were operated on.
Seventeen out of 90 patients (19%) with a type B fracture showed residual
instability after internal fixation (one unilateral, four bimalleolar and 12
trimalleolar fractures). Five of these patients showed a dislocation in the
sagittal plane (anteroposterior) clinically or on the radiographs, five a
dislocation in the coronal plane with dislocation of the tibia on the medial
aspect of the ankle joint, and four an incongruency on the medial aspect of
joint. In three cases, no preoperative abnormality indicating instability was
found. The fractures were all fixed using an additional positioning screw.In
patients, the positioning screw was removed after 8-12 weeks, in six patients
removal was performed after 1 year along with removal of the plate. All 17
patients were reviewed 1 year after internal fixation, 16/17 showed a good or
excellent result with identical or only minor impairment of range of motion
the ankle joint. CONCLUSION: Unstable ankle joints after internal fixation of
type B malleolar fractures exist. Residual instability most often occurs
trimalleolar fractures with initial joint dislocation. Treatment with an
additional positioning screw generally produced a satisfactory result.
PMID: 12213426 [PubMed - indexed for MEDLINE]
164: Arthroscopy. 2002 Sep;18(7):E35.
Broken poly-L-lactic acid interference screw after ligament reconstruction.
Shafer BL, Simonian PT.
Department of Orthopaedics and Sports Medicine, University of Washington,
Seattle, Washington 98195-6500, USA.
The interference screw is a reliable method used to secure tendon to bone and
bone to bone in ligament reconstruction. Historically, metal interference
have been used for this purpose in both anterior cruciate ligament (ACL) and
posterior cruciate ligament (PCL) reconstruction. However, several problems
associated with the use of metal interference screws have led to the
use of bioabsorbable implants. Poly-L-lactic acid (PLLA) biodegradable
interference screws have been used successfully for graft fixation in
reconstruction. Although adverse reactions have been reported with the use of
biodegradable implants, late screw breakage is rare. To our knowledge no case
exists of late screw breakage with bioabsorbable interference screws used in
ligament reconstruction. We present one case in the setting of an ACL
reconstruction and one with combined PCL and posterolateral corner
PMID: 12209420 [PubMed - indexed for MEDLINE]
165: J Bone Joint Surg Am. 2002 Sep;84-A(9):1528-33.
Refractures in patients at least forty-five years old. a prospective analysis
twenty-two thousand and sixty patients.
Robinson CM, Royds M, Abraham A, McQueen MM, Court-Brown CM, Christie J.
Edinburgh Orthopaedic Trauma Unit, The Royal Infirmary of Edinburgh,
United Kingdom.
BACKGROUND: Individuals who sustain a low-energy fracture are at increased
of sustaining a subsequent low-energy fracture. The incidence of these
refractures may be reduced by secondary preventative measures, although
justifying such interventions and evaluating their impact is difficult
substantive evidence of the severity of the refracture risk. The aim of this
study was to quantify the risk of sustaining another fracture following a
low-energy fracture compared with the risk in an age and sex-matched
population. METHODS: During the twelve-year period between January 1988 and
December 1999, all inpatient and outpatient fracture-treatment events were
prospectively audited in a trauma unit that is the sole source of fracture
treatment for a well-defined local catchment population. During this time,
22,060 patients at least forty-five years of age who had sustained a total of
22,494 low-energy fractures of the hip, wrist, proximal part of the humerus,
ankle were identified. All refracture events were linked to the index
in the database during the twelve-year period. The incidence of refracture in
the cohort of patients who had sustained a previous fracture was divided by
"background" incidence of index fractures within the same local population to
obtain the relative risk of refracture. Person-years at-risk methodology was
used to control for the effect of the expected increase in mortality with
advancing age. RESULTS: Within the cohort, 2913 patients (13.2%) subsequently
sustained a total of 3024 refractures during the twelve-year period. Patients
with a previous low-energy fracture had a relative risk of 3.89 of sustaining
subsequent low-energy fracture. The relative risk was significantly increased
for both sexes, but it was greater for men (relative risk = 5.55) than it was
for women (relative risk = 2.94). The relative risk was 5.23 in the youngest
cohort (patients between forty-five and forty-nine years of age), and it
decreased with increasing age to 1.20 in the oldest cohort (patients at least
eighty-five years of age). CONCLUSIONS: Individuals who sustain a low-energy
fracture between the ages of forty-five and eighty-four years have an
relative risk of sustaining another low-energy fracture. This increased risk
greater when the index fracture occurred earlier in life; the risk decreased
with advancing age. Secondary preventative measures designed to reduce the
of refracture following a low-energy fracture are likely to have a greater
impact on younger individuals.
PMID: 12208908 [PubMed - indexed for MEDLINE]
166: Foot Ankle Int. 2002 Aug;23(8):744-8.
Ruptured tibio-fibular syndesmosis: comparison study of metallic to
bioabsorbable fixation.
Sinisaari IP, Luthje PM, Mikkonen RH.
Department of Orthopaedic Surgery, Kuusankoski District Hospital,
The patients of this study come from a series of 43 consecutive ankle
patients with syndesmotic rupture operated on at our department. Of these
patients, 18 were treated with bioabsorbable self-reinforced poly-L-lactide
screw and 12 treated with metallic screw. All agreed to participate in this
study. They were examined after a minimum follow-up period of 12 months. The
patients were examined for measurements from ankle radiographic and computed
tomography films, loaded dorsal range of movement of the ankle, and duration
sick leave. Subjective results were obtained by a constructed questionnaire.
There were no significant differences between the patient groups in any of
parameters measured. We conclude that the fixation of a syndesmotic rupture
be done with a bioabsorbable self-reinforced poly-L-lactide screw.
PMID: 12199389 [PubMed - indexed for MEDLINE]
167: Med Biol Eng Comput. 2002 May;40(3):302-10.
Biomechanical analysis of fatigue-related foot injury mechanisms in athletes
recruits during intensive marching.
Gefen A.
Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv
University, Tel Aviv, Israel.
An integrative analysis, comprising radiographic imaging of the foot, plantar
pressure measurements, surface electromyography (EMG) and finite element (FE)
modelling of the three-dimensional (3D) foot structure, was used to determine
the effects of muscular fatigue induced by intensive athletic or military
marching on the structural stability of the foot and on its internal stress
state during the stance phase. The medial/lateral (M/L) tendency towards
instability of the foot structure during marching in fatigue conditions was
experimentally characterised by measuring the M/L deviations of the footground
centre of pressure (COP) and correlating these data with fatigue of specific
lower-limb muscles, as demonstrated by the EMG spectra. The results
accelerated fatigue of the peroneus longus muscle in marching conditions
(treadmill march of 2 km completed by four subjects at an approximately
velocity of 8 km h-1). Severe fatigue of the peroneus longus is apparently
dominant cause of lack of foot stability, which was manifested by abnormal
lateral deviations of the COP during the stance phase. Under these
ankle sprain injuries are likely to occur. The EMG analysis further revealed
substantial fatigue of the pre-tibial and triceps surae muscles during
marching (averaged decreases of 36% and 40% in the median frequency of their
signal spectra, respectively). Incorporation of this information into the 3D
model of the foot resulted in a substantial rise in the levels of calcaneal
metatarsal stress concentrations, by 50% and 36%, respectively. This may
to the mechanism by which stress fractures develop and provide the
tools for future clinical investigations.
PMID: 12195977 [PubMed - indexed for MEDLINE]
168: J Foot Ankle Surg. 2002 Jul-Aug;41(4):243-6.
Acute tarsal tunnel syndrome following partial avulsion of the flexor
longus muscle: a case report.
Mezrow CK, Sanger JR, Matloub HS.
Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, WI,
An acute posterior tibial nerve compression from a partially ruptured flexor
hallucis longus (FHL) muscle is reported. This etiology for acute tarsal
syndrome has not been previously described. A 17-year-old male sustained
multiple injuries in a motor vehicle accident, including a tibial shaft
and a posterior medial right ankle laceration of the same limb. The injured
had no sensation on the plantar aspect of the foot and heel, decreased active
great toe flexion, and associated leg pain. Exploration of the posterior
nerve for presumed laceration revealed the nerve to be intact, but compressed
a tense tarsal tunnel from a retracted partially ruptured flexor hallucis
tendon. Decompression of the tunnel and resection of the devascularized
resulted in complete neurologic recovery.
PMID: 12194515 [PubMed - indexed for MEDLINE]
169: J Bone Joint Surg Br. 2002 Jul;84(5):774-5; author reply 775.
Conservative versus operative treatment for displaced ankle fractures in
patients over 55 years of age.
Faraj AA, Monkhouse R.
Publication Types:
PMID: 12188503 [PubMed - indexed for MEDLINE]
170: Z Orthop Ihre Grenzgeb. 2002 Jul-Aug;140(4):428-34.
[Prognostic factors for avascular necrosis following talar fractures]
[Article in German]
Schulze W, Richter J, Russe O, Ingelfinger P, Muhr G.
Chirurgische Universitatsklinik und Poliklinik, Ruhr-Universitat Bochum,
Berufsgenossenschaftliche Kliniken Bergmannsheil, Bochum.
AIM: We performed an investigation of factors for avascular necroses after
fracture and on the reliability of the Hawkins Sign. METHOD: From 1984 until
1997 a total of 98 patients with 99 talus fractures were surgically treated.
these, 79 patients with 80 fractures were examined clinically and
radiologically. The average postoperative interval was 6 years and 2 months.
RESULTS: With respect to the 65 central fractures, the rate of necrosis
to 14 %, that of collum fractures to 17 %. Necroses arose solely in
central fractures of the talus, type III and IV according to Marti/Weber
fracture classification. The rate of necrosis rose with the degree of
dislocation of the fractures. In 24 patients the Hawkins Sign could be
retrospectively investigated. It proved to be a relatively reliable sign for
vitality since only 1 out of 12 patients with positive or partial positive
Hawkins Sign developed avascular necrosis. Neither a short interval between
accident and operation, the age at the time of the accident, nor the
fracture of the medial malleolus showed a necrosis preventive influence. In 5
out of 9 talus necroses the patients were very or mostly satisfied with the
result of their treatment. CONCLUSION: The Hawkins Sign proved to be a
relatively reliable sign for vitality of the talus after fracture. Risk for
avascular necrosis increases according to the degree of fracture dislocation.
PMID: 12183794 [PubMed - indexed for MEDLINE]
171: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2002 Jul;16(4):245-7.
[Function of fibula in stability of ankle joint]
[Article in Chinese]
Ding YL, Song YM.
Department of Orthopedic Surgery, West China Hospital, Sichuan University,
Chengdu, Sichuan, P. R. China 610041.
OBJECTIVE: To summarize the function of fibula in stability of ankle joints.
METHODS: Recent original articles were extensively reviewed, which were
to the physiological function and biomechanical properties of fibula, the
influence of fibular fracture on stability of ankle joints and mechanism of
osteoarthritis of ankle joints. RESULTS: The fibula had the function of
weight-bearing; and it was generally agreed that discontinued fibula could
to intra-articular disorder of ankle joint in children; but there were
viewpoints regarding the influence of fibular fracture on the ankle joint in
adults. CONCLUSION: Fibula may play an important role in stability of ankle
Publication Types:
Review, Tutorial
PMID: 12181788 [PubMed - indexed for MEDLINE]
172: Iowa Orthop J. 2002;22:99-102.
Forty-year outcome of ankle "cup" arthroplasty for post-traumatic arthritis.
Muir DC, Amendola A, Saltzman CL.
Ankle arthroplasty for post-traumatic tibiotalar arthritis remains
controversial. The current literature strongly recommends arthrodesis,
especially in those patients who will overload the joint: the young, the
and the overweight patients. The case described here is a 40-year follow up.
31-year old man underwent talar dome resurfacing with a custom Vitallium
for post-traumatic arthritis in 1962. He continued to work as a heavy laborer
until retirement in 1987 and presently remains virtually asymptomatic with
regard to his foot and ankle. The longevity of this individual implant has
remarkable. The unique design, minimal resection, surgical approach and
remarkable success merit discussion in the light of publication of
bleak reports of arthroplasty in this patient population.
PMID: 12180622 [PubMed - indexed for MEDLINE]
173: Transplantation. 2002 Aug 15;74(3):362-6.
Risk factors for fractures in kidney transplantation.
O'Shaughnessy EA, Dahl DC, Smith CL, Kasiske BL.
Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
BACKGROUND: Risk factors for fracture after kidney transplantation need to be
identified to target patients most likely to benefit from preventive
METHODS: Medical records were reviewed for 1572 kidney transplants done at a
single center between February, l963 and May, 2000 with 6.5+/-5.4 years of
follow-up. RESULTS: One or more fractures occurred in 300 (19.1%), with
fractures in 101 (6.4%). After excluding fractures of the foot or ankle
transplants, 8.3%), avascular necrosis (n=86, 5.5%), and vertebral fractures
(n=28, 1.8%), there were one or more fractures in 196 (12.5%), with a
incidence of 12.0%, 18.5%, and 23.0% at 5, 10, and 15 years, respectively. In
multivariate Cox proportional hazards analysis, age had no effect on
in men. Compared with men and younger women, women 46-60 and >60 years old
respectively, 2.11 (95% confidence interval 1.43-3.12, P=0.0002) and 3.47
(2.16-5.60, P<0.0001) times more likely to have fractures. Kidney failure
type 1 and 2 diabetes increased the risk by 2.08 (1.47-2.95, P<0.0001) and
(1.15-3.20, P=0.0131), respectively. A history of fracture pretransplant
increased the risk by 2.15 (1.49-3.09, P<0.0001). Each year of pretransplant
kidney failure increased the risk by 1.09 (1.05-1.14, P<0.0001). Obesity
mass index >30 kg/m2) was associated with 55% (17-76%, P=0.0110) less risk.
Different immunosuppressive medications, acute rejections, and multiple other
factors were not independently associated with fractures. CONCLUSIONS: The
population of transplant patients at high risk for fracture can be identified
using age/gender, pretransplant fracture history, diabetes, obesity, and
of pretransplant kidney failure.
PMID: 12177615 [PubMed - indexed for MEDLINE]
174: J Orthop Trauma. 2002 Aug;16(7):525-8.
Maisonneuve fracture associated with a bimalleolar ankle fracturedislocation: a
case report.
Hensel KS, Harpstrite JK.
Tripler Army Medical Center, Orthopaedic Surgery Service, Honolulu, HI 96859,
The Maisonneuve fracture consists of a proximal fibular fracture with
syndesmotic ligament disruption and injury to the medial ankle structures.
accepted mechanism of injury is an external rotation force applied to the
with the foot in either supination or pronation. Because most Maisonneuve
fractures involve complete syndesmotic disruption, operative treatment is
usually indicated. A case report is presented of an unusual fracture
pattern-i.e., that of a distal fibular fracture with lateral ankle
associated with a Maisonneuve fracture. To our knowledge, only two other
cases are reported in the English literature.
PMID: 12172286 [PubMed - indexed for MEDLINE]
175: J Orthop Trauma. 2002 Aug;16(7):498-502.
Surgical treatment of a displaced lateral malleolus fracture: the antiglide
technique versus lateral plate fixation.
Lamontagne J, Blachut PA, Broekhuyse HM, O'Brien PJ, Meek RN.
Laval University, Quebec, Montreal, Canada, and Vancouver General Hospital,
University of British Columbia, Vancouver, British Columbia, Canada.
OBJECTIVES: To assess the outcomes of the surgical management of "isolated"
displaced lateral malleolar fractures, comparing the techniques of lateral
plating and antiglide plating as described previously. DESIGN: This is a
retrospective review, being largely a surgeon-randomized comparative study.
SETTING: The study was carried out at a university teaching hospital that
as a provincial trauma referral service and provides local community care.
senior surgeons are all orthopaedic trauma subspecialists. PATIENTS: A total
193 patients meeting our inclusion criteria, with isolated lateral malleolus
fractures surgically treated at the Vancouver General Hospital between 1987
1998, were studied. INTERVENTION: Eighty-five were treated with antiglide
plating, whereas the remaining 108 patients underwent traditional lateral
plating. MAIN OUTCOME MEASURES: The functional results were evaluated with
ankle scoring system described previously. We also compared the complication
rates, including failure of fixation, infection, wound dehiscence, and need
hardware removal. RESULTS: Both groups were comparable for age, sex
distribution, mechanism of injury, and occupation. There was no difference in
ankle score, function, and infection rate. The incidence of wound dehiscence
reoperation for hardware removal was slightly higher in the lateral plate
but the difference was not statistically significant. CONCLUSIONS: The
of the surgical management of a displaced lateral malleolus fracture is
comparable with both techniques. Although few studies have reported some
advantages using the antiglide technique, our data do not support one
over the other.
PMID: 12172280 [PubMed - indexed for MEDLINE]
176: J Orthop Trauma. 2002 Aug;16(7):473-83.
Three-dimensional assessment of tibial malunion after intramedullary nailing:
preliminary study.
Boucher M, Leone J, Pierrynowski M, Bhandari M.
Department of Orthopaedic Surgery, and the School of Rehabilitation Science,
McMaster University, Hamilton, Ontario, Canada.
OBJECTIVES: The purpose of this study was twofold: (a) to introduce a new
three-dimensional digital assessment technique for the estimation of angular
rotational malunion and (b) to determine if an association exists between
malunion and functionally defined post-traumatic degeneration at the knee and
ankle joint. DESIGN: Nonrandomized, cohort study, with 5.46 years (range 2 to
years) of follow-up. Subjects underwent a novel three-dimensional technique
determine the functional mechanical axis of both the knee and tibiotalar
Both the affected and unaffected limbs were tested. Differences between both
limbs provided assessment of malunion in three planes with 1.8 +/- 0.1
(mean +/- SD) reliability. Patients completed the Western Ontario McMaster
University Osteoarthritis Index, the Lower Extremity Functional Scale, and
Assessment System of Lower Extremity Function. Standard postoperative
radiographs were also examined for evidence of malunion. SETTING:
University-based Level 1 trauma center. PATIENTS: Seventy-one subjects with
isolated tibial fracture repaired with intramedullary nails were identified;
thirteen met eligibility criteria for study inclusion. RESULTS: A total of 77
percent of the patients (mean follow-up 5.5 years, range 2 to 10 years) were
malaligned in one or more of the three planes examined (malunion
defined as >or=10 rotation, >or=5 varus-valgus, and >or=10
procurvatum-recurvatum). Mean varus-valgus deformity was 11.8 +/- 6.3
mean procurvatum-recurvatum deformity was 3.2 +/- 2.5 degrees, and
medial-lateral rotational deformity was 9.6 +/- 4.7 degrees. There was no
significant correlation (p > 0.05) between the overall alignment of the
leg (intertibial difference) in any of the three directional planes and the
subject's response to any of the three functional outcome scales used.
Three-dimensional analysis differed significantly from radiographic
interpretation when malunion occurred in the coronal plane (p = 0.0003).
CONCLUSIONS: This study suggests that failure to meet conventionally accepted
standards for tibial alignment might be common. Fortunately, these values
not associated with adverse functional outcomes. A three-dimensional system,
which determines the functional mechanical axis of the knee and tibiotalar
joints, may be a valuable and reliable method by which to determine malunion
after fracture fixation.
PMID: 12172277 [PubMed - indexed for MEDLINE]
177: Foot Ankle Int. 2002 Jul;23(7):647-50.
Stress fractures of the medial malleolus--review of the literature and report
a 15-year-old elite gymnast.
Shabat S, Sampson KB, Mann G, Gepstein R, Eliakim A, Shenkman Z, Nyska M.
The Orthopaedic Surgery Department, The Sapir Medical Center, Kfar-Saba,
Stress fracture of the medial malleolus is rare and not reported in children.
report a case of a 15-year-old elite gymnast with open physes sustaining a
medial malleolar stress fracture. The patient was treated initially by rest
gradually returned to sport with full recovery. Two months later she
developed a
complete fracture of the medial malleolus of the same side. This was treated
surgically by open reduction and internal fixation with a cancellous screw
soon after the operation she returned to full activities. Emphasis is given
the suspected mechanism which led to this unique fracture and to the hormonal
aspects in the professional adolescent gymnast. We recommend surgical
of stress fracture of the medial malleolus especially for elite athletes,
leading to early recovery and return to sports activities.
Publication Types:
Review of Reported Cases
PMID: 12146777 [PubMed - indexed for MEDLINE]
178: Foot Ankle Int. 2002 Jul;23(7):625-8.
Participation in sports after arthrodesis of the foot or ankle.
Vertullo CJ, Nunley JA.
Division of Orthopaedics, DUMU, Durham, NC 27710, USA.
Currently no data or guidelines exist for the surgeon on how to advise
about returning to sports participation after arthrodesis within the foot or
ankle. Sequelae of inappropriate activity after arthrodesis includes
periarticular arthrosis, arthrodesis failure and stress fracture. Some
arthrodeses will preclude certain sports because it limits the patient's
to perform movement vital to the game, for example, ankle arthrodesis
basketball players from jumping. Questionnaires were sent to members of the
American Orthopaedic Foot and Ankle Society (AOFAS) and to trainers of
professional basketball and American football teams. This paper reports on
responses of orthopaedic foot and ankle surgeons about return to sports
participation, after arthrodeses within the foot and ankle, and suggests
guidelines for sports participation after an arthrodesis of the lower
A selective sports participation policy is advised. Patients with an ankle or
triple fusion should avoid high-impact sports, while those with more distal
arthrodeses should be monitored for arthrosis and stress fracture.
PMID: 12146773 [PubMed - indexed for MEDLINE]
179: Acta Orthop Scand. 2002 Jun;73(3):344-51.
Surgical treatment of talus fractures: a retrospective study of 80 cases
followed for 1-15 years.
Schulze W, Richter J, Russe O, Ingelfinger P, Muhr G.
Department of Surgery, BG-Kliniken Bergmannsheil, Ruhr-University Bochum,
We retrospectively reviewed 79 patients (80 talar fractures) operated on
1994 and 1997. The average follow-up was 6 (1-15) years. 15 patients had a
Marti/Weber fracture type I, 14 patients a type II, 32 patients a type III,
19 patients a type IV fracture. 46 patients suffered a fracture of the talar
neck, Hawkins type I in 10 patients, type II in 18, type III in 17 and type
in 1 patient. 18/23 patients directly placed in our department were operated
within 6 hours of admission. Primary arthrodesis of both the ankle and
joint was performed twice. Secondary arthrodesis of the ankle joint was done
only 3 patients. Combined secondary arthrodesis of the ankle and subtalar
was performed in 5 and arthrodesis of the talonavicular joint in 1 patient.
According to the Hawkins score, 35/80 feet achieved good/very good function
versus 43 with the Mazur score. Radiographs showed ankle or subtalar
in two thirds of the patients. A normal range of motion was achieved in 18
and 19 subtalar joints. The overall rate of talar necrosis was 9/80
PMID: 12143985 [PubMed - indexed for MEDLINE]
180: Foot Ankle Clin. 2001 Dec;6(4):853-66, ix.
Soft tissue coverage options for ankle wounds.
Levin LS.
Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, and
Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
27710, USA.
Soft tissue deficiencies of the ankle are caused by several mechanisms, such
trauma, tumor, and infection. Compounding the reconstructive problems is that
soft tissue problems often present in patients who have underlying diseases
as peripheral vascular disease, diabetes or both. For example, a 65-year-old
person with diabetes who smokes two packs of cigarettes per day sustains an
ankle fracture. After undergoing open reduction and internal fixation of the
fracture, there is subsequent wound behiscence over the patient's fibular
The wound edges cannot be reapproximated, and there is loss of soft tissue.
should treatment be for this soft tissue problem? Another example is a
45-year-old rheumatoid patient who takes 20 mg of steroids a day and
posterior tibial tendon repair after rupture. One month after surgery, the
surgical wound dehisces, resulting in exposure of the tendon repair. What is
approach for adequate and effective soft tissue treatment? The purpose of
article is to address such complex problems and to provide an algorithm for
tissue reconstruction of the ankle.
Publication Types:
Review, Tutorial
PMID: 12134585 [PubMed - indexed for MEDLINE]
181: J South Orthop Assoc. 2001 Fall;10(3):129-39.
Outcome of subtalar arthrodesis after calcaneal fracture.
Kolodziej P, Nunley JA.
Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
27710, USA.
Between 1983 and 1995, we used subtalar arthrodesis to treat 16 consecutive
patients for continued pain after an intra-articular calcaneal fracture.
time to union was 3 months (2 to 4 months). Complications were minor in 4
patients, and major in 4 others. Length of follow-up in 14 patients was 55
months (range, 12 to 112 months). Hindfoot scores (clinical rating system of
American Orthopaedic Foot and Ankle Society) improved from 38 (range, 28 to
to 67 (range, 39 to 94). Results of medical outcome surveys indicate that
patients had low scores in areas related to physical conditioning, physical
functioning, and bodily pain. We conclude that the majority of patients can
improvement with surgical reconstruction that addresses a specific problem,
pain relief is usually not complete.
PMID: 12132824 [PubMed - indexed for MEDLINE]
182: Unfallchirurg. 2002 May;105(5):474-7.
[Anterograde intramedullary tibio-talo calcaneus arthrodesis (aIMTCA) with
spongiosaplasty in pseudarthrosis]
[Article in German]
Gunter U, Jentsch P, Heller G.
Caritas-Kliniken Pankow, Klinik fur Chirurgie, Berlin.
Pseudarthrosis occur in 65% of all ankle joint arthrodesis. From the
therapeutical point of view we make a distinction between vital
and avital (hypotrophic) respectively stable and instable pseudarthrosis. The
hypotrophic forms demand an additional cancellous or bone grafting.
instable pseudarthrosis have to be treated with a biological osteosynthesis.
the hindfoot the so called compression arthrodesis made one's way. But there
still a discussion about the best method, intern or extern fixation. We
about a case of hypotrophic pseudarthrosis with a mal-position occurring
an ankle joint arthrodesis with a Charnley-Fixateur. A fusion of the ankle
could be carried out with a proximal respectively anterograde intramedullary
nail and allogene cancellous graft.
PMID: 12132210 [PubMed - indexed for MEDLINE]
183: J Trauma. 2002 Jul;53(1):55-60.
Results of ankle fractures with involvement of the posterior tibial margin.
Langenhuijsen JF, Heetveld MJ, Ultee JM, Steller EP, Butzelaar RM.
Department of General Surgery, St. Lucas Andreas Hospital, Amsterdam, The
BACKGROUND: Ankle fractures have a significantly worse functional outcome
they include a posterior tibial fragment. In 57 trimalleolar fractures, the
effect of size, internal fixation, and anatomic reduction of the posterior
fragment on the prognosis was evaluated. METHODS: A modified Weber protocol
used, providing a rating system for subjective, objective, and radiographic
results. A visual analogue scale for subjective actual pain was also scored.
RESULTS: The involvement of the articular surface ranged from 8% to 55%. Size
fixation of the fragment did not influence prognosis. Joint congruity in
fragments >or= 10% of the articular surface was a significant factor
prognosis. Overall, the modified Weber protocol result was excellent in 10%,
good in 15%, fair in 25%, and poor in 50% of patients. However, the low
visual analogue scale of 3.0 in the whole group does not appear
of 50% poor results, indicating that the modified Weber protocol is fairly
strict and overestimates the number of poor results. CONCLUSION: Joint
with or without fixation was a significant factor influencing prognosis.
Congruity should be achieved for fragments >or= 10% of the tibial articular
PMID: 12131390 [PubMed - indexed for MEDLINE]
184: Radiol Clin North Am. 2002 Mar;40(2):289-312, vii.
Imaging of athletic injuries to the ankle and foot.
Dunfee WR, Dalinka MK, Kneeland JB.
Radiology Associates of Tarrant County, Fort Worth, TX 76104, USA.
Conventional radiographs in conjunction with clinical examination remains the
primary method for evaluating the acute athletic injury. In most cases,
suspected acute tendon and ligament injuries are initially treated based on
physical examination. Magnetic resonance (MR) imaging, with its multiplanar
capability and superb soft tissue contrast, is quickly becoming the method of
choice for evaluating chronic foot and ankle pain and further defining the
extent of tendon and ligament injuries. This article reviews the common acute
and chronic (overuse) foot and ankle athletic injuries with an emphasis on
imaging characteristics.
Publication Types:
Review, Tutorial
PMID: 12118826 [PubMed - indexed for MEDLINE]
185: Osteoporos Int. 2002;13(6):513-8.
Risk factors for fractures of the wrist, shoulder and ankle: the Blue
Eye Study.
Ivers RQ, Cumming RG, Mitchell P, Peduto AJ.
Institute for International Health, University of Sydney, Newtown, NSW,
Few studies have examined risk factors for fractures of the wrist, shoulder
ankle. The Blue Mountains Eye Study is a population-based longitudinal study
3654 people aged 49 years or older resident in an area west of Sydney,
Australia. Detailed eye examinations and interviews were carried out at
(1992-3) and after 5 years (1997-9). Information about fractures sustained
during follow-up were collected by a combination of self-report and a search
hospital radiology records. After 4.7 years follow-up subjects had sustained
fractures of the distal forearm, 20 fractures of the proximal humerus and 33
ankle fractures. In multivariate models factors independently associated with
wrist fractures in women were no vigorous exercise in the past 2 weeks
risk RR 0.4, 95% CI 0.2-0.9) and ever use of HRT (RR 0.4, 95% CI 0.1-1.0).
Factors independently associated with ankle fractures were male sex (RR 0.3,
CI 0.1-0.8) and visual field loss (RR 2.8, 95% CI 1.2-6.6). These findings
in keeping with other studies, and suggest that different types of
fracture have different, if overlapping, sets of risk factors.
PMID: 12107667 [PubMed - indexed for MEDLINE]
186: Osteoporos Int. 2002;13(6):450-5.
An osteoporosis clinical pathway for the medical management of patients with
low-trauma fracture.
Chevalley T, Hoffmeyer P, Bonjour JP, Rizzoli R.
Division of Bone Diseases, WHO Collaborating Center for Osteoporosis and Bone
Diseases, Department of Internal Medicine, University Hospitals of Geneva,
Patients with an osteoporotic fracture have at least a 2-fold risk for
additional fracture and should benefit from targeted diagnostic and treatment
procedures for osteoporosis. To address this issue, we set up an osteoporosis
clinical pathway (OCP) for the medical management of patients with low-trauma
fracture. Following acute management of the fracture by the orthopedic team,
patients are enrolled in the pathway, which is based on an interaction
the OCP multidisciplinary team, orthopedic surgeons and/or primary care
physicians. After collection of patient data, suggestions for additional
diagnostic examinations with their interpretation, and treatment proposals
made. Patients and their families are also invited to attend a
interactive educational program on physical therapy, lifestyle habits and
nutrition. During a 36-month period, 385 patients (311 women, 74 men; mean
+/- SD: 73.0 +/- 13.5 years; hip fracture 45%, ankle/tibia 24%, proximal
8.6%, spine 5.5%, pelvis 3.9%, distal forearm 3.6%, other sites 17.4%) were
enrolled in the OCP. An osteoporosis awareness questionnaire administered
10 days of fracture showed that 73% of patients believed that their fracture
not related to the disease. Dual-energy X-ray absorptiometry, performed in
of patients, showed that 86% had low bone mass or osteoporosis. Specific
antiosteoporotic therapy was proposed for 33% of patients in addition to
and vitamin D supplements, the latter suggested for 93%. A survey performed
216 patients 6 months later, indicated that 63% of the suggested treatments
been prescribed and that 67% of this group were continuing treatment. Such a
clinical pathway for the medical management of low-trauma fracture can help
identify patients with osteoporosis in a high-risk population, provide
to the orthopedic surgeon and/or the primary care physician for diagnostic
treatment procedures, and should significantly contribute to increase
of the disease in patients and their families.
PMID: 12107657 [PubMed - indexed for MEDLINE]
187: Mil Med. 2002 Jun;167(6):454-8.
The "floating ankle": a pattern of violent injury. Treatment with thin-pin
external fixation.
McHale KA, Gajewski DA.
Department of Orthopedic Surgery and Rehabilitation, Walter Reed Army Medical
Center, Washington, DC 20307-5001, USA.
The "floating ankle" is an underappreciated pattern of injury that results
violent trauma and/or blast injuries in military personnel. It is
by an intact ankle mortise with a distal tibia fracture and an ipsilateral
fracture, creating instability around the ankle. This pattern of injury may
the result of the military boot, which both protects the foot from immediate
amputation or further injury and renders the distal tibia susceptible to
fracture at the boot top. Four patients with open floating ankle injuries
treated with thin-pin circular fixation with good results. Two patients
bone transport for segmental loss. All patients are ambulatory without
assistance or bracing. Thin-pin external fixation is a reasonable approach to
this complex injury pattern, especially in the presence of marked soft tissue
compromise with or without segmental bone loss.
PMID: 12099078 [PubMed - indexed for MEDLINE]
188: J Long Term Eff Med Implants. 2002;12(1):35-52.
A long-term clinical study on dislocated ankle fractures fixed with
self-reinforced polylevolactide (SR-PLLA) implants.
Voutilainen NH, Hess MW, Toivonen TS, Krogerus LA, Partio EK, Patiala HV.
Department of Orthopaedics and Traumatology, Helsinki University Central
Hospital, Topeliuksenkatu 5, FIN-00260 Helsinki, Finland.
Sixteen patients with dislocated ankle fractures fixed between 1988 and 1991
with self-reinforced poly(L-lactide; SR-PLLA) screws and/or rods were
up after 8.6 to 11.7 years (mean 9.6 years) at the Department of Orthopaedics
and Traumatology, Helsinki University Central Hospital. In all patients
reduction of the fractures was retained and uneventful bony union was
Good or excellent long-term functional results were observed in 15 out of 16
patients. One patient had post-traumatic osteoarthritis. In 5 patients, a
tissue reaction was observed over an extruding screw head with mild symptoms,
which led to removal of small palpable masses. There were two superficial
infections, one after a primary operation and one caused by a late tissue
reaction after an operation. The correct operative technique, where all
extruding extraosseous SR-PLLA material should be removed during the primary
operation, should be followed.
PMID: 12096641 [PubMed - indexed for MEDLINE]
189: Wilderness Environ Med. 2002 Summer;13(2):153-5.
Clinical images. Deep lacerations to both hands.
Rodway G.
PMID: 12092970 [PubMed - indexed for MEDLINE]
190: Plast Reconstr Surg. 2002 Jul;110(1):360-2.
How reliable is the distally based peroneus brevis muscle flap?
Barr ST, Rowley JM, O'Neill PJ, Barillo DJ, Paulsen SM.
Publication Types:
PMID: 12087297 [PubMed - indexed for MEDLINE]
191: Z Orthop Ihre Grenzgeb. 2002 May-Jun;140(3):334-8.
[Functional postoperative treatment of internally fixed ankle fractures with
flexible arthrodesis boot (Variostabil)]
[Article in German]
Biewener A, Rammelt S, Teistler FM, Grass R, Zwipp H.
Klinik und Poliklinik fur Unfall- und Wiederherstellungschirurgie,
Universitatsklinikum "Carl Gustav Carus" der TU Dresden, Germany.
AIM: Postoperative treatment following osteosynthesis of ankle fractures in a
flexible arthrodesis boot (Variostabil) aims at fast restoration of the
of the injured extremity while allowing early full weight bearing. This
treatment regimen was validated in a clinical and experimental study.
(1) In the clinical study part, 56 patients with internally fixed ankle
fractures received after treatment with the arthrodesis boot for 6 weeks. (2)
the experimental study part, the intravascular pressure was recorded in a
vein of 8 healthy volunteers during knee bends. RESULTS: (1) No implant
or secondary dislocation was seen due to the after treatment. All patients
subjective comfort and mobility as excellent. 90.5 % had a good to excellent
functional result with the Philips Score. (2) Wearing the arthrodesis boot
effected significantly faster venous outflow (25.8 +/- 15.2 vs. 11.3 +/- 6.0
mmHg/sec, p < 0.05) and higher pressure amplitude (53.6 +/- 12.0 vs. 26.5 +/9.6 mmHg) during knee bends, compared to a below-the-knee plaster cast.
CONCLUSIONS: The flexible arthrodesis boot offers safe protection of ankle
fractures combined with superior functional performance (undisturbed gait,
training of the ankle joint, high patient comfort and mobility, accelerated
venous outflow) as compared to cast immobilization.
Publication Types:
Clinical Trial
PMID: 12085301 [PubMed - indexed for MEDLINE]
192: Injury. 2002 Apr;33(3):292-4.
Fracture-dislocation of the ankle with fixed displacement of the fibula
the tibia--a rare variant.
White SP, Pallister I.
Department of Orthopaedics, Morriston Hospital, Swansea, UK.
PMID: 12084656 [PubMed - indexed for MEDLINE]
193: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 1999 May;13(3):152-4.
[Application of repairing tibia and soft tissue defect with free fibula
tissue grafting]
[Article in Chinese]
Zhen P, Liu XY, Wen YM.
Center of Orthopedic Surgery, General Hospital of PLA of Lanzhou, Lanzhou,
Gansu, P. R. China 730050.
OBJECTIVE: To investigate a good method for repairing the long bone defect of
tibia combined with soft tissue defect. METHODS: From 1988-1998, sixteen
patients with long bone defect of tibia were admitted. There were 12 males, 4
females and aged from 16 to 45 years. The length of tibia defect ranged from
cm to 12 cm, the area of soft tissue defect ranged from 5 cm x 3 cm to 12 cm
x 6
cm. Free fibula grafting was adopted in repairing. During operation, the two
ends of fibular artery were anastomosised with the anterior tibial artery of
recipient, and the composited fibular flap were transplanted. RESULTS: All
grafted fibula unioned and the flap survived completely. Followed up for 6 to
111 months, 14 patients acquired the normal function while the other 2
received arthrodesis of the tibial-talus joint. In all the 16 patients, the
unstable ankle joint could not be observed. CONCLUSION: The modified method
characterized by the clear anatomy, the less blood loss and the reduced
operation time. Meanwhile, the blood supply of the grafted fibula can be
PMID: 12080785 [PubMed - indexed for MEDLINE]
194: Can J Surg. 2002 Jun;45(3):196-200.
Morbidity resulting from the treatment of tibial nonunion with the Ilizarov
Sanders DW, Galpin RD, Hosseini M, MacLeod MD.
Division of Orthopedic Surgery, University of Western Ontario, London.
OBJECTIVE: To determine the sources and magnitude of residual morbidity after
successful treatment of tibial nonunion using the Ilizarov device and
techniques. DESIGN: A retrospective cohort study. SETTING: A level 1 trauma
centre. PATIENTS: Sixteen patients with healed tibial nonunion. INTERVENTION:
Application of the Ilizarov device and techniques to obtain union of a
ununited tibial fracture. MAIN OUTCOME MEASURES: Patient satisfaction and
sources of morbidity through clinical review and a visual analogue scale. Two
disease-specific outcome measurement scales were used to assess ankle
dysfunction. Radiographs were examined to determine the presence of
RESULTS: Residual pain was present in over 90% of patients at a mean followup
of 39 months: in 80% the worst pain was in the ankle, less than 10% felt the
worst pain in the knee or at the fracture site. Mean ankle osteoarthritis
were 3.4 for pain and 4.0 for disability, compared with 0.76 and 0.90
respectively for age-matched controls. Mean ankle-hindfoot scores were
64 and 100. CONCLUSION: Ankle pain with disability is the major source of
residual disability after successful use of the Ilizarov device for the
treatment of tibial nonunion.
PMID: 12067172 [PubMed - indexed for MEDLINE]
195: Eur J Radiol. 2002 Jul;43(1):45-56.
Overuse and sports-related injuries of the ankle and hind foot: MR imaging
Sijbrandij ES, van Gils AP, de Lange EE.
Department of Radiology, University Hospital Utrecht and Central Military
Hospital, Heidelberglaan 100, 3509 AA Utrecht, The Netherlands.
Professional and recreational sporting activities have increased
in recent years and have led to a rise in the number of sports-related and
overuse injuries. Magnetic resonance (MR) imaging has become an important
for evaluating the lower leg for providing the necessary information for
management and rehabilitation following this injury. The purpose of this
is to give an overview of the MR findings of common overuse injuries and
sports-related injuries to the bones and soft-tissue structures of the hind
and ankle.
PMID: 12065121 [PubMed - indexed for MEDLINE]
196: Instr Course Lect. 2002;51:159-67.
Principles of management of the severely traumatized foot and ankle.
Baumhauer JF, Manoli A 2nd.
Division of Foot and Ankle Surgery, Department of Orthopaedics, University of
Rochester Medical Center, Rochester, New York, USA.
Publication Types:
Review, Tutorial
PMID: 12064101 [PubMed - indexed for MEDLINE]
197: J Bone Joint Surg Am. 2002 Jun;84-A(6):971-80.
Comment in:
J Bone Joint Surg Am. 2003 Jul;85-A(7):1396; author reply 1396.
J Bone Joint Surg Am. 2003 Mar;85-A(3):571; author reply 571-2.
Long-term outcome after tibial shaft fracture: is malunion important?
Milner SA, Davis TR, Muir KR, Greenwood DC, Doherty M.
Department of Orthopaedic and Accident Surgery, Queen's Medical Center,
Nottingham, United Kingdom.
BACKGROUND: Fractures of the shaft of the tibia often heal with some
Although there is biomechanical evidence that such angulation alters load
transmission through the joints of the lower limb, it is not clear whether it
can eventually lead to osteoarthritis. METHODS: One hundred and sixty-four
individuals who had sustained a tibial shaft fracture were assessed in a
research clinic thirty to forty-three years after the injury. The subjects
evaluated with regard to self-reported lower limb joint pain, stiffness, and
disability (assessed with the Western Ontario and McMaster Universities
osteoarthritis questionnaire); clinical signs of osteoarthritis; and
radiographic evidence of osteophytes and joint-space narrowing in the knees,
ankles, and subtalar joints. RESULTS: Twenty-two (15%) of the 151 subjects
reported no other knee injury reported at least moderate knee pain, and eight
(6%) of the 145 subjects who reported no other ankle injury reported at least
moderate ankle pain. Seventeen (13%) of the 135 subjects who reported no
knee or ankle injury reported at least moderate disability. The ipsilateral
demonstrated a higher prevalence than the contralateral side in terms of pain
with passive ankle movement (nineteen versus nine subjects, p = 0.02), pain
passive subtalar movement (fifteen versus four subjects, p = 0.01), and
radiographic signs of ankle joint space narrowing (twelve subjects versus one
subject, p = 0.0055). Knee osteoarthritis was frequently bilateral. Fortyseven
fractures (29%) healed with coronal angulation of > or = 5 degrees. Apart
an association between shortening of > or = 10 mm and self-reported knee pain
= 0.016), there were no significant univariate associations between these
malunions and the development of osteoarthritis. Seventeen (15%) of 114
subjects had overall malalignment of the lower limb, defined as a hip-kneeankle
angle outside the normal range of 6.25 degrees of varus to 4.75 degrees of
valgus. This malalignment was due to the fracture malunion in nine subjects
predated the fracture in eight. In limbs with varus or valgus malalignment,
there was an excess of subtalar stiffness (p = 0.04) and a nonsignificant
toward more frequent knee pain. In limbs with varus malalignment, there was a
nonsignificant trend toward more frequent radiographic evidence of
osteoarthritis in the medial compartment of the knee joint. Most of the
in whom osteoarthritis was observed had normal overall alignment of the lower
limb. CONCLUSIONS: The thirty-year outcome after a tibial shaft fracture is
usually good, although mild osteoarthritis is common. Fracture malunion is
the cause of the higher prevalence of symptomatic ankle and subtalar
osteoarthritis on the side of the fracture. Although varus malalignment of
lower limb occurs occasionally and may cause osteoarthritis in the medial
compartment of the knee, other factors are more important in causing
osteoarthritis after a tibial shaft fracture.
PMID: 12063331 [PubMed - indexed for MEDLINE]
198: Acta Orthop Belg. 2002 Apr;68(2):178-81.
Penetration injury of the hindfoot following intramedullary nail fixation of
tibial fracture.
Faraj AA, Johnson VG.
Orthopaedic Department, Hull Royal Infirmary, Analby Road, Hull, United
Technical errors during intramedullary nail insertion are not uncommon. We
report a case of tibial guide wire penetration into the distal tibial
surface, the talus and the calcaneus during insertion of the nail with the
dorsiflexed. This has not been reported in the past. Computerized tomogram
was a
useful tool in the diagnosis. This complication was associated with
long-standing ankle pain, which however eventually settled. We advise
use of biplanar C-arm image during the insertion of the guide wire, the
and tibial nail into the medullary canal of the tibia or other long bones.
of these instruments should be forced through. Once the knobbed guide wire is
exchanged to a straight guide wire, the wire should not be forced through or
reamed over, and the nail should be introduced over the guide wire with
Early intraoperative identification and recording of this iatrogenic accident
necessary in order to explain the situation to the patient and modify
PMID: 12051007 [PubMed - indexed for MEDLINE]
199: Br J Neurosurg. 2002 Apr;16(2):165-7.
'Look beneath the stockings'--delayed diagnosis of ankle fractures in
with thoracic cord compression.
Reddy MM, Tyagi A, Towns G.
Department of Neurosurgery, Leeds General Infirmary, UK.
Two patients with thoracic cord compression and ankle fractures are
The diagnosis and treatment of the ankle fractures was delayed in these
patients. The lack of pain sensation in the lower limbs and the use of TED
stockings that covered the area of abnormality were the reasons for the
PMID: 12046737 [PubMed - indexed for MEDLINE]
200: Foot Ankle Int. 2002 May;23(5):406-10.
Pulmonary embolism following operative treatment of ankle fractures: a report
three cases and review of the literature.
Wang F, Wera G, Knoblich GO, Chou LB.
Cornell University Medical College, Ithaca, NY, USA.
The risks of thromboembolism following operative treatment of ankle fractures
are deep vein thrombosis (DVT) and pulmonary embolism (PE). These are
potentially life-threatening complications. Many orthopedic surgeons fail to
appreciate the potential complications of thromboembolic events because of
rare and delayed occurrence in foot and ankle operations. The purpose of this
report is to describe the potential for DVT and PE following ankle
We present three cases in which patients who underwent operative treatment of
ankle fractures subsequently developed PE. We also review the literature on
prevalence of thrombosis, risk factors, methods of prophylaxis, and use of
prophylaxis in surgical procedures of the lower extremity.
Publication Types:
Review, Tutorial
PMID: 12043984 [PubMed - indexed for MEDLINE]