Use of a comprehensive systemic ultrasound evaluation in the diagnosis and analysis of acute lateral region ankle sprain.

BACKGROUND: For the diagnosis of acute lateral ankle sprain, many clinicians use ultrasound; they typically focus on the lateral ligament complex, which is the most common site of lesions in ankle sprain. However, this approach risks missing other foot and ankle lesions. The present study aimed to provide and analyze the results of a new ultrasound method of diagnosis for acute lateral ankle sprain which can thoroughly investigate overall lesions of the foot and ankle. METHODS: Retrospective cross-sectional cohort study of 123 patients who underwent diagnostic ultrasound within 1 week of acute lateral ankle injury was performed. Causes of ankle sprain, incidence and severity of each ligament injury, location of anterior talofibular ligament (ATFL) injury, accompanying ligament injury, and occult fracture were analyzed. RESULTS: Among the 102 cases of ATFL injuries, 60 (58.5%) had islolated ATFL injury, 28 (27.5%) had accompanying calcaneofibular ligament injury (CFL), and 14 (13.7%) had accompanying midtarsal or syndesmosis injury. ATFL injuries occurred on the fibula attachment in 48 (47.1%) cases, ligament mid-substance in 24 (23.5%) cases, and talus attachment in 30 (29.4%) cases. Among the 165 lesions from 123 cases, injuries of the fourth or fifth dorsal tarsometatarsal (12 cases, 7.3%), bifurcate (11 cases, 6.7%), and anterior tibiofibular (11 cases, 6.7%) ligaments were not rare. CONCLUSION: These findings suggest that an ultrasound examination involving investigation of the midtarsal joint and syndesmotic ligament, as well as the ATFL and CFL, is useful for comprehensive, systemic diagnosis of acute lateral ankle sprain.

Computed tomography of bicondylar tibial plateau fractures after distraction with a bridging external fixation.

BACKGROUND: The goal of this study was to compare the inter- and intra-observer reliabilities of computed tomography (CT) scans of bicondylar tibial plateau fractures (Bi-TPFs) with or without distraction with a bridging external fixation (EF) as interpreted by inexperienced surgeons. METHODS: Patients that underwent CT after distraction with a bridging EF were allocated to group 1 (n = 18), and patients that underwent CT before distraction with a bridging EF were allocated to group 2 (n = 18). Five observers were given plain radiographs and CT images to assess (survey 1) and this assessment was repeated six weeks later (survey 2). Agreements regarding fracture classification and pre-operative planning were evaluated using kappa coefficients. In addition, to evaluate fracture severity, we designed a severity score. RESULTS: Inter-observer reliabilities for fracture classification and pre-operative planning were higher in group 1 than in group 2. Surveys 1 and 2 revealed similar kappa coefficients in the two study groups. The mean absolute difference (MAD) in severity scores allocated at the two surveys was significantly different between the two groups (P = 0.045). Intra-observer reliabilities of fracture classification and pre-operative planning were also higher in group 1 than in group 2. In addition, level of training was found to have a significant impact on the MAD in severity scores (P = 0.007). CONCLUSIONS: Inter- and intra-observer reliabilities for fracture classification and pre-operative planning were better for inexperienced surgeons when CT was performed after distraction with a bridging EF for Bi-TPFs. Thus, when staged treatment using EF is selected in Bi-TPF patients, the authors suggest that CT scans be performed after distraction with a bridging EF especially for inexperienced surgeons.

Can Double Osteotomy Be a Solution for Adult Hallux Valgus Deformity With an Increased Distal Metatarsal Articular Angle?

No previous study has reported the results of double metatarsal osteotomy for adult hallux valgus deformity with an increased distal metatarsal articular angle (DMAA). The purpose of the present study was to evaluate the results after double metatarsal osteotomy in adult patients with incongruent hallux valgus deformity. We retrospectively reviewed 16 cases of consecutive first metatarsal double metatarsal osteotomy without lateral soft tissue release in 14 patients with symptomatic hallux valgus associated with an increased DMAA (≥15° after proximal chevron osteotomy on intraoperative radiographs). Clinical results were assessed using the American Orthopaedic Foot and Ankle Society scale and the visual analog scale. The radiographic results were assessed over time, and changes in the DMAA and the relative length of the first metatarsal were assessed by measuring each value preoperatively and at the last follow-up visit. The American Orthopaedic Foot and Ankle Society and visual analog scale scores were significantly improved after surgery. The hallux valgus angle and intermetatarsal angle were stabilized >3 months after surgery. The sesamoid position did not increase significantly beyond the immediate postoperative period. The mean DMAA was corrected from 21.6° (range 15° to 29°) preoperatively to 11.1° (range -2° to 17°) at the last follow-up visit. The mean amount of shortening of the first metatarsal after surgery was 5.5 (range 4 to 7) mm. In conclusion, double metatarsal osteotomy without lateral soft tissue release in adult hallux valgus deformity results in high postoperative recurrence and complication rates.

New Skeletal Muscle Mass Index in Diagnosis of Sarcopenia.

BACKGROUND: We sought to develop a novel index based on the skeletal muscle mass that reflects the change of quality of life (QOL), and is the most appropriate index for the body composition of the elderly in Korea. Whether lower extremity skeletal muscle mass index (LESMI) is an appropriate novel new index to diagnose patients with sarcopenia was also evaluated. A cut-off value for each index was reported to facilitate the diagnosis of patients with sarcopenia in a Korean population. METHODS: We used the 5th Korean National Health and Nutrition Examination Survey data from 2010. We analyzed 409 elderly patients, including 231 men and 178 women, aged ≥65 years. Patients were diagnosed by calculating their skeletal muscle index based on the skeletal muscle mass measured using dual energy X-ray absorptiometry. Obesity and osteoporosis were used to screen data and EuroQOL-5 dimension as a health questionnaire. RESULTS: The prevalence of sarcopenia in each index was obtained based on its cut-off value for diagnosing sarcopenia. There was a significant difference between the obesity rate of elderly patients diagnosed with sarcopenia and those who were not based on each index. There was no significant difference in the prevalence of osteoporosis between the groups. Sarcopenia diagnosis based on the LESMI was significantly correlated with QOL. CONCLUSIONS: LESMI, a novel index based on skeletal muscle mass, reflects changes in QOL and is appropriate for the body composition of elderly people in Korea.

Usefulness of K-Point Injection for the Nonspecific Neck Pain in So-Called K-Point Syndrome.

BACKGROUND: Shoichi Kokubun introduced his successful experience with local anesthetic injection at the occipital insertion of the sternocleidomastoid muscle in K-point syndrome. The purpose of this study was to evaluate the short-term and long-term effectiveness of K-point injection and investigate factors affecting treatment results. METHODS: K-point injection was performed in 58 patients with K-point syndrome at Yeungnam University Medical Center. The syndrome was associated with cervical whiplash injury in 10 patients and was of nonspecific origin in the rest. One milliliter of 2% lidocaine mixed with 1 milliliter of dexamethasone was injected in 50 patients and 2 milliliters of 1% lidocaine alone in the rest. Initially, the severity of local tenderness at the K-point and other tender points was examined and the degree of immediate pain relief effect was assessed within 1 hour after injection. Early effect within 1 month after the injection and current effect were evaluated in 27 patients using a modified Kim's questionnaire with regard to the duration of improvement, degree of improvement in pain and daily living activities, and satisfaction. RESULTS: Of the total 58 patients, 44 (75.8%) apparently had immediate pain relief after K-point injection. The only factor associated with successful immediate pain relief was the whiplash injury associated with traffic accident (TA). The early pain control effect was associated with the immediate effect. The current effect was associated with the early effect alone. Satisfaction with the K-point injection was related to early successful pain relief. CONCLUSIONS: K-point injection would be useful for early pain relief in nonspecific neck pain syndrome so called K-point syndrome, but not for current pain relief. Especially, it was very effective for early pain control in the whiplash injury associated with TA.