RESUMO
The most important determinant in the treatment of malleolar fractures is stability. Stable fractures have an intact deep deltoid ligament and do not displace with functional treatment. If the deep deltoid/medial malleolar complex is disrupted, the talus is at risk of displacement. Weber (2010) showed that weightbearing radiographs predicted stability in patients with undisplaced ankle fractures. We developed clinical criteria for potential instability and applied them to a prospective series of patients. The criteria included a medial clear space of <4 mm; medial tenderness, bruising or swelling; a fibular fracture above the syndesmosis; a bimalleolar or trimalleolar fracture; an open fracture; and a high-energy fracture mechanism. A prospectively documented series of 43 patients chose functional brace treatment of the potentially unstable fractures. Weightbearing radiographs were performed with the patient wearing the brace before treatment and free of the brace at clinical union (6 to 9 weeks for all patients). The patients were encouraged to bear full weight and actively exercise their ankles in the brace. All fractures healed without displacement. The risk of displacement was 0% (95% confidence interval 0% to 9.5%). The results of the present preliminary series give support for the use of weightbearing radiographs to guide treatment of undisplaced ankle fractures.
Assuntos
Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/terapia , Traumatismos do Tornozelo/diagnóstico por imagem , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/terapia , Suporte de Carga , Adulto , Idoso , Fraturas do Tornozelo/fisiopatologia , Traumatismos do Tornozelo/fisiopatologia , Traumatismos do Tornozelo/terapia , Articulação do Tornozelo/diagnóstico por imagem , Braquetes , Feminino , Humanos , Instabilidade Articular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia , Recuperação de Função FisiológicaRESUMO
The case of a 15-year-old patient presenting with pain as well as paraesthesia over the lateral aspect of the leg is reported. Clinical and radiological investigations showed an aneurysmal bone cyst arising from the proximal fibula and pressing on the common peroneal nerve. Surgical decompression of the nerve and curettage of the cyst was performed resulting in complete resolution of his symptoms. Our aim is to alert surgeons that this problem may occur and that the entire nerve needs to be exposed when dealing with the cyst.