Asistencia artroscópica y fijación interna percutánea en fracturas de Maisonneuve. Evaluación por imágenes de los resultados / Arthroscopy and percutaneous internal fixation in Maisonneuve fractures. Imaging evaluation

Introducción: La fractura de Maisonneuve es una lesión caracterizada por la fractura subcapital del peroné asociada a una lesión capsuloligamentaria de tobillo. Su tratamiento supone la restauración de la anatomía ósea y capsuloligamentaria normal para restablecer las fuerzas de contacto tibioastragalinas fisiológicas. Esta calidad de reducción puede ser difícil de alcanzar, sobre todo, con técnicas percutáneas. Objetivo: Evaluar mediante imágenes la calidad de la reducción de fracturas de Maisonneuve reducidas en forma cerrada (bajo visualización directa artroscópica) y fijadas por vía percutánea. Materiales y Métodos: Se analizaron radiografías e imágenes de tomografía computarizada preoperatorias y posoperatorias, comparativas de los tobillos operado y sano. Resultados: Se evaluaron 13 fracturas. Los parámetros radiográficos posoperatorios (espacio claro medial, solapamiento tibioperoneo distal, espacio claro tibioperoneo) no registraron diferencias, excepto por el intervalo tibioperoneo anterior que aumentó en un caso. La medición tomográfica posoperatoria del solapamiento tibioperoneo distal y el intervalo tibioperoneo anterior reveló que todas las reducciones eran satisfactorias. Dos pacientes tenían valores alterados en la sindesmosis tibioperonea distal con diferencia >2 mm respecto del tobillo sano. Conclusión: Recomendamos la asistencia artroscópica para el manejo de la fractura de Maisonneuve como herramienta de control intraoperatorio para una fijación percutánea más segura. Nivel de Evidencia: IV

Introduction: Maisonneuve fracture (MF) is an injury characterized by the subcapital fracture of the fibula associated with a capsuloligamentous injury of the ankle. Treatment involves the restoration of normal bone and capsuloligamentous anatomy in order to reestablish physiological tibiotalar contact forces. This quality of reduction can be difficult to achieve, especially with percutaneous techniques. Objective: To evaluate the quality of reduction in Maisonneuve fractures reduced in a closed manner (under direct arthroscopic visualization) and fixed percutaneously. Materials and Methods: We analyzed comparative preoperative and postoperative radiographs and CT scans of the operated and healthy ankles. Results: 13 fractures were evaluated. Radiographic parameters of postoperative procedures (medial clear space, distal tibiofibular overlap, tibiofibular clear space) did not register differences except for the anterior tibiofibular space, which had increased in 1 case. Postoperative tomographic measurements of tibiofibular clear space and anterior tibiofibular space showed 100% satisfactory reductions. Two patients presented altered distal tibiofibular overlap values with a difference greater than 2 mm compared to the healthy ankle. Conclusion: We recommend arthroscopy for the management of MF as an intraoperative control tool for safer percutaneous fixation. Level of Evidence: IV

Fractura de tibia como complicación del uso de un dispositivo de fijación elástica en la sindesmosis / Tibial fracture as a complication of the use of an elastic fixation device in the syndesmosis

La fijación elástica en las lesiones de la sindesmosis es un procedimiento que se realiza ampliamente y brinda buenos resultados. Presentamos un caso de una fractura de tibia como complicación de la fijación elástica de la sindesmosis, su tratamiento y una revisión bibliográfica en la cual no hemos encontrado reportes sobre esta complicación. Nivel de Evidencia: IV

Elastic fixation in syndesmosis injuries is a widely performed procedure with good outcomes. We report a case of a tibial fracture as a complication of the elastic fixation of the syndesmosis, its treatment, and a literature review, in which we have not found reports of this complication. Level of Evidence: IV

Application of intermittent flap opening in L-shaped surgical incision of calcaneal fracture / 中国骨伤

OBJECTIVE@#To explore clinical effect of intermittent flap opening technique in L-shaped incision of calcaneal fracture.@*METHODS@#From January 2017 to January 2019, 48 patients with Sanders typeⅡ to Ⅳ calcaneal fractures were treated by open reduction and internal fixation. According to different flap opening techniques, the patients were divided into control group and observation group, 24 patients in each group. In observation group, there were 17 males and 7 females, aged from 20 to 60 years old with an average of(45.12±9.56) years old;7 patients were typeⅡ, 10 patients were type Ⅲ and 7 patients were type Ⅳ according to Sanders classification;3 patients were C0, 16 patients were C1 and 5 patients were C2 according to Tscherne-Gotzen soft-tissue assessment;treated with intermittent flap technique. In control group, there were 19 males and 5 females aged from 20 to 60 years old with an average of (47.32±10.67) years old;7 patients were typeⅡ, 11 patients were type Ⅲ and 6 patients were type Ⅳ according to Sanders classification;2 patients were C0, 18 patients were C1 and 4 patients were C2 according to Tschemc-Gotzen soft-tissue assessment;treated with static flap opening technique. Operation time, flap retraction time, changes of Böhler angle and Gissane angle before and after operation at 3 days, and occurrence of incision complications were observed and compared between two groups.@*RESULTS@#All patients were followed up from 3 to 6 months with an average of(4.52±1.01) months. There were no significant differences in operation time, changes of Böhler angle and Gissane angle before and after operation at 3 days between the two groups(P>0.05);there was statistical difference in flap retraction time between two groups(P<0.05). Occurrence of incision complications in observation group was significantly lower than that in control group (P<0.05).@*CONCLUSION@#Intermittent flap opening technique is superior to static opening technique in reducing incision complications of lateral "L" approach of calcaneus. Single Kirschner wire opening does not affect the exposure, reduction and fixation of fracture during operation.

Treatment of Sanders typeⅡto Ⅲ calcaneal fractures with percutaneous reduction and minimally invasive calcaneal screw fixation / 中国骨伤

OBJECTIVE@#To investigate clinical effect of percutaneous reduction combined with internal fixation of calcaneal nail in treating Sanders typeⅡto Ⅲ calcaneal fractures.@*METHODS@#From July 2017 to August 2019, clinical data of 98 patients with Sanders typeⅡto Ⅲ calcaneal fractures treated were retrospectively analyzed, and divided into observation group and control group according to different surgical methods. In observation group, there were 35 males and 21 females, aged from 23 to 58 years old with an average of (34.50±7.81) years old;29 patients with Sanders typeⅡand 27 patients with Sanders type Ⅲ;30 patients on the left side and 26 patients on the right side;the time from fracture to operation ranged from 1 to 4 days with an average of (3.45±0.54) days;and treated with percutaneous reduction combined with internal fixation of calcaneal nail system. In control group, there were 25 males and 17 females, aged from 25 to 60 years old with an average of (35.27±7.64) years old;23 patients with Sanders type Ⅱ and 19 patients with Sanders type Ⅲ;24 patients on the left side and 18 patients on the right side;the time from fracture to operation ranged from 2 to 5 days with an average of (3.42±0.62) days;and treated with open reduction and internal fixation. Operation time, blood loss, hospital stay, fracture healing time, and postoperative visual analogue scale (VAS) at 1 day, preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Böhler angle, Gissane angle and calcaneus width, and postoperative complications were compared between two groups.@*RESULTS@#All patients were followed up from 13 to 18 months with an average of (15.6±2.2) months. There were significant differences in operation time, blood loss, hospital stay, fracture healing time and postoperative VAS at 1 day between two groups (P<0.05). There was statistical difference in postoperative AOFAS score at 12 months between two groups (P<0.05), and AOFAS score at 12 months after operation was higher than that before operation (P<0.05). According to AOFAS score, 21 patients got excellent result, 30 good and 5 moderate in observation group, and 10 excellent, 22 good, 7 moderate and 3 poor in control group, which had statistical difference between two groups (P<0.05). Postoperative Böhler angle, Gissane angle and calcaneus width at 6 months were better than that before operation between two groups(P<0.05). One patient in observation and 20 patients in control group occurred skin numbness after operation, and 14 patients occurred skin necrosis in control group, there were obvious difference between two groups(P<0.01).@*CONCLUSION@#Compared with open reduction and internal fixation, percutaneous reduction combined with internal fixation system in treating Sanders typeⅡto Ⅲ calcaneal fractures is feasible for fracture repair without waiting for foot deswelling, which could accurately restore normal shape and position of the fractured heel bone, completely eliminate fracture malunion, and reduce postoperative complications. Therefore, it could shorten operation time, hospital stay, fracture healing time, reduce amount of blood loss, promote postoperative recovery, and less complications, high safety, which could be used as a choice of orthopedic surgery for foot and ankle trauma.

Comparison of clinical effect and postopertaive incisions between No-touch technique and traditional retractor in treating calcaneal fracture / 中国骨伤

OBJECTIVE@#To compare clinical efficacy of No-touch technique and traditional retractor in treating calcaneal fracture.@*METHODS@#Clinical data of 74 calcaneal fracture patients with closed Sanders typeⅡ to Ⅳ were retrospectively analyzed from July 2019 to June 2021. According to different treatment methods, the patients were divided into No-touch group and conventional group, 37 patinets in each group. In No-touch group, there were 25 males and 12 females, aged from 19 to 70 years old with an average of (42.64±14.16) years old;17 patients were typeⅡ, 14 patinets with type Ⅲ, 6 patients with type Ⅳ according to Sanders fracture classification;three 2.0 mm Kirschner wires were implanted into the talus body, talus neck, and cuboid bone, and the flap was turned upward to expose the operation area. In conventional group, there were 30 males and 7 females, aged from 19 to 67 years old with an average of (41.56±11.38) years old;17 patients with typeⅡ, 12 patients with type Ⅲ, 8 patients with type Ⅳ according to Sanders fracture classification;the operation was completed by exposing the operation area with traditional retractor. Operation time, postoperative incision complications, postoperaive American Orthopedic Foot and Ankle Society (AOFAS) ankle hind foot score at 6 months between two groups were compared.@*RESULTS@#Seventy-four patients were followed up, and follow-up time in No-touch group ranged from 6 to 17 months with an average of(9.57±2.72) months, while in conventional group ranged from 6 to 16 months with an averge of(9.14±2.71) months, and no difference in follow-up between two groups (P>0.05). Operation time in No-touch group (55.67±7.94) min was shorter than that in conventional group (70.16±9.41) min (P<0.05);four patients in No-touch group occurred incision complications, while 8 patients in normal group, and had statistically difference(P<0.05). Daily activities and support, maximum walking distance (block), ground walking, limited degree of flexion, extension and valgus, foot alignment and total score of AOFAS scores in No-touch group was significantly higher than that of conventional group (P<0.05). There were no significant difference in pain degree, abnormal gait and ankle hind foot stability between two groups(P>0.05). According to AOFAS score, 19 patients got excellent result, 16 good and 2 poor in No-touch group;while 9 excellent, 24 good, and 4 poor in conventional group, and no difference between two groups (P>0.05).@*CONCLUSION@#Compared with traditional retractor in treating calcaneal fracture, No-touch technology could significantly shorten operation time, reduce incidence of postopertive complications, while two methods could improve excellent and good rate of ankle joint function recovery after operation.

Platelet-rich plasma on ankle sprains – efficacy on pain reduction and shorter return to play: A systematic review of available randomized control trials

Background@#The role of platelet-rich plasma (PRP) has been widely studied, but only recently did trials emerge that probed into its potential role in ankle sprains. With the limited available literature, most of the trials results showed that it might have a role in faster healing and pain reduction. @*Objectives@#The purpose of this review is to summarize available studies on ankle sprains in order to identify if there is good initial evidence of its role on return to play (RTP) among active individuals as well as pain reduction. It is also to identify if results were consistent among studies. @*Methodology@#A systematic search of available literature in online databases was done to compare results about outcome measures on pain score and RTP. Included studies are those with a population of 18 years and above treated with PRP with or without post-procedural immobilization. Outcome scorings that assessed pain as a parameter was also included. @*Results@#Three randomized controlled trials and two prospective studies were identified. Results showed an average of 8 weeks to RTP (p-value - 0.006) with decreased pain in ankle sprains treated with PRP and functional therapy. @*Limitation@#Only one randomized controlled trial (RCT) compared PRP with a placebo and a small population of all studies made available. More comparable RCTs are needed to strengthen results of the studies. @*Conclusion@#The use of PRP on ankle sprains may have a potential role in shorter time to RTP and pain reduction.

Fractura de astrágalo asociado a fractura del cuboides en un niño de 9 años: reporte de caso / Talar fracture associated with cuboid fracture in a 9-year-old boy: case report / Fratura do tálus associada à fratura do cubóide em menino de 9 anos: relato de caso

Introducción: El astrágalo tiene una anatomía única y juega un papel fundamental en la función del tobillo y pie. Las fracturas de astrágalo se consideran una urgencia ortopédica especialmente las fracturas de cuello desplazadas, debido al alto riesgo de necrosis avascular. Sin embargo, estas son raras en los niños con una prevalencia estimada del 0,008% de todas las fracturas pediátricas. Las fracturas del cuello del astrágalo se asocian con una alta tasa de complicaciones, entre las más importantes se destacan la artrosis postraumática y la necrosis avascular. Éstas están relacionadas principalmente con el grado de desplazamiento inicial del cuello del astrágalo y la incidencia puede ser del 100%. Objetivos: Los objetivos del presente trabajo son demostrar la evolución de un paciente con una patología poco frecuente, con una asociación lesional no reportada hasta el momento y realizar una revisión bibliográfica del tema. Material y métodos: Se evaluó de forma retrospectiva un paciente de sexo masculino de 9 años con una luxo-fractura de cuello de astrágalo de pie izquierdo asociado a una fractura de cuboides. Se evaluaron los resultados clínicos radiológicos y funcionales luego de 3 años de evolución. Resultados: En nuestro caso se realizó reducción abierta y fijación percutánea. Se logró una excelente consolidación ósea sin complicaciones y con buena funcionalidad del tobillo luego de 3 años de seguimiento. Se realizó la escala AOFAS obteniendo una puntuación de 93/100. No presentó limitaciones en cuanto al dolor, con un total de 40 puntos, no mostró limitaciones en cuanto a la función, con un total de 45 puntos. Observamos una leve desaxación en valgo del retropie, asintomático, con un total de 8 puntos. Conclusiones: Las fracturas del astrágalo son raras en la población pediátrica pero pueden ocasionar complicaciones graves. En nuestro caso observamos una fractura grave, con una asociación lesional no descrita hasta el momento, que presentó muy buena evolución, con una consolidación ósea, sin complicaciones y con buen resultado funcional a los 3 años de la cirugía. Al tratarse de una patología muy poco frecuente y rara, la bibliografía revisada es en general de baja evidencia científica y se basa en su mayoría en reporte de casos clínicos, excepto una revisión sistemática con bajo numero de pacientes.

Introduction: The talus has a unique anatomy and plays a fundamental role in the function of the ankle and foot. Talar fractures are considered an orthopedic emergency, especially displaced neck fractures, due to the high risk of avascular necrosis. However, these are rare in children with an estimated prevalence of 0.008% of all pediatric fractures. Talar neck fractures are associated with a high rate of complications, the most important of which include post-traumatic osteoarthritis and avascular necrosis. These are mainly related to the degree of initial displacement of the talar neck and the incidence can be 100%. Objectives: The objectives of this work are to demonstrate the evolution of a patient with a rare pathology, with an injury association not reported so far and to carry out a bibliographic review of the topic. Material and methods: A 9-year-old male patient with a talar neck fracture dislocation of the left foot associated with a cuboid fracture was retrospectively evaluated. Clinical, radiological and functional results were evaluated after 3 years of evolution. Results: In our case, open reduction and percutaneous fixation were performed. Excellent bone union was achieved without complications and with good ankle functionality after 3 years of follow-up. The AOFAS scale was performed, obtaining a score of 93/100. It did not present limitations in terms of pain, with a total of 40 points, it did not show limitations in terms of function, with a total of 45 points. We observed a slight valgus dexation of the hindfoot, asymptomatic, with a total of 8 points. Conclusions: Talar fractures are rare in the pediatric population but can cause serious complications. In our case we observed a serious fracture, with an injury association not described until now, which presented a very good evolution, with bone consolidation, without complications and with good functional result 3 years after surgery. As it is a very infrequent and rare pathology, the literature reviewed is generally of low scientific evidence and is based mostly on clinical case reports, except for a systematic review with a low number of patients.

Introdução: O tálus possui anatomia única e desempenha papel fundamental na função do tornozelo e do pé. As fraturas do tálus são consideradas uma emergência ortopédica, principalmente as fraturas deslocadas do colo, devido ao alto risco de necrose avascular. No entanto, estas são raras em crianças, com uma prevalência estimada de 0,008% de todas as fraturas pediátricas. As fraturas do colo do tálus estão associadas a uma alta taxa de complicações, sendo as mais importantes a osteoartrite pós-traumática e a necrose avascular. Estas estão relacionadas principalmente ao grau de deslocamento inicial do colo do tálus e a incidência pode ser de 100%. Objetivos: Os objetivos deste trabalho são demonstrar a evolução de um paciente com patologia rara, com associação de lesão até o momento não relatada e realizar uma revisão bibliográfica sobre o tema. Material e métodos: Foi avaliado retrospectivamente um paciente do sexo masculino, 9 anos de idade, com fratura luxação do colo do tálus do pé esquerdo associada a fratura do cuboide. Os resultados clínicos, radiológicos e funcionais foram avaliados após 3 anos de evolução. Resultados: No nosso caso foi realizada redução aberta e fixação percutânea. Excelente consolidação óssea foi alcançada sem complicações e com boa funcionalidade do tornozelo após 3 anos de acompanhamento. Foi realizada a escala AOFAS, obtendo pontuação de 93/100. Não apresentou limitações em termos de dor, com um total de 40 pontos, não apresentou limitações em termos de função, com um total de 45 pontos. Observamos leve dexação em valgo do retropé, assintomática, com total de 8 pontos. Conclusões: As fraturas do tálus são raras na população pediátrica, mas podem causar complicações graves. No nosso caso observamos uma fratura grave, com associação de lesão até então não descrita, que apresentou evolução muito boa, com consolidação óssea, sem complicações e com bom resultado funcional 3 anos após a cirurgia. Por se tratar de uma patologia muito pouco frequente e rara, a literatura revista é geralmente de baixa evidência científica e baseia-se maioritariamente em relatos de casos clínicos, exceto uma revisão sistemática com um número reduzido de doentes.

Fractura de Tillaux en adultos. Reporte de un caso y revisión de la bibliografía / Tillaux fracture in adults. Case report and literature review

Introducción: La fractura de la región anterolateral de la epífisis distal de la tibia, o tubérculo de Tillaux-Chaput, es conocida como fractura de Tillaux. Se trata de una fractura extremadamente rara en los adultos, pero tiene una importancia fundamental, porque compromete la superficie articular tibio-astragalina, la estabilidad de la sindesmosis y, en algunos casos, la incisura peronea. Se presenta el caso de una mujer de 45 años con un traumatismo rotatorio del tobillo izquierdo e impotencia funcional y dolor en la región anterolateral del tobillo. Las radiografías generaron la sospecha de un trazo de fractura correspondiente al tubérculo de Tillaux-Chaput. Por lo tanto, se realizó una tomografía computarizada que confirmó una fractura de Tillaux, que tenía un desplazamiento >2 mm y compromiso de la incisura peronea. La paciente fue sometida a reducción abierta y fijación interna. La fractura consolidó a los 3 meses. Al año de la cirugía, su estado clínico y funcional es excelente. Conclusión: La sospecha diagnóstica que surge de una completa anamnesis y un meticuloso examen físico, y la confirmación mediante estudios por imágenes son esenciales para abordar correctamente patrones de fracturas raros, como la fractura de Tillaux. Nivel de Evidencia: IV

Introduction: The fracture of the anterolateral region of the distal tibial epiphysis, or Tillaux-Chaput tubercle, is known as Tillaux fracture. It is an exceptional entity in adults, but it has significant importance because it affects the tibiotalar joint surface, the stability of the syndesmosis, and, in some cases, the fibular notch. We present the case of a 45-year-old woman treated in the Emergency Service due to rotational trauma to the left ankle and functional impairment and pain in the anterolateral region of the ankle. The radiographs led to the suspicion of a fracture line corresponding to the Tillaux-Chaput tubercle. Therefore, a CT scan was performed, which confirmed a Tillaux fracture with a >2 mm displacement and involvement of the fibular notch. The patient underwent open reduction and internal fixation. The fracture consolidated after 3 months. One year after surgery, her clinical and functional status was excellent. Conclusion:Diagnostic suspicion through meticulous physical examination and anamnesis and confirmation by imaging studies are essential for the proper management of rare fracture patterns, such as Tillaux fractures. Level of Evidence: IV

Clasificación de Leonetti y Tigani para fracturas del pilón tibial: validación con residentes de Traumatología y Ortopedia, y fellows en tobillo y pie / Validation of the classification of Leonetti and Tigani in tibial pilon fractures through resident doctors in Traumatology and Orthopedics and foot and ankle fellows

Objetivo: Validar la clasificación de Leonetti y Tigani con evaluadores de diferentes niveles de experiencia. materiales y métodos: Se evaluó a 54 pacientes (54 fracturas del pilón tibial) en forma retrospectiva. Se tomaron radiografías de tibia distal, de frente y perfil, y una tomografía computarizada con cortes axiales, sagitales, coronales y reconstrucción 3D. Se incluyeron todos los subtipos de la clasificación de Leonetti y Tigani. Los evaluadores tenían diferentes niveles de entrenamientos: dos eran fellows en pie y tobillo, y dos, residentes del último año de formación. Para determinar la concordancia interobservador, cada caso fue clasificado en tipo I, II, III o IV, según Leonetti y Tigani. Para evaluar la concordancia intraobservador el mismo evaluador analizó los casos a las 6 semanas. Se utilizó el coeficiente kappa para determinar el grado de concordancia entre evaluadores y ese valor fue expresado con un intervalo de confianza del 95%. Resultados: La concordancia intraobservador fue moderada y muy buena para cada fellow, y buena y muy buena para los residentes, entre la primera y segunda evaluación. La concordancia interobservador arrojó un coeficiente kappa global de 0,7156 (IC95% 0,60-0,83), un valor bueno cuando se consideraron todas las fracturas por todos los evaluadores. Conclusiones: El sistema de clasificación de fracturas del pilón tibial alcanza concordancias superiores a las de estudios previos de otras clasificaciones. Dichas concordancias se lograron con médicos con diferentes niveles de experiencia y conocimiento. Nuestros hallazgos contribuyen a la validación externa e independiente de este nuevo sistema de clasificación. Nivel de Evidencia: IV

Objective: To validate the classification of Leonetti and Tigani with evaluators of different levels of expertise. Materials and methods: 54 patients with 54 tibial pilon fractures were evaluated retrospectively. Patients were studied using AP and lateral radiography of the distal tibia, as well as CT scans (axial, coronal, and sagittal images with reconstruction). All subtypes of the Leonetti classification were included. The evaluators presented different levels of training: two Foot and Ankle fellows and two residents in their last year of training. To determine the interobserver agreement, each case was classified into types I, II, III and IV according to Leonetti. To determine the intraobserver agreement, the cases were analyzed by the same evaluator after 6 weeks. The kappa coefficient (k) was used to determine the degree of agreement between the evaluators, that value was expressed with a 95% confidence interval. Results: The intraobserver agreement between the first and second evaluation for fellows was moderate and very good. For the residents, it was good and very good. The interobserver agreement for the classification of tibial pilon fractures presented an overall kappa of 0.7156 (95%CI: 0.60 to 0.83), which is a good value when all fractures are considered by all evaluators. Conclusion:This tibial pilon fracture classification system surpasses previous studies of other classifications in terms of agreement. These agreements were reached with physicians with varying levels of expertise. Our findings contribute to the external and independent validation of this new classification system. Level of Evidence: IV

Tendones peroneos: una revisión contemporánea / Peroneal tendons. Contemporary update

La patología de peroneos es compleja y frecuentemente subdiagnosticada. El conocimiento detallado de la anatomía, biomecánica y fisiopatología es fundamental para realizar un correcto diagnóstico y tratamiento. El objetivo de este artículo es revisar la información más actualizada sobre la patología de los tendones peroneos (tendinopatía, inestabilidad y rotura).

Pathology of the peroneal tendons is complex and often underdiagnosed. Knowledge of anatomy, biomechanics, and physiopathology is necessary for diagnosing and treating this condition. The objective of this article is to review the most updated information regarding peroneal tendon pathology (tendinopathy, dislocation/subluxation, and tears), which may help managing patients with lateral pain of the foot and ankle.

A new method of anterior talofibular ligament reconstruction: Arthroscopically artificial ligament reconstruction with tensional remnant-repair / 中华创伤杂志(英文版)

PURPOSE@#To investigate the clinical effects of arthroscopically artificial ligament reconstruction with tensional remnant-repair in patients who are obese, and/or with demand for highly intensive sports, and/or with poor-quality ligament remnants.@*METHODS@#A retrospective case series study was performed on patients treated by arthroscopically anterior talofibular ligament (ATFL) reconstruction with tensional remnant repair technique from January 2019 to August 2021. General data, including demographics, surgical time, and postoperative adverse events, were recorded. The American Orthopaedic Foot and Ankle Society score (AOFAS), foot and ankle ability measure (FAAM), visual analog scale (VAS), and anterior talar translation were measured preoperatively and at 6 weeks, 3 months, and 2 years postoperatively. Ultrasonography examination was performed preoperatively and 2 years postoperatively to evaluate the ATFL. Data were analyzed using SPSS 19.0. F test was used to analyze the pre- and postoperative VAS, FAAM, and AOFAS scores. The significance was set at p < 0.05.@*RESULTS@#There were 20 males and 10 females among the patients with a mean age of (30.71 ± 5.81) years. The average surgical time was (40.21 ± 8.59) min. No adverse events were observed after surgery. At 2 years postoperatively, the anterior talar translation test showed grade 0 laxity in all patients. VAS score significantly decreased from preoperatively to 6 weeks, 3 months, and 2 years postoperatively (p < 0.001). Improvement of FAAM score and the AOFAS score from preoperatively to 6 weeks, 3 months, and 2 years postoperatively was statistically significant (p < 0.001). At 3 months postoperatively, most patients (23/30) could return to their pre-injured activities of daily living status. At 2 years postoperatively, all patients were able to return to their pre-injured activities of daily living status, and almost every patient (18/19) who expected highly intensive sports returned to sports with only 1 obese patient failing to achieve the goal. The ultrasonography examination at 2 years postoperatively showed that there was a linear band structure of soft tissue on the tension-rich fiber tape image from the fibular to the talar attachment sits of ATFL.@*CONCLUSION@#The novel arthroscopically artificial ligament reconstruction with tensional remnant-repair technique for ATFL achieved satisfactory clinical outcomes in the short and medium term after operation, and allowed early return to pre-injured activities, which could be a reliable option for patients with chronic lateral ankle instability.

Locking loop stitch with suture-bridge technique in repair of acute closed distal Achilles tendon rupture by using suture anchors / 中国骨伤

OBJECTIVE@#To explore clinical efficacy of Locking loop stitch with suture-bridge technique in repair of acute closed distal Achilles tendon rupture by using suture anchors.@*METHODS@#From July 2019 to March 2021, 20 patients with acute closed distal Achilles tendon rupture were treated by minimally invasive suture anchor locking suture bridging repair technique. Among them, including 18 males and 2 females, aged from 19 to 52 years old with an average of(40.0±9.0) years old. Complications were observed, and recovery of ankle function was evaluated by American Orthopaedic Foot & Ankle Society(AOFAS) ankle and hindfoot function scoring system before operation and 1 year after operation.@*RESULTS@#All patients followed up from 6 to 18 months with an average of (12.0±3.2) months. The incisions were healed at stageⅠwithout infection and skin necrosis occurred;no gastrocnemius nerve injury and deep vein thrombosis of the lower extremities occurred;and no heel pain and Achilles tendon re-rupture occurred. AOFAS scores of ankle and hindfoot increased from(59.0±4.3) before opertaion to(95.1±2.6) at 1 year after operation (t=-32.1, P<0.05).@*CONCLUSION@#The effect of locking suture bridging with suture anchor nails to repair acute distal Achilles tendon rupture is definite, and it could reduce incidence of complications such as Achilles tendon re-rupture, nerve injury, and skin necrosis, which has advantages of small surgical trauma, reliable anastomosis method and good functional recovery, and is an ideal method for treating acute closed distal Achilles tendon rupture.

Treatment of lateral ankle joint ligament sprain by shaking and poking manipulation based on finite element method / 中国骨伤

OBJECTIVE@#To conduct a preliminary study on joint injuries of anterior and calcaneal fibular ligaments of the lateral ankle joint, and to analyze mechanism of action of shaking and poking in treating ankle joint and biomechanical properties of ankle during the recovery of joint injuries.@*METHODS@#CT scan was performed on a male volunteer with right ankle sprain. Mimics 10.0, Solidworks 2016, Hypermesh 12.0 and Abaqus 6.13 software were used to establish 3D nonlinear finite element analysis model of foot and ankle, and the validity of model was verified. Combined with clinical study, the finite element simulation analysis was carried out on the toe flexion, dorsiflexion, varus and valgus of ankle joint under different treatment periods by adjusting elastic modulus of ligament to simulate ligament injury.@*RESULTS@#With the treatment of shake and prick and recovery of ligament injury, the maximum stress and area with large stress on tibial pitch and fibular joint surface gradually increased under the four working conditions, and the stress value of the maximum stress ligament gradually increased, and the stress of the anterior and calcaneal fibular ligament dispersed and transferred, and the axial force gradually decreased.@*CONCLUSION@#The finite element method was used to simulate the mechanical condition of the shaking and stamping technique, and the changes of the forces of the ligament and articular surface before and after treatment of anterior and calcaneal ligament combined injury of ankle talus were intuitively observed. The treatment effect was quantified, and could provid objective and scientific basis for clinical promotion and application of this technique.

Cross-sectional study on ankle sprain and its related factors in physical education college / 中国骨伤

OBJECTIVE@#To explore prevalence, risk factors and treatment of ankle sprain of young college student , in order to obtain accurate epidemiological data.@*METHODS@#From March 2019 to May 2019, 552 college students(1 104 sides of anke joints) from Xi'an Physical Education university were enrolled in study according to inclusion and excludion standard, including 309 males and 243 females aged from 16 to 24 years old with an average of (20.9±3.7) years old. Age, gender, and body mass indes(BMI) etc were recorded. Morbidity of acute and chronic ankle sprains of physical students, treatment after the first sprain (cold compress, cast or plaster bracing and medicine), visual analogue scale (VAS) during walking were assessed through ankle sprain questionnaire;Cumberland ankle instability tool (CAIT), Maryland foot score were applied to assess ankle function. Lateral ankle ligament injury was objectively assessed by musculoskeletal ultrasonography.@*RESULTS@#The prevalence of acute ankle sprain(AAS) was 96.20% (531/552), and the incidence of AAS was 59.96% (622/1 104). The prevalence of chronic ankle joint instability(CAI) was 16.85% (93/552), and the incidence of CAI was 8.97% (99/1 104). In the four categories of sports, college student suffered from multiple sprains in performance majors group was 22.20% (14/63), including of aerobicsand dance performance. The incidence of AAS of ball sports was 8.60%(14/163). After the first sprain, most college students(94.4%) were received cold compression, about 60% of them went to hospital;however, only 44.7% students were received standard treatmens(cast or plaster), only 35.3% of them were received hard ankle orthosis. In 552 college students, 44 students were suffered from more than 4 times of ankle sprain, and the total incidence was 7.97% (44/552). Cumberland score was 26.6±2.4, Cumberland score of students sprained ankle joint more than 4 times was (29.2±1.1), suggested it was a risk factor for ankle joint instability. VAS of students sprained ankle joint more than 4 times was higher than that of less than 4 times(P<0.05), Maryland foot score was significantly lower than that of that of <4 times(P<0.05). Musculoskeletal ultrasonography measured the thickness of anterior tibiofibular ligament(ATFL) was (2.41±0.41) mm, and the thickness of calcaneofibular ligament(CFL) was (1.92±0.21) mm, and had no statistical difference(P>0.05).@*CONCLUSION@#Ninty-four percent college students had at least once ankle sprain, ankle sprains were more common in erobics and ball sports. After the first sprain, the proportion of cast or plaster treatment was less than 50%. Sprained ankle joint more than 4 times is a risk factor, and musculoskeletal ultrasonography showed thickening of both ATFL and CFL, while no statstical difference.

Clinical study on a novel minimally invasive Achilles tendon suture instrument for treating fresh closed Achilles tendon rupture / 中国修复重建外科杂志

OBJECTIVE@#To assess the effectiveness of a novel minimally invasive Achilles tendon suture instrument in the treatment of fresh closed Achilles tendon rupture.@*METHODS@#A retrospective study was conducted on 150 patients who underwent surgical intervention for fresh closed Achilles tendon rupture. Eighty patients were treated with the novel minimally invasive Achilles tendon suture instrument (minimally invasive group) and 70 patients with traditional open surgery (traditional group). The two groups were comparable in terms of gender, age, injured side, cause of injury, the interval between injury and operation, and the distance from the fracture end to the calcaneal tuberosity ( P>0.05). The operation time, intraoperative blood loss, incision length, hospital stays, hospitalization expenses, and complications were recorded and compared. At 1 year after operation, the ankle joint function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.@*RESULTS@#The minimally invasive group demonstrated significantly shorter operation time, smaller incision length, and lower intraoperative blood loss when compared with the traditional group ( P<0.05). However, there was no significant difference in terms of hospital stays and hospitalization expenses between the two groups ( P>0.05). All patients were followed up 12-24 months after operation (mean, 15.5 months). In the traditional group, 6 cases of incision necrosis and 7 cases of Achilles tendon adhesion occurred, while in the minimally invasive group, all incisions healed at first intention and no Achilles tendon adhesion occurred. The differences in the incidences of the two complications between the two groups were significant ( P<0.05). At 1 year after operation, the AOFAS ankle-hindfoot score in the minimally invasive group was superior to that of the traditional group ( P<0.05).@*CONCLUSION@#In comparison with traditional open surgery, the use of self-designed novel minimally invasive Achilles tendon suture instrument proves to be an ideal technique for treating fresh closed Achilles tendon ruptures. This approach offers the benefits of smaller incisions, fewer complications, and better postoperative functional recovery, without increasing hospital costs.

TightRope elastic fixation combined with functional total repair of inferior tibiofibular ligament in treatment of distal tibiofibular syndesmosis injury / 中国修复重建外科杂志

OBJECTIVE@#To study the effectiveness of TightRope elastic fixation combined with functional total repair of the inferior tibiofibular ligament in the treatment of distal tibiofibular syndesmosis injury.@*METHODS@#The clinical data of 34 patients with distal tibiofibular syndesmosis injury who met the selection criteria between January 2020 and January 2022 were retrospectively analyzed, and they were divided into improved group (TightRope elastic fixation combined with functional total repair of inferior tibiofibular ligament) and control group (distal tibiofibular screw fixation) according to the surgical methods, with 17 cases in each group. There was no significant difference in age, gender, body mass index, fracture type, and other baseline data between the two groups (P>0.05). The operation time, intraoperative blood loss, and complications were recorded in the two groups. The American Orthopaedic Foot and Ankle Society (AOFAS) score, ankle metatarsal flexion and dorsal extension range of motion were used to evaluate the ankle function. The patient satisfaction survey was conducted at last follow-up.@*RESULTS@#All 34 patients were followed up 8-20 months, with a median of 13 months. The operation time and intraoperative blood loss in the improved group were significantly longer than that in the control group (P<0.05). In the improved group, no infection or poor reduction occurred, and only 1 patient had TightRope knot reaction at 6 months after operation. In the control group, there were 2 cases of poor reduction, 1 case of lower tibiofibular screw rupture, and 1 case of subcutaneous infection (cured after anti-infection treatment). There was no significant difference in the incidence of complications between the two groups (P>0.05). At last follow-up, the AOFAS score and ankle metatarsal flexion and dorsal extension range of motion of the improved group were significantly better than those of the control group (P<0.05). The satisfaction rates of patients in the improved group and the control group were 94.1% and 82.4%, respectively, showing significant difference (P<0.05).@*CONCLUSION@#TightRope elastic fixation combined with functional total repair of inferior tibiofibular ligament in the treatment of distal tibiofibular syndesmosis injury has sufficient fixation strength, and can achieve better effectiveness and joint function compared with traditional screw fixation.

El peroné flotante: resultado de una luxación tibioastragalina pura con lesión de la articulación tibioperonea proximal: reporte de caso / The floating fibula: outcome of pure tibiotalar dislocation with lesion to the proximal tibiofibular joint: case report

ANTECEDENTES El peroné flotante tras un traumatismo de alta energía es una entidad muy poco frecuente. Este es el primer reporte de caso asociado a luxación del tendón bicipital. OBJETIVO Presentar un caso de peroné flotante tras luxación divergente de tobillo asociado a luxación peronea proximal. MATERIALES Y MÉTODOS Mujer de 17 añ que, tras accidente de tráfico, sufrió caída y presentó dolor y deformidad del tobillo izquierdo, junto con dolor e impotencia funcional de la rodilla ipsilateral. En las radiografías, se apreció una luxación pura divergente del tobillo izquierdo de tipo IV. Se realizó reducción cerrada en urgencias. El estudio se complementó con una resonancia magnética que mostró una rotura completa de la sindesmosis y del ligamento deltoideo, así como una fractura no desplazada de la meseta tibial externa, junto con un desgarro de la cápsula tibioperonea proximal y desprendimiento completo del ligamento lateral externo y del tendón bicipital desde su inserción en la cabeza del peroné. Se realizó reanclaje de la sindesmosis y del ligamento deltoideo, así como del ligamento lateral externo y del tendón bicipital mediante anclajes óseos metálicos y reducción de peroné tanto proximal como distalmente, mediante sistema de sutura tipo botón. Se inmovilizó con férula cruropédica por cuatro semanas. RESULTADOS La paciente presentó recuperación completa de la fuerza a los cinco meses de seguimiento, con movilidad completa del tobillo y de la rodilla. CONCLUSIÓN El peroné flotante es muy poco frecuente; sólo se ha descrito un caso en la literatura. Implica la disrupción de la articulación tibioperonea proximal y distal, lo que puede provocar inestabilidad en la rodilla y en el tobillo. Por tanto, ante un traumatismo de alta energía en el tobillo, es necesaria la exploración minuciosa de la rodilla ipsilateral.

BACKGROUND Floating fibula after high-energy trauma is a very uncommon entity. The present is the first report of a case associated with avulsion of the bicipital tendon. PURPOSE To present a case of floating fibula after divergent ankle dislocation associated with proximal peroneal dislocation. MATERIALS AND METHODOS A 17-year-old woman who fell after a traffic accident and presented pain and deformity of the left ankle with pain and functional impotence in the ipsilateral knee. The radiographs showed a pure divergent type-IV left-ankle dislocation. Closed reduction was performed in the emergency room. The study was complemented with a magnetic resonance imaging scan which showed complete rupture of the syndesmosis and the deltoid ligament, as well as a non-displaced fracture of the external tibial plateau together with a tear of the proximal tibiofibular capsule and complete detachment of the external lateral ligament and bicipital tendon from its insertion in the peroneal head. The syndesmosis and deltoid ligament were reanchored, as well as the external lateral ligament and the bicipital tendon, using metallic bone anchors and fibula reduction both proximally and distally, using a suture-button system. The patient was immobilized with a long-leg splint for four weeks. RESULTS The patient presented complete recovery of strength at five months of follow-up. CONCLUSSION Floating fibula is a rare entity, with only one case described in the literature. It involves a disruption of the proximal and distal tibiofibular joint, which can lead to knee and ankle instability. Therefore, in cases of high-energy trauma to the ankle, a careful examination of the ipsilateral knee is necessary.

Nursing in sports ankle injury based on the fitness exercise / A enfermagem nas lesões de tornozelo com base no exercício de aptidão física / La enfermería en las lesiones del tobillo basada en el ejercicio de aptitud física

ABSTRACT Introduction Ankle injury is an acute soft tissue pathology where the ankle ligaments are distended, lacerated, or ruptured due to violence during sport. This joint is also one of the most vulnerable in sports. After an injury, immediate and adequate care is significant in reducing pain and complication. Objective Statistically analyze the sports injuries of the ankle cases, determining the principal reasons for injury and outlining preventive measures. Methods A statistical investigation on the sports injuries of 275 Qiqihar higher education students was performed with questionnaires and teaching practice methods. The research was focused on the injured structures and the injury causes analysis. In parallel, corresponding proposals aimed at preventing these sports injuries were raised. Results Joint injuries and ankle sprains followed by hematomas represented the most significant proportion of ankle injuries. The reasons are lack of physical fitness, lack of awareness of self-protection, inadequate preparation in the sporting environment facilities, and performing tasks outside what the superior specified was specified. Conclusion Medical work needs to increase dissemination so that people realize the causes of sports injuries. At the same time, it helps people master the care measures before and after the injury. This reduces the incidence of sports injuries and reduces the occurrence of complications. Evidence level II; Therapeutic Studies - Investigating the results.

RESUMO Introdução A lesão no tornozelo é uma patologia aguda dos tecidos moles na qual os ligamentos do tornozelo são distendidos, lacerados, ou rompidos devido a violência durante o esporte. Essa articulação é também uma das mais vulneráveis nos esportes. Depois de uma lesão, o cuidado imediato e correto é significativo para aliviar a dor e reduzir complicações. Objetivo Analisar estatisticamente os casos de lesões esportivas do tornozelo, levantando as principais razões de lesão e traçar condutas preventivas. Métodos Uma investigação estatística sobre as lesões esportivas de 275 estudantes do ensino superior de Qiqihar foi executada com questionário e métodos de prática de ensino. A pesquisa foi concentrada na análise das estruturas lesionadas e a causa da lesão. Paralelamente foram levantadas propostas correspondentes visando a prevenção dessas lesões esportivas. Resultados As lesões articulares e entorses do tornozelo seguidas por hematomas representaram a maior proporção de lesões no tornozelo. Dentre os motivos, destacaram-se a falta de preparo físico, falta de consciência de autoproteção, preparação inadequada nas instalações do ambiente esportivo e execuções de tarefas fora do especificado pelo superior. Conclusão O trabalho médico precisa aumentar a divulgação para que as pessoas percebam as causas das lesões esportivas. Ao mesmo tempo, ajuda as pessoas a dominar as medidas de cuidado antes e depois da lesão. Isso reduz a incidência de lesões esportivas e reduz a ocorrência de complicações. Nível de evidência II; Estudos terapêuticos - Investigação de resultados.

RESUMEN Introducción La lesión de tobillo es una patología aguda de las partes blandas en la que los ligamentos del tobillo se distienden, desgarran o rompen debido a la violencia durante la práctica deportiva. Esta articulación es también una de las más vulnerables en el deporte. Después de una lesión, una atención rápida y correcta es importante para aliviar el dolor y reducir las complicaciones. Objetivo Analizar estadísticamente los casos de lesiones esporádicas del tobillo, levantando las principales causas de lesión y trazar conductas preventivas. Métodos Se realizó una investigación estadística sobre las lesiones deportivas de 275 estudiantes de educación superior en Qiqihar con métodos de cuestionario y práctica docente. La investigación se centró en el análisis de las estructuras lesionadas y la causa de la lesión. Paralelamente, se plantearon las correspondientes propuestas encaminadas a la prevención de estas lesiones deportivas. Resultados Las lesiones articulares y los esguinces de tobillo, seguidos de los hematomas, representaron la mayor proporción de lesiones de tobillo. Entre los motivos, destacaron la falta de preparación física, la falta de conciencia de autoprotección, la preparación inadecuada en las instalaciones del entorno deportivo y la ejecución de tareas fuera de lo especificado por el superior. Conclusión El trabajo médico debe aumentar la difusión para que la gente se dé cuenta de las causas de las lesiones deportivas. Al mismo tiempo, ayuda a las personas a dominar las medidas de cuidado antes y después de la lesión. Esto reduce la incidencia de las lesiones deportivas y disminuye la aparición de complicaciones. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.