Temporary Cast Application in Dislocated Ankle Fractures Leads to High Rates of Secondary Loss of Reduction: Does the Lauge-Hansen Injury Type Matter?

BACKGROUND: For the temporary treatment of ankle fracture dislocations (AFDs), previous studies indicate higher rates of secondary loss of reduction (LOR) with splint immobilization, prompting consideration for expanding indications for external fixation (ExFix). However, these studies did not investigate the influence of fracture morphology to further improve patient selection. The aim of this study was to investigate the influence of Lauge-Hansen injury type on the LOR rate in bimalleolar or trimalleolar AFDs for temporary cast vs ExFix immobilization. METHODS: In this retrospective cohort study, patients with isolated AFD cases treated at our institution from 2011 to 2020 were reviewed. Inclusion criteria required radiographs depicting initial dislocation and appropriate reduction after Cast or ExFix immobilization. Exclusion criteria encompassed concomitant injuries, open fractures, conservative management as well as surgery performed within 48 hours or at a different facility. Patients were grouped by temporary treatment (Cast or ExFix). The primary endpoint was LOR prior to definitive surgery across various Lauge-Hansen types. RESULTS: The LOR rate was significantly higher in the cast group (40/152, 26.3%) compared to the ExFix group (5/191, 2.6%; P < .0001). In the cast group, LOR was associated with an increase in time to definitive surgery by a mean of 3 days (P < .002). During cast treatment, LOR was significantly more likely for pronation abduction (P = .001) and supination external rotation injuries (P < .0001), whereas no significant differences were observed for pronation external rotation (P = .006), supination adduction (P > .99), and fractures not classifiable (P > .99). CONCLUSION: In cases of AFDs resulting from supination external rotation or pronation abduction trauma according to the Lauge-Hansen classification, especially in the setting of an additional posterior malleolar fracture, primary application of external fixation should be considered to reduce the risk for secondary loss of reduction. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

A morphological review of medial malleolar fractures - A large single centre series.

BACKGROUND: Many approaches to management of medial malleolar fractures are described in the literature however, their morphology is under investigated. The aim of this study was to analyse the morphology of medial malleolar fractures to identify any association with medial malleolar fracture non-union or malunion. METHODS: Patients who had undergone surgical fixation of their MMF were identified from 2012 to 2022, using electronic patient records. Retrospective analysis of their preoperative, intraoperative, and postoperative radiographs was performed to determine their morphology and prevalence of non-union and malunion. Lauge-Hansen classification was used to characterise ankle fracture morphology and Herscovici classification to characterise MMF morphology. RESULTS: A total of 650 patients were identified across a 10-year period which could be included in the study. The overall non-union rate for our cohort was 18.77% (122/650). The overall malunion rate was 6.92% (45/650). Herscovici type A fractures were significantly more frequently mal-reduced at time of surgery as compared to other fracture types (p = .003). Medial wall blowout combined with Hercovici type B fractures showed a significant increase in malunion rate. There is a higher rate of bone union in patients who had been anatomically reduced. CONCLUSION: The morphology of medial malleolar fractures does have an impact of the radiological outcome following surgical management. Medial wall blowout fractures were most prevalent in adduction-type injuries; however, it should not be ruled out in rotational injuries with medial wall blowouts combined with and Herscovici type B fractures showing a significant increase in malunions. Herscovici type A fractures had significantly higher malreductions. LEVEL OF EVIDENCE: Level 3 - Retrospective Cohort Study.

The first generation of a regional-scale 1-m forest canopy cover dataset using machine learning and google earth engine cloud computing platform: A case study of Arkansas, USA.

Forest canopy cover (FCC) is essential in forest assessment and management, affecting ecosystem services such as carbon sequestration, wildlife habitat, and water regulation. Ongoing advancements in techniques for accurately and efficiently mapping and extracting FCC information require a thorough evaluation of their validity and reliability. The primary objectives of this study are to: (1) create a large-scale forest FCC dataset with a 1-meter spatial resolution, (2) assess the regional spatial distribution of FCC at a regional scale, and (3) investigate differences in FCC areas among the Global Forest Change (Hansen et al., 2013) and U.S. Forest Service Tree Canopy Cover products at various spatial scales in Arkansas (i.e., county and city levels). This study utilized high-resolution aerial imagery and a machine learning algorithm processed and analyzed using the Google Earth Engine cloud computing platform to produce the FCC dataset. The accuracy of this dataset was validated using one-third of the reference locations obtained from the Global Forest Change (Hansen et al., 2013) dataset and the National Agriculture Imagery Program (NAIP) aerial imagery with a 0.6-m spatial resolution. The results showed that the dataset successfully identified FCC at a 1-m resolution in the study area, with overall accuracy ranging between 83.31% and 94.35% per county. Spatial comparison results between the produced FCC dataset and the Hansen et al., 2013 and USFS products indicated a strong positive correlation, with R2 values ranging between 0.94 and 0.98 for county and city levels. This dataset provides valuable information for monitoring, forecasting, and managing forest resources in Arkansas and beyond. The methodology followed in this study enhances efficiency, cost-effectiveness, and scalability, as it enables the processing of large-scale datasets with high computational demands in a cloud-based environment. It also demonstrates that machine learning and cloud computing technologies can generate high-resolution forest cover datasets, which might be helpful in other regions of the world.

Patterns of Anterior Inferior Tibiofibular Ligament Avulsion Fracture Accompanied by Ankle Fracture.

The anterior inferior tibiofibular ligament (AITFL) avulsion fracture accompanying an ankle fracture can compromise ankle stability, necessitating accurate evaluation and a clear understanding of its pathophysiology.. The aim of this study was to investigate the association between AITFL avulsion fracture and Lauge-Hansen, Wagstaffe classification. A retro-prospective study was conducted at a university-affiliated tertiary care medical center. We selected 128 patients who underwent surgery at our institution between January 2013 and July 2017 and analyzed the association between AITFL avulsion fracture and the foot position. According to the modified Wagstaffe classification system, there were 39 cases of type II, followed by 9 cases of type III and 8 cases of type IV. Of the7 pronation-abduction fractures, 3 were AITFL avulsion fracture (43%), while of the 21 pronation-external rotation fractures, 9 were AITFL avulsion fracture (43%). Of the 95 supination-external rotation fractures, there were 56 cases (59%) of AITFL avulsion fractures. Of the pronation fractures, 0% were fibular avulsion fractures and 43% were tibial avulsion fractures. Of the supination fractures, 44% were fibular avulsion fractures and 16% were tibial avulsion fracture. The difference in the ratio of fibular to tibial avulsion fractures between pronation and supination fractures was significant (p < .001). These results suggest that tibial avulsion fractures of type IV in the modified Wagstaffe classification and pronation fractures occur due to collision with the anterolateral corners of the distal bone when the talus externally rotates. Moreover, in cases of pronation fractures, a new type of AITFL avulsion fracture has been observed.

Leprosy Classification, Clinical Features, Epidemiology, and Host Immunological Responses: Failure of Eradication in 2023.

Leprosy is of big concern in the medical fraternity. Leprosy is also known as Hansen's disease. It is a curable communicable disease that remains prevalent in most countries all over the globe. It is a chronic granulomatous infection commonly caused by Mycobacterium leprae and Mycobacterium lepromatosis, which mainly show an effect on the skin and peripheral nerves. To control the disease and minimize the impact of the disease, much effort has been put into it for decades. Nearly 0.2 million fresh cases were documented in 2017 worldwide in spite of being declared "eradicated" by the WHO in the year 2000. However, impressive achievements have been made in several countries, including India; still, we are lagging behind the ultimate goal of the final disappearance of leprosy. Extensive migration is a crucial element that may transmit leprosy to unaffected areas. Additionally, there are several areas in the USA where person-to-person leprosy transmission has been reported without a prior history of exposure. Recently, WHO instigated a new Global Leprosy Strategy 2021-2030, termed "Towards Zero Leprosy." In this article, we review the clinical features, leprosy epidemiology, transmission, classification, host immunological response, and diagnostic challenges.

A Testlet Diagnostic Classification Model with Attribute Hierarchies.

In this article, a testlet hierarchical diagnostic classification model (TH-DCM) was introduced to take both attribute hierarchies and item bundles into account. The expectation-maximization algorithm with an analytic dimension reduction technique was used for parameter estimation. A simulation study was conducted to assess the parameter recovery of the proposed model under varied conditions, and to compare TH-DCM with testlet higher-order CDM (THO-DCM; Hansen, M. (2013). Hierarchical item response models for cognitive diagnosis (Unpublished doctoral dissertation). UCLA; Zhan, P., Li, X., Wang, W.-C., Bian, Y., & Wang, L. (2015). The multidimensional testlet-effect cognitive diagnostic models. Acta Psychologica Sinica, 47(5), 689. https://doi.org/10.3724/SP.J.1041.2015.00689). Results showed that (1) ignoring large testlet effects worsened parameter recovery, (2) DCMs assuming equal testlet effects within each testlet performed as well as the testlet model assuming unequal testlet effects under most conditions, (3) misspecifications in joint attribute distribution had an differential impact on parameter recovery, and (4) THO-DCM seems to be a robust alternative to TH-DCM under some hierarchical structures. A set of real data was also analyzed for illustration.

Hyperfunction variant rs708035 of interleukin 1 receptor-associated kinases 2 gene involved in the predisposition of leprosy infection.

BACKGROUND: Mycobacterium leprae (slow-growing bacteria) is the etiological agent for leprosy infection, which is a chronic granulomatous disease. Symptoms initiate with the loss of sensation in the affected areas, which can lead to severe injuries, cuts and burns. IRAK2 (interleukin-1 receptor-associated kinases 2) is reported to function in the regulation of the NFκB pathway. The frequency of the IRAK2 polymorphism (rs708035) was unknown in the Pakistani population. Therefore, the study was designed to identify the role of the rs708035 SNP (single nucleotide polymorphism) in susceptibility to leprosy. METHODOLOGY: The case-control study was designed, and participants were selected by Ridley-Jopling Classification. Blood samples from healthy individuals and patients were collected after ethical approval. Genomic DNA was extracted for the amplification of selected polymorphisms by tetra-primer amplification refractory mutation system polymerase chain reaction. The desired products were observed via agarose gel (2.5%) electrophoresis followed by data analysis using bioinformatics tools (SNP Stats and SHEsis) and statistical tests (odds ratio, OR, and chi square). RESULTS: The study revealed that the mutant genotype (TT) was found to be frequent among cases (22.80%) in comparison with the controls (1.66%). The SNP rs708035 was significantly associated with the progression of leprosy (χ2  = 17.62, p < 0.0001). The targeted SNP significantly increases the risk of leprosy 2.3 times (OR = 2.3119, 95% CI 1.2729-4.1989, p < 0.01). The genetic model also confirms the significant association of the A/T genotype with leprosy in the over-dominant model (OR = 2.83, 95% CI 1.16-6.89, p < 0.001). CONCLUSIONS: The study revealed a significant association of the targeted SNP with leprosy and provided baseline data regarding the association of rs708035. The current research could be utilized for the preparation of biomarkers by considering a larger sample size. HIGHLIGHTS: The patients suffering from leprosy faced various comorbidities, including hypertension and diabetes. The study reports for the first time a significant association of interleukin 1 receptor associated kinases 2 (IRAK2) single nucleotide polymorphism (SNP) rs708035 among the Pakistani population (Karachi). The current study provides baseline data to develop diagnostic biomarkers for early detection of leprosy.

Weber Ankle Fracture Classification System Yields Greatest Interobserver and Intraobserver Reliability Over AO/OTA and Lauge-Hansen Classification Systems Under Time Constraints in an Asian Population.

No previous studies have evaluated the intra- and interobserver reliability between the Weber, Lauge-Hansen and AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification systems under time constraints. This study compares the interobserver and intraobserver reliability of the aforementioned classification systems under simulated time constraints. Anteroposterior and lateral radiographs of ankle malleolar fractures from 80 consecutive patients from 2015 to 2016 were classified by 2 independent observers according to Weber, Lauge-Hansen and AO/OTA. Classifications were conducted over 4 successive weeks under timed (25-seconds) and untimed conditions, with 1-week gaps between each classification. Cohen's kappa and percentage agreement were calculated. Cohen's kappa for interobserver agreement ranged 0.67 to 0.67 and 0.59 to 0.73 for untimed and timed classifications for Weber; 0.38 to 0.47 and 0.44 to 0.50 for Lauge-Hansen; 0.28 to 0.49 and 0.13 to 0.37 for AO/OTA. Intraobserver agreement ranged from 0.83 to 0.85 and 0.78 to 0.79 for untimed and timed classifications for Weber; 0.46 to 0.65 and 0.59 to 0.73 for Lauge-Hansen; 0.42 to 0.63 and 0.40 to 0.51 for AO/OTA. Based on the Landis and Koch's benchmark scale, there was substantial agreement in the inter- and intraobserver variables for Weber; moderate agreement in inter- and intraobserver variables for Lauge-Hansen; fair and moderate agreement in inter- and intraobserver variables respectively for AO/OTA. Interobserver and intraobserver reliability was the most substantial for Weber, followed by Lauge-Hansen and AO/OTA. Time constraint did not have a statistically significant effect on the reliability of classifications. We recommend concurrent usage of the Weber and Lauge-Hansen system, since they demonstrate the greatest reliability and reproducibility, and confer better understanding of the fracture type, respectively.

Evaluation of Ankle Fractures in 228 Patients From a Single Center Using Three-Dimensional Computed Tomography Mapping.

Purpose: The ankle joint has a complex anatomy structure with many causative factors and various injury mechanisms, and the clinical presentation of ankle fractures is diverse. This study aimed to analyze the characteristics of ankle fractures by applicating three-dimensional fracture line mapping technique. Methods: A retrospective study was conducted on 228 patients with ankle fractures. Three-dimensional reconstruction was performed by CT images and the fracture reconstruction model was superimposed onto a standard model of the tibiofibula for fracture line drawing. Then the fracture lines were converted into a three-dimensional coordinate point data set. And the fracture line maps as well as the fracture line heat maps were generated in 3-Matic software and Unigraphics NX software, respectively. Results: The dense area of the fibular fracture lines was located above the tibiofibular joint ligament and wrapped obliquely around the distal fibula from the anterior edge of the fibular neck. The fibular fracture line could be divided into three categories according to the degree of denseness. The dense area of the tibial fracture line is located within the anterior tibial fornix, the anterolateral corner, and the fibular notch. The tibial fracture lines can be classified into four categories according to the density of the fracture lines. The combined medial malleolus + posterior malleolar fracture line situation was found to be not encompassed by the existing AO and Lauge-Hansen (LH) classification systems according to this classification. Conclusion: The 3D fracture line mapping technique can better reflect the distribution of ankle fracture lines and could help to establish a new ankle fracture typing system in the future.

Enfermedad de Hansen: comunicación de un caso de lepra tuberculoide en Chile / Hansen's disease: case report of tuberculoid leprosy in Chile

Resumen La enfermedad de Hansen o lepra es una enfermedad infecciosa crónica causada por Mycobacterium leprae, y que afecta principalmente la piel y nervios periféricos. En los últimos años, se ha logrado un mejor control de la enfermedad en forma global. Sin embargo, en Chile la incidencia de la lepra ha ido en aumento. Presentamos el caso clínico de un paciente de 40 años, haitiano, con lesiones e histopatología compatibles con una lepra tuberculoide. Se discute la importancia en la educación sobre enfermedades menos prevalentes en Chile y se hace una revisión sobre la fisiopatología, clínica y clasificación de la enfermedad de Hansen.

Abstract Hansen's disease or leprosy is a chronic infectious disease caused by Mycobacterium leprae, mainly affecting the skin and peripheral nerves. In recent years, a better control of the disease has been achieved globally. However, in Chile the incidence of leprosy has continued to increase. We present a case of a 40-year-old patient Haitian nationality with lesions and histopathology compatible with tuberculoid leprosy. We discuss the importance of education on less prevalent diseases in Chile, in conjunction with a review of the pathophysiology, clinic, and classification of Hansen's disease.

Need to restage Korean melanoma patients following publication of the 8th edition of the American Joint Committee on Cancer staging manual.

BACKGROUND: The tumor, nodes and metastasis (TNM) classification and stage grouping have been updated in the 8th edition of the American Joint Committee on Cancer (AJCC) melanoma staging manual. However, restaging all the previous cases are not recommended. AIMS: The aims of the study were to investigate the necessity of restaging Korean melanoma patients staged by the previous edition of the AJCC manual. METHODS: Differences in the staging criteria of the 7th and 8th editions of the AJCC manual were identified. The staging of 276 primary melanomas from January 2011 to December 2018 was classified by both 7th and 8th editions of the manual and their differences were compared. RESULTS: Staging by 7th and 8th edition of the AJCC manual differed in 64 cases (23.2%). The pathological prognostic staging changed in 35 (12.7%), and 29 (10.5%) had changes in only TNM classification but not the pathological staging. None of the patients needed additional sentinel lymph node biopsy or systemic treatment as a result of restaging. Additional counseling was needed for the patients, because melanoma-specific survival was increased in the 8th edition. LIMITATIONS: This is a retrospective study with relatively small number of patients at a single tertiary center in Korea. CONCLUSION: Assessment of the need for additional sentinel lymph node biopsy or systemic treatment is recommended because of the latest changes in the AJCC melanoma staging manual. Although the restaging of previously staged melanomas is not significantly needed in our patients, still the differences in TNM classification and/or pathological prognostic staging suggest the need to separately recognize the patients previously staged by 7th edition and recently staged by 8th edition. Careful counseling about melanoma-specific survival is needed for Asian patients.

Comparing global and local maps of the Caribbean pine forests of Andros, home of the critically endangered Bahama Oriole.

Forest loss is occurring at alarming rates across the globe. The pine rockland forests of Andros, The Bahamas, likely represent some of the largest stands of Bahamian subspecies of Caribbean pine in the world. Given the unique species that inhabit these pine forests, such as the endemic and critically endangered Bahama Oriole, monitoring habitats on Andros is crucial to inform conservation planning. We developed a 2019 land classification map to assess the status of nine terrestrial habitats on Andros. Our Random Forest classification model predicted habitat classes with high overall accuracy. Caribbean pine was the dominant land class making up roughly one-third of the total terrestrial area. Whereas much of the pine forest area was found as small patches, most were close to other patches of pine suggesting isolation of forest patches is low. We compared our known intact forest areas to recent forest loss identified by the Hansen et al. Global Forest Change product and assessed areas of habitat disturbance in high-resolution imagery. Our results suggest that this global map overpredicted forest loss on Andros. The small degree of true forest loss on Andros was driven mostly by anthropogenic activity. A cross-tabulation of the Hansen forest loss with fire data showed that understory fires were frequently associated with falsely classified deforestation. Given the threats of climate change to this open forest type-intensifying fire regimes, strengthening hurricanes, and sea level rise-monitoring changes in open forest extent is a critical task across the Caribbean region and the world.

Application of X-ray image measurement in the early diagnosis of sports injury of ankle ligament.

OBJECTIVES: To study the value of X-ray analysis method of ankle fracture based on injury mechanism to improve the imaging diagnosis level of ankle fracture. METHODS: This study was conducted from January 2016 to December 2019. It included 105 cases of fractures caused by sprained ankle joints. Their age was between 21-81 years with an average of 49.5 years, The traditional X-ray analysis method (Group-A) and the injury mechanism-based ankle fracture X-ray analysis method (Group-B) were used to analyze X-ray image data. Group-B also performed Weber classification and Lauge-Hansen classification on cases. Installment. RESULTS: Of the 105 patients with ankle fractures, 97 patients in Group-B were able to make Lauge-Hansen classification. Of these 97 ankle fractures, 137 were found in Group-A, and 158 were found in Group-B. The wrong diagnosis of fracture in Group-A was 18%, and the wrong diagnosis of fracture in Group-B was 0.5%. There was a statistically significant difference between the two groups (P <0.05). CONCLUSION: The X-ray analysis method of ankle fractures based on injury mechanism can effectively improve the detection rate of hidden ankle fractures and high fibular fractures, and reduce the missed diagnosis, which is superior to the traditional X-ray analysis methods. At the same time, Weber classification, Lauge-Hansen classification and staging can be made for most cases, which is conducive to guiding clinical treatment.

Evaluation of the Reproducibility of Lauge-Hansen, Danis-Weber, and AO Classifications for Ankle Fractures.

Objective The present study aims to analyze the intra- and interobserver reproducibility of the Lauge-Hansen, Danis-Weber, and Arbeitsgemeinschaft für Osteosynthesefragen (AO) classifications for ankle fractures, and the influence of evaluators training stage in these assessments. Methods Anteroposterior (AP), lateral and true AP radiographs from 30 patients with ankle fractures were selected. All images were evaluated by 11 evaluators at different stages of professional training (5 residents and 6 orthopedic surgeons), at 2 different times. Intra- and interobserver agreement was analyzed using the weighted Kappa coefficient. Student t-tests for paired samples were applied to detect significant differences in the degree of interobserver agreement between instruments. Results Intraobserver analysis alone had a significant agreement in all classifications. Moderate to excellent interobserver agreement was highly significant ( p ≤ 0.0001) for the Danis-Weber classification. The Danis-Weber classification showed, on average, a significantly higher degree of agreement than the remaining classification systems ( p ≤ 0.0001). Conclusion The Danis-Weber classification presented the highest reproducibility among instruments and the evaluator's little experience had no negative influence on the reproducibility of ankle fracture classifications. Level of Evidence II, Diagnostic Studies - Investigating a Diagnostic Test .

Evaluation of the Reproducibility of Lauge-Hansen, Danis-Weber, and AO Classifications for Ankle Fractures / Avaliação da reprodutibilidade das classificações Lauge-Hansen, Danis-Weber e AO para fraturas do tornozelo

Abstract Objective The present study aims to analyze the intra- and interobserver reproducibility of the Lauge-Hansen, Danis-Weber, and Arbeitsgemeinschaft für Osteosynthesefragen (AO) classifications for ankle fractures, and the influence of evaluators training stage in these assessments. Methods Anteroposterior (AP), lateral and true AP radiographs from 30 patients with ankle fractures were selected. All images were evaluated by 11 evaluators at different stages of professional training (5 residents and 6 orthopedic surgeons), at 2 different times. Intra- and interobserver agreement was analyzed using the weighted Kappa coefficient. Student t-tests for paired samples were applied to detect significant differences in the degree of interobserver agreement between instruments. Results Intraobserver analysis alone had a significant agreement in all classifications. Moderate to excellent interobserver agreement was highly significant (p ≤ 0.0001) for the Danis-Weber classification. The Danis-Weber classification showed, on average, a significantly higher degree of agreement than the remaining classification systems (p ≤ 0.0001). Conclusion The Danis-Weber classification presented the highest reproducibility among instruments and the evaluator's little experience had no negative influence on the reproducibility of ankle fracture classifications. Level of Evidence II, Diagnostic Studies - Investigating a Diagnostic Test.

Resumo Objetivo Avaliar a reprodutibilidade intra- e interobservador das classificações de Lauge-Hansen, Danis-Weber e Arbeitsgemeinschaft für Osteosynthesefragen (AO) para as fraturas de tornozelo, e a influência do estágio de formação dos participantes na avaliação. Métodos Foram selecionadas radiografias de 30 pacientes com fratura de tornozelo nas incidências anteroposterior (AP), perfil e AP verdadeiro. Todas as imagens foram avaliadas por 11 participantes em diferentes estágios de formação profissional (cinco residentes e seis cirurgiões ortopédicos), em dois momentos distintos. Analisou-se a concordância inter- e intraobservador por meio do coeficiente Kappa ponderado. O teste t de Student para amostras pareadas foi aplicado para verificar se havia diferença significativa no grau de concordância interobservador entre os instrumentos. Resultado Observou-se que existe concordância significativa em todas as classificações quando da análise intraobservador isolada. Existe concordância interobservador altamente significativa de grau moderado a ótimo na classificação de Danis-Weber (p ≤ 0,0001). A classificação de Danis-Weber apresentou, em média, grau de concordância significativamente maior que as outras classificações (p ≤ 0,0001). Conclusão A classificação de Danis-Weber se mostrou a mais reprodutiva entre os instrumentos avaliados, e a pouca experiência do avaliador não influencia negativamente a reprodutibilidade das classificações das fraturas do tornozelo. Nível de Evidência II, Estudos Diagnósticos - Investigação de um Exame para Diagnóstico.

Perfil de funcionalidade de pessoas afetadas pela hanseníase / Profile of functionality of persons affected by leprosy

RESUMO Objetivo analisar o perfil de funcionalidade e deficiência de pessoas afetadas pela hanseníase. Métodos estudo quantitativo, realizado com 43 pessoas em seis unidades de referência, contendo grupos de apoio ao autocuidado em hanseníase. Foram utilizados um questionário sociodemográfico e clínico e o instrumento World Health Organization Disability Assessment Schedule . As análises utilizaram estatística descritiva, os testes de qui-quadrado de adequação de ajustamento para as variáveis categóricas, binomial e Mann-Whitney. Resultados a mediana (intervalo interquartil) nos domínios Participação, Mobilidade, Cognição e Atividades de Vida foram, respectivamente, 37,5 (20,8-54,2), 25,0 (6,3-56,3), 20,0 (0,0-40,0) e 10,0 (0,0-40,0), representando o impacto da doença nesses domínios. Conclusão as pontuações de funcionalidade foram maiores nos domínios Participação e Mobilidade, como reflexo das incapacidades físicas, discriminação e estigma na vida das pessoas afetadas pela hanseníase.

ABSTRACT Objective to analyze the functioning and disability profile of persons affected by leprosy. Methods a quantitative study, carried out with 43 people in six reference units with support groups for self-care in leprosy. A sociodemographic and clinical questionnaire and the World Health Organization Disability Assessment Schedule instrument were used. The analyses used descriptive statistics, the chi-square test of adjustment adequacy for categorical variables, binomial and Mann-Whitney. Results the median (interquartile range) in the Participation, Mobility, Cognition and Life Activities domains were 37.5 (20.8-54.2), 25.0 (6.3-56.3), 20.0 (0.0-40.0) and 10.0 (0.0-40.0), respectively, representing the impact of the disease in these domains. Conclusion the functionality scores were higher in the Participation and Mobility domains, reflecting physical disabilities, discrimination and stigma in the lives of people affected by leprosy.

Mapeamento das incapacidades cinésio-funcionais de acordo com a CIF em pessoas diagnosticadas com hanseníase / Mapping of functional movement related disabilities based on the ICF model in persons with leprosy

As sequelas da hanseníase interferem no bem-estar físico, na vida pessoal e socioeconômica. Devido a essa complexidade, fica difícil relatar objetivamente a abrangência do impacto da hanseníase, porém, o modelo de Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) surgiu para classificar as condições de doença e suas consequências biopsicossociais, facilitando o diagnóstico clínico funcional de uma maneira mais realística, além da esfera biomédica. O objetivo deste estudo foi mapear as incapacidades cinésio-funcionais de pessoas com hanseníase utilizando a CIF. Trata-se de um estudo transversal, com amostra composta por pessoas com hanseníase, recrutadas no Centro de Especialidades Médicas de Aracaju e Hospital Universitário. Para coleta de dados foram utilizadas avaliações padronizadas e validadas, representando cada domínio da CIF. A análise foi descritiva e as disfunções, que foram prevalentes em 5% dos participantes, foram selecionadas como relevantes. Participaram 29 voluntários, 44,9 (±13,72) anos, 60% sexo masculino. As incapacidades funcionais mais presentes foram: 1) Estrutura do corpo - "Estrutura das áreas da pele - s810" com 78%; 2) Função do corpo - "Função tátil - b265" e "Funções relacionadas a força muscular - b730" com 100% de presença; 3) Atividade - "Levantar e carregar objetos - d430" e "Andar - d450" apresentaram limitação em 100% dos participantes; 4) Participação "Recreação e Lazer - d920" foi observada em 89% dos participantes; 5) Impacto ambiental - "Serviços, sistemas e políticas de saúde - e580" em 56% dos participantes e nos fatores pessoais o estigma com 100% de presença. Este estudo determinou quais aspectos biopsicossociais são os mais relevantes em pessoas com hanseníase e os seus resultados podem ser usados como planejamento de prevenção e tratamento dessa doença. (AU)

Leprosy sequelae interfere with physical, personal and socioeconomic life. Due to this complexity, it is difficult to objectively report the extent of the impact of leprosy; however, the International Classification of Function, Disability and Health (ICF) model classifies disease clinical conditions and their biopsychosocial consequences, facilitating a more realistic functional clinical diagnosis of leprosy, beyond the biomedical sphere. The objective of this study was to map the functional movement related disabilities of people with leprosy using the ICF. This is a cross-sectional study, with a sample composed of people with leprosy, recruited at the Aracaju Medical Specialty Center and University Hospital. For data collection, standardized and validated evaluations were used, representing each ICF domain. The analysis was descriptive, and the dysfunctions that were prevalent in 5% of the participants were selected as relevant. Twenty-nine volunteers participated, 44.9 (± 13.72) years, 60% male. The most present functional disabilities were: 1) Structure of the body - "Structure of the skin areas - s810" with 78%; 2) Body function - "Tactile function - b265" and "Functions related to muscular strength - b730" with 100% presence; 3) Activity - "Lifting and loading objects - d430" and "Floor - d450" presented limitation in 100% of participants; 4) Participation "Recreation and Leisure - d920" was observed in 89% of participants; 5) Environmental impact - "Health services, systems and policies - e580" in 56% of the participants and in the personal factors the stigma with 100% presence. This study determined which biopsychosocial aspects are most relevant in people with leprosy and its results can be used as planning for the prevention and treatment of this disease. (AU)

Ankle Fracture with a Complex Injury Mechanism and Misleading Hook Test Result: A Case Report.

Ankle fractures and their mechanisms of injury can be complex. We report a case of a patient with an uncertain mechanism of injury and an uncommon combination of lower extremity fractures, which fit the criteria for a Lauge-Hansen classification pronation-external-rotation fracture, Maisonneuve fracture, Wagstaffe fracture, and posterior pilon fracture. Plain radiographs and computed tomography scan revealed Chaput tubercle avulsion fractures, an anterior distal fibular fracture fragment, multiple lateral malleolar fractures, a posterior malleolar fracture fragment with proximal displacement, a die-punch fragment between the posterior malleolar fragment and the tibia, a proximal fibular fracture, and possible ankle syndesmotic diastasis. Intraoperative hook test was negative after fixation of the fractures, so syndesmotic fixation was not performed. At 3-month follow-up, plain radiographs showed obvious syndesmotic diastasis. At 1-year follow-up, symptoms persisted and syndesmotic fusion was recommended but declined by the patient. This case demonstrates that both ankle fractures and their mechanisms of injury can be remarkably complex and confusing, posterior pilon fractures can occur along with pronation-external-rotation ankle fractures, syndesmotic fixation should be considered for all patients with Maisonneuve fractures, reliance on the hook test for surgical management decisions may not always be reliable, and there exists a need for a more accurate and reliable intraoperative test to determine the presence of ankle syndesmotic injury.