Irreducible Ankle Fracture Dislocation Because of Tibialis Posterior and Flexor Digitorum Longus Tendon Entrapment in the Interosseous Membrane: A Case Report.

CASE: We describe the case of a 63-year-old man with anterior ankle dislocation and fracture confirmed by x-ray. Postreduction x-ray and computed tomography (CT) revealed Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) type 44C3 and Lauge-Hansen pronation-external rotation-type ankle fractures. CONCLUSION: This was a rare case of ankle fracture dislocation because of entrapment of the tibialis posterior and flexor digitorum longus tendons in the interosseous membrane. Tendon entrapment should be suspected in cases of high-energy injuries, Weber type C fractures, Lauge-Hansen pronation-external rotation fractures, syndesmosis widening, and irreducible fractures using manual closed reduction. Fractures and soft tissues should be evaluated by changing the CT settings.

Factors Associated With Successful Closed Reduction of Dislocated Ankle Fractures at a US Level-1 Trauma Center.

Dislocated ankle fractures represent a common presenting pathology at US emergency departments, and several different procedural and anesthetic techniques are employed for attempted closed reduction of these injuries. The objective of this investigation was to evaluate the frequency of and factors associated with success in the closed reduction of dislocated ankle fractures. A diagnostic code search produced 1050 ankle fractures presenting to an urban US level-1 emergency department. These medical records were interrogated and first categorized into whether or not a closed reduction was attempted. Those identified closed reduction attempts were further categorized into whether the attempt was successful. A comparative analysis was subsequently performed of variables associated with procedure success. Of the 1050, 97 (9.2%) required closed reduction and of these, 76 (78.4%) were successfully closed reduced on the first attempt. No differences were observed in initial procedure success with respect to subject age (p = .701), subject gender (p = .623), fracture laterality (p = 1.00), open versus closed injuries (p = .282), fracture mechanism (p = 1.00), utilized anesthetic technique (p value range 0.291-0.616), or the specialty performing the reduction (p-value range 0.402-1.00). A descriptive subanalysis was performed on those fractures with an unsuccessful first closed reduction attempt. It is our hope that this investigation adds to the body of knowledge with respect to a commonly performed procedure by foot and ankle surgeons.

Syndesmotic fixation in supination-external rotation ankle fractures: a prospective randomized study.

BACKGROUND: This study was designed to assess whether transfixion of an unstable syndesmosis is necessary in supination-external rotation (Lauge-Hansen SE/Weber B)-type ankle fractures. METHODS: A prospective study of 140 patients with unilateral Lauge-Hansen supination-external rotation type 4 ankle fractures was done. After bony fixation, the 7.5-Nm standardized external rotation (ER) stress test for both ankles was performed under fluoroscopy. A positive stress examination was defined as a difference of more than 2 mm side-to-side in the tibiotalar or tibiofibular clear spaces on mortise radiographs. If the stress test was positive, the patient was randomized to either syndesmotic transfixion with 3.5-mm tricortical screws or no syndesmotic fixation. Clinical outcome was assessed using the Olerud-Molander scoring system, RAND 36-Item Health Survey, and Visual Analogue Scale (VAS) to measure pain and function after a minimum 1-year of followup. RESULTS: Twenty four (17%) of 140 patients had positive standardized 7.5-Nm ER stress tests after malleolar fixation. The stress view was positive three times on tibiotalar clear space, seven on tibiofibular clear space, and 14 times on both tibiotalar and tibiofibular clear spaces. There was no significant difference between the two randomization groups with regards to Olerud-Molander functional score, VAS scale measuring pain and function, or RAND 36-Item Health Survey pain or physical function at 1 year. CONCLUSION: Relevant syndesmotic injuries are rare in supination-external rotation ankle fractures, and syndesmotic transfixion with a screw did not influence the functional outcome or pain after the 1-year followup compared with no fixation.

Abductor pollicis longus deviation grant operation: a new procedure on the thumb in ulnar cum low median palsy for correction of subluxation of carpometacarpal (CMC) joint.

For correction of instability of the carpometacarpal joint (CMC joint) of the thumb in combined paralysis of ulnar and median nerves in leprosy bone fusing procedures have been used, but they are not desirable and can often be avoided. A procedure analogous to the "Extensor pollicis brevis deviation graft operation" for the correction of instability of the metacarpophalangeal joint of the thumb is described here. The new procedure appears to be useful to correct and stabilize the subluxated carpometacarpal joint of the thumb actively during the use of the hand. When thumb web contracture has occurred and the passive range of movement needed for successful opponents replacement of thumb is not available, this new procedure helps to prepare such a severe deformed thumb for correction at earlier time.

[Irreducible fracture dislocation of the ankle: report of two cases].

The goal of operative treatment of ankle fracture are to obtain an anatomical reduction and rigid fixation to ensure a healed fracture and normally functioning recovery. Irreducible ankle fracture or fracture-dislocation is seldom encountered in clinical practice. Two cases of irreducible ankle fractures are presented. They are different from previous cases reported in the literature. During operation we recognized that the extensor tendons were entrapped in the distal tibiofibular joint under the extensor retinaculum. The reducible ankle fractures reported in the literature, together with the two cases in this report, are classified into three categories. Type I is a medial malleolar fracture with deltoid ligament or posterior tibialis tendon interposition. Type II is an irreducible fracture dislocation of the ankle due to posterior dislocation of the fibula. Type III is a diastatic ankle fracture with extensor tendons entrapped in the distal tibiofibular joint and restricted by extensor retinaculum. The mechanism of the irreducible ankle fracture is discussed and correlated with Lauge-Hansen classification and mechanism.

[Dislocation fractures of the upper ankle joint. Classification--treatment--results]. / Verrenkungsbrüche des oberen Sprunggelenkes. Klassifizierung--Behandlung--Ergebnisse.

Between 1959 and 1989 a total of 1,387 ankle fractures were analysed under different aspects. For several reasons the authors prefer the classification by Lauge-Hansen schematized by Maatz. After the period of change from conservative to surgical treatment the actual state of operative approach is described. Early complications and late results are presented via smaller groups of patients. Evidently SE fractures have the worst prognosis independent of the success of the operation.

[Progression towards dislocations of foot bone lesions in leprosy]. / De l'évolution vers la dislocation des lésions osseuses du pied du lépreux.

From a series of 211 tarsal, medio-tarsal and metatarso-phalangeal dislocations, the authors, after having recalled the lesion mechanism, adopted a classification and gave a place to preventive conservative surgery in 52 cases. The early forms can have early limited arthrodesia. The developed lesions present indications of arthrodesia--isolated reconstruction or associated to spongy or cortico-spongy bone grafts. The late forms impose amputation even when the forefoot seems of good bone quality because the metatarsal-phalangial stiffness is the cause for the failure of the Wladimiroff-Mickulicz interventions.

[Course of bone lesions of leprosic feet towards dislocation of the tarsus and metatarsus]. / Evolution des lésions osseuses du pied lépreux vers la dislocation du tarse et du métatarse.

The authors have observed 135 dislocations of the tarsus in leprosic feet. They recall the mechanism of the lesion and propose a classification. 42 cases were operated on to prevent further deformities. When early treated limited arthrodeses may be beneficial in some cases. In more severe cases rebuilding arthrodesis alone or associated to cancellous bone grafting is indicated. In very severe cases amputation is only indicated because the Wladimiroff-Mickulicz technique as well as grafts lead to failures related to the metatarsophalangeal joints stiffness.

[The pattern of injuries of the ankle joint in ski boots--a retrospective analysis]. / Das Verletzungsmuster des Sprunggelenkes im Skischuh--eine retrospektive Analyse.

This study is dealing with the analysis of isolated ankle fractures in ski boots which are nowadays very seldom. Modern equipment and excellent prepared skiing facilities reduced this kind of trauma. In the early sixties about 60% of lower extremity injuries were caused by ankle fractures. Now, 25 years later, only 10% of injuries concerning to lower extremity are injuries of medial and lateral ankle or of the talofibular ligaments. At the department of trauma surgery of the university hospital of Innsbruck we use a questionnaire for winter sports injuries. We made a retrospective follow up study of the last three years, in which we found 100 patients with ankle injuries. Pilon tibial- and tibia shaft fractures are not included. The classification was made by the Lauge-Hansen system. Supination-inversion and supination-eversion fractures were found more often than others. Fractures of both medial and lateral ankles were only seen in three cases. One reason for this result could be a lack of movement of the ankle in the ski-boot. Modern plastic boots seem to protect ankle and distal tibia and fibula. Another remarkable result was the fact that we could not find any difference in the types of fractures comparing patients with released and not released bindings.