Prospective Computed Tomographic Analysis of Osteochondral Lesions of the Ankle Joint Associated With Ankle Fractures.

BACKGROUND: Osteochondral lesions (OCLs) associated with ankle fracture correlate with unfavorable outcome. The goals of this study were to detect OCLs following ankle fracture, to associate fracture type to OCLs and to investigate whether OCLs affect clinical outcome. METHODS: 100 ankle fractures requiring operative treatment were prospectively included (46 men, 54 women; mean age 44 ± 14 years, range 20-77). All ankle fractures (conventional radiography; 71 Weber B, 22 Weber C, 1 Weber A, 4 isolated medial malleolus and 2 isolated posterior malleolus fractures) were treated by open reduction and internal fixation. Multidetector computed tomography (CT) was performed postoperatively. For each OCL, the location, size, and Loomer OCL classification (CT modified Berndt and Harty classification) were determined. The subjective Foot and Ankle Outcome Scoring (FAOS) was used for clinical outcome at 1 year. RESULTS: OCLs were found in 10/100 ankle fractures (10.0%). All OCLs were solitary talar lesions. Four OCLs were located posteromedial, 4 posterolateral, 1 anterolateral, and 1 anteromedial. There were 2 type I OCLs (subchondral compression), 6 type II OCLs (partial, nondisplaced fracture) and 2 type IV OCLs (displaced fracture). Mean OCL size (largest diameter) was 4.4 ± 1.7 mm (range, 1.7 mm to 6.2 mm). Chi-square analysis showed no significant association between ankle fracture type and occurrence of OCLs. OCLs did occur only in Lauge-Hansen stage III/IV ankle fractures. There were no significant differences in FAOS outcome between patients with or without OCLs. CONCLUSIONS: Ten percent of investigated ankle fractures had associated OCLs on CT. Although no significant association between fracture type and OCL was found, OCLs only occurred in Lauge-Hansen stage III/IV ankle fractures. With the numbers available, OCLs did not significantly affect clinical outcome at 1 year according to FAOS. LEVEL OF EVIDENCE: Level IV, observational study.

[Long-term follow-up of osteoarthritis after conservative treatment of ankle fractures]. / Dugotrajno pracenje osteoartritisa nakon konzervativno lijecenog prijeloma gornjeg noznog zgloba.

In a period between 1982 and 1998 a total of 171 patients with ankle fracture were treated conservatively and rehabilitated in the same rehabilitation institution. All patients were seen at follow up in 1998 exactly at the date of the fracture in five groups with one, two, three, eleven and sixteen years from the fracture respectively. There were not significant differences in sex and age among groups. According to Danis-Weber's system, in the total material there were 53.8% type A, 40.9% type B and 5.3% type C fractures, and according to Lauge-Hansen's system there were 54.4% type SA, 34.5% type SE, 7.6% type PA and 3.5% type PE fractures. According to the Olerud's and Molander's scoring system there were the highest percentages of good results in all series (in average 52%) and there were not found significant differences between the results of the groups (P = 0.154). According to linear analogue scale of function there were the highest percentages of good results in all groups (in average 55.6%) and with significant differences between the results of the groups (P = 0.012). There were found significant differences between the results of late reductions of malleolar fragments of the groups (P = 0.028) with changing for the worse in groups with longer time interval from fracture. Posttraumatic osteoarthritis was found in first year after fracture already (41.5%). There were found significant differences between the results of the groups (P = 0.001) with severe degrees of osteoarthritis in groups with longer time from fracture.

[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.

[The foot in leprosy]. / II piede lebbroso.

The more frequently occurring bone lesions of leprosy of the foot are described with illustrations from patients with leprosy seen some years previously in Sardinia. These cases are classified into groups depending on the presence of osteoporosis, osteitis, lesions with predominantly inflammatory manifestations, those with a spindle-shaped appearance and lastly those with pathological fractures. The anatomical relationship between cutaneous and bone lesions is outlined.