The Current UK Consensus on the Management of Weber B and Posterior Ankle Fractures: A Questionnaire Study as Part of the Acute Management of Ankle Fractures (AUGMENT) Audit.

Ankle fractures are common conditions which are associated with significant morbidity when managed incorrectly. With the incidence due to triple by 2030, standards of practice were created by the British Orthopaedic Association and the British Orthopaedic Foot and Ankle Society to ensure optimal treatment. In spite of this, anecdotally there is still a variation in practice and therefore a questionnaire study was designed to explore clinician decision-making around Weber B and Posterior Malleolus ankle fractures. Five scenarios explored management regarding minimally and grossly displaced injuries, as well as the use of further imaging. The questionnaires were distributed via AUGMENT collaborators at their sites and at the British Orthopaedic Foot and Ankle Society congress 2018. About 315 questionnaires were completed and included in analysis. For Weber B injuries, overall there was a consensus across all respondents with minimally displaced and grossly displaced fractures being treated conservatively and operatively respectively. For Posterior Malleolus injuries, there was variation in practice between Foot and Ankle specialists and their non-Foot and Ankle colleagues. Computed tomography (CT) was more likely to be used to assess these injuries by specialists (97.50 vs 69.79%) and these injuries were more likely to be treated operatively across the board. This study identified key variation in practice of the management of Posterior Malleolar ankle fractures, including the use of imaging to further define the anatomy and the decision to operate. Foot and Ankle surgeons were more likely to organize CT scans and to surgically manage these injures.

Association between knee extensor and ankle plantarflexor muscle thickness and echo intensity with postural sway, mobility and physical function in older adults.

The purpose of this study was to assess the association between muscle thickness and echo intensity of the knee extensors and ankle plantarflexors with postural sway, mobility and physical function in older adults. Twenty-one older men and women (age; 69.9 ± 4.3 years) were assessed for postural sway (centre of pressure movement), mobility (i.e. Timed-Up and-Go-test [TUG]), physical function (i.e. 5 times sit-to-stand [STS]), and ultrasound derived measures of muscle thickness and echo intensity of the vastus lateralis (VL) and gastrocnemius medialis (GM). Significant inverse correlations were observed between VL and GM thickness with TUG (r = -0.432 to -0.492) and STS (r = -0.473 to -0.596). Significant positive correlations were observed between VL and GM echo intensity with TUG (r = 0.459 to 0.518) and STS (r = 0.481 to 0.635). Significant positive correlations were also detected between GM echo intensity and anteroposterior sway (r = 0.451 to 0.534). Two key findings emerged from the present experiment. First, this study provides novel evidence that ankle plantarflexor echo intensity, but not thickness, was associated with anteroposterior postural sway among older adults. Second, we provide new evidence that muscle thickness and echo intensity of the knee extensors and uniquely, the ankle plantarflexors, presented with similar magnitude associations with TUG and STS performance in older adults.

The emergence of age-related deterioration in dynamic, but not quiet standing balance abilities among healthy middle-aged adults.

The purpose of the present study was to quantify differences in lower extremity reach performance, static posturography and gait outcomes between young (20-39 years), middle-aged (40-59 years) and older (60-79 years) adults using identical tests and parameters. This was a cross-sectional study with three parallel groups (young [20-39 years] vs. intermediate [40-59 years] vs. older [60-79 years] adults). In a randomised order each participant completed: (i) static posturography, (ii) lower extremity reach performance, and (iii) gait assessment. Changes in balance between age groups were analysed using analysis of variance (ANOVA). Additionally, correlational analysis was used to identify relationships between age and outcome measures. Centre of pressure (COP) movement was greater in older compared to intermediate-aged (d = 0.50-2.40) and young (d = 0.54-2.61) adults (p < 0.001). Reduced lower extremity reach distance was found in older compared to intermediate-aged (d = 1.28-3.60) and young (d = 2.09-3.87) adults (p < 0.001), while young adults demonstrated greater reach distances than intermediate (d = 0.64-1.74) aged adults (p < 0.001). Correlational analysis revealed moderate to strong positive correlations between age across the adult life span (20-79 years) for all COP metrics and lower extremity reach outcomes. When correlational analyses were performed only in the young and middle-aged groups (20-59 years), coefficients were weak and not significant for the COP, but remained moderate for lower extremity reach performance. Lower extremity reach performance reveals earlier age-related declines in postural stability that are not evident during quiet standing tasks of varying difficulty. These findings should contribute to the early identification of potential balance deficits in those where balance problems do not yet exist, which will assist clinical decision making with respect to timely implementation of fall prevention strategies.

Delayed Impairment of Postural, Physical, and Muscular Functions Following Downhill Compared to Level Walking in Older People.

Transient symptoms of muscle damage emanating from unaccustomed eccentric exercise can adversely affect muscle function and potentially increase the risk of falling for several days. Therefore, the aims of the present study were to investigate the shorter- and longer-lasting temporal characteristics of muscle fatigue and damage induced by level (i.e., concentrically biased contractions) or downhill (i.e., eccentrically biased contractions) walking on postural, physical, and muscular functions in older people. Nineteen participants were matched in pairs for sex, age and self-selected walking speed and allocated to a level (n = 10, age = 72.3 ± 2.9 years) or downhill (n = 9, age = 72.1 ± 2.2 years) walking group. Postural sway, muscle torque and power, physical function (5× and 60 s sit-to-stand; STS), and mobility (Timed-Up-and-Go; TUG) were evaluated at baseline (pre-exercise), 1 min, 15 min, 30 min, 24 h, and 48 h after 30 min of level (0% gradient) or downhill (-10% gradient) walking on a treadmill. Following downhill walking, postural sway (+66 to 256%), TUG (+29%), 60 s STS (+29%), five times STS (-25%) and concentric power (-33%) did not change at 1-30 min post exercise, but were significantly different (p < 0.05) at 24 and48 h post-exercise when compared to baseline (p < 0.05). Muscle torque decreased immediately after downhill walking and remained impaired at 48 h post-exercise (-27 to -38%). Immediately following level walking there was an increase in postural sway (+52 to +98%), slower TUG performance (+29%), fewer STS cycles in 60 s (-23%), slower time to reach five STS cycles (+20%) and impaired muscle torque (-23%) and power (-19%) which returned to baseline 30-min after exercise cessation (p > 0.05). These findings have established for the first time distinct impairment profiles between concentric and eccentric exercise. Muscle damage emanating from eccentrically biased exercise can lead to muscle weakness, postural instability and impaired physical function persisting for several days, possibly endangering older adult's safety during activities of daily living by increasing the risk of falls.