Overtightening of the ankle syndesmosis: is it really possible?

BACKGROUND: Many surgeons and orthopaedic references recommend that fixation of a disrupted distal tibiofibular syndesmosis be performed with the ankle in dorsiflexion to avoid overtightening and subsequent restriction of ankle dorsiflexion. This recommendation is based in large part on one cadaveric study without clinical correlation. The purpose of the present study was to examine whether overtightening of the syndesmosis limits maximal ankle dorsiflexion. METHODS: Nineteen cadaveric ankles were used for the study. Each ankle was tested for the initial range of motion after release of the Achilles tendon proximal to the ankle joint. All capsular and ligamentous structures remained intact. Kirschner wires were placed in the tibia and talus. The angle between the wires with the ankle maximally dorsiflexed was measured before and after syndesmotic compression. Syndesmotic compression was achieved with a 4.5-mm lag screw with the ankle in plantar flexion. RESULTS: There was no difference between the values for maximal dorsiflexion before and after syndesmotic compression. CONCLUSIONS: Syndesmotic compression in and of itself does not diminish ankle dorsiflexion in a cadaveric model. CLINICAL RELEVANCE: Maximal dorsiflexion of the ankle during syndesmotic fixation is not required in order to avoid loss of dorsiflexion. It is likely that the most important aspect of syndesmotic fixation is anatomic reduction of the syndesmosis and that the degree of ankle dorsiflexion during fixation is not important.

Perceived control over menopausal hot flushes: exploring the correlates of a standardised measure.

OBJECTIVES: A substantial minority of women report considerable distress during hot flushes. Coping with various chronic health problems has been related to perceived control in previous studies. Hence this study developed a standardised measure to investigate whether perceived control is associated with less distress during menopausal hot flushes. METHOD: The study presented a suitably re-worded 15-item scale (the Arthritis Helplessness Index, originally developed by Nicassio et al., J Rheumatol 1985;12:462-467. Scoring was reversed so that high scores signified greater perceived control. A volunteer sample of 43 women (mean age 51 years) completed the scale together with several further measures. A total of 35 women returned 12 month follow-up questionnaires. RESULTS: The Perceived Control Index (PCI) scores correlated with standardised measures of self-esteem and simple self-ratings (0-100) of perceived control, and remained very stable over 12 months. Self-rated distress during flush episodes was more closely related to perceived control than to more objective factors such as flush frequency and chronicity. CONCLUSION: These findings support further investigation into whether subjective coping with flushes may be improved by psychological interventions that enhance perceived control and self-esteem.

The use of a biopsy punch in surgical preparation of drug self-administering animals.

This report describes a simple surgical method of exiting an implanted intravenous catheter through the skin via a nonsutured site. The preparation, which makes use of a biopsy punch, avoids placing the catheter exiting point through the incision used for subcutaneously fixing the catheter platform on the back of the animal.