Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.575
Filtrar
1.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(10): 1346-1351, 2020 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-33063503

RESUMO

Objective: To review the research progress in the diagnosis and treatment of distal tibiofibular syndesmosis injury. Methods: The recent literature about distal tibiofibular syndesmosis injury was reviewed and analyzed. Results: Distal tibiofibular syndesmosis injury is commonly seen in ankle joint injury, the anatomical complexities make diagnosis and treatment difficult. Preoperative physical examination, radiologic evaluation, and intraoperative stress-testing are important for the diagnosis. Aggressive treatment is also recommended for these injuries to prevent long-term chronic instability. Internal fixation is the main treatment, including metal screw, degradable screw, elastic fixation, and hybrid techniques. Metal screw fixation is still the current mainstream, but elastic fixation represented by Suture-button is more in line with the physiological characteristics of ankle joint, and the rate of secondary operation is low while the clinical outcome is satisfactory. The application prospect of elastic fixation is worthy of expectation. Conclusion: It's crucial for patient with ankle fracture to repair the distal tibiofibular syndesmosis injury. How to diagnose the injury more accurately and simply, how to increase the success rate of reduction, and how to reduce the complications of surgery are still worthy for further exploration.


Assuntos
Traumatismos do Tornozelo , Fraturas Ósseas , Traumatismos do Tornozelo/diagnóstico , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Parafusos Ósseos , Fixação Interna de Fraturas , Humanos
2.
Clin Imaging ; 67: 237-245, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32871428

RESUMO

OBJECTIVE: We present a series of 20 cases of a sleeve-type injury of the distal tibia characterized by traumatic periosteal stripping caused by a high ankle sprain. We characterize the magnetic resonance imaging findings associated with this injury and highlight its association with distal tibial osteonecrosis. MATERIALS AND METHODS: We collected 20 cases of high ankle sprains with periosteal stripping of the distal tibia through teaching files and a search through our PACS database. We recorded the presence and pattern of syndesmotic ligamentous injury and the presence or absence of syndesmotic widening in patients with periosteal stripping. The presence or absence of associated fractures and osteonecrosis was noted and characterized by location. RESULTS: The most commonly torn ligament was the anterior inferior tibiofibular ligament. 25% (5/20) of the patients in our series developed osteonecrosis. Osteonecrosis developed as early as 3-4 weeks following the initial injury. Of the patients with osteonecrosis, 40% (2/5) had fractures of the posterior malleolus. All patients with osteonecrosis had widening of the syndesmosis. Two of the five patients with osteonecrosis were in the pediatric age group. CONCLUSION: In contrast to conventional syndesmotic and interosseous ligamentous tearing, high ankle injuries with tibial periosteal stripping may result in avulsion of the extra-osseous vasculature supplied by the periosteum, leading to osteonecrosis. This pattern of injury has not been emphasized in the literature. Our findings underscore the importance of the integrity of the periosteum for maintaining adequate vascularity of the distal tibia.


Assuntos
Traumatismos do Tornozelo/diagnóstico por imagem , Osteonecrose/diagnóstico por imagem , Adolescente , Traumatismos do Tornozelo/patologia , Feminino , Fraturas Ósseas , Humanos , Ligamentos Laterais do Tornozelo/lesões , Imagem por Ressonância Magnética/métodos , Masculino , Ruptura , Ossos do Tarso , Tíbia/patologia
3.
Medicine (Baltimore) ; 99(32): e21679, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769937

RESUMO

BACKGROUND: Syndesmotic injuries account for a significant number of ankle injuries. There is no consensus regarding the recommended method of treatment. The purpose of this study was to evaluate: METHODS:: This study was performed and reported in accordance with the Strengthening the Reporting of Observational studies in Epidemiology checklist. The records of 200 patients with ankle fractures who had undergone surgical treatment in our clinics between January 2014 and January 2018 were retrospectively investigated. This retrospective cohort study was approved by the institutional review board in the 2nd Hospital of Jilin University. The primary outcome measure was the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale and the Foot Function Index. Secondary outcome measures included visual analog scale score, complications, range of movement of ankle, reoperations, and radiologic outcomes. For statistical comparison of the clinical and radiologic findings between the 2 groups, we used SPSS, version 21.0 (SPSS, Chicago, IL), statistical software. P Values of < .05 were considered statistically significant. CONCLUSION: The hypothesis was that the SB technique would achieve better functional outcomes as compared to the syndesmotic screw technique after surgery. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5793).


Assuntos
Articulação do Tornozelo/cirurgia , Procedimentos Ortopédicos/instrumentação , Procedimentos Ortopédicos/normas , Adulto , Idoso , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/anormalidades , Articulação do Tornozelo/diagnóstico por imagem , Estudos de Coortes , Feminino , Seguimentos , Humanos , Imobilização/instrumentação , Imobilização/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/estatística & dados numéricos , Estudos Retrospectivos , Estatísticas não Paramétricas , Resultado do Tratamento
4.
Medicine (Baltimore) ; 99(28): e20576, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664061

RESUMO

Pilon fractures are always results of the high-energy trauma. They are often accompanied with serious soft tissue injury, and tension blisters happened in most cases. For comminuted fractures and poor soft tissue, how to select the incision is challenging. This study aimed to explore the outcomes of the treatment of ten 43-B/C pilon fractures using an anteromedial fibula approach.Ten closed pilon fractures combined with fibula fractures were treated in our hospital from January 2015 to July 2016. Six cases were AO/OTA type 43-B and 4 cases were 43-C, including 9 males and 1 female with a mean age of 36.3 years (range: 20-60 years). When the skin wrinkled, all patients were treated by the senior authors with open reduction and internal fixation using an anteromedial fibula approach. Postoperatively, patients were followed up at 1 month, 3 months, 6 months, 12 months, and 18 months, respectively. The incision healing, the American Orthopedic Foot and Ankle Society scores and fracture healing were recorded to get a comprehensive evaluation of the effect for the incision.All patients were followed from 9 to 18 months (average: 14.1 months). Anatomic reduction was achieved in 7 cases and satisfactory in 3 cases by the Burwell-Charnley radiological criteria evaluation. All patients had complete retention of the dorsal extensor tendon sheath. The most incisions had a good healing without necrosis at 2 weeks after surgery except 1 case. The factures were healed at a range of 12 to 18 weeks (average: 13.7 ±â€Š1.2 weeks). The American Orthopedic Foot and Ankle Society scores were excellent in 7 cases and good in 3 cases at 1 year after surgery (average: 85.6 ±â€Š4.2 points). The satisfactory outcomes were achieved in most patients.The anteromedial fibula approach used for pilon fractures can lead to an effective exposure and allow fixation of tibia and fibula fractures with minimal soft tissue injury. It is a safe, simple, and effective approach that allows for satisfactory functional rehabilitation of the ankle joint. LEVEL OF EVIDENCE:: therapeutic Level IV.


Assuntos
Traumatismos do Tornozelo/cirurgia , Fixação de Fratura/métodos , Fraturas da Tíbia/cirurgia , Adulto , Traumatismos do Tornozelo/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas da Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto Jovem
5.
Rev. Soc. Andal. Traumatol. Ortop. (Ed. impr.) ; 37(1): 55-62, ene.-mar. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-193473

RESUMO

La luxación periastragalina lateral abierta es una entidad infrecuente dentro de las lesiones que afectan al pie y tobillo. Se presenta el caso de una luxación periastragalina lateral abierta que se trató mediante reducción abierta por interposición del tendón del tibial posterior y posterior inmovilización con una férula suropédica. A los 7 meses el rango de movilidad era completo, sin inestabilidades y no doloroso. Este artículo remarca la importancia de cómo actuar de forma emergente con esta patología y realizar una reducción precoz para evitar problemas mayores. El uso de antibiótico precoz y de un lavado abundante de la luxación son los primeros pasos a seguir


Open lateral periastral dislocation is an infrequent entity within injuries that affect the foot and ankle. The case of an open lateral peritalar dislocation that was treated by open reduction by interposition of the posterior tibial tendon and posterior immobilization with a surpedic splint is presented. At 7 months the range of motion was complete, without instability and painless. This article highlights the importance of how to act emergently with this pathology and carry out an early reduction to avoid major problems. The use of early antibiotics and abundant lavage of the dislocation are the first steps to follow


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/cirurgia , Tomografia Computadorizada por Raios X
6.
Br J Oral Maxillofac Surg ; 58(5): 597-601, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32192763

RESUMO

Staff in emergency departments often rely on heuristics and algorithms to make clinical decisions on a wide range of problems. Clinical predictor rules such as the Ottawa ankle rules serve to reduce the need for unnecessary radiographs and help to give frontline staff the confidence to make a diagnosis. The current study aimed to achieve consensus on the variables to test for inclusion in a set of predictor rules for suspected fractures of the mandible and midface. A three-stage modified Delphi study was conducted of members and fellows of the British Association of Oral and Maxillofacial Surgeons (BAOMS). At the third stage, there was agreement of more than 51% to retain 11/35 of the suggested predictors for mandibular fractures and 14/28 of the midface predictors. To develop and validate clinical predictor rules for use by frontline staff, these variables will now form part of a prospective data gathering exercise at a major trauma centre.


Assuntos
Traumatismos do Tornozelo , Traumatismos do Tornozelo/diagnóstico por imagem , Serviço Hospitalar de Emergência , Humanos , Mandíbula/diagnóstico por imagem , Estudos Prospectivos , Radiografia , Sensibilidade e Especificidade
7.
Jt Dis Relat Surg ; 31(1): 123-9, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32160505

RESUMO

OBJECTIVES: This study aims to improve the diagnostic reliability of syndesmosis injuries through evaluation of radiological measurements in the Turkish population and to provide mean reference values to prevent malreduction and overcompression during the treatment. PATIENTS AND METHODS: This retrospective study was performed between January 2018 and May 2018. The bilateral anteroposterior (AP) and lateral radiographs of 100 patients (60 males, 40 females; mean age 42.9 years; range, 23 to 72 years) who presented at our polyclinic were analyzed. Tibiofibular overlap (TFO), tibiofibular clear space (TFCS) and medial clear space (MCS) measurements were performed on the AP radiographs. The lateral radiographs were evaluated in respect of the anterior tibiofibular interval (ATFI), posterior tibiofibular interval (PTFI), and anterior tibiofibular ratio (ATFR) for syndesmosis reduction assessment. The lower and upper limits, mean and median values of the measurements were recorded. RESULTS: The measurements on the AP radiographs were determined to be as TFO: 7.9±2.4 mm (4-13), TFCS: 3.8±0.9 mm (2.2-6), MCS: 3.3±0.4 mm (2.7-4.5), and superior clear space: 3.3±0.3 mm (2.7-3.8). According to the measurements on the AP radiographs, the TFCS did not show any difference in terms of the variables of age, gender and side (p=0.070, p=0.219 and p=1.0, respectively). These measurements on the AP radiographs showed a high statistical consistency in terms of side (p=0.72, p=1.0, p=0.900 and p=0.920, respectively). The measurements on the lateral radiographs were as ATFI: 12.8±2.4 mm (8-18), PTFI: 6.1±2.9 mm (3-15) and ATFR: 0.4±0.1 (0.28-0.5). According to the measurements on the lateral radiographs, the ATFR did not show any difference in terms of the variables of age, gender and side (p=0.750, p=0.570 and p=0.848, respectively). The lateral measurements indicated statistical consistency in terms of side (p=0.400, p=0.260 and p=0.848, respectively). CONCLUSION: On the AP radiographs, TFCS was found to be reliable and the intraoperative evaluation of its high consistency with the opposite extremity is appropriate to avoid overcompression. The evaluation of ATFR on lateral radiographs was found to be reliable and evaluation is recommended to avoid intraoperative malreduction.


Assuntos
Traumatismos do Tornozelo/diagnóstico por imagem , Adulto , Idoso , Traumatismos do Tornozelo/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Reprodutibilidade dos Testes , Estudos Retrospectivos , Turquia , Adulto Jovem
8.
Radiologe ; 60(6): 532-540, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32112155

RESUMO

CLINICAL/METHODICAL ISSUE: Bipedal locomotion means high mechanical stress on the lower extremities and susceptibility to fractures. On the one hand, these can be the result of a one-time traumatic stress in the context of high speed traumas or falls, but can also result from repetitive microtraumas with subsequent stress fractures. STANDARD RADIOLOGICAL METHODS: For all fracture entities and localizations, X­ray diagnostics is the basic modality. METHODICAL INNOVATIONS: For optimal surgical reconstruction of intra-articular fractures or in complex fracture configurations, computed tomography should be generously used to improve postoperative outcome. PERFORMANCE: The classification of the individual fractures should enable standardised further therapy planning, especially with regard to conventional or surgical treatment. ACHIEVEMENTS: The combination of X­ray, magnetic resonance imaging and computed tomography makes a reliable diagnosis regarding foot fractures possible. PRACTICAL RECOMMENDATIONS: Important for the use of individual classification systems is always, in addition to clinical relevance, the safe and equal understanding of the individual types and degrees by the radiologist and the referring colleague.


Assuntos
Traumatismos do Tornozelo , Tornozelo , Fraturas Intra-Articulares , Traumatismos do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo , , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Radiografia
9.
J Am Acad Orthop Surg ; 28(13): 517-527, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32109919

RESUMO

Injuries to the tibio-fibular syndesmotic ligaments are different than ankle collateral ligament injuries and occur in isolation or combination with malleolar fractures. Syndesmotic ligament injury can lead to prolonged functional limitations and ultimately long-term ankle dysfunction if not identified and treated appropriately. The syndesmosis complex is a relatively simple construct of well-documented ligaments, but the dynamic kinematics and the effects of disruption have been a point of contention in diagnosis and treatment. Syndesmotic ligament injuries are sometimes referred to as "high ankle sprains" because the syndesmotic ligaments are more proximal than the collateral ligaments of the ankle joint. Rotational injuries to the ankle often result in malleolar fractures, which can be combined with ankle joint or syndesmotic ligament injuries. Most of the orthopaedic literature to this point has addressed syndesmosis ligament injuries in combination with fractures and not isolated syndesmotic ligament injuries. Thus, we propose a simplified general video guide to do the diagnostic examinations and arthroscopic-assisted reduction based on current evidence-based medicine.


Assuntos
Fraturas do Tornozelo/diagnóstico , Fraturas do Tornozelo/cirurgia , Traumatismos do Tornozelo/diagnóstico , Traumatismos do Tornozelo/cirurgia , Artroscopia/métodos , Fixação Interna de Fraturas/métodos , Fixação de Fratura/métodos , Ligamentos Articulares/lesões , Ligamentos Articulares/cirurgia , Exame Físico/métodos , Anestesia , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/fisiopatologia , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo , Fenômenos Biomecânicos , Parafusos Ósseos , Medicina Baseada em Evidências , Humanos , Ligamentos Articulares/diagnóstico por imagem , Ligamentos Articulares/fisiopatologia , Planejamento de Assistência ao Paciente , Radiografia , Técnicas de Sutura , Suturas
10.
Bone Joint J ; 102-B(2): 212-219, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009435

RESUMO

AIMS: In a randomized controlled trial with two-year follow-up, patients treated with suture button (SB) for acute syndesmotic injury had better outcomes than patients treated with syndesmotic screw (SS). The aim of this study was to compare clinical and radiological outcomes for these treatment groups after five years. METHODS: A total of 97 patients with acute syndesmotic injury were randomized to SS or SB. The five-year follow-up rate was 81 patients (84%). The primary outcome was the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale. Secondary outcome measures included Olerud-Molander Ankle (OMA) score, visual analogue scale (VAS), EuroQol five-dimension questionnaire (EQ-5D), range of movement, complications, reoperations, and radiological results. CT scans of both ankles were obtained after surgery, and after one, two, and five years. RESULTS: The SB group had higher median AOFAS score (100 (interquartile range (IQR) 92 to 100) vs 90 (IQR 85 to 100); p = 0.006) and higher median OMA score (100 (IQR 95 to 100) vs 95 (IQR 75 to 100); p = 0.006). The SS group had a higher incidence of ankle osteoarthritis (OA) (24 (65%) vs 14 (35%), odds ratio (OR) 3.4 (95% confidence interval (CI) 1.3 to 8.8); p = 0.009). On axial CT we measured a significantly smaller mean difference in the anterior tibiofibular distance between injured and non-injured ankles in the SB group (-0.1 mm vs 1.2 mm; p = 0.016). CONCLUSION: Five years after syndesmotic injury treated with either SB or SS, we found better AOFAS and OMA scores, and lower incidence of ankle OA, in the SB group. These long-term results favour the use of SB when treating an acute syndesmotic injury. Cite this article: Bone Joint J 2020;102-B(2):212-219.


Assuntos
Fraturas do Tornozelo/cirurgia , Traumatismos do Tornozelo/cirurgia , Parafusos Ósseos , Fixação Interna de Fraturas/instrumentação , Âncoras de Sutura , Fraturas do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/diagnóstico por imagem , Seguimentos , Humanos , Resultado do Tratamento
11.
AJR Am J Roentgenol ; 214(4): 871, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32045309

RESUMO

OBJECTIVE. The purpose of this article is to show the sonographic anatomy of the extremities relevant to various ligamentous, tendinous, and articular injuries occurring in the hand, wrist, and ankle. A brief discussion and depiction of the specific elements relevant to the pathophysiologic mechanism of these entities is followed by demonstrations of the dynamic ultrasound techniques that can be used to diagnose these injuries. The schematics and video clips illustrate the normal and pathologic features of these injuries. The first two videos discuss soft-tissue injuries to the hand and wrist, and the third addresses ankle injuries. CONCLUSION. After clinical assessment, dynamic ultrasound examination is a useful tool for diagnosing and assessing the degree of severity of several soft-tissue injuries to the extremities, some of which can be detected only during active movement. Familiarity with these specific dynamic techniques will enhance the value of the ultrasound examination.


Assuntos
Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos da Mão/diagnóstico por imagem , Lesões dos Tecidos Moles/diagnóstico por imagem , Ultrassonografia/métodos , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Tornozelo/fisiopatologia , Traumatismos da Mão/fisiopatologia , Humanos , Lesões dos Tecidos Moles/fisiopatologia , Traumatismos do Punho/fisiopatologia
12.
Am J Emerg Med ; 38(7): 1458-1462, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31973934

RESUMO

INTRODUCTION: Coolant spray application in musculoskeletal injuries is an effective and harmless method to treat pain and reduce functional limitation. This study assessed the clinical value of coolant spray application on patient comfort before and during the radiographic imaging process along with its early analgesic and anti-edema effects. METHODS: A total of 155 patients, admitted to the emergency department between April 1, 2019, and June 31, 2019, were included in this study. The patients were randomly assigned to either a coolant spray or a saline spray (placebo) group. To the coolant spray group patients, Cryos ®Spray (Phyto Performance, Italy) was applied. To the placebo group patients, a normal saline solution in a bottle covered with white opaque paper and refrigerated at 4 °C was sprayed. Radiographic images of the patients were scored for appropriateness of the standard imaging characteristics. RESULTS: The mean scores were 8.13 ± 1.8 and 6.58 ± 2.2 for the coolant spray and normal saline spray groups, respectively; the differences were statistically significant between the two groups (mean difference: -1.56, 95% CI:-2.20 to -0.92; p = .000). Patients with fractures on their radiographs and treated with coolant spray received higher scores than similar patients treated with normal saline spray (mean difference:-1.92, 95% CI:-3.28 to -0.55; p = .009). The proportion of patients requesting analgesic treatment before discharge was statistically lower in the coolant spray group compared to the normal saline group (p = .025). CONCLUSIONS: The radiographic images taken after coolant spray intervention in patients with acute ankle trauma were more successful in showing the target structures.


Assuntos
Traumatismos do Tornozelo/terapia , Crioterapia , Administração Tópica , Adolescente , Adulto , Aerossóis , Analgésicos/uso terapêutico , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/terapia , Traumatismos do Tornozelo/diagnóstico por imagem , Método Duplo-Cego , Uso de Medicamentos/estatística & dados numéricos , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor , Estudos Prospectivos , Radiografia , Adulto Jovem
13.
Jpn J Nurs Sci ; 17(1): e12270, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31161728

RESUMO

AIM: Ankle injuries are commonly seen in the emergency department (ED) and contribute to overcrowding. In Oman, injuries are a leading cause of years of life lost, disability-adjusted life years, and pose a burden to the healthcare system. This study aimed to evaluate the effectiveness of ED triage nurse-led application of the Ottawa Ankle Rules (OARs) toward improving the healthcare outcomes of ankle injury patients. METHODS: A quasi-experimental design was used to collect data (demographic characteristics, waiting time, length of stay, and number of radiographic tests) from 96 patients. The intervention group (n = 46) received ED triage nurse-led assessment and initiation of radiographic tests based on the OARs. The control group (n = 50) received usual care. RESULTS: The participants' mean age was 26.4 ± 7.90 years. The main causes of ankle injuries were football (36%), falls (31%) and twisting while walking (24%). There was a significant difference in number of ankle X-rays (t = 6.19; p < .001); length of stay (U = 549; p < .001); and waiting time (U = 167; p < .001) between the control and intervention group. The intervention reduced the mean waiting time and length of stay by 25.09 and 41.01 min, respectively. CONCLUSION: Application of the OARs by the ED triage nurse can decrease the number of unnecessary radiographic tests, waiting time and length of stay in the ED. Nurses' utilization of evidence-based clinical decision-making tools can improve ED care outcomes of common acute conditions such as ankle injuries.


Assuntos
Traumatismos do Tornozelo/enfermagem , Recursos Humanos de Enfermagem no Hospital , Triagem , Adolescente , Adulto , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/tratamento farmacológico , Estudos de Casos e Controles , Serviço Hospitalar de Emergência , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Omã , Resultado do Tratamento , Adulto Jovem
15.
Br J Radiol ; 93(1106): 20190620, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31573325

RESUMO

CT is a readily available imaging modality for cross-sectional characterization of acute musculoskeletal injuries in trauma. Dual-energy CT provides several additional benefits over conventional CT, namely assessment for bone marrow edema, metal artifact reduction, and enhanced assessment of ligamentous injuries. Winter sports such as skiing, snowboarding, and skating can result in high speed and high energy injury mechanisms; dual-energy CT is well suited for the characterization of those injuries.


Assuntos
Esportes na Neve/lesões , Tomografia Computadorizada por Raios X/métodos , Adulto , Traumatismos do Tornozelo/diagnóstico por imagem , Doenças da Medula Óssea/diagnóstico por imagem , Edema/diagnóstico por imagem , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/lesões , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Lesões do Quadril/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Traumatismos do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/diagnóstico por imagem , Fraturas da Tíbia/diagnóstico por imagem , Traumatismos do Punho/diagnóstico por imagem , Adulto Jovem
16.
Orthop Clin North Am ; 51(1): 121-130, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739875

RESUMO

Peroneal tendon pathology is becoming an increasingly recognized source of lateral-sided ankle pain. High clinical suspicion, along with judicious physical examination coupled with confirmatory advanced imaging modalities, are necessary to make an accurate diagnosis and aid in guiding treatment. Peroneal pathology encompasses several distinct conditions. Peroneal tendon tears and injuries to the peroneal retinaculum must be identified to guide treatment. Patients with peroneal pathology report high levels of satisfaction after surgical management with most returning to their preinjury level of function. An early and accurate diagnosis, along with treatment tailored to the individual, is necessary to obtain optimal outcomes.


Assuntos
Traumatismos do Tornozelo/cirurgia , Traumatismos dos Tendões/cirurgia , Transferência Tendinosa/métodos , Tendões/cirurgia , Tornozelo/anatomia & histologia , Tornozelo/diagnóstico por imagem , Tornozelo/patologia , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/patologia , Fenômenos Biomecânicos , Cadáver , Humanos , Incidência , Instabilidade Articular/epidemiologia , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Imagem por Ressonância Magnética , Medidas de Resultados Relatados pelo Paciente , Radiografia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Ruptura , Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos dos Tendões/patologia , Tendões/anatomia & histologia , Tendões/patologia
17.
Skeletal Radiol ; 49(1): 1-17, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31289899

RESUMO

The distal tibiofibular joint is a fibrous joint that plays a crucial role in the stability of the ankle joint. It is stabilized by three main ligaments: the anterior inferior tibiofibular ligament, the posterior inferior tibiofibular ligament, and the interosseous tibiofibular ligament, which are well delineated on magnetic resonance imaging. Pathology of the distal tibiofibular joint is mostly related to trauma and the longer-term complications of trauma, such as soft tissue impingement, heterotopic ossification, and synostosis. This review article outlines the MRI anatomy and pathology of this joint.


Assuntos
Traumatismos do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/anatomia & histologia , Articulação do Tornozelo/diagnóstico por imagem , Ligamentos Articulares/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Traumatismos do Tornozelo/diagnóstico , Artrografia/métodos , Doença Crônica , Humanos , Ligamentos Articulares/anatomia & histologia , Ligamentos Articulares/lesões , Posicionamento do Paciente
18.
Einstein (Sao Paulo) ; 18: eAO4739, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31553355

RESUMO

OBJECTIVE: To use magnetic resonance imaging to assess the prevalence of foot and ankle ligament injuries and fractures associated with ankle sprain and not diagnosed by x-ray. METHODS: We included 180 consecutive patients with a history of ankle sprain, assessed at a primary care service in a 12-month period. Magnetic resonance imaging findings were recorded and described. RESULTS: Approximately 92% of patients had some type of injury shown on the magnetic resonance imaging. We found 379 ligament injuries, 9 osteochondral injuries, 19 tendinous injuries and 51 fractures. Only 14 magnetic resonance imaging tests (7.8%) did not show any sort of injury. We observed a positive relation between injuries of the lateral complex, syndesmosis and medial ligaments. However, there was a negative correlation between ankle ligament injuries and midfoot injuries. CONCLUSION: There was a high rate of injuries secondary to ankle sprains. We found correlation between lateral ligament injuries and syndesmosis and deltoid injuries. We did not observe a relation between deltoid and syndesmosis injuries or between lateral ligamentous and subtalar injuries. Similarly, no relation was found between ankle and midfoot injuries.


Assuntos
Traumatismos do Tornozelo/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Traumatismos do Tornozelo/diagnóstico por imagem , Brasil/epidemiologia , Cartilagem Articular/lesões , Criança , Feminino , Humanos , Ligamentos Laterais do Tornozelo/lesões , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
19.
Br J Radiol ; 93(1105): 20180989, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31742428

RESUMO

OBJECTIVE: To assess the rates of fractures and ligament injuries in patients with an acute ankle injury and a normal radiographic examination, and to consider the most appropriate examination protocol. METHODS: Patients with an acute ankle injury who presented to the John Radcliffe Hospital Emergency Department with a normal radiographic examination were eligible for the study. They were invited to receive a cone beam CT and ultrasound examination at a local radiology department within 5 days of their ankle injury. RESULTS: Of the 100 patients recruited to the study, 19 patients were found to have major fractures and 42 patients had small avulsion fractures. Additionally, 42 patients had ankle effusions and there were a large number of soft tissue injuries. There were 83 acute injuries of the anterior talofibular ligament, 19 of the anterior tibiofibular ligaments, 26 of the calcaneofibular ligament, 39 of the deltoid ligament complex, 21 of the talonavicular ligament, 14 of the spring ligament and 3 of the calcaneocuboid ligament. CONCLUSION: Conventional radiographic examination misses significant fractures of the foot and ankle and the presence of an ankle effusion does not relate to the severity of injury. Ultrasound is a useful imaging technique that can supplement clinical practice, but it is unlikely to replace current protocols alone. Cone beam CT is an appropriate alternative to plain radiography, being more sensitive in detecting fractures and delivering a similar dose of radiation. However, neither CT or ultrasound examination can detect all avulsion fractures. Simple anterior process fractures of the calcaneus are associated with talonavicular ligament injuries and the medial ligaments are injured in almost 50% of cases when there is a lateral ligament injury. ADVANCES IN KNOWLEDGE: Fractures in the foot and ankle are detected more precisely with cone beam CT compared to radiographs. Cone beam CT delivers similar doses of to conventional radiographs which is around 10% of that resulting from conventional CT. Ultrasound examination is an effective assessment tool to detect ligamentous injuries. The absence of an ankle effusion does not exclude a major fracture.


Assuntos
Traumatismos do Tornozelo/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico/métodos , Fraturas Ósseas/diagnóstico por imagem , Ligamentos Articulares/diagnóstico por imagem , Ligamentos Articulares/lesões , Lesões dos Tecidos Moles/diagnóstico por imagem , Ultrassonografia/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
20.
J Am Podiatr Med Assoc ; 109(6): 426-430, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31755771

RESUMO

BACKGROUND: Confirmation of anatomical reduction of ankle syndesmosis is mandatory because improper reduction leads to poor functional results. Coronal plane evaluation of syndesmosis is well described in the literature, but there is little information about sagittal plane evaluation. We sought to evaluate the relationship of fibula and tibia in the sagittal plane and create a new reference that can be applied easily and reliably. METHODS: Lateral ankle radiographs of 337 individuals with no history of ankle fracture were evaluated. A line was drawn between the anterior and posterior cortices of the distal lateral tibia, and the length of this line was measured (line 1). The distance between the anterior and posterior cortices of the fibula on this line was measured, and the center of this second distance was identified and marked. The posterior half of the fibular width was divided by line 1 and was named the lateral posterior ankle ratio (LPAR). Statistical analysis was performed by side and sex. RESULTS: Mean patient age was 38.6 years; mean LPAR was 0.48. There was a significant difference between men and women by age (P < .001) and LPAR (P = .01). There was no significant difference between right and left ankles by age (P = .63) and LPAR (P = .64). The LPAR was less than 0.40 in 6.8% of the radiographs, 0.40 to 0.50 in 57.9%, and greater than 0.50 to 0.60 in 32.9%. CONCLUSIONS: The LPAR should approximate 50% in normal lateral ankle images and, by extrapolation, after syndesmotic reduction.


Assuntos
Articulação do Tornozelo/anatomia & histologia , Fíbula/anatomia & histologia , Radiografia , Tíbia/anatomia & histologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Traumatismos do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/diagnóstico por imagem , Feminino , Fíbula/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Fatores Sexuais , Tíbia/diagnóstico por imagem , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA