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1.
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
2.
Foot Ankle Clin ; 24(2): 239-264, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31036267

RESUMO

The most common cause for end-stage ankle osteoarthritis is posttraumatic, sometimes resulting from concomitant supramalleolar deformity. Aims of the supramalleolar osteotomy include restoring the lower-leg axis to improve intraarticular load distribution and retarding degeneration of the tibiotalar joint. Preoperative planning is based on conventional weight-bearing radiographs. Often advanced imaging, including computed tomography and/or MRI, is needed for a better understanding of the underlying problem. Postoperative complications are not uncommon, including progression of tibiotalar osteoarthritis in up to 25% within 5 years of all patients who have supramalleolar osteotomies.


Assuntos
Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Artrite/prevenção & controle , Osteotomia/métodos , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/fisiopatologia , Artrite/diagnóstico por imagem , Artrite/etiologia , Articulações do Pé/diagnóstico por imagem , Articulações do Pé/fisiopatologia , Articulações do Pé/cirurgia , Humanos , Osteotomia/efeitos adversos , Cuidados Pré-Operatórios
3.
Orthop Clin North Am ; 50(3): 401-414, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31084843

RESUMO

Poor clinical results are seen with syndesmotic injuries in the setting of ankle sprains and ankle fractures. The goal of syndesmosis repair is to restore the normal anatomic relationship of the distal tibiofibular joint and prevent ankle arthritis. Indications for surgical intervention for isolated syndesmotic injuries include frank syndesmosis diastasis, medial clear space widening on plain radiographs, significant radiographic syndesmosis diastasis during stress examination, or subtle syndesmotic diastasis detected by arthroscopic evaluation. Complications after syndesmosis repair include symptomatic hardware, malreduction, and arthritis. Anatomic reduction of the syndesmosis leads to better outcomes following surgery.


Assuntos
Fraturas do Tornozelo/cirurgia , Traumatismos do Tornozelo/cirurgia , Ligamentos Articulares/lesões , Ligamentos Articulares/cirurgia , Fraturas do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/diagnóstico por imagem , Artroscopia , Parafusos Ósseos , Contraindicações de Procedimentos , Fixação Interna de Fraturas/efeitos adversos , Humanos , Ligamentos Articulares/diagnóstico por imagem , Osteoartrite/prevenção & controle , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/prevenção & controle , Radiografia
4.
Eur J Radiol ; 114: 76-84, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31005181

RESUMO

OBJECTIVE: to compare quantitative kinematic 4-D CT parameters between healthy volunteers and pathologic patients (joint stiffness or chronic ankle instability). METHODS: Thirteen healthy volunteers without previous ankle trauma, 18 patients with clinical subtalar joint stiffness and 10 patients with chronic ankle instability diagnosed based on clinical and imaging findings were prospectively evaluated with 4-D CT. This study was approved by the local ethics committee and all patients signed an informed consent. The subtalar joint was evaluated during a prono-supination cycle. Two angles and two distances between the talus and the calcaneus were measured semi-automatically and independently by two readers. Measurement variations were compared in these three different groups. RESULTS: There were statistically significant differences between axial and coronal talocalcaneal angles of healthy volunteers and patients with joint stiffness (p < 0.0001). The best sensitivities and specificities for the identification of subtalar joint stiffness were 92-100% and 74-94%. Mean and maximal posterior calcaneal facet uncovering were significantly lower in patients with chronic ankle instability patients compared to healthy volunteers (p < 0.006) with sensitivities and specificities of 92-95% and 80-92% respectively. CONCLUSION: Quantitative analysis in 4D CT can provide an objective criteria for the differentiation between healthy volunteers and patients with subtalar joint stiffness and chronic ankle instability.


Assuntos
Traumatismos do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/diagnóstico por imagem , Tomografia Computadorizada Quadridimensional , Instabilidade Articular/diagnóstico por imagem , Articulação Talocalcânea/diagnóstico por imagem , Adulto , Traumatismos do Tornozelo/patologia , Articulação do Tornozelo/patologia , Fenômenos Biomecânicos/fisiologia , Feminino , Voluntários Saudáveis , Humanos , Instabilidade Articular/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Interpretação de Imagem Radiográfica Assistida por Computador , Articulação Talocalcânea/patologia , Adulto Jovem
5.
Semin Musculoskelet Radiol ; 23(2): e36-e55, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30925633

RESUMO

Radiologists should be familiar with basic principles of fracture fixation and the normal imaging appearances of implant constructs and their complications. The surgeon's selection of external fixation, intramedullary nail fixation, open reduction and internal fixation, or some combination depends on patient factors, fracture configuration, injury to the soft tissue envelope, and surgeon experience. Complications including loss of fixation with resultant malalignment, nonunion, infection, and posttraumatic osteoarthritis present additional challenges for the surgeon as well as the radiologist. This article reviews the rationale behind fracture fixation in fractures of the lower leg, ankle, and foot. Examples of postoperative complications are also reviewed.


Assuntos
Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/cirurgia , Ossos do Pé/diagnóstico por imagem , Ossos do Pé/lesões , Ossos do Pé/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Fixadores Internos , Complicações Pós-Operatórias/diagnóstico por imagem , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Fixação Interna de Fraturas/instrumentação , Humanos , Desenho de Prótese , Falha de Prótese , Reoperação
6.
J Orthop Surg Res ; 14(1): 69, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30819216

RESUMO

BACKGROUND: The objective of the current study is to compare reliability, accuracy, sensitivity, and specificity in magnetic resonance imaging (MRI) evaluation of anterior talofibular ligament (ATFL) among the routine axial scanning plane, oblique axial-coronal scanning plane, and oblique axial-sagittal scanning plane. METHODS: Twenty cadaveric feet were studied. ATFL was exposed before scanning. Routine axial, oblique axial-coronal, and oblique axial-sagittal MRI scanning of 20 ATFL-intact cadaveric feet were acquired utilizing a 1.5-T MRI unit. The scans were repeated on the 20 cadaveric feet after the ATFL was artificially injured. In total, 120 sets of MR images were obtained and were randomly numbered. Three independent observers who were blinded to the experiment evaluated the images. Interobserver agreement, sensitivity, specificity, and accuracy were calculated and compared between different scanning planes utilizing the McNemar test. RESULTS: The interobserver agreement was fair to good (kappa, 0.55 to 0.65) in the routine axial plane, fair to good (kappa, 0.557 to 0.75) in the oblique axial-sagittal plane, and excellent (kappa, 0.85 to 0.95) in the oblique axial-coronal plane. The accuracy was significantly higher when utilizing oblique axial-coronal MRI scanning than routine axial MRI scanning (reader 1: p = .018; reader 2: p = .005). CONCLUSIONS: The diagnostic accuracy of oblique axial-coronal plane MRI was higher than the routine axial plane concerning ATFL injury, and the interobserver agreement was excellent. The oblique axial-coronal plane could be added to the MRI scanning protocol during clinical practices to improve the diagnostic accuracy of ATFL injury.


Assuntos
Traumatismos do Tornozelo/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/lesões , Imagem por Ressonância Magnética/normas , Tornozelo/diagnóstico por imagem , Tornozelo/patologia , Traumatismos do Tornozelo/patologia , Cadáver , Humanos , Ligamentos Laterais do Tornozelo/patologia , Variações Dependentes do Observador , Reprodutibilidade dos Testes
7.
Eur J Radiol ; 112: 222-228, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30777215

RESUMO

OBJECTIVES: The aim of this study was to determine the correlation of the intra-operative fluoroscopic 2D- and 3D-images compared with a postoperative CT-scan, in terms of quality of reduction and fixation of calcaneal fractures. METHODS: Patients requiring open reduction and internal fixation (ORIF) of a calcaneal fracture were recruited as part of the EF3X-trial. During surgery, intra-operative images of fluoroscopic 2D- and 3D-imaging were obtained to assess the quality of the reduction and implant position. All patients received a postoperative CT-scan within one week. The operating surgeon evaluated intra-operatively both 2D- and 3D-images according to a 23-item scoring protocol on a 3-point Likert scale. A scoring panel, consisting of three clinical experts, evaluated all images in a blinded and independent fashion. Intraclass correlation coefficients (ICC) with their 95% confidence intervals (CI) were calculated using a two-way-random model with absolute agreement. RESULTS: A total of 102 calcaneal fractures were included. Agreement of 3D-imaging for the quality of reduction was better than 2D-imaging, although still fair, but for fixation moderate to good. Agreement between the 2D-images and the CT-scans was poor to fair. Intra-operative 2D-imaging received the highest ratings for image quality and interpretability, followed by CT-scanning. CONCLUSION: Implant position can be evaluated satisfactory with the aid of intra-operative 3D imaging. Although intra-operative 3D imaging had a better agreement with postoperative CT-scanning than 2D-imaging, there is a need to improve image quality and suppress scattering from implants to improve the additional value of intra-operative 3D imaging in calcaneal fracture reduction and fixation.


Assuntos
Calcâneo/lesões , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Redução Aberta/métodos , Adulto , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/cirurgia , Calcâneo/diagnóstico por imagem , Calcâneo/cirurgia , Feminino , Fluoroscopia/métodos , Fraturas Ósseas/diagnóstico por imagem , Humanos , Imagem Tridimensional/métodos , Cuidados Intraoperatórios/métodos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Tomografia Computadorizada por Raios X/métodos
8.
Emerg Med J ; 36(1): 56-57, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30635348

RESUMO

A short cut review was carried out to establish whether diagnostic ultrasound can accurately diagnose integrity of the lateral ligament complex in comparison to MRI. Two studies were directly relevant to the question using the described search methodology. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. Despite the utility of ultrasound there is no certainty of its advantage over MRI for injuries of the anterior talofibular ligament.


Assuntos
Traumatismos do Tornozelo/diagnóstico , Ligamentos Colaterais/lesões , Ultrassonografia/normas , Tornozelo/fisiopatologia , Traumatismos do Tornozelo/diagnóstico por imagem , Atletas , Traumatismos em Atletas/diagnóstico , Ligamentos Colaterais/diagnóstico por imagem , Medicina de Emergência Baseada em Evidências/métodos , Futebol Americano/lesões , Humanos , Masculino , Ultrassonografia/métodos , Adulto Jovem
9.
J Foot Ankle Surg ; 58(2): 288-290, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30612873

RESUMO

In the emergency settings, increased body mass index (BMI) is a risk factor for traumatic orthopedic injuries. The aim of this study was to assess the association between the acute ankle injuries (sprain or fracture) and BMI. This prospective cohort study included patients ≥18 years of age with acute traumatic ankle injuries (either sprain or fracture) caused by fall from own height when walking at ground level and who received primary treatment at the emergency room of a university hospital between May and October 2017. Of the 107 patients who met the inclusion criteria, 58 (54%) patients experienced acute ankle sprains and 49 (46%) experienced acute ankle fractures. No significant association was detected between fracture severity (as assessed by the Danis-Weber classification) and BMI (p = .860). The most frequent ankle injury in patients with normal BMI was ankle sprain. In our cohort, obesity was not the primary determinant of the severity of ankle injury. However, age was a key determinant of the type of injury; patients >30 years of age were 20% more likely to suffer an ankle fracture.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Traumatismos do Tornozelo/epidemiologia , Índice de Massa Corporal , Obesidade/epidemiologia , Doença Aguda , Adolescente , Adulto , Fatores Etários , Idoso , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/fisiopatologia , Estatura , Estudos de Coortes , Comorbidade , Feminino , Seguimentos , Hospitais Universitários , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Entorses e Distensões/diagnóstico por imagem , Entorses e Distensões/epidemiologia , Entorses e Distensões/fisiopatologia , Estatísticas não Paramétricas , Adulto Jovem
10.
In Vivo ; 33(1): 255-261, 2019 Jan-Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30587633

RESUMO

BACKGROUND/AIM: The aim of the present study was to assess the impact of syndesmotic screw fixation on overall clinical outcomes following Weber B-type ankle fractures. MATERIALS AND METHODS: A total of 21 patients with syndesmotic rupture requiring screw fixation were compared to 40 patients with an intact syndesmosis. Olerud-Molander-Ankle-Score, American Orthopedic Foot & Ankle Society ankle hindfoot score, and the Short Form Health Survey-36 were recorded. Weight-bearing plain radiographs were performed to rate post traumatic osteoarthrosis according to the Kellgren-Lawrence score. Pain levels were evaluated with a visual analog scale. RESULTS: A total of 61 patients with a mean follow-up of 6.6 years (range=2-12 years) satisfied the inclusion criteria. Pain level, clinical outcome scores, and radiographs did not reveal significant differences between the groups. Ankle joints with syndesmotic rupture showed a significant restriction in dorsiflexion compared to those with an intact syndesmosis (15 vs. 20°, p=0.028). CONCLUSION: Syndesmotic rupture does not affect clinical and radiological outcome parameters following Weber B-type ankle fractures, but does lead to a significant restriction in dorsiflexion of the ankle joint.


Assuntos
Fraturas do Tornozelo/terapia , Traumatismos do Tornozelo/terapia , Articulação do Tornozelo/fisiopatologia , Parafusos Ósseos , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/fisiopatologia , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Radiografia , Recuperação de Função Fisiológica , Resultado do Tratamento
11.
J Foot Ankle Surg ; 58(2): 243-247, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30583836

RESUMO

Lateral hindfoot pain associated with stage 2 to 3 adult-acquired flatfoot is often attributed to subfibular impingement. Preoperative magnetic resonance imaging (MRI) is generally performed to assess the extent of degeneration within the posterior tibial tendon, attenuation of medial soft tissue constraints, and degeneration of hindfoot and/or ankle articulations. The purpose of this study is to determine the incidence of lateral collateral ligament disease/injury associated with stages 2 and 3 adult-acquired flatfoot. The subjects were identified using a searchable computerized hospital database between 2015 and 2017. Stage 2 or 3 adult-acquired flatfoot deformity was confirmed in patients via chart review and MRI analysis. Lateral ankle ligament injury was confirmed using patient MRI results per the hospital radiologist and documented within the patients' chart. Inclusion criteria required that patients be diagnosed with Johnson and Strom stage 2 or 3 flatfoot deformity with documented lateral ankle pain and that preoperative MRI scans be available with the radiologist's report. Patient exclusion criteria included patients <18 years of age, patients with flatfoot deformity caused by previous trauma, tarsal coalition, neuropathic arthritis, patients with previous surgery, or patients with incomplete medical records. In total, 118 patients were identified with these parameters. Of the 118 patients, 74 patients (62.7%) had documented lateral ankle ligament injury on MRI. Of the 77 patients with stage 2 adult-acquired flatfoot, 55 (71.4%) had confirmed lateral ankle ligament injury on MRI. Of the 41 patients with stage 3 adult-acquired flatfoot, 19 (46.3%) had confirmed lateral ankle ligament injury on MRI. This study demonstrates a relatively high incidence of lateral ligament disease associated with adult-acquired flatfoot deformity. These findings might have long-term implications regarding ankle arthritis after surgical management of adult-acquired flatfoot.


Assuntos
Deformidades Adquiridas do Pé/epidemiologia , Ligamentos Laterais do Tornozelo/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Disfunção do Tendão Tibial Posterior/cirurgia , Amplitude de Movimento Articular/fisiologia , Adulto , Idoso , Traumatismos do Tornozelo/complicações , Traumatismos do Tornozelo/diagnóstico por imagem , Estudos de Coortes , Intervalos de Confiança , Bases de Dados Factuais , Feminino , Pé Chato/diagnóstico por imagem , Pé Chato/etiologia , Pé Chato/cirurgia , Deformidades Adquiridas do Pé/etiologia , Deformidades Adquiridas do Pé/fisiopatologia , Humanos , Ligamentos Laterais do Tornozelo/fisiopatologia , Ligamentos Laterais do Tornozelo/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Disfunção do Tendão Tibial Posterior/complicações , Disfunção do Tendão Tibial Posterior/diagnóstico por imagem , Prevalência , Prognóstico , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Resultado do Tratamento
12.
Injury ; 49 Suppl 4: S58-S62, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30526950

RESUMO

The treatment of open distal tibia fractures remains challenging, particularly when the fracture involves severe soft tissue damage and segmental bone loss. We present the case of a 33-year-old woman who sustained an open distal tibia fracture type 43-A3.3, with segmental bone loss, and a closed bifocal fibular fracture. The fractures were initially fixed with a temporary external fixator. The open distal tibial fracture underwent an intramedullary nailing on day six post-trauma, while the segmental bone loss was refilled with a temporary cement spacer, in order to create a biologic chamber, according to the technique by Masquelet et al. At three months post-trauma, the temporary cement spacer was removed and the bone loss was filled with an autologous bone graft obtained with the Reaming Irrigation Aspiration (RIA) system. The fracture successfully healed at 13 months post-trauma. Masquelet technique, in association with the RIA system, represents a valid strategy in the treatment of non-infected open complex fracture of the distal tibia with severe bone and soft tissue loss.


Assuntos
Traumatismos do Tornozelo/cirurgia , Transplante Ósseo/métodos , Lesões por Esmagamento/cirurgia , Fixadores Externos , Fixação Intramedular de Fraturas , Fraturas Expostas/cirurgia , Fraturas da Tíbia/cirurgia , Adulto , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/fisiopatologia , Lesões por Esmagamento/diagnóstico por imagem , Lesões por Esmagamento/fisiopatologia , Feminino , Consolidação da Fratura/fisiologia , Fraturas Expostas/diagnóstico por imagem , Fraturas Expostas/fisiopatologia , Humanos , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/fisiopatologia , Transplante Autólogo , Resultado do Tratamento
13.
Radiol Clin North Am ; 56(6): 893-916, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30322489

RESUMO

Ankle impingement syndromes encompass various pathologic entities that contribute to ankle pain with limited range of motion. Although classically described in athletes, these changes can occur in individuals of all ages, often with a history of prior ankle trauma. Ankle impingement is broadly categorized as anterolateral, anterior, posterior, anteromedial, and posteromedial, depending on the area of the ankle affected. Both osseous and soft tissue abnormalities can contribute to impingement symptoms, and a combination of these is often present. Multiple imaging modalities have been evaluated in the work-up of suspected impingement, including radiography, CT, MR imaging, and ultrasound.


Assuntos
Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos em Atletas/diagnóstico por imagem , Articulação do Tornozelo/anatomia & histologia , Diagnóstico Diferencial , Humanos , Manejo da Dor , Medição da Dor , Recidiva , Fatores de Risco , Sensibilidade e Especificidade , Síndrome
14.
J Pediatr Orthop ; 38(9): e524-e529, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30199409

RESUMO

BACKGROUNDS: To evaluate the surgical management of a symptomatic subfibular ossicle after severe ankle sprain with functional instability and pain sequelae in children. METHODS: We analyzed 36 patients complaining of functional instability without laxity, 1 year after an ankle inversion trauma associated with the observation of a subfibular ossicle. We systematically suggested the open excision of the residual ossicles, followed by 6 weeks of immobilization and proprioceptive physiotherapy. Seventeen of them, constituting the "resection" group accepted this surgical approach. The remaining 19 patients, the "control" group, received only rehabilitative care. The American Orthopaedic Foot and Ankle Society ankle pain and function score was evaluated in both groups. RESULTS: The mean latest follow-up was 4 years and 4 months (range, 1 y 8 mo to 14 y 7 mo). A significant improvement of the American Orthopaedic Foot and Ankle Society score was observed and was significantly higher in the resection group with a mean gain of 31 points (SD=31.8), versus 7 points (SD=7) in the control group (P<0.001). CONCLUSIONS: We conclude that in the absence of objective laxity, excision of the os subfibulare appears as a simple and effective technique in the treatment of posttraumatic functional instability and ankle pain. LEVEL OF EVIDENCE: Level IV-retrospective case-control study.


Assuntos
Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Instabilidade Articular/cirurgia , Adulto , Traumatismos do Tornozelo/complicações , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/reabilitação , Articulação do Tornozelo/diagnóstico por imagem , Artralgia/cirurgia , Estudos de Casos e Controles , Criança , Feminino , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/reabilitação , Masculino , Modalidades de Fisioterapia , Estudos Retrospectivos
15.
J Pediatr Orthop ; 38(9): e530-e535, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30074589

RESUMO

BACKGROUND: Although subfibular ossicles have been linked to various clinical problems, whether its origin is congenital or traumatic remains unclear. The objectives of this study were to determine the incidence of subfibular ossicle formation after ankle inversion in children. METHODS: Among 896 pediatric patients who visited a single primary care unit after foot and ankle trauma, 593 patients sustaining ankle inversion injury were included in this study. For each pediatric patient, physical examination and radiographic examination were performed. The incidence of subfibular ossicle was evaluated based on initial radiographic examination. To analyze the incidence of unprecedented subfibular ossicle formation after ankle inversion injury, radiographs of 188 patients who were followed up for >6 months were evaluated according to the grade of initial injury. RESULTS: At initial visit, 1.0% of examined ankles (12 from 1186 ankles) showed well-corticated subfibular ossicle not related to initial injuries. Overall incidence of subfibular ossicle at final follow-up after ankle inversion injury was 39.4% (74/188). Incidence of subfibular ossicle at final follow-up was associated with initial injury grade. As for the morphology of ossicle, 93.2% (55/59) of cases with wafer bone fragment at the time of initial injury became oval or round-shaped subfibular ossicle at final radiograph. CONCLUSIONS: The chance of ossicle formation after ankle inversion injury was substantially high in pediatric population. On the basis of the findings of our study, we carefully suggest that majority, if not all, of subfibular ossicles would be posttraumatic in pediatric period. LEVEL OF EVIDENCE: Level IV-case series.


Assuntos
Traumatismos do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/fisiopatologia , Osteogênese , Adolescente , Articulação do Tornozelo/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Traumatismos do Pé/diagnóstico por imagem , Humanos , Masculino , Radiografia , Estudos Retrospectivos
17.
Rev. esp. med. nucl. imagen mol. (Ed. impr.) ; 37(3): 191-202, mayo-jun. 2018. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-174502

RESUMO

La patología del pie y tobillo es una de las más frecuentes del sistema musculoesquelético y de gran repercusión en la calidad de vida de los pacientes. El diagnóstico preciso supone un desafío clínico importante debido a que la compleja anatomía y la función del pie dificultan la localización del origen del dolor por un examen clínico de rutina. En el estudio de la patología del pie se han utilizado técnicas anatómicas (radiografía, resonancia magnética [RM], ultrasonido y tomografía computarizada [TC]) y funcionales (gammagrafía ósea [GO], tomografía de emisión de positrones [PET] y RM). La imagen híbrida combina las ventajas de los estudios morfológicos y funcionales de forma sinérgica, ayudando al clínico en la gestión de problemas complejos. En este artículo profundizamos en la anatomía y en la biomecánica del pie y tobillo y describimos las indicaciones potenciales de las técnicas hibridas actuales disponibles para el estudio de la patología del pie y tobillo


Disorders of the foot and ankle are some of the most frequent ones affecting the musculoskeletal system and have a great impact on patients’ quality of life. Accurate diagnosis is an important clinical challenge because of the complex anatomy and function of the foot, that make it difficult to locate the source of the pain by routine clinical examination. In the study of foot pathology, anatomical imaging (radiography, magnetic resonance imaging [MRI], ultrasound and computed tomography [CT]) and functional imaging (bone scan, positron emission tomography [PET] and MRI) techniques have been used. Hybrid imaging combines the advantages of morphological and functional studies in a synergistic way, helping the clinician manage complex problems. In this article we delve into the anatomy and biomechanics of the foot and ankle and describe the potential indications for the current hybrid techniques available for the study of foot and ankle disease


Assuntos
Humanos , Imagem Multimodal/métodos , Doenças do Pé/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Traumatismos do Tornozelo/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Fraturas do Tornozelo/diagnóstico por imagem , Ossos do Tarso/diagnóstico por imagem , Diagnóstico Precoce , Pé Diabético/diagnóstico por imagem , Doenças do Pé/fisiopatologia , Doenças do Pé/cirurgia , Imagem por Ressonância Magnética , Dor Musculoesquelética/diagnóstico por imagem , Dor Musculoesquelética/etiologia , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tornozelo/diagnóstico por imagem
18.
Br J Radiol ; 91(1088): 20170779, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29762056

RESUMO

OBJECTIVE: To evaluate if opposed-phase (OP) imaging obtained from the turbo spin echo (TSE) modified Dixon (mDixon) technique can increase the sensitivity of MRI for diagnosing ankle fractures. METHODS: This study included 95 CT-confirmed ankle fractures with additional MRI of the ankle using a TSE modified Dixon (mDixon) technique. Two groups of images were analyzed independently: Group 1-imaging group without OP imaging; Group 2-imaging group with OP imaging. Readers assessed the images using a 4-point confidence score to detect fractures. During the first review session, the fracture site was blinded. For the second review session, the fracture site was provided. Sensitivity and positive-predictive value were calculated. RESULTS: In both sessions, the sensitivity for Group 2 was significantly greater than that for Group 1 (Session 1: 76.3% vs 62.6%, p < 0.0001; Session 2: 80.5% vs 65.3%, p < 0.0001). The positive-predictive value of Group 2 was significantly lower in both sessions 1 and 2 (Session 1: 85.8% vs 97.5%, p < 0.0001; Session 2: 90.5% vs 96.9%, p = 0.0068). Among the 28 false-negative fractures missed in Group 1 (Session 1), 12 (9 minimal displaced and 4 small diameter fractures) were identified in Group 2 (Session 1). While 8.9% showed lower movement, 33.6% showed upper movement in Group 2 compared with Group 1. Possible causes of false-positive lesions were subcutaneous fat, bone marrow edema, and intraosseous vessel mimic fractures. CONCLUSION: OP imaging obtained using the modified Dixon technique provided better sensitivity and improved descriptions of fractures, especially for minimal displaced fractures and small diameter fractures. However, caution is required when diagnosing fractures with OP imaging because pseudofractures can appear as a result of adjacent bone marrow edema, vascular structures, or subcutaneous fat lobules. Advances in knowledge: In MRI, minimal displaced or small chip bone fracture maybe missed, OP imaging obtained using the mDixon technique provided better sensitivity and improved descriptions of fractures using the black boundary artifact.


Assuntos
Traumatismos do Tornozelo/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
19.
J Orthop Surg Res ; 13(1): 122, 2018 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-29788978

RESUMO

BACKGROUND: Various imaging techniques have been utilized for the diagnosis of chronic lateral ankle ligament injury. This systemic review will explore the effectiveness of different imaging techniques in diagnosing chronic lateral ankle ligament injury. METHODS: Relative studies were retrieved after searching 3 databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trails). Eligible studies were summarized. Data were extracted to calculate pooled sensitivity and specificity of magnetic resonance imaging (MRI), ultrasonography (US), stress radiography, and arthrography. RESULTS: Fifteen studies met our inclusion and exclusion criteria. A total of 695 participants were included. The pooled sensitivities in diagnosing chronic ATFL injury were 0.83 [0.78, 0.87] for MRI, 0.99 [0.96, 1.00] for US, and 0.81 [0.68, 0.90] for stress radiography. The pooled specificities in diagnosing chronic ATFL injury were 0.79 [0.69, 0.87] for MRI, 0.91 [0.82, 0.97] for US, and 0.92 [0.79, 0.98] for stress radiography. The pooled sensitivities in diagnosing chronic CFL injury were 0.56 [0.46, 0.66] for MRI, 0.94 [0.85, 0.98] for US, and 0.90 [0.73, 0.98] for arthrography. The pooled specificities in diagnosing chronic CFL injury were 0.88 [0.82, 0.93] for MRI, 0.91 [0.80, 0.97] for US, and 0.90 [0.77, 0.97] for arthrography. CONCLUSION: This systematic review with meta-analysis investigated the accuracy of imaging for the diagnosis of chronic lateral ankle ligament injury. Ultrasound manifested high diagnostic accuracy in diagnosing chronic lateral ankle ligament injury. Clinicians should be aware of the limitations of MRI in detecting chronic CFL injuries.


Assuntos
Traumatismos do Tornozelo/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/lesões , Imagem por Ressonância Magnética/normas , Artrografia/métodos , Artrografia/normas , Estudos de Casos e Controles , Doença Crônica , Humanos , Imagem por Ressonância Magnética/métodos
20.
J Orthop Surg Res ; 13(1): 95, 2018 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-29678138

RESUMO

BACKGROUND: To improve the diagnostic accuracy of distal tibiofibular syndesmoses (DTS), this study quantified the range in variations of the normal DTS in a Chinese population, based on CT scan images. METHODS: The study population comprised 92 patients with unilateral ankle injury. CT scans included the non-injured contralateral DTS. The position of the fibula relative to the fibular notch (incisure) of the tibia was quantified by inclusion or separation indices, based on whether the fibula was within or outside the fibular incisure, respectively. The patients were apportioned accordingly to either a DTS contained- or separate-type group (average ages 45 and 42.1 years, respectively; 19 men/26 women and 24 men/23 women). Further variations in the position of the fibula relative to the tibia were quantified with length, anterior, and posterior indices. RESULTS: The baseline characteristics of the contained- and separate-type groups were statistically comparable. The length, anterior, extra-anterior, posterior, and extra-posterior indices were successfully calculated. The anterior index of the contained group was significantly greater than that of the separated group, while the posterior index was significantly less. CONCLUSIONS: This study provides measurements of the normal tibiofibular syndesmosis in a Chinese population. In individuals whose fibula lay within the fibular incisure of the tibia, the fibula was likely to be more anterior than that of individuals whose fibula lay outside the incisure. Offered as a reference, these data should improve diagnosis of injury of the DTS.


Assuntos
Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/epidemiologia , Articulação do Tornozelo/diagnóstico por imagem , Antropometria/métodos , Vigilância da População , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
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