Ankle Stiffness Research Articles

Description of orthotic properties and effect evaluation of ankle-foot orthoses in non-spastic calf muscle weakness.

To describe the orthotic properties and evaluate the effects of ankle-foot orthoses for calf muscle weakness in persons with non-spastic neuromuscular disorders compared with shoes-only. Cross-sectional study. Thirty-four persons who used ankle-foot orthoses for non-spastic calf muscle weakness. The following orthotic properties were measured: ankle-foot orthosis type, mass, and ankle and footplate stiffness. For walking with shoes-only and with the ankle-foot orthoses, walking speed, energy cost and gait biomechanics were assessed. Four types of ankle-foot orthosis were identified: shaft-reinforced orthopaedic shoes (n = 6), ventral ankle-foot orthoses (n = 10), dorsal leaf ankle-foot orthoses (n = 12) and dorsiflexion-stop ankle-foot orthoses (n = 6). These types differed significantly with regards to mass, ankle-and footplate stiffness. Compared with shoes-only, all ankle-foot orthoses/orthopaedic shoes groups combined increased walking speed by 0.18 m/s (95% confidence interval (95% CI) 0.13-0.23), reduced energy cost by 0.70 J/kg/m (95% CI 0.48-0.94) and limited ankle dorsiflexion by -3.0° (95% CI 1.3-4.7). Higher ankle-foot orthoses ankle stiffness correlated with greater reductions in walking energy cost and maximal ankle dorsiflexion angle. Ankle-foot orthoses for persons with non-spastic calf muscle weakness vary greatly in properties and effects on gait. The large variation in effectiveness may be due to differences in ankle stiffness, although this requires further prospective evaluation.

Quality of life, function and disability in individuals with chronic ankle symptoms: a cross-sectional online survey

BackgroundChronic ankle conditions affect approximately 20% of Australian adults. Although there is a plethora of research on chronic hip and knee conditions, there is limited understanding of the impact of ankle problems. Thus, the significance of chronic ankle conditions is not clear. The aim of this study was to compare self-reported function, disability, instability, physical activity and quality of life (QoL) between adults with and without ankle symptoms. A secondary aim was to explore factors associated with QoL.MethodIndividuals with symptoms of ankle pain and stiffness (symptomatic individuals) and controls with no ankle pain or stiffness (asymptomatic individuals) completed a cross-sectional online survey. The survey included the Ankle Osteoarthritis Scale (AOS), Foot and Ankle Ability Measure (FAAM), Cumberland Ankle Instability Tool (CAIT), International Physical Activity Questionnaire (IPAQ), Assessment of QoL (AQoL-6D), and questions about ankle injury history.ResultsA total of 394 individuals (270 symptomatic and 124 asymptomatic) with mean age of 48.8 (standard deviation (SD): 12.1) years and body mass index of 28.7 (7.7) kgm− 2 completed the survey. Standardized mean differences (SMD) were large to very large (1.45 to 3.20) for greater disability (AOS) and instability (CAIT), and poorer function (FAAM) in symptomatic compared to asymptomatic individuals. Individuals with ankle symptoms had higher body mass index and lower QoL (medium effect: SMD > 1). There were no differences in self-report physical activity between groups. Lower activities of daily living (ADL) function (FAAM-ADL) best explained QoL in a multiple regression model (R2 = 0.66, p = 0.001).ConclusionIndividuals with ankle symptoms reported ankle instability, greater disability, compromised function and worse QoL compared to asymptomatic individuals. There was a strong relationship between ankle function and QoL. Ankle-specific ability during ADL best explained the reduced QoL in individuals with ankle symptoms. Clinicians and researchers should consider ankle function as an antecedent to poorer QoL in patients who have ankle symptoms.

A comparative study of intramedullary interlocking nailing and minimally invasive plate osteosynthesis in extraarticular distal tibia fractures

Introduction: Distal tibial fractures are very commonly encountered by orthopaedic surgeons. They are one of the perplexing injuries encountered due to its poor blood supply and limited soft tissue cover. Our aim is to study and compare clinical and radiological outcome in extra articular fractures of distal tibia treated by IMILN and MIPPO locking compression plates with reference to rate of healing, functional outcome, and complications. Material and Methods: This was a prospective observational study, with a sample size of 30, 15 randomly assigned to MIPPO group and the remaining to the IM nailing group. The patients one year with clinical and radiological assessment. The data was then recorded in a semi-structured pro forma and entered in an MS Excel Spreadsheet. Statistical analysis was performed using SPSS v20. Results: Most of the population was over the age of 55 years for IMILN group, but younger in MIPPO i.e. 30-55 years. The most common mode of injury was RTA in both the study groups. 80% cases of IMILN had associated fibular fracture compared to 46.7% in the MIPPO group. Average time for fracture union was 5.4 months in IMILN group vs 65.3 months in the MIPPO group, which was not statistically significant. We observed fewer complications in terms of implant irritation, ankle stiffness and infection (superficial and deep) were seen in interlocking group as compared to plating group. Conclusion: MIPPO with a medial distal tibial locking plate and closed reduction with intramedullary nailing are equally viable options for management of extra-articular fractures of the distal tibia.

A comparative study of management of distal one third tibia fracture by low multidirectional locked nail and minimally invasive plate osteosynthesis (MIPO)

Background: The distal tibia fractures are mainly due to road traffic accident, fall from height and sometimes twisting of ankle. Fractures around the ankle joint are difficult to manage because of precarious vascularity in nature. In addition it is in subcutaneous location which adds to further difficulty in the fracture management. Internal fixation devices such as locking intramedullary nails, locking compression plates are mainly used for the fracture fixation of distal tibia. It is critical to understand the fracture pattern occurring in the distal tibia and the form of fixation available. Methods: A comparative study of management of fracture of distal one third tibia with low multidirectional locked nail and plating by MIPO was undertaken among 57 patients with extra-articular distal tibia fractures, in the department of orthopaedics, IMS & SUM Hospital, Bhubaneswar from June 2017 to June 2019. The Patients were followed up for clinical and radiological evaluation. The final results at the end of 1 year follow-up were evaluated using the Kaikkonen ankle score and Lysholm knee scoring system as excellent, good, fair, and poor. Results: In IMLN group, mean time for union was 4.60+/-0.60months compared to 6.22+/-2.32 months in plating group which was significant (P=0.0018). Less complications in terms of delayed union, nonunion and incidence of infection and ankle stiffness, were seen in interlocking group as compared to plating group (P=0.001). Conclusion: It is observed that low multidirectional locked nailing is better in terms of early total weight bearing, early union, and decreased risks of complications. Thus, it is a better choice for patient undergoing the treatment for extra- articular distal one third tibia fractures.

Minimally invasive percutaneous plate osteosynthesis (MIPPO) in treatment of distal meta-physeal fractures of tibia: A study on Complications

‘Biological’ internal fixation avoids the need for precise reduction, especially of the intermediate fragments, and takes advantage of indirect reduction. This principle applies equally to locked nailing, bridge plating, and internal fixator-like devices. Indirect reduction aims only to align the fragments. It avoids exposure of the bone thus reducing the surgical trauma. Flexible fixation is advocated to induce formation of callus and is achieved by using wide bridging of the area of the fracture. The patients were followed up at intervals of three weeks for up to 6-10 months to assess the radiological union. After the 1st follow up of 4 weeks patient is allowed to partially bear weight. The fracture was designated as united, when there was periosteal bridging callus at the fracture site at least in three cortices in the antero-posterior and lateral views. Trabeculations extending across the fracture site was also taken into consideration. Partial and full weight bearing were allowed. Two of the patients developed superficial skin infections, which were treated with daily dressings and appropriate antibiotics according to the culture and sensitivity reports. All the infections subsided on the above said treatment. We had 1 patient with ankle stiffness. Probably due to the lack of compliance to the advised physiotherapy at home after discharge of the patient. Ankle stiffness ranged from restriction of ankle movement from 20-40%.

The influence of sagittal trunk lean on uneven running mechanics.

The role of trunk orientation during uneven running is not well understood. This study compared the running mechanics during the approach step to and the step down for a 10 cm expected drop, positioned halfway through a 15 m runway, with that of the level step in 12 participants at a speed of 3.5 m s-1 while maintaining self-selected (17.7±4.2 deg; mean±s.d.), posterior (1.8±7.4 deg) and anterior (26.6±5.6 deg) trunk leans from the vertical. Our findings reveal that the global (i.e. the spring-mass model dynamics and centre-of-mass height) and local (i.e. knee and ankle kinematics and kinetics) biomechanical adjustments during uneven running are specific to the step nature and trunk posture. Unlike the anterior-leaning posture, running with a posterior trunk lean is characterized by increases in leg angle, leg compression, knee flexion angle and moment, resulting in a stiffer knee and a more compliant spring-leg compared with the self-selected condition. In the approach step versus the level step, reductions in leg length and stiffness through the ankle stiffness yield lower leg force and centre-of-mass position. Contrariwise, significant increases in leg length, angle and force, and ankle moment, reflect in a higher centre-of-mass position during the step down. Plus, ankle stiffness significantly decreases, owing to a substantially increased leg compression. Overall, the step down appears to be dominated by centre-of-mass height changes, regardless of having a trunk lean. Observed adjustments during uneven running can be attributed to anticipation of changes to running posture and height. These findings highlight the role of trunk posture in human perturbed locomotion relevant for the design and development of exoskeleton or humanoid bipedal robots.

Determining the relationship between physical status and musculoskeletal injuries in children: a cohort study.

Background: In Japan, in 2016, the School Health and Safety Act was revised and examination of extremities in addition to scoliosis became mandatory. Musculoskeletal examinations were subsequently started using a mark sheet-type questionnaire. In the present study, we aimed to analyze the relationship between physical findings and musculoskeletal problems and propose a preventive strategy for musculoskeletal injuries.Methods: In 2017, a total of 4,073 elementary and middle school students underwent direct musculoskeletal examination. In a direct examination, the following elements were included: torticollis; scoliosis; stiffness of the shoulder, elbow, hip, knee, and ankle; flexion and extension in standing position; flat foot; hallux valgus; and alignment of the upper and lower extremities. Of the 4,073 students who underwent direct examination in early 2017, only 3,754 were able to complete the mark sheet-type questionnaires in early 2018. A prospective longitudinal analysis of the data gathered was performed.Results: A total of 396 (11%) students had injuries. The ankle sprain/non-ankle sprain group comprised 119 (3%)/3,635 (97%) students, while the fracture/non-fracture group comprised 105 (2.8%)/3,650 (97.2%) students, respectively. Comparing the sprain group with the non-sprain group, ankle stiffness significantly correlated with ankle sprain in the univariable and multivariable analyses. Injuries occurred more frequently among boys, older students, students with stiff bodies, and students who were involved in sports activities of longer duration.Conclusion: Ankle stiffness was assumed to be a risk factor for ankle sprain. Stretching of the ankle might be effective for preventing ankle sprain. However, further interventional studies are needed to confirm this finding.

Treatment of distal tibial fractures using locked plates: low contact dynamic compression plate

Background Distal tibial fracture accounts for approximately three per 10 000 women/year plus 28 per 10 000 men/year. Conservative treatment often results in malunion, nonunion, and ankle stiffness. Moreover, surgery faces challenge of difficult rigid fixation of the relatively short distal fragment, plus poor soft tissues and blood supply at the distal tibia. New modalities for overcoming these problems have recently been developed, including locked plates technology, which allows buttressing of the distal fragment by multiple locked screws, which are introduced by fixed different angles creating fixed-angle stability. Aim To evaluate the outcome of using distal tibial locked plate in fixation of closed extraarticular distal tibial fractures through minimally invasive plate osteosynthesis (MIPO) technique. Patients and methods A prospective study was conducted on 30 patients with distal tibial fracture fixed by distal tibial locked plate in Cairo University Hospital from January 2013 to September 2015. The mean age in the study was 39.7 years. Overall, 40% were females, whereas 60% were males. This study included 18 (60%) cases of type AO 43-A1, with mean healing time of 3.2 months; seven (23%) cases of AO 43-A2, with mean healing time of 6.75 months (one of them revised by another locked plate and grafting, so healed after 11 months); and five (17%) cases AO 43-A3, with mean healing time 3.6 months. One case was not united, and seven cases showed delayed union after 4–6 months. Two cases showed superficial infection, which resolved with antibiotics; one case developed deep infection, which necessitated serial surgical debridement for four times, with removal of plate in the last one and rotational flab coverage; and five cases showed angulations (four of them showed 5° angulation in anteroposterior plane, where one of the them showed in addition 10° posterior angulation, which was considered unacceptable, but the patient refused revision, whereas the fifth case had pure posterior angulation of 5°). Results Ankle range of motion (ROM) evaluation according to Ovadia score was as follows: 67% of cases were excellent, 13% of them were good, and 20% were fair; with mean ankle ROM being restored 70% of the normal side. Conclusion Locked plate is a comparable modality for distal tibial fractures to the new nailing systems and is superior to the convention ones in the rates of union and good alignment. Although concurrent fibular fixation did not prevent lateral angulations in some cases, fixation of the distal tibia alone with locked plate prevented angulation in others.

Ultrasound-Guided Aspiration and Steroid Injection for Postsurgical Ankle Stiffness and Pain

Ultrasound-Guided Aspiration and Steroid Injection for Postsurgical Ankle Stiffness and Pain

Medial Gastrocnemius Muscle Architecture Is Altered After Exhaustive Stretch-Shortening Cycle Exercise.

Muscle architecture is an important component of muscle function, and recent studies have shown changes in muscle architecture with fatigue. The stretch-shortening cycle is a natural way to study human locomotion, but little is known about how muscle architecture is affected by this type of exercise. This study investigated potential changes in medial gastrocnemius (MG) muscle architecture after exhaustive stretch-shortening cycle exercise. Male athletes (n = 10) performed maximal voluntary contractions (MVC) and maximal drop jump (DJ) tests before and after an exercise task consisting of 100 maximal DJs followed by successive rebound jumping to 70% of the initial maximal height. The exercise task ceased upon failure to jump to 50% of maximal height or volitional fatigue. Muscle architecture of MG was measured using ultrasonography at rest and during MVC, and performance variables were calculated via a force plate and motion analysis. After SSC exercise, MVC (−13.1%; p = 0.005; dz = 1.30), rebound jump height (−14.8%, p = 0.004; dz = 1.32), and ankle joint stiffness (−26.3%; p = 0.008; dz = 1.30) decreased. Ankle joint range of motion (+20.2%; p = 0.011; dz = 1.09) and MG muscle-tendon unit length (+12.0%; p = 0.037; dz = 0.91) during the braking phase of DJ, the immediate drop-off in impact force (termed peak force reduction) (Δ27.3%; p = 0.033; dz = 0.86), and lactate (+9.5 mmol/L; p < 0.001; dz = 3.58) increased. Fascicle length increased at rest (+4.9%; p = 0.013; dz = 1.16) and during MVC (+6.8%; p = 0.048; dz = 0.85). Pennation angle decreased at rest (−6.5%; p = 0.034, dz = 0.93) and during MVC (−9.8%; p = 0.012; dz = 1.35). No changes in muscle thickness were found at rest (−2.6%; p = 0.066; dz = 0.77) or during MVC (−1.6%; p = 0.204; dz = 0.49). The greater MG muscle-tendon stretch during the DJ braking phase after exercise indicates that muscle damage likely occurred. The lower peak force reduction and ankle joint stiffness, indicative of decreased active stiffness, suggests activation was likely reduced, causing fascicles to shorten less during MVC.

Changes in Ground Reaction Forces, Joint Mechanics, and Stiffness during Treadmill Running to Fatigue

Purpose: This study aimed to determine the changes in lower extremity biomechanics during running-induced fatigue intervention. Methods: Fourteen male recreational runners were required to run at 3.33 m/s until they could no longer continue running. Ground reaction forces (GRFs) and marker trajectories were recorded intermittently every 2 min to quantify the impact forces and the lower extremity kinematics and kinetics during the fatiguing run. Blood lactate concentration (BLa) was also collected before and after running. Results: In comparison with the beginning of the run duration, (1) BLa significantly increased immediately after running, 4 min after running, and 9 min after running; (2) no changes were observed in vertical/anterior–posterior GRF and loading rates; (3) the hip joint range of motion (θROM) significantly increased at 33%, 67%, and 100% of the run duration, whereas θROM of the knee joint significantly increased at 67%; (4) no changes were observed in ankle joint kinematics and peak joint moment at the ankle, knee, and hip; and (5) vertical and ankle stiffness decreased at 67% and 100% of the run duration. Conclusion: GRF characteristics did not vary significantly throughout the fatiguing run. However, nonlinear adaptations in lower extremity kinematics and kinetics were observed. In particular, a “soft landing” strategy, achieved by an increased θROM at the hip and knee joints and a decreased vertical and ankle stiffness, was initiated from the mid-stage of a fatiguing run to potentially maintain similar impact forces.

Effectiveness of Joint Stiffness and Power Alternations in Different Shoe Insole Hardness on Injury Prevention During Jump-landing

PurposeStudies on how the shoe insole hardness regulate joint stiffness and transfer energy in the lower extremity during jump landing are scarce. The current study aimed to determine the effectiveness of shoe insole changes in joint power and stiffness during landing from jumps. MethodsFifteen healthy male athletes volunteered to perform jump-landing in various shoe insole conditions. Kinematics and kinetics data were examined to calculate joint stiffness and peak negative power (absorbing power).ResultsThe shoe insole hardness significantly affected ankle joint stiffness (P≤0.05). Furthermore, enhanced shoe inserts hardness increased ankle joint stiffness. Moreover, soft insole significantly increased negative peak power, compared to the hard insole condition (P=0.01). ConclusionIncreasing the shoe insert hardness can higher affect the distal ankle joint, compared to the proximal joints. However, landing with soft shoe insoles increased the negative joint power during landing; it implied neuromuscular adaptation in response to the impact signals and elevated eccentric force by the knee extensors.

Anticipatory coadaptation of ankle stiffness and sensorimotor gain for standing balance.

External perturbation forces may compromise standing balance. The nervous system can intervene only after a delay greater than 100 ms, during which the body falls freely. With ageing, sensorimotor delays are prolonged, posing a critical threat to balance. We study a generic model of stabilisation with neural delays to understand how the organism should adapt to challenging balance conditions. The model suggests that ankle stiffness should be increased in anticipation of perturbations, for example by muscle co-contraction, so as to slow down body fall during the neural response delay. Increased ankle muscle co-contraction is indeed observed in young adults when standing in challenging balance conditions, and in older relative to young adults during normal stance. In parallel, the analysis of the model shows that increases in either stiffness or neural delay must be coordinated with decreases in spinal sensorimotor gains, otherwise the feedback itself becomes destabilizing. Accordingly, a decrease in spinal feedback is observed in challenging conditions, and with age-related increases in neural delay. These observations have been previously interpreted as indicating an increased reliance on cortical rather than spinal control of balance, despite the fact that cortical responses have a longer latency. Our analysis challenges this interpretation by showing that these observations are consistent with a functional coadaptation of spinal feedback gains to functional changes in stiffness and neural delay.

The effects of ankle stiffness on mechanics and energetics of walking with added loads: a prosthetic emulator study

BackgroundThe human ankle joint has an influential role in the regulation of the mechanics and energetics of gait. The human ankle can modulate its joint ‘quasi-stiffness’ (ratio of plantarflexion moment to dorsiflexion displacement) in response to various locomotor tasks (e.g., load carriage). However, the direct effect of ankle stiffness on metabolic energy cost during various tasks is not fully understood. The purpose of this study was to determine how net metabolic energy cost was affected by ankle stiffness while walking under different force demands (i.e., with and without additional load).MethodsIndividuals simulated an amputation by using an immobilizer boot with a robotic ankle-foot prosthesis emulator. The prosthetic emulator was controlled to follow five ankle stiffness conditions, based on literature values of human ankle quasi-stiffness. Individuals walked with these five ankle stiffness settings, with and without carrying additional load of approximately 30% of body mass (i.e., ten total trials).ResultsWithin the range of stiffness we tested, the highest stiffness minimized metabolic cost for both load conditions, including a ~ 3% decrease in metabolic cost for an increase in stiffness of about 0.0480 Nm/deg/kg during normal (no load) walking. Furthermore, the highest stiffness produced the least amount of prosthetic ankle-foot positive work, with a difference of ~ 0.04 J/kg from the highest to lowest stiffness condition. Ipsilateral hip positive work did not significantly change across the no load condition but was minimized at the highest stiffness for the additional load conditions. For the additional load conditions, the hip work followed a similar trend as the metabolic cost, suggesting that reducing positive hip work can lower metabolic cost.ConclusionWhile ankle stiffness affected the metabolic cost for both load conditions, we found no significant interaction effect between stiffness and load. This may suggest that the importance of the human ankle’s ability to change stiffness during different load carrying tasks may not be driven to minimize metabolic cost. A prosthetic design that can modulate ankle stiffness when transitioning from one locomotor task to another could be valuable, but its importance likely involves factors beyond optimizing metabolic cost.

Visuomotor Ankle Training on a Stiffness-Controlled Robotic Platform Improves Ankle Motor Control and Lower Extremity Function in Chronic Stroke Survivors

This study demonstrated the feasibility of a 6-week, visuomotor ankle training program using a stiffness-controlled, 2 degree-of-freedom robotic platform and investigated its effectiveness on paretic ankle motor control and lower extremity function in patients with stroke. In this feasibility study, two chronic stroke survivors with right hemiparesis participated in the training involving ankle motor control for 12 sessions over 6 weeks. While standing on a compliant robotic platform that simulated rotational stiffness comparable to the ankle joint stiffness of unimpaired individuals, participants performed visually-guided target reaching ankle movement tasks in the sagittal and frontal planes, i.e., dorsiflexion, plantarflexion, inversion, and eversion directions, totaling 160 trials per session. Both participants successfully completed the 6-week training without any discomfort or safety issues. This visuomotor ankle training on the compliant robotic platform contributed to the significant improvement of paretic ankle motor control, evidenced by less variable, smoother, and faster ankle movements. At the conclusion of the training, a significant improvement in the fast walking speed was observed in both participants (over 20% in one subject and over 50% in the other), validating clinical relevance of the training. The Berg Balance Scale score evaluating postural balance was also improved, but only one subject showed a clinically significant improvement (8 points), while the other did not reach the clinical significance (2 points). These results suggest the potential benefits of the visuomotor ankle training program using a stiffness-controlled robotic platform to patients with stroke by providing a desirable therapeutic target towards improved ankle motor control and lower extremity function.

Changes in joint, muscle, and tendon stiffness following repeated hopping exercise.

The purpose of this study was to elucidate the mechanisms of decline in joint stiffness after repeated stretch‐shortening cycle exercises according to changes in both muscle‐tendon properties and neuromuscular activities. Eleven males performed fatigue task (5 sets of 50 hopping). Ankle joint stiffness and electromyographic activities (mEMG) of plantar flexor and tibial anterior muscles during drop jump were measured before and after fatigue task. Active muscle stiffness with (100 deg·sec−1) and without (250 deg·sec−1) stretch reflex were calculated according to changes in estimated muscle force and fascicle length during fast stretching after submaximal isometric contractions. Tendon stiffness was measured during ramp and ballistic contractions. After fatigue task, joint stiffness significantly decreased by 20.7 %, whereas mEMG of measured muscles during drop jump did not. After fatigue task, active muscle stiffness with and without stretch reflex significantly decreased by 15.7 % and 21.5 %, and tendon stiffness measured during ramp and ballistic contractions did not change. In addition, the relative change in joint stiffness was significantly correlated with that in active muscle stiffness with stretch reflex (r = 0.737, P = 0.009), but not with those in the other measured variables. These results suggested that the decline in joint stiffness after repeated hopping exercises would be caused by changes in active muscle stiffness, but not those in tendon properties or neuromuscular activities.

Treatment of Open Comminuted Diaphyseal Fracture of the Tibia by Ilizarov

Background: Management of open diaphyseal tibial shaft fractures can be comminuted due to lack of soft tissue coverage and blood supply of the tibial shaft. Open reduction and internal fixation [ORIF] with plates and screws achieves stability, allows joint mobilization but does not allow early weight bearing which as a stimulus is a must for early union. Closed reduction and intramedullary fixation compromise the intramedullary blood supply and increases the risk of infection in open fractures. Ilizarov is considered safe in treating these open injuries, at the same time it has the advantages of easy application, minimal invasive, and convenient subsequent soft tissue repair. Objective: The aim of current study was to evaluate treatment of open comminuted diaphyseal tibial fracture by ilizarov external fixator; its effective, availability, outcomes and complications. Patients and Methods: This prospective study included a total of 10 patients with comminuted tibial diaphyseal fractures managed with early Ilizarov external fixator, attending at Alharam Hospital. This study was conducted between Feb 2018 and July 2019. General assessment indicators included pain, complete union, deformity in comparison to healthy limb, infection, leg limb discrepancy, stiffness and activity of the patients were analysed. Results: Follow-up of all participants for analysis was done. The follow-up time was 17 months. Three cases developed ankle stiffness. The average total range of knee motion in our cases was 130.5 (range 125-140). A significant limp occurred only in 3 cases. NO persistent limp persisted in our cases. Fifteen patients had minimal pain at the site of fracture. Signicant pain occurred in three cases. Pin site infection occurred in 7 patients. All the patients achieved full union and activity. Excellent results were obtained in 4 cases (40%). Good results were obtained in 3 cases (30%) with overall good to excellent results were about (70%). Fair results were obtained in 3 cases (30%). Conclusion: It could be concluded that the Ilizarov external fixator is a golden horse for orthopedic surgeons. It holds wonderful promise in the management of open diaphyseal tibial shaft fractures.

Functional outcome of distal tibia fracture treated with locking compression plate using minimally invasive percutaneous plate osteosynthesis technique (MIPPO): A prospective study

Introduction: Treating distal tibia fracture is a greater challenge for surgeons to manage even today. The difficulty is due to its poor blood supply and limited soft tissue envelope. Various techniques are now available for the treatment of tibia fractures. The occurrence of implant failure, skin necrosis, infection and malunion are high in case of distal tibia fractures. Aims/Objective: Our aimed was to analyze the functional outcome of distal tibia fractures treated by MIPPO Technique using the American Orthopedic Foot and Ankle Society Score. Method: A total of 20 patients of a closed distal Tibia fracture were studied by us with a MIPO with LCP Technique in Department of Orthopedics at DYP Medical College and hospital Kolhapur during the period from June 2017 and June 2019 and were prospectively followed for average duration of 16 months (6-24 months). Results: In our study the mean age of patients was 43 out of which 65% was male and 35% was female. Functional outcome was measured using the AOFAS score and mean AOFAS score was 84.45 at the end of 6 months. Under our study out of 20 patients 4 had excellent outcome, 14 had good result, 2 had acceptable result on basis of AOFAS score. Conclusion: MIPPO is an effective method of treatment for distal tibia fractures because it offers a Bio-logical advantage by preserving periosteal blood supply and combine with C-arm guidance helps in indirect reduction of distal tibia fracture in restoring length an alignment, thus reducing the chances of malunion and deformities. It helps in early mobilization of ankle movement and reduces the ankle stiffness thus improving clinical and functional outcome.

Role of Total Ankle Arthroplasty in Stiff Ankles – Long Term Follow-Up

Category:Ankle, Ankle ArthritisIntroduction/Purpose:Operative treatment of end-stage ankle arthritis involves either ankle arthrodesis (AA) or total ankle arthroplasty (TAA). The theoretical benefit of TAA is the ability to preserve range of motion (ROM) at the tibiotalar joint.Previous studies have questioned whether it is justified to perform TAA over AA in stiff, arthritic ankles. However, a recent study showed that patients who underwent TAA with stiff ankles preoperatively experienced significant clinical improvement in range of motion and gait function compared to more flexible groups at 1-year follow-up. We retrospectively assessed these same gait and functional parameters to see if these improvements held up in long-term follow-up.Methods:A retrospective study of long-term, prospectively collected functional gait data in 33 TAA patients at a mean of 7.6 years postoperatively (range 4.8-13.3) used a multivariate regression model to determine the effect of ankle stiffness on the long- term, objective outcomes of TAA. Data was analyzed by quartiles (Q1, Q2+Q3, Q4) of preoperative sagittal ROM using one-way analysis of variance (ANOVA) to compare both preop and postop gait parameters. The two middle quartiles were combined to conform to distribution of the data. The multivariate analysis determined the independent effect of age, gender, BMI, years post- surgery, and preop ROM on every preop and postop parameter of gait.Results:Statistically significant differences were found in all three gait parameter categories, including temporal-spatial (step length and walking speed), kinematic (total sagittal ROM and maximum plantarflexion), and kinetic (peak ankle power). The stiffest ankles preoperatively (Q1) had the greatest absolute increase in total sagittal ROM postoperatively, +5.3o, compared to -1.3o (p<0.0174) in Q4 (most flexible). However, Q1 had the lowest absolute total postoperative sagittal ROM of 13.1 o, compared to 19.7 o (p<0.0108) in Q4. Q1 also had the lowest preoperative step length, walking speed, maximal plantarflexion, and peak ankle power when compared to the other subgroups. There was no difference in any of these same parameters postoperatively. BMI and years post-surgery had no effect on outcomes, while age and gender had a minimal effect.Conclusion:Preoperative range of motion was once again predictive of overall postoperative gait function in long-term follow-up at an average of 7.2 years. A greater degree of preoperative sagittal range of motion was predictive of greater postoperative sagittal range of motion in long-term follow-up. Patients with the stiffest ankles preoperatively once again had a statistically and clinically greater improvement in function as measured by multiple parameters of gait. This shows that the clinically meaningful improvement in gait function after total ankle arthroplasty holds up in long-term follow-up, even in the setting of limited preoperative sagittal range of motion.

Treatment of Open Comminuted Diaphyseal Fracture of the Tibia by Ilizarov

Background: Management of open diaphyseal tibial shaft fractures can be comminuted due to lack of soft tissue coverage and blood supply of the tibial shaft. Open reduction and internal fixation [ORIF] with plates and screws achieves stability, allows joint mobilization but does not allow early weight bearing which as a stimulus is a must for early union. Closed reduction and intramedullary fixation compromise the intramedullary blood supply and increases the risk of infection in open fractures. Ilizarov is considered safe in treating these open injuries, at the same time it has the advantages of easy application, minimal invasive, and convenient subsequent soft tissue repair. Objective: The aim of current study was to evaluate treatment of open comminuted diaphyseal tibial fracture by ilizarov external fixator; its effective, availability, outcomes and complications. Patients and Methods: This prospective study included a total of 10 patients with comminuted tibial diaphyseal fractures managed with early Ilizarov external fixator, attending at Alharam Hospital. This study was conducted between Feb 2018 and July 2019. General assessment indicators included pain, complete union, deformity in comparison to healthy limb, infection, leg limb discrepancy, stiffness and activity of the patients were analysed. Results: Follow-up of all participants for analysis was done. The follow-up time was 17 months. Three cases developed ankle stiffness. The average total range of knee motion in our cases was 130.5 (range 125-140). A significant limp occurred only in 3 cases. NO persistent limp persisted in our cases. Fifteen patients had minimal pain at the site of fracture. Signicant pain occurred in three cases. Pin site infection occurred in 7 patients. All the patients achieved full union and activity. Excellent results were obtained in 4 cases (40%). Good results were obtained in 3 cases (30%) with overall good to excellent results were about (70%). Fair results were obtained in 3 cases (30%). Conclusion: It could be concluded that the Ilizarov external fixator is a golden horse for orthopedic surgeons. It holds wonderful promise in the management of open diaphyseal tibial shaft fractures.