Ankle Level Research Articles

Peripheral nerve blocks for the management of lumbo-sacral radiculopathy: A prospective study.

The epidural injections used to treat lumbar radiculopathy are potentially associated with serious complications like neurological injuries and epidural abscess. The nociceptors have the unique property of being pseudo-unipolar, as its both ends are expected to be functionally same. We have hypothesized that peripheral nerve blocks given at the distal site should be able to provide pain relief. This prospective study was planned to assess the efficacy of peripheral nerve blocks in lumbar radiculopathy. Thirty-four patients who fit the eligibility criteria were included in this open labeled prospective preliminary study. They were administered peripheral nerve blocks at ankle level with 4 ml of 0.25% bupivacaine and 40 mg of triamcinolone. The outcomes measured at 15 days, 1 month, 2 months, and 3 months after the intervention were the pain intensity (Numerical Rating Scale), the Global Perceived Effect, functional status (Roland Morris Disability Questionnaire), Beck's Depression Inventory score, employment status, and analgesic intake. At 15 days, 1 month, and 2 months, 88% of the patients reported a ≥50% decrease in their pain scores and a GPE ≥6, while at 3 months 85% of the patients reported a significant decrease in their pain scores and a GPE ≥6. Peripheral nerve blocks are effective in the management of pain in patients with chronic lumbosacral radiculopathy. The ability to administer it in an outpatient setting, without image guidance and the absence of debilitating side effects, makes it an attractive treatment option.

Countermovement Jump Performance Is Related to Ankle Flexibility and Knee Extensors Torque in Female Adolescent Volleyball Athletes.

Ankle flexibility and isokinetic knee torque/power generating capacity were previously suggested to contribute or to be correlated to the vertical countermovement jump (CMJ) performance. The aim of this study was to investigate the effect of the passive ankle joint dorsi flexion (θPDF) and the knee muscle's isokinetic torque and power on the CMJ in adolescent female volleyball players. The θPDF at a knee extension angle of 140 degrees were measured for 37 female post-pubertal volleyball players. Then, the players were assigned to either the flexible (n = 10) or inflexible (n = 14) groups according to earlier recommended criteria. Testing included the CMJ with and without an arm swing, and maximal knee extensions and flexions in 3 angular velocities on an isokinetic dynamometer. CMJ height performed with or without an arm swing (r(22) = 0.563, p = 0.040 and r(22) = 0.518, p = 0.009, respectively) and relative power (r(22) = 0.517, p = 0.010 and r(22) = 0.446, p = 0.030, respectively) were positively correlated with the extensors' torque at 180°/s and were negatively correlated with the flexibility level of the dominant side ankle (r(22) = -0.529, p = 0.008 and r(22) = -0.576, p = 0.030, respectively). A moderate positive correlation was also revealed between the CMJ height with and without an arm swing and the power of the non-dominant knee extensors (r(22) = 0.458, p = 0.024 and r(22) = 0.402, p = 0.049, respectively) and flexors (r(22) = 0.484, p = 0.016 and r(22) = 0.477, p = 0.018, respectively). Results of the 2 × 2 repeated ANOVA measurements revealed that flexible players jumped significantly (p < 0.05) higher during the CMJs, whilst there was a group effect only on the isokinetic knee extensor muscles' torque. In conclusion, a more flexible ankle joint and a higher isokinetic knee extensor's torque generating capacity resulted in higher CMJ performance. Therefore, ankle flexibility should be emphasized in training and is suggested to be included in preseason screening tests of youth female volleyball players.

Chronic Ankle Instability and Associated Self-Reported Function in South African Professional Ballet Dancers.

Ankle sprains are the most common acute injury among dancers and may result in the development of chronic ankle instability (CAI). Chronic ankle instability is characterized by recurrent ankle sprains, incidents of the ankle "giving way," and sensations of instability and has been reported to negatively impact functioning and psychosocial status. The large number of ankle sprains in addition to contextual factors relating to professional dancing, suggests that CAI may be a significant problem in professional ballet dancers. This study aimed to determine the prevalence of CAI and describe the ankle injury history and level of self-reported function in South African ballet dancers. This descriptive, cross-sectional study included all professional ballet dancers employed by three professional South African ballet companies (n = 65). The Identification of Functional Ankle Instability Questionnaire (IdFAI), Foot and Ankle Ability Measure (FAAM), Dance Functional Outcome Survey (DFOS), and a researcher-developed injury history questionnaire were completed by consenting participants. Descriptive statistics were calculated. A CAI prevalence of 73.3% CI [55.6%, 85.8%] was calculated among 30 participants. Twenty-five (83.3%) participants reported sustaining at least one significant ankle sprain with 88% (n = 22) indicating dance related activities as the cause. Dancers with CAI demonstrated a tendency to have less control over their ankles giving way and tended to take longer to recover from their ankles giving way than those dancers not affected. Eight participants (36.4%) with CAI were identified as having a significant level of disability on the FAAM activities of daily living (ADL) subscale and six participants (27.3%) on the sport subscale. Participants with CAI had a median total score of 83.5; IQR [80 - 90] on the DFOS. The self-reported function of South African professional ballet dancers is not severely affected, however, the high prevalence of CAI and reported symptoms is concerning. Education on CAI symptoms, prevention, and evidence-based management is recommended.

A Combinatorial Optimization Strategy for Performance Improvement of Stratum Ventilation Considering Outdoor Weather Changes and Metabolic Rate Differences: Energy Consumption and Sensitivity Analysis

Since occupants spend most of their time indoors, an energy-saving and comfortable indoor environment are particularly important. The differences in the metabolic rate of occupants make them have different requirements for their thermal environment. To save energy under the comprehensive needs of occupants for thermal environment, the combinatorial optimization strategy based on NSGA-II and improved the TOPSIS method is proposed in this study. Firstly, the physical model of the CFD simulation is verified by experiments. Secondly, the specific operation cases corresponding to combinations of different levels of factors are determined via the RSM method, and the ventilation performance prediction model considering the metabolic rate differences and outdoor weather changes is established. Thirdly, supply air velocities and temperatures are optimized by using Pareto-based NSGA-II; the Pareto optimal solution set under different outdoor temperatures is obtained. Finally, based on the Pareto optimal solutions at different outdoor temperatures, the optimal strategy under dynamic outdoor air temperature is obtained by improved TOPSIS by the CRITIC method. The optimization of ventilation parameters significantly improved the ventilation performance, and the results show that the predicted mean vote, energy consumption, vertical air temperature difference between head and ankle levels and the local mean age of air for different metabolic rates decrease by 64.1%, 4.74%, 24.83% and 7.39% on average, respectively. Moreover, the relative energy saving rate increases as the metabolic rate increases, and the strategy facilitates adaptation to outdoor weather changes and meets the individual needs of occupants for the indoor environment. This has important implications for achieving the global goal of energy efficiency and emission reduction.

Correction of serum prooncogenic cytokines and metastases by 5-hydroxypyrimidine derivatives and doxorubicin after removal of a primary tumor node in mice with the Lewis lung epidermoid carcinoma

The effect of a single injection of doxorubicin, 8-day administration of two 5-hydroxypyrimidine derivatives, SNK-411 (2-Isobutyl-4,6-dimethyl-5-hydroxypyrimidine) and SNK-578 (hydrochloride of 2-isobutyl-4,6-dimethyl-5-hydroxypyrimidine), on metastases, lifespan and serum cytokines has been investigated in С57ВL/6 mice after removal of a primary tumor node of Lewis lung carcinoma (LLC). LLC cells (1×106) were injected in the footpad of right hind feet of mice in control and experimental groups; after 14 days of tumor development the hind feet with the tumor were amputated at the ankle level. One hour before the amputation mice received a single injection of doxorubicin (4 mg/kg) and 8-day therapy with the 5-hydroxypyrimidine derivatives started. SNK-578 monotherapy was performed at a dose of 10 mg/kg administered intraperitoneally (i.p.). SNK-411 was administered per os at a dose of 25 mg/kg. In the case of combined therapy mice also received a single injection of doxorubicin (4 mg/kg; i.p.). The metastasis inhibition index in mice-treated with SNK-411 and SNK-578 were 53.3% as compared with control mice (with removed tumor). The mice-treated with SNK-411, doxorubicin, and the combination SNK-578 + doxorubicin had lifespan increased by 60.2%, 53.9%, and 42.9%, respectively. A single injection of doxorubicin, the course administration of the 5-hydroxypyrimidine derivative alone and in combination with single injection of doxorubicin completely decreased serum levels of the prooncogenic Th2-cytokines IL-4, and IL-6 and significantly decreased the level of the Th2-cytokine IL-5. Administration of doxorubicin, SNK-411 and SNK-578 did not influence serum concentration of Th1-cytokine interferon gamma (IFN-γ). These data confirm our previous findings that administration of the compounds studied decreased concentrations of prooncogenic IL-4 and IL-6 in tumor-bearing mice with LLC and had no effect on concentrations of the Th1-cytokine IFN-γ.

Characterization of Motor Unit Firing and Twitch Properties for Decoding Musculoskeletal Force in the Human Ankle Joint In Vivo.

Understanding how motor units (MUs) contribute to skeletal mechanical force is crucial for unraveling the underlying mechanism of human movement. Alterations in MU firing, contractile and force-generating properties emerge in response to physical training, ageing or injury. However, how changes in MU firing and twitch properties dictate skeletal muscle force generation in healthy and impaired individuals remains an open question. In this work, we present a MU-specific approach to identify firing and twitch properties of MU samples and employ them to decode musculoskeletal function in vivo. First, MU firing events were decomposed offline from high-density electromyography (EMG) of six lower leg muscles involved in ankle plantar-dorsi flexion.We characterized their twitch responses based on the statistical distributions of their firing properties and employed them to compute MU-specific activation dynamics. Subsequently, we decoded ankle joint moments by linking our framework to a subject-specific musculoskeletal model. We validated our approach at different ankle positions and levels of activation and compared it with traditional EMG-driven models. Our proposed MU-specific formulation achieves higher generalization across conditions than the EMG-driven models, with significantly lower coefficients of variation in torque predictions. Furthermore, our approach shows distinct neural strategies across a large repertoire of contractile conditions in different muscles. Our proposed approach may open new avenues for characterizing the relationship between MU firing and twitch properties and their influence on force capacity. This can facilitate the development of targeted rehabilitation strategies tailored to individuals with specific neuromuscular conditions.

A Cohort Study on Neuropathic Pain of the Sural Nerve-Can Neurectomy Be Considered a Valid Treatment Option?

Sural nerve neuroma is often caused by an injury during prior surgery, for example, osteosynthesis or ligament refixations at ankle level. Different surgical techniques to treat neuroma have been described. Neurectomy of an injured symptomatic sural nerve has been described as a treatment option for neuropathic pain. The aim of this study was to evaluate the outcomes of this technique to operatively treat sural nerve neuroma in our department. From 2010 to 2020, a total of 30 consecutive patients with neuropathic pain and suspected neuroma of the sural nerve underwent sural nerve neurectomy. A medical chart review was performed to collect patient-, pain-, and treatment-specific factors. Outcomes were registered. After neurectomy, 22 patients (73.3%) had persisting pain. In logistic regression models evaluating the risk of persisting pain after sural nerve neurectomy, no independent predictor of higher risk of persisting pain could be identified. For sural nerve neuromas, neurectomy remains an option as the surgical morbidity is minor, but patients need to be counseled that only a fourth of those undergoing surgery will be pain-free afterward.

Branching patterns of the superficial fibular nerve: an anatomical study with meta-analysis.

To review variations regarding the branching patterns of the superficial fibular nerve (SFN) concerning the deep fascia of leg and to the ankle joint level. Searches were conducted in PubMed, Scopus, Lilacs, and Web of Science databases on October 14th, 2021. We followed the PRISMA guidelines to report this review. Articles with data on SFN variations prevalence were included. The data were extracted and pooled into a meta-analysis. We also dissected 60 formalin-fixed Brazilian fetuses (n = 120 lower limbs). Twenty-five studies (n = 1272 lower limbs) comprised this review. Concerning the SFN branching at the deep fascia, Type 1 variation (in which the SFN pierces the fascia as a single nerve trunk) had a pooled prevalence of 86.4% (95% CI 84.5-88.2), while Type 2 had a pooled prevalence of 13.6% (95% CI 11.8-15.5). At the ankle joint level, Type 2 variation (in which the SFN branches off below the joint level) was the most common anatomical pattern, with a pooled prevalence of 78.7% (95% CI 74.5-82.7). Typically, the SFN branches off between its exit from the deep fascia and the ankle joint level. The SFN variations have great importance for surgeries, such as arthroscopies and fascia release surgeries, regional anesthesia, and clinical evaluation of SFN entrapment syndrome.

Ankle and Hindfoot Alignment Changes in Advanced OA Varus Knees After Cruciate Retaining Total Knee Arthroplasty: A Prospective Cohort Study.

Correct alignment of the knee is considered to be one of the most influential factors in determining the long-term outcomes after Total Knee Arthroplasty (TKA), and is believed to decrease both the mechanical and shear stresses placed on the bearing surfaces, as well as the bone/prosthesis interfaces. Compensatory malalignment of ankle and hindfoot is a recognized cause for ankle disability and deformity in long-standing osteoarthritic patients with varus deformity. This study aims to assess changes in ipsilateral ankle and hindfoot if any, pre- and post-operative TKA. 65 knees of 54 patients of osteoarthritis knee were evaluated for alignment in knee, ankle and hindfoot pre- and post-TKA. Pre- and post-operative scanogram were evaluated for knee and ankle alignment. Hindfoot alignment view was used to calculate hindfoot alignment angle. All parameters were compared before TKA and after 10weeks TKA and Wilcoxon signed rank test was used to test the significance of the values. Mean age of the patients was 62.9years (49-80years). Mean varus before surgery was 14.49 which changed to 4.01 and mean hindfoot angle valgus reduced from 9.23 to 6.62, both of which was found significant. Significant changes were also observed between pre- and post-op measurements of knee society scores, AOFAS, with improved functional outcomes both in knee and ankle. This study reveals the radiological and functional changes occurring in the ankle and hindfoot after acute correction of long-standing varus deformity of the knee using total knee arthroplasty. Hindfoot valgus alignment in varus knees decreased significantly post-TKA without any intervention at ankle level. In cases undergoing knee arthroplasty, effect of the acute change in the alignment of the knee on the ankle and hindfoot should be taken into consideration and the amount of correction of knee alignment can be a predictor of correction of ankle and hindfoot malalignment too. The lateral benefit of improvement in ankle pain after TKA is a significant gain in this study.

The value of the peroneus brevis tendon cross-sectional area in early diagnosing of peroneus brevis tendinitis: The peroneus brevis tendon cross-sectional area.

A thickened peroneus brevis tendon has been considered to be an important morphologic parameter of peroneus brevis tendinitis (PBT). Previous researchers have found that the peroneus brevis tendon thickness (PBTT) is correlated with inflammation of the peroneus brevis tendon. However, inflammatory hypertrophic change is different from simple thickness. Thus, we devised the peroneus brevis tendon cross-sectional area (PBTCSA) as a new diagnostic parameter to analyze the hypertrophy of the whole PBT. We assumed that the PBTCSA is a major morphologic parameter useful for early PBT diagnosis. Peroneus brevis tendon images were collected from 22 patients with PBT and from 22 normal subjects who underwent ankle-magnetic resonance imaging and revealed no evidence of PBT. The T1-weighted axial ankle-magnetic resonance imaging images were evaluated at the ankle level from all participants. The PBTT was measured as the thickest point at the transverse image of the peroneus brevis tendon. The PBTCSA was measured as the cross-sectional ligament whole area of the peroneus brevis tendon that was most hypertrophied in the axial A-MR images. The average PBTT was 2.22 ± 0.29 mm in the normal group and 2.85 ± 0.36 mm in the PBT group. The average PBTCSA was 6.98 ± 1.54 mm2 in the normal group and 13.11 ± 2.45 mm2 in the PBT group. PBT patients had significantly greater PBTT (P < .001) and PBTCSA (P < .001) than the normal group did. A receiver operating characteristic curve analysis revealed that the most suitable cutoff value of the PBTT was 2.51 mm, with 81.8% sensitivity and 81.8% specificity, and an AUC for the score was 0.93. The most suitable cutoff value of the PBTCSA was 10.08 mm2, with 90.9% sensitivity and 90.9% specificity, and AUC for the score was 0.98. Even though the PBTT and PBTCSA were both significantly associated with PBT, the PBTCSA was a more sensitive diagnostic parameter.

LESÕES NO EXERCÍCIO AERÓBICO: CAUSAS E PREVENÇÃO

ABSTRACT Introduction: Professional aerobic exercises require high performance from exercisers. Injuries are common during their execution. Understanding the causal reasons is essential for prevention methods to reduce athletes’ injuries. Objective: Investigate the influential factors of ligament injuries caused by aerobic exercise. Methods: This paper analyzes the injuries caused by aerobic exercise through mathematical statistics. Time, course, degree of injury, location of the injury, cause, early treatment time, primary approach, treatment methods, recovery conditions, and speed in recovery time of sports injuries were investigated. Results: Injuries are mainly concentrated at the hip, knee, and ankle joint level; sprains are the first injuries, followed by muscle strains, lower back muscle contractures, kneecap deformities, and joint ligament injuries. The leading causes of injuries were poor warm-up, excessive load, technical errors, and fatigue. Conclusion: Various physiotherapy methods can improve the recovery rate from ligament injuries. This method can also improve sports ligament injuries’ prevention and treatment effects. Evidence Level II; Therapeutic Studies - Investigating the result.

An experimental comparison of radiant wall and ceiling cooling system integrated with ground source heat pump and direct expansion fan coil system in a highly glazed office room

Hydronic radiant systems, which provide a thermal comfort environment, come to the fore in different building applications due to their energy saving potential and being integrated with renewable energy systems. The aim of this study is to present a full-scale experiment to compare the thermal comfort performances of radiant ceiling, wall and wall + ceiling systems coupled ground source heat pump and direct expansion fan coil system implemented in Yildiz Technical University Science and Technology Application and Research Center, Istanbul, Turkey. Air velocity, horizontal and vertical air temperature differences, mean radiant temperature and humidity values, which are four physical parameters that can affect the thermal satisfaction of office workers for 9 different experimental conditions, are measured for fan coil and all radiant systems. The results indicate that vertical temperature differences between ankle and head level vary from 0.9 °C to 1.4 °C for both fan coil system and all radiant system configurations in different location of the test room. Acceptable overall comfort in indoor environments Class A only showed stable performance with an average of 0.12 PMV and 5.3 % PPD when ceiling + wall radiant panels were actively cooled. The result shows that the difference between room air temperature and room operating temperature varies between 0.45 °C and 0.6 °C when cooling loads are met by radiant systems. This may not make it possible to use indoor air temperature instead of indoor operating temperature in the control of radiant systems. Moreover, the thermal environment of the radiant system are more uniform than fan coil system due to low air temperature stratification, air velocity and small differences between mean radiant temperature and indoor air temperature.

Establishing a low-risk zone for a temporary extra-articular calcaneo-tibial pin fixation in an unstable ankle or subtalar joint

This study aimed to establish a low-risk zone to avoid neurovascular injury during a temporary extra-articular calcaneo-tibial pin fixation in an unstable ankle or subtalar joint. A line from the calcaneal tuberosity center to the lateral end of the posterior malleolus at the ankle joint level defines the lateral border of this zone. Another line from the calcaneal tuberosity center to the midpoint of the anterior distal tibial articular surface at the joint level defines its medial border. This region was assumed to have a low neurovascular injury risk upon pin insertion. Fifty ankles from 50 patients who had undergone magnetic resonance imaging (MRI) for ankle disorders were assessed. T1-weighted oblique axial MRI slices were oriented to the pin trajectory. The mean distances between the sural nerve and the lateral border of the low-risk zone and between the posterior tibial neurovascular structures and the medial border of the low-risk zone were 15.0 ± 2.5 (range 9.1 to 21.1) and 12.8 ± 2.6 (6.3 to 20.8) mm, respectively. No neurovascular structures were identified within the low-risk zone. These findings demonstrated that an unstable ankle or subtalar joint can be temporarily fixated with an extra-articular calcaneo-tibial pin at a defined zone with a low neurovascular injury risk.

Neutrophil to lymphocyte (NTL) ratio and its prognostic significance in patients with diabetic foot syndrome (DFS)

BACKGROUND &amp; OBJECTIVE: Neutrophil to lymphocyte ratio has an important role to predict the outcome of diabetic foot syndrome. The aim is to evaluate NTL ratio as a prognostic factor in diabetic foot syndrome and its importance in diabetic wounds.&#x0D; METHODOLOGY: Descriptive cross-sectional study was to evaluate NTL ratio for prognosis of DFS. All cases were assessed for smoking, body mass index, presence of wound, glycated hemoglobin level, peripheral limb ischemia and infection. Patients were examined for a period of 12 months to assess wound if it resulted in minor amputation (below the level of ankle), major amputations (below/above knee amputation), chronic wound or completely healed wound. Chi-Square test was applied for categorical data.&#x0D; RESULTS: Total 100 patients were included and 61% were smokers. Average BMI was 31.7 and 34.5 in males and females. Complete wound healing found in 18% cases after debridement and chronic wounds in 15% patients. Subjects had to undergo major (above ankle) 16% and minor (below ankle) 51% amputations. Mean NTL count was 3.5 in fully healed wounds, 4.3 in chronic wounds, 6.9 in major amputations, and 5.2 in minor amputations. As the p-value indicates, there is a significant relationship between healed wounds, minor amputations, Chronic wounds and major amputations and the NTL ratio.&#x0D; CONCLUSION: Results revealed NTL ratio has independent prognosis in DFS for anticipating wound upshot. NTL ratio has a significant link with healed wounds, minor amputations, and major amputations, as indicated by p-value.

Three-Dimensional Lower-Limb Kinematics from Accelerometers and Gyroscopes with Simple and Minimal Functional Calibration Tasks: Validation on Asymptomatic Participants.

The use of inertial measurement units (IMUs) to compute gait outputs, such as the 3D lower-limb kinematics is of huge potential, but no consensus on the procedures and algorithms exists. This study aimed at evaluating the validity of a 7-IMUs system against the optoelectronic system. Ten asymptomatic subjects were included. They wore IMUs on their feet, shanks, thighs and pelvis. The IMUs were embedded in clusters with reflective markers. Reference kinematics was computed from anatomical markers. Gait kinematics was obtained from accelerometer and gyroscope data after sensor orientation estimation and sensor-to-segment (S2S) calibration steps. The S2S calibration steps were also applied to the cluster data. IMU-based and cluster-based kinematics were compared to the reference through root mean square errors (RMSEs), centered RMSEs (after mean removal), correlation coefficients (CCs) and differences in amplitude. The mean RMSE and centered RMSE were, respectively, 7.5° and 4.0° for IMU-kinematics, and 7.9° and 3.8° for cluster-kinematics. Very good CCs were found in the sagittal plane for both IMUs and cluster-based kinematics at the hip, knee and ankle levels (CCs > 0.85). The overall mean amplitude difference was about 7°. These results reflected good accordance in our system with the reference, especially in the sagittal plane, but the presence of offsets requires caution for clinical use.

Role of the Lateral Ankle Ligaments in the Vertical Stability of the Fibula

Category:Basic Sciences/Biologics; Ankle; TraumaIntroduction/Purpose:In unstable ankle fractures, syndesmosis and the deltoid ligament have been widely studied, and their importance in their pathophysiology and treatment is recognized. This is not the case of the ankle lateral ligaments, and in particular, their role in the vertical stability of the fibula is unknown. Given their anatomical position, they should avoid proximal translation of the distal fragment of the fibula fracture. Purpose: To quantify the superior translation of the fibula by applying a constant proximal traction force as the syndesmosis and lateral ankle ligaments are sectioned sequentially.Methods:Eleven human ankle cadaveric specimens were used (6 female, 5 male). Removal of the skin and muscles was performed down to the ankle level, preserving the interosseous membrane (IOM). A deep dissection was performed to identify the inferior tibiofibular ligaments and the lateral ligaments of the ankle. Each piece was mounted on a platform specially designed for this work (fig 1), fixing the foot with an axial load of 25 kg, and a proximal traction force of 50 N was applied to the fibula. The syndesmotic ligaments, IOM, anterior talofibular ligaments (ATFL), and calcaneofibular ligament (CFL) were sequentially sectioned. The proximal displacement of the fibula was measured after each sequential section. Normality analysis was performed with the Kolmogorov-Smirnov and Shapiro-Wilkins tests. Differences between groups were evaluated with the ANOVA test with Dunnett and Newman-Keuls post-test.Results:When applying 50 N of proximal traction, the proximal and vertical displacement of the fibula was as follows; no sectioning 1.96 +- 1.19 mm, syndesmosis/IOM sectioning 3.96 +- 1.33 mm, ATFL sectioning 5.9 +- 1.73 mm and 10.2 +- 2.76 mm after sectioning the CFL. Normal distribution was observed in all groups. All measurements had a statistically significant difference between each group (p <0.05).Conclusion:In this model, a complete syndesmosis/IOM lesion produces a mean fibular proximal displacement of 3.96 mm. By adding the ATFL and CFL complete injury, it reaches 10.2 mm. Clinical relevance: In an unstable ankle dislocation with a significant fibular proximal displacement, there is probably a severe compromise of the lateral ligament complex, which could have clinical relevance as it is part of the bone and ligamentary stability ring of the ankle. This is the first study that describes the role of the lateral ligament complex in fibular vertical stability.

A Numerical and Experimental Investigation of a Confluent Jets Ventilation Supply Device in a Conference Room

In this study, confluent jets ventilation (CJV) supply devices with three different nozzle arrays (1 × 19, 2 × 19, 3 × 19) were investigated both numerically and experimentally at two different airflow and supply air temperature set-ups. The performance of the CJV supply devices was investigated concerning thermal comfort, indoor air quality (IAQ), and heat removal effectiveness in a conference room environment. A comparison between the experimental and numerical results showed that the ϑ2¯−f model had the best agreement out of the investigated turbulence models. The numerical results showed that the size of the array had a great impact both on near-field development and on the conditions in the occupied zone. A larger array with multiple rows and a lower momentum conserved the inlet temperature and the mean age of the air better than a single-row array with a higher momentum. A larger array with multiple rows had a higher IAQ and a greater heat removal effectiveness in the occupied zone because the larger array conserved the mean age of air better and the buoyancy driven flow was slightly better at removing the heat. Because of the lower inlet velocities, they also had lower velocities at ankle level, which decreased the risk of draft and thermal discomfort.

May the Symptomatic Subtalar Joint Be Conservatively Treated With Intra-Articular Hyaluronic Acid Injections After a Calcaneus Fracture?

Subtalar pain following intra-articular calcaneus fractures may be associated with disability, pain, and a negative impact on the quality of life. Salvage procedures as subtalar fusion are associated with further consequences as stiffness, altered ankle biomechanics, and adjacent articular overloading with degenerative changes. The objective of the present study is to evaluate the short-term effects of viscosupplementation with intra-articular hyaluronic acid (HA) on function and pain, in patients with painful subtalar joint after calcaneus fracture. We searched for patients who underwent osteosynthesis of intra-articular calcaneus fracture between January 2011 and July 2015 and were diagnosed during the follow-up with pain and subtalar osteoarthritis. Between January and December of 2018, 13 patients (50 ± 10 years) accepted to participate in this study and received intra-articular HA injections. Three consecutive doses of 20 mg of HA were administered within a week interval, through anterolateral injections into the subtalar joint. We prospectively evaluated the function using the ankle/hindfoot American Orthopaedic Foot & Ankle Society score (AOFAS) and level of pain using the visual analog scale (VAS) before the intervention and 4, 12, and 24 weeks after the first injection. Hindfoot function improved with an increase of AOFAS from 55 ± 19 before the intervention to 88 ± 20 at the 24th week (P = .001). Similarly, we observed relief of pain during the 24 weeks following intra-articular hyaluronic acid injection, with a decrease in VAS from 8.3 ± 1.3 before treatment to 2.2 ± 3.0 at the 24th week (P = .001). For patients experiencing pain and dysfunction with subtalar osteoarthritis after intra-articular calcaneus fracture, viscosupplementation with intra-articular HA may be associated with improvement in function and pain in the short term. Furthermore, patients with higher grades of osteoarthritis may have limited benefit in pain relief and function improvement. IV, Case series.

Improving work efficiency and thermal comfort by negative vertical temperature gradient in heating model of impinging jet ventilation

In heating model, impinging jet ventilation (IJV) supplies warm air jet with high momentum which impinges and spread over floor. Thermal stratification in opposite direction (temperature of foot area is higher than head area.) is found in the area near supply opening, because high residual momentum of the jet after impinging can resist thermal buoyancy in a considerable distance on floor surface. Negative vertical temperature gradient was seldom explored. To study how negative vertical temperature gradient affects local thermal comfort and work performance, 16 subjects (8 males and 8 females) were asked to work in a room with three negative vertical temperature gradients (1, 3, 5k/m) between head (1.1 m) and ankle levels (0.1 m). In this study, overall thermal sensation, local thermal sensation of body segments and work performance were collected. The results show that work performance and thermal comfort could be improved by higher negative vertical temperature gradients.

Performance evaluation of impinging jet ventilation combined with ductless personalized ventilation

Impinging jet ventilation (IJV), which supplies a high momentum air jet impinging and spreading over the floor, could be used in both cooling and heating modes. However, as a low-level supply system, the excessive temperature difference between head and ankle levels may exist due to the cool air being directly supplied to the occupied zone. As one type of different personalized ventilation (PV) terminal device, ductless personalized ventilation (DPV) is a self-standing system and doesn’t require an extended air duct. In this study, numerical simulation was used to assess the performance of DPV combined with IJV in office buildings under different operating parameters. The results show that a large temperature difference between the occupant’s head and ankle will be significantly decreased by the application of DPV while not influencing the stratification characteristics of impinging jet ventilation.