Ankle Sprain Research Articles

Patient-Reported Outcomes Following Open Broström-Gould Procedure: Minimum 5-Year Follow-Up.

Ankle sprains are a common musculoskeletal injury among the general population and often involve the lateral ligament complex. Although the majority of ankle sprains are treated successfully with nonsurgical conservative measures, an estimated 5% to 20% of ankle injuries ultimately develop chronic lateral ankle instability (CAI). Multiple surgical treatment modalities for the lateral ankle complex exist, such as anatomical and nonanatomical reconstruction. The current gold standard for primary surgical repair is the Broström-Gould procedure. This is the first article to provide PROMIS scores following BG and the largest study with 5-year outcomes for an open BG. This was a descriptive study of a retrospective cohort of patients undergoing a BG with a minimum follow-up of 5 years. Patient-reported outcome instruments collected postoperatively were PROMIS Pain, Physical Function, Depression, and FAAM. Further preoperative clinic characteristics were analyzed to correlate with the final outcome. The electronic medical record was queried for Current Procedural Terminology (CPT) code 27698 (Broström-Gould) from January 2010 to June 2017. Surveys were conducted in the clinic and through phone interviews. Patient charts were reviewed to obtain basic patient demographic information including sex, age, race, and body mass index (BMI). The following preoperative variables were recorded: history of prior CAI procedures, history of major trauma, duration of symptoms, number of diagnosed ankle sprains, other collagen pathologies, generalized ligament laxity, participation in sports/activity level, peroneal subluxation, clinically diagnosed peroneus longus or brevis tendinopathy, deltoid ligament injury, anterior ankle impingement, and posterior ankle impingement. The PROMIS and Foot and Ankle Ability Measure (FAAM) scores were obtained with a combination of clinic and phone interviews. Data were aggregated in Microsoft Excel and entered in R (version 4.2.0) for statistical analysis. Our results show that the minimum 5-year patient-reported PROMIS scores for patients following a Broström-Gould procedure are as follows: PROMIS physical function, 50.5; PROMIS pain interference, 48.2; and PROMIS depression, 38.2. This indicates, at a minimum, that patients 5 years removed from the procedure are within 1 SD of the general population in regard to PROMIS physical function and pain. Our patient-reported FAAM, activities of daily living, and FAAM sports scores were 59.6 and 13.0 respectively. Preoperative magnetic resonance imaging (MRI) findings were recorded. Arthroscopic examination was performed before lateral ligaments reconstruction for patients with intra-articular pathologies confirmed on MRI. The findings from our study offer evidence supporting the effectiveness of the Broström-Gould procedure to be associated with normal physical function, even 5 years after surgery. Furthermore, our research identified specific factors such as tobacco use, diabetes, and sports participation that independently correlated with reported outcome measures. These insights enable physicians to better manage patient expectations and tailor treatment strategies accordingly. Our study establishes a foundation for future prospective research endeavors that aim to leverage the PROMIS system for comprehensive outcome assessments. Level III, retrospective cohort study.

Trans-syndesmotic fixation in supination external rotation type 4 injuries: Are intraoperative tests reliable?

Ankle fractures occur due to a rotational mechanism. According to the Lauge-Hansen classification, supination-external rotation (SER) injuries are the most common type. Following osseous fixation, the evaluation and treatment of syndesmotic injuries in these injuries are controversial. This study aimed to evaluate the clinical, functional, and radiological results of trans-syndesmotic fixation using intraoperative tests in SER type 4 ankle injuries. Ankle syndesmosis was intraoperatively evaluated using cotton/hook and manual external rotation stress tests in 64 patients with SER type 4 fracture dislocation injuries. These patients were divided into two groups: those treated with and without trans-syndesmotic fixation in addition to open reduction and internal fixation of the fractures. Ankle range of motion (ROM), American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score, and Olerud-Molander Ankle Score (OMAS), tibiofibular overlap, tibiofibular clear space, and joint arthritis based on the Kellgren-Lawrence (K-L) scale were evaluated. Median values of OMAS (Z=-3.92, p<0.001), AOFAS (Z=-4.31, p<0.001), and ROM (Z=-2.95, p=0.003) were higher in Group 1. There were no differences between the groups regarding tibiofibular overlap median values (Z=-0.59, p=0.0554), tibiofibular clear space (Z=-1.13, p=0.258), and Kellgren-Lawrence arthritis scale. Lack of posterior malleolus fixation was found to increase the risk of arthritis by 18.197 times, despite having trans-syndesmotic fixation, which was statistically significant (Confidence Interval, CI: 2.482-133.417, p=0.004) (Table 4). Median values of OMAS, AOFAS, and ROM in patients without trans-syndesmotic fixation were lower. These results indicate that intraoperative tests may not provide entirely accurate results in SER type 4 injuries. Failure to detect a syndesmotic injury timely can result in instability. Therefore, we think that routine trans-syndesmotic fixation, as well as posterior malleolus fixation in SER type 4 ankle injuries, may improve outcomes.

The role of Ottawa ankle rules in geriatric emergency department visits.

Ankle injuries are a common reason for visits to the emergency department (ED). An effective diagnosis and treatment process is crucial for the swift recovery of patients and for alleviating congestion in EDs. This study aims to evaluate the adequacy and effectiveness of the Ottawa Ankle Rules (OAR) in geriatric patients presenting to the emergency department (ED). Between February 2022 and November 2022, 160 patients aged 65 and older (118 women, 42 men) who presented to the ED with isolated ankle injuries were included in the study. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of the OAR. The study found fractures in 37.5% of patients. The sensitivity of the OAR was 98.33%, the specificity was 86%, the negative predictive value was 98.85%, and the positive predictive value was 80.82%. This study demonstrates that the OAR is highly sensitive in the geriatric population but shows some limitations in terms of specificity and positive predictive value. These results support the effectiveness of using the OAR in evaluating ankle injuries in the geriatric population but also highlight the need for cautious application due to the potential for false-positive outcomes.

Epidemiology and Characteristics of Ankle and Foot Injuries in Electric Scooter-Related Accidents.

The use of electric scooters (e-scooters) continues to increase as a simple, inexpensive means of transport, resulting in a sharp increase in the incidence of scooter-related accidents. No study to date has closely examined the injury extent to the lower leg, joints, and extremities from e-scooter-related accidents. Here, we investigated the epidemiology and injury patterns of such accidents, focusing on injuries to the ankle and foot. Based on data from a single tertiary hospital's database, the demographics of 563 patients with scooter-associated injuries were analyzed retrospectively. Among the patients, 229 patients who were injured by e-scooter riding were further investigated. Based on the data, the general demographics of whole scooter-associated injuries and the injury characteristics and fracture cases of the lower leg, ankle, and foot were analyzed. During the 4-year study period, the number of patients injured by e-scooters increased every year. Lower extremities were the most common injury site (67.2%) among riders, whereas injuries to the head and neck (64.3%) were more common in riders of non-electric scooters. Among the lower leg, ankle, and foot injuries of riders (52 cases), the ankle joint (53.8%) was the most commonly injured site, followed by the foot (40.4%) and lower leg (21.2%). The fracture group scored significantly higher on the Abbreviated Injury Scale than the non-fracture group (p < 0.001). Among the fracture group (20 cases), ankle fractures (9 cases) were most common, including pronation external rotation type 4 injuries (4 cases) and pilon fractures (2 cases). Five patients (25%) had open fractures, and 12 patients (60%) underwent surgical treatment. The ankle and foot are the most common injury sites in e-scooter-related accidents. Given the high frequency and severity of e-scooter-related ankle and foot injuries, we suggest that more attention be paid to preventing these types of injuries with greater public awareness of the dangers of using e-scooters.

Bone injury imaging in knee and ankle joints using fast-field-echo resembling a CT using restricted echo-spacing MRI: a feasibility study.

To explore the consistency of FRACTURE (Fast-field-echo Resembling A CT Using Restricted Echo-spacing) MRI and X-Ray/computerized tomography (CT) in the evaluation of bone injuries in knee and ankle joints. From Nov. 2020 to Jul. 2023, 42 patients with knee joint or ankle joint injuries who underwent FRACTURE MRI examinations were retrospectively collected. 11 patients were examined by both X-Ray and FRACTURE examinations. 31 patients were examined by both CT and FRACTURE examinations. The fracture, osteophyte, and bone destruction of the joints were evaluated by two radiologists using X-Ray/CT and FRACTURE images, respectively. Kappa test was used for consistency analysis. The evaluation consistency of fracture, osteophyte and bone destruction via X-Ray and FRACTURE images by radiologist 1 were 0.879, 0.867 and 0.847 respectively, and for radiologist 2 were 0.899, 0.930, and 0.879, respectively. The evaluation consistency of fracture, osteophyte and bone destruction via CT and FRACTURE images by radiologist 1 were 0.938, 0.937 and 0.868 respectively, and for radiologist 2 were 0.961, 0.930, and 0.818, respectively. For fracture, osteophyte, and bone destruction of knee and ankle joints. FRACTURE MRI showed a high consistency with X-Ray/CT examinations.

Pancreatic cancer with multiple liver metastasis complicating multi organ infarcts from Marantic endocarditis and Trousseau’s syndrome

Background: Marantic endocarditis and Trousseau’s syndrome are historically linked with pancreatic cancer. The patient had catastrophic embolic events which caused multi organ infarct due to underlying advanced pancreatic cancer. Doctors should be aware of early signs and symptoms of pancreatic cancer and conduct necessary clinical assessments and investigations that can prevent any severe complications. Case Presentation: A middle-aged healthy gentleman who presented with left-sided weakness, slurred speech, left-sided sensory neglect, mild headache, and fever. CT head showed acute right-sided temporal ischemic changes with subsequent magnetic resonance imaging (MRI) head showed multiple infarcts in the brain. A transesophageal echocardiogram reported possible MV vegetation. MRI of the liver was done due to deranged LFTs which showed multiple liver metastasis with a primary mass in the tail of the pancreas. Left leg ultrasound Doppler showed a large left leg deep vein thrombosis involving the femoral vein as he complained of left leg pain for 2 months and went to GP with right leg pain 3 months ago which was treated as a right ankle sprain. The clinical events explained that most likely he developed Trousseau’s syndrome 3 months ago and the embolic phenomena were due to rare Marantic endocarditis (Non-bacterial thrombotic endocarditis) secondary to pancreatic cancer. Ultrasound-guided biopsy of liver metastasis was planned, but sadly the patient passed away the next day. Conclusion: The diagnosis of early pancreatic cancer with imaging poses a challenge sometimes, therefore the pancreatic protocol of CT or MRI is the first line of investigation. Moreover, the cause of unprovoked thrombo-embolism should be investigated to rule out any underlying malignancy.

Comparison of an Adaptive Ankle Brace to Conventional Taping for Rehabilitation of Acute Ankle Injury in Young Subelite Soccer Players: A Pilot Study.

Ankle sprains are a common injury in sports, for which use of external ankle support during rehabilitation has been suggested to improve clinical outcomes. Cohort study. Thirteen soccer players experiencing acute lateral ankle sprain injury were provided a novel adaptive ankle brace or conventional ankle taping (control) as external ankle support throughout the injury rehabilitation process. All other clinical procedures were identical, and rehabilitation was supervised by the same team staff member. Time from injury to clearance to return to sport was tracked. Player experience with the ankle brace also was queried via electronic surveys. The median time to return to sport was less for the Brace group (52.5d) compared to the Control group (79.5d), but the distributions of the 2 groups were not found to differ significantly (P = .109). Player surveys indicated they felt the brace to be comfortable or very comfortable, with better freedom of movement than other braces and the same freedom of movement as wearing no brace. All players reported wearing the brace to be the same or better experience as ankle taping. These preliminary results indicate that the adaptive ankle brace is at least as effective as ankle taping for providing external support during the rehabilitation phase following acute lateral ankle sprain and suggest it may be a more effective ankle support solution in terms of patient compliance than conventional bracing or taping.

Comparison of Balance Between Badminton and Volleyball Recreational Players with Chronic Ankle Instability: A Cross-sectional Study

Introduction: Chronic Ankle Instability (CAI) is an injury that presents persistent instability and “giving way” symptoms. The higher rate of reinjury following an initial Lateral Ankle Sprain (LAS) is associated with the development of CAI, which affects athletic and functional performance. Impairment of musculotendinous receptors following an initial ankle sprain may result in recurrent ankle instability. Some studies have suggested an association between CAI and issues with static and dynamic balance. Comparisons of static balance between recreational badminton and volleyball players and dynamic balance between recreational badminton and volleyball players with CAI are required to provide athletes with the proper balance training exercises. Aim: To analyse the static balance of badminton and volleyball recreational players with CAI using the Balance Error Scoring System (BESS) and a Plantar Pressure Analysis System (PPAS), as well as the dynamic balance of those players using the Y Balance Test (YBT). Materials and Methods: A cross-sectional study was conducted where recreational players with CAI who play badminton and volleyball were screened using the Cumberland Ankle Instability Tool (CAIT), and 46 participants were selected based on inclusion and exclusion criteria. The study was conducted in the indoor and outdoor stadiums of NITTE (Deemed to be University), Mangaluru, Karnataka, India. The study duration was from March 2023 to March 2024. Ethical clearance was obtained from the same university for the study. Following this, static and dynamic balance of each group was assessed using BESS (number of errors), PPAS (sway velocity), and YBT (distance reached by the limb). The static balance between the groups and dynamic balance between the groups were analysed in Jamovi software using independent sample t-test. Results: Following the analysis, static balance between badminton and volleyball recreational players using BESS showed a non significant difference with a p-value of 0.282, while PPAS showed non significant differences with p-values of 0.174 for double leg stance and 0.063 for single leg stance. Similarly, dynamic balance between badminton and volleyball recreational players using YBT showed non significant differences with p-values of 0.467, 0.768, and 0.299 for anterior, posteromedial, and posterolateral directions, respectively. Conclusion: The study concluded that there was no significant difference in static as well as dynamic balance between badminton and volleyball recreational players with CAI. However, it is important to evaluate the static and dynamic balance of recreational players to enhance performance and prevent injuries.

Bone marrow edema in a postpartum female following ankle sprain: a case report.

Bone marrow edema in a postpartum female following ankle sprain: a case report.

Functional results of patients with ankle syndesmosis injuries treated with the dynamic fixation (the syndesmosis TightRope® suture button) compared to the rigid fixation

Introduction/Objective. Sprains account for 85% of all ankle injuries. Syndesmosis injuries occur in 1?18% of patients with ankle sprains and are more common in contact sports involving forced foot dorsiflexion. Methods. In our study, we compared 30 patients treated with dynamic fixation for acute syndesmotic injury with patients treated with rigid fixation. The criteria for comparison were: American Orthopedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale, visual analogue scale (VAS), EuroQol five-dimension questionnaire (EQ-5D), range of motion, complications and reoperations. Results. The mean AOFAS score for patients treated with rigid fixation was 88.6, while the mean score for patients treated with dynamic fixation was 91.6. The mean VAS score for rigid fixation was 83.5, while it was 85.8 for dynamic fixation. Infection as a complication of rigid fixation was present in two patients (11.8%), while it was absent in the dynamic fixation group. The need for implant removal occurred in two patients treated with rigid fixation (11.8%) and in one patient treated with dynamic fixation (7.7%). Conclusion. Based on our results and the results reported by other authors, we prove that there is a lower incidence of problems related to implants and the need for the implant removal with dynamic fixation, based on the results of AOFAS score, we notice better and faster recovery with dynamic fixation as well.

Pancreatic cancer with multiple liver metastasis complicating multi organ infarcts from Marantic endocarditis and Trousseau’s syndrome.

Background Marantic endocarditis and Trousseau’s syndrome are historically linked with pancreatic cancer. The patient had catastrophic embolic events which caused multi organ infarct due to underlying advanced pancreatic cancer. Doctors should be aware of early signs and symptoms of pancreatic cancer and conduct necessary clinical assessment and investigations which can prevent any severe complications. Case presentation A middle-aged healthy gentleman who presented with left sided weakness, slurred speech, left sided sensory neglect, mild headache and fever. CT head showed acute right sided temporal ischaemic changes with subsequent MRI head showed multiple infarcts in the brain. Transoesophageal echocardiogram reported possible MV vegetation. MRI of the liver was done due to deranged LFTs which showed multiple liver metastasis with primary mass in the tail of pancreas. Left leg ultrasound doppler showed a large left leg deep vein thrombosis involving femoral vein as he complained of left leg pain for 2 months and went to GP with right leg pain 3 months ago which was treated as right ankle sprain. The clinical events explained that most likely he developed Trousseau&amp;apos;s syndrome 3 months ago and the embolic phenomena was due to rare Marantic endocarditis (Non-bacterial thrombotic endocarditis) secondary to pancreatic cancer. Ultrasound guided biopsy of liver metastasis was planned, but sadly the patient passed away the next day. Conclusion The diagnosis of early pancreatic cancer with imaging poses a challenge sometimes, therefore the pancreatic protocol of CT or MRI is the first line investigation. Moreover, the cause of unprovoked thrombo-embolism should be investigated to rule out any underlying malignancy.

Influence of Chronic Ankle Instability on Physical Activity: A Critically Appraised Topic

Lateral ankle sprains are the most common injury sustained by physically active individuals. The overwhelming majority of people who sprain their ankle go on to develop chronic ankle instability (CAI). CAI may cause affected individuals to limit their physical activity, leading to health issues such as obesity and cardiovascular disease. The growing body of literature suggests that functional limitations reported by individuals with CAI may lead a the decrease in physical activity. This critically appraised topic sought to determine if adolescent and college-aged individuals with CAI have lower physical activity levels than their healthy peers. A literature search was conducted in between August 2021–February 2022 using the terms “chronic ankle instability” and “physical activity.” Studies were included if the participants were adolescent or college-aged and had CAI. Three studies meeting the inclusion criteria were identified. The first study reported that college students with CAI walk fewer steps per week than their healthy peers, while the second study observed higher physical activity levels among adolescents with CAI. The third study incorporated details on how there is a high prevalence of ankle injury in adolescents, so methods to prevent the injury should be followed to avoid injury earlier on. Despite the conflicting evidence on how CAI impacts physical activity levels, physical activity remains important for long-term health. Thus, it is necessary to emphasize that individuals with CAI should seek treatment to mitigate recurrent ankle sprains in order to safely continue with physical activity.

Effectiveness of Platelet-Rich Plasma in Reducing Pain and Increasing Function After Acute Lateral Ankle Sprain: A Critically Appraised Topic.

Ankle sprains are one of the most common injuries in athletics, and many lead to recurrent sprains, chronic ankle instability, and persistent symptoms. Treatment improvements are needed. Platelet-rich plasma (PRP) involves formulating autologous plasma with higher platelet concentration to be injected in the desired tissue. There is currently high-quality evidence supporting the use of PRP with lateral epicondylitis and knee osteoarthritis to accelerate the healing process and decrease pain. Does the injection of PRP relieve pain faster and improve function compared with no injection or placebo in patients with a lateral ankle sprain? A computerized search yielded 191 studies; of these, 3 studies fit the inclusion and exclusion criteria. PRP injection reduces pain and increases function after lateral ankle sprain 5 to 8weeks after intervention. The use of PRP after lateral ankle sprain to decrease pain and increase function is supported with moderate evidence. Based on the Strength of Recommendation Taxonomy, evidence from the included studies is considered as level B, reflecting limited quality patient-oriented evidence.

Stroboscopic Goggles Impair Postural Control in Those With and Without Chronic Ankle Instability: A Critically Appraised Topic

Clinical Scenario: Ankle sprains are highly common and can lead to chronic ankle instability (CAI). Individuals with CAI have a variety of sensorimotor impairments including poor postural control and altered sensory organization strategies. Visual occlusion modalities, if worn during neuromuscular control exercises, may facilitate greater postural control gains and a more appropriate sensory organization strategy. However, a cumulative review of the ability of visual occlusion modalities (e.g., stroboscopic goggles) to impair postural control and thus demonstrate the potential to facilitate greater postural gains has not yet been completed. Clinical Question: Does stroboscopic vision impair postural control in those with and without CAI, and if so, is the impairment comparable between the groups? Summary of Key Findings: Regardless of how postural control was assessed, stroboscopic vision impaired postural control relative to an eyes open (i.e., no goggles) condition. All studies demonstrated that those with and without CAI were impacted equally. Stroboscopic vision resulted in postural control impairments comparable to an eyes closed in some but not all studies. Clinical Bottom Line: Stroboscopic vision impairs postural control in both those with CAI and uninjured controls. Strength of Recommendation: There is moderate-quality evidence (Grade B) that stroboscopic vision impairs postural control in those with CAI and uninjured controls.

Operative Management of Lateral Ankle Instability: Examination Under Anesthesia, Ankle Arthroscopy and Stabilization Technique

Background: Ankle sprains are common injuries that can result in chronic ankle instability. Indications: Indications for surgical management include recurrent instability, failed conservative management for 3 to 6 months, and inability to return to play or activity. Technique Description: The patient’s ankle is initially examined under anesthesia with anterior drawer testing to confirm the diagnosis of ankle instability. Ankle arthroscopy is then preformed to identify and treat additional intra-articular pathology prior to modified Broström repair. During arthroscopy, care is taken to protect the superficial peroneal nerve. Routinely we perform a “drive-through sign” to assess syndesmotic stability and also debride pathologic intra-articular tissue such as hypertrophied synovium. Following the completion of arthroscopy, an incision is made directly over the fibula. The anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and distal fibular periosteum are dissected off the fibula. Two 3.0-mm suture anchors are placed at the origin of the CFL ligament and the ATFL ligament, and previously dissected tissue is incorporated for repair. We reinforce the CFL and ATFL tissues with incorporation of the distal fibular periosteum. Suture tape augmentation is considered for patients at high risk of recurrence, such as those with ligamentous laxity. After completion of our repair, the ankle is again examined under anesthesia with satisfactory confirmation of improved ankle stability. Results: Outcomes of our technique are promising, with improvement in patient-reported outcome measures, restoration of range of motion, return to sport as high as 94%, and low failure rates. Discussion: For patients with chronic instability, our described technique for sequential examination under anesthesia, ankle arthroscopy, and our modified Broström result in satisfactory improvement in ankle stability and patient symptoms. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form.

Accuracy of Ottawa Ankle Rules in Adolescent Foot and Ankle Injuries

Accuracy of Ottawa Ankle Rules in Adolescent Foot and Ankle Injuries

A Systematic Design of a Sports Injuries Prevention Program in Volleyball

Background and Aims Volleyball is one of the most popular sports in Iran and every year more teenagers and adults are attracted to this sport. However, there is no systematic injury prevention program for Iranian volleyball players in accordance with the cultural, economic and social conditions of the country. Therefore, the purpose of this study is to design an intervention program to prevent volleyball sports injuries in a systematic manner using the intervention mapping protocol. Methods The IM method was used to design the program which has 6 steps: (1) Needs assessment, (2) Determining intervention outcomes and objectives, (3) designing the intervention by selecting theory and their practical applications, (4) producing the intervention program, (5) Developing an implementation plan, and (6) Developing an evaluation plan. To design the intervention, we used the steps 1 to 4. Results The designed program included a warm-up program with more than 45 movements (with different types and levels for players with different abilities) that should be performed at least two sessions a week before training or competition. The program consisted of three 3-week phases and provided to the trainers every week to observe the gradual improvement in intensity, repetition, complexity, and time of training. The duration of each weekly session was 15 minutes, including 4-5 minutes of cardiorespiratory exercises (to increase body temperature and cardiorespiratory preparation) and 9-10 minutes of exercises to prevent shoulder, knee and ankle injuries. Conclusion Despite being time consuming, the IM is a suitable method for designing an intervention to prevent injuries in volleyball. The designed injury prevention intervention is a 15-minute warm-up program that includes more than 45 exercises for amateur volleyball players. The feasibility of this program is under investigation and the study of its effect will be conducted in the upcoming months.

The Relationship between High Heels and Ankle Injury in Latin Dance

The Relationship between High Heels and Ankle Injury in Latin Dance

ХАРАКТЕРИСТИКА ПОВРЕЖДЕНИЙ МАЛОБЕРЦОВОЙ КОСТИ ПРИ ПЕРЕЛОМАХ ЛОДЫЖЕК И ДИСТАЛЬНОГО ОТДЕЛА ГОЛЕНИ

The study purpose was the evaluation of fibula injuries in malleolar fractures and distal tibia fractures (segments 44 and 43 according to AO/OTA fracture classification), to reveal the most typical types of injuries and morphological fracture parameters, which could be important for the development of the intramedullary fixator of the fibula. Radiological data of 57 patients with malleolar fractures and 54 patients with distal tibia fractures were evaluated. In ankle injuries the vast majority of fibula fractures (84.2%) were presented by transsyndesmotic injuries (type B according to AO/OTA), majority of fibula fractures (89%) were simple, without signs of comminution, the fracture plane passed at an angle of 33.1°±10.7° to the axis of the fibula, the center of fracture was located at the level of 21.6±8.8 mm from ankle articular surface. In distal tibia fractures fibula injuries were more variable: in 20% of cases there were no fibula fracture at all, 6% involved the proximal part, 27% - shaft and 47% distal part of the fibula. Comminuted fractures were seen in 32% of cases, the center of the fracture was located from 10 mm distal to the tibia articular surface to 317 mm proximal to it (Ме 35 mm, Q1-Q3: 15-68 mm). The revealed data shows that most important for the development of the intramedullary fibular fixator are ankle injuries, which have more predictable pattern.

Classification of chronic ankle instability using machine learning technique based on ankle kinematics during heel rise in delivery workers.

Ankle injuries in delivery workers (DWs) are often caused by trips, and high recurrence rates of ankle sprains are related to chronic ankle instability (CAI). Heel rise requires joint angles and moments similar to those of the terminal stance phase of walking that the foot supinates. Thus, our study aimed to develop, determine, and compare the predictive performance of statistical machine learning models to classify DWs with and without CAI using ankle kinematics during heel rise. In total, 203 DWs were screened for eligibility. Seven predictors were included in our study (age, work duration, body mass index, calcaneal stance position angle [CSPA] in the initial and terminal positions during heel rise, calcaneal movement during heel rise [CMHR], and plantar flexion angle during heel rise). Six machine learning algorithms, including logistic regression, decision tree, AdaBoost, Extreme Gradient boosting machines, random forest, and support vector machine, were trained. The random forest model (area under the curve [AUC], 0.967 [excellent]; F1, 0.889; accuracy, 0.925) confirmed the best predictive performance in the test datasets among the six machine learning models. For Shapley Additive Explanations, old age, low CMHR, high CSPA in the initial position, high PFA, long work duration, low CSPA in the terminal position, and high body mass index were the most important predictors of CAI in the random forest model. Ankle kinematics during heel rise can be considered in the classification of DWs with and without CAI.