Malleolus Research Articles

Comparative Study on Effectiveness of Laser Versus Phonopheresis along with Muscle Energy Technique for Jumpers Knee in Badminton Players

The ability to change direction and position of the body quickly and effectively while maintaining postural stability and orientation are important in badminton sports. There is also harmony related to skill and plan achievement during dynamic balance and agility. The purpose of the study is to compare the effectiveness of the LASER and phonopheresis along with muscle energy techniques in jumpers knee happens in badminton players. Experimental design, comparative study and Random sampling technique is used in this study. 40 samples were used with the duration of 3 months for this study. Group A consists of 20 athletes treated with LASER and muscle energy techniques whereas Group B consists of 20 athletes treated with Phonophoresis using Piroxicam gel and muscle energy techniques. Proforma like age, height, weight, level of competition, hours of practice, medical and surgical history, and limb length measurements (asis to medial malleolus) are collected from each player. The subjects were divided into two equal groups. Group A was given low level laser therapy and muscle energy techniques and Group B phonopheresis and muscle energy techniques Outcome measures are done with VISA -P, LEFS, NPRS, SIT AND REACH TEST. Mean and Standard Deviation were used to assess all the parameters. Paired ‘t- test’ was used to find out the` significant difference among the effectiveness of LASER along with Muscle Energy Technique and phonopheresis along with muscle energy techniques on jumper’s knee by VISA -P, LEFS, NPRS and Sit and reach test in athletes. LASER therapy associated with Muscle energy technique was effective in improving Jumper’s knee when compared with Phonopheresis associated with Muscle energy technique over 7 days of period.

Os subtibiale displacement secondary to pronation-external rotation ankle injury: A case report.

Os subtibiale is a rare accessory ossicle of the ankle, considered not of clinical significance. But its presence in trauma patients may cause misdiagnosis as malleolar fracture and over-treatment. Because the ossicle is attached to the deltoid ligament, ankle trauma that cause medial compartment injury may detach os subtibiale from medial malleolus. In these situations, MR imaging may help to diagnose the deltoid injury, demonstrate the features of the ossicle, and guide treatment.

Distances and angles in standing long-leg radiographs: comparing conventional radiography, digital radiography, and EOS

ObjectiveDistances and angles measured from long-leg radiographs (LLR) are important for surgical decision-making. However, projectional radiography suffers from distortion, potentially generating differences between measurement and true anatomical dimension. These phenomena are not uniform between conventional radiography (CR) digital radiography (DR) and fan-beam technology (EOS). We aimed to identify differences between these modalities in an experimental setup.Materials and methodsA hemiskeleton was stabilized using an external fixator in neutral, valgus and varus knee alignment. Ten images were acquired for each alignment and each modality: one CR setup, two different DR systems, and an EOS. A total of 1680 measurements were acquired and analyzed.ResultsWe observed great differences for dimensions and angles between the 4 modalities. Femoral head diameter measurements varied in the range of > 5 mm depending on the modality, with EOS being the closest to the true anatomical dimension. With functional leg length, a difference of 8.7% was observed between CR and EOS and with the EOS system being precise in the vertical dimension on physical-technical grounds, this demonstrates significant projectional magnification with CR-LLR. The horizontal distance between the medial malleoli varied by 20 mm between CR and DR, equating to 21% of the mean.ConclusionsProjectional distortion resulting in variations approaching 21% of the mean indicate, that our confidence on measurements from standing LLR may not be justified. It appears likely that among the tested equipment, EOS-generated images are closest to the true anatomical situation most of the time.

Anatomical leg length discrepancy in children: Can it be accurately determined using 3-D motion capturing?

BackgroundLeg length discrepancy (LLD) is common in youth and is cause by several conditions. Long leg X-rays is the gold standard technique of measuring LLD. It is highly accurate and reliable compared to clinical method, but expose the subject to radiation. Instrumented Gait Analysis (IGA) serves not only as a means to measure joint kinematics during gait but also as a valuable tool for assessing Leg Length Discrepancy (LLD) while standing.Research Question.The purpose of this study was to compare different methods of determining the LLD in paediatric population. We hypothesize that IGA using joint centres is more accurate and precise than the tape measurement. MethodsThirty-one patients with mean age 12.3 (SD=2.4) years were retrospectively included in the study. Their LLD varied between 0 and 36 mm. Three methods for determining LLD were compared to radiography using Bland-Altman analysis: 1. Tape measurement, 2. IGA, summarizing the distance from the spina iliaca anterior superior to the medial malleolus marker via the medial knee condyle marker. 3. IGA, summarizing distances between ankle, knee, and hip joints centres where the latter is calculated with different equations. ResultsThe IGA joints method performed better than the tape measurement or IGA markers method. The equations of Davis calculating the hip joint centre had the highest accuracy with mean difference to radiography of 0.7 mm (SD=6.3). The simple Harrington method resulted in a slightly reduced accuracy but higher precision 0.9 mm (SD=6.2). The Harrington method with leg length as input was less accurate 1.0 mm (SD=6.7), but was still considerably better than the tape measurement 1.8 mm (SD=7.0) or IGA markers method 1.1 mm (SD=11.5).Significance.Determining LLD with IGA using the distances between ankle, knee and hip joints centres is a feasible method that can be applied in clinical practice to calculate LLD.

Topographical landmarks for lateral calcaneal artery sensate flap- A cadaveric study

The lateral calcaneal artery (LCA) flap is used for treating skin defects of the foot. We aim to study the relationship between the LCA and the Sural Nerve (SN) with the lateral malleolus (LM) to delineate the topographical landmarks for identifying LCA and SN while designing the LCA flap. The foot was dissected to identify LCA and SN in 32 formalin-fixed lower limbs. The LCA and SN were identified and separated from the superficial fascia of the foot. Measurements such as the distance between the LCA and LM, SN and LM, and LCA and SN were taken in (a) horizontal plane, (b) 45º oblique plane passing, (c) vertical plane from the most prominent point on LM, including the luminal diameter of LCA.In the horizontal plane, the LCA and SN were present at a mean distance of 24.56±5.2 mm and 22.64±6.26 mm from the LM, respectively. In a 45° oblique plane, LCA and SN were present at a mean distance of 29.10±6.12 mm and 22.68±7.05 mm from the LM, respectively. In the vertical plane, the SN was present at a mean distance of 26.59± 8.87 mm from the LM.LCA was present in the horizontal plane and 45 oblique plane and was absent in the vertical plane in relation to LM; hence, the LCA flap should not extend beyond the 45 oblique plane, and the internal diameter of LCA should not be less than 1.02mm.

Ankle fractures with Chaput fragment: A new classification system with insights into morphology and relation to surgical treatment

BackgroundThe Chaput fragment, a bony avulsion of the anterolateral margin of the distal tibia, is a less commonly discussed fracture pattern in ankle injuries. Its significance in ankle fractures and the optimal fixation technique remains unclear due to limited literature. This study aims to describe the morphology of ankle fractures with Chaput fragment and introduce a new classification system. Materials and methodsWe retrospectively analyzed 33 patients with ankle fractures with associated Chaput fragment treated at our institute over a 3-year period. Data on patient demographics, fracture classification, surgical approach, and fixation method were collected, and a novel classification system for Chaput fragments was proposed. ResultsFour distinct morphological types of Chaput fragment were identified (types 1–4), and three newer variants of trimalleolar fractures were identified (anterior, lateral, and medial variants). Type 1 refers to a small avulsion fragment attached to the anterior-inferior tibiofibular ligament; Type 2 is an anterolateral oblique type; Type 3 refers to an anterolateral fragment with extension into the medial malleolus and Type 4 is a comminuted Chaput fragment. Type 1 Chaput fragment was the most prevalent (60.6%), followed by Type 2 (24.3%), Type 4 (9.1%), and Type 3 (6.1%). The fixation methods ranged from screw fixation, plate fixation, and suture fixation to combinations of these techniques or even indirect stabilization with syndesmotic screws. ConclusionOur new classification system based on morphology includes all possible variants of Chaput fracture. This preliminary data needs to be corroborated by more studies and validated by a larger number of observers

Open reduction and internal fixation in treatment of four cases of bipolar clavicle dislocations

To summarize the method and effectiveness of open reduction and internal fixation in the treatment of 4 cases of bipolar clavicle dislocations. Between June 2017 and June 2022, 4 patients with bipolar clavicle dislocations were admitted. There were 3 males and 1 female. The age ranged from 27 to 63 years, with an average age of 45 years. There were 2 cases of crushing injury of mine car, 1 case of traffic accident injury, and 1 case of heavy object injury. The time from injury to operation was 3-7 days, with an average of 5.0 days. The sternoclavicular joint dislocations were classified as Grade Ⅱ in 1 case and type Ⅲ in 3 cases, and anterior dislocation in 3 cases and posterior dislocation in 1 case. The acromioclavicular joint dislocations were classified as Tossy type Ⅱ in 2 cases and type Ⅲ in 2 cases. After open reduction, the sternoclavicular joint and acromioclavicular joint were fixed with lateral malleolus locking titanium plate and clavicular hook plate, respectively. All operations were successfully completed without vascular or nerve injury. All incisions healed by first intention. All patients were followed up 12-18 months, with an average of 14 months. At last follow-up, the shoulder joint functions were rated as excellent in 3 cases and good in 1 case according to Rockwood score. During follow-up, there was no loosening of internal fixator or fracture. The internal fixators were removed in all patients at 5-7 months after operation (mean, 6 months), and no re-dislocation occurred after removal. For bipolar clavicle dislocation, open reduction combined with lateral malleolus locking titanium plate fixation of the sternoclavicular joint and clavicle hook plate fixation of the acromioclavicular joint can achieve good effectiveness. It has the advantages of simple operation, high safety, firm fixation, and fewer complications, and the shoulder function recovers well.

Distribution, course, and spatial relationships of the saphenous nerve: A 3D neuroanatomical map for nerve stimulation.

The overall objective of this study was to construct a 3D neuroanatomical map of the saphenous nerve based on cartesian coordinate data to define its course in 3D space relative to bony and soft tissue landmarks. Ten lower limb embalmed specimens were meticulously dissected, digitized, laser scanned, and modelled in 3D. The course of the main branches, number of collateral branches, and relationship of saphenous nerve to the great saphenous vein were defined and quantified using the high-fidelity 3D models. In 60% of specimens, the saphenous nerve was found to have three branches in the leg, infrapatellar, anterior, and posterior. In 40% of specimens, the posterior branch was absent. Three landmarks were found to consistently localize the anterior branch: the medial border of tibia at the level of the tibial tuberosity, the medial border of tibia at the level of the mid-point of leg, and the mid-point of the anterior border of the medial malleolus. The posterior branch, when present, had variable branching patterns but did not extend as far distally as the medial malleolus in any specimen. Anatomically, the anterior and posterior branches at the level of the tibial tuberosity could be most advantageous for nerve stimulation due to their close proximity to the bifurcation of the saphenous nerve where the branches are larger and more readily localizable than distally. Additionally, the tibial tuberosity is a prominent landmark that can be easily identified in most individuals and could be used to localize the anterior and posterior branch using ultrasound or other imaging modalities. These findings will enable implementation of highly realistic computational models that can be used to simulate saphenous nerve stimulation using percutaneous and implanted devices.

WEIGHT BEAR THEN DISCHARGE: A SAFE MANAGEMENT STRATEGY FOR ISOLATED WEBER B LATERAL MALLEOLUS FRACTURES. OUTCOMES OF 658 PATIENTS

Myriad protocols exist for isolated Weber B lateral malleolus fractures with a congruent tibiotalar joint on initial radiographs. Stress and weight-bearing radiographs, all at various timepoints, may be employed to identify those injuries that develop significant talar shift but consensus is elusive. This study outlines a safe and reproducible protocol for such injuries, utilising a removable orthosis, immediate weight bearing and standard supine radiographs.A retrospective analysis of a prospective trauma database was analysed to identify patients with an isolated Weber B ankle fracture with adequate presentation radiographs demonstrating a congruent mortise. Patient records and radiographs were evaluated a minimum of 5 years after initial presentation to determine ankle stability, complications, and the burden on outpatient services.Between 2014 and 2016, 657 patients were referred to the specialist trauma clinic from the emergency department. Of the 657, 52 patients had inadequate ED radiographs to determine ankle congruity. At the two-week assessment, 11 of the 52 demonstrated talar shift and required intervention. Therefore 646 patients demonstrated ankle congruity at two weeks after weight bearing. No patient demonstrated talar shift at the six-week assessment. Average number of follow up appointments was 2.4 with 3.5 radiographs. Our new treatment protocol advocates discharge after a single orthopaedic assessment after two weeks of weight bearing.This study supports immediate weight-bearing of Weber B ankle fractures with a congruent mortise in an orthosis. Follow up beyond two weeks is unnecessary and our protocol offers a safe means of significantly reducing the outpatient burden.

The Radiological Anatomy of the Distal Tibiofibular Joint: A Retrospective Computed Tomography Study.

Introduction Distal tibiofibular joint (DTFJ) injuries are commonly encountered in patients with ankle fractures. Achieving optimal fixation is mandatory, but it requires a thorough understanding of the local anatomical relationships. For this reason, we performed a retrospective CT study in healthy ankles to radiologically describe the normal anatomy of the DTFJ and the anatomical relationship of the fibula within the ankle joint. Materials and methods For this study, we retrospectively examined 60 CT scans of healthy, non-injured ankles in a plantigrade position. Patients with prior ankle surgery or systemic diseases with ankle involvement were excluded because we needed to describe the normal anatomy of the joint. The radiological evaluation included the position of the fibula in the fibular notch and the rotational relationship of the fibula with the talus and the medial malleolus. Results Our study included 60 healthy ankles. Thirty-three were right ankles, and 27 were left. The cohort included 36 females and 24 males with a mean age of 48.3 years old. We found that the fibular notch was retroverted on the transverse plane, with the tibiofibular engagement being 0.11 mm (SD=1.57 mm, SE=0.2 mm), at 1 cm proximally to the tibial plafond. Additionally, we observed that the fibula was internally rotated against the lateral talar facet, while the medial and lateral malleolus facets were externally rotated in between. Moreover, we found a strong positive correlation between the incisura retroversion and fibular engagement at 1 cm above the tibial plafond line (Pearson correlation=0.273, p=0.03). Conclusion Our study highlights the importance of gaining a comprehensive understanding of the inherent anatomy of the DTFJ to achieve reduction goals in ankle fractures. According to our results, in ankle fracture treatment, surgeons should aim for anatomical fracture and syndesmotic fixation, with the fibula in internal rotation against the lateral talar facet. Additionally, as normal tibiofibular engagement is borderline, we do not suggest that over-tightening the syndesmotic screws is essential. This study's findings can aid surgeons in reducing the malreduction rates in patients with ankle fractures.

VENOUS ULCERS OF THE LOWER EXTREMITIES

These are wounds that begin as little scratches, itches, or hemorrhages from an enlarging, convoluted rich vein. Like any wound, this one attempts to cure itself; but, because to poor circulation, edema, and the superimposition of infection, it worsens and grows larger over time, particularly in the elderly, the very sick, inactive people, smokers, allergy sufferers, diabetics, and people with certain collagen illnesses. The area where the initial skin damage occurred is usually where they are found, internally but also medially or laterally, above the medial malleolus and below the nape. In a typical organism, a wound would heal in a few days, however in the aforementioned circumstances, the wound worsens and enlarges. About 80% of the time, post-thrombotic syndrome or untreated varicose vein disease is the cause of these ulcers.

The Effect of Prone and Supine Limb Positioning on the Radiographic Evaluation of Posterolateral Plate Fixation of the Posterior Malleolus.

To facilitate the posterolateral approach to the posterior malleolus patients are often positioned prone initially, then turned supine to complete fixation at the medial malleolus. We sought to define observed differences in the radiographic appearance of implants relative to the joint line, in prone and supine positions. A 3.5mm tubular plate and a 3.5mm posterior distal tibial periarticular plate were applied sequentially to 3 individual cadaveric legs, via a posterolateral approach. The tubular plate was positioned to simulate buttress fixation and the posterolateral plate placed more distally. Each limb was secured on a custom jig and radiographs were taken on a mobile c-arm fluoroscopy machine with a calibration ball. A series of prone AP, supine PA and mortise radiographs were taken. Prone radiographs were also taken in different degrees of caudal tilt to simulate knee flexion which occurs in practice, during intraoperative positioning. Plate tip-joint line distances were measured and Mann-Whitney U tests performed. There was no statistically significant difference in plate tip-joint line distance when comparing equivalent prone and supine views (PA/AP or mortise). However, significant differences in apparent implant position were noted with alterations in caudal tilt. When taking a prone image, when the knee is flexed to 20 degrees, the plate tip will appear 6.5-8.5mm more proximal than in the equivalent supine image where the knee is extended and the fluoroscopy beam is orthogonal to the anatomic axis of the tibia. Observed differences in radiographic appearance of metalwork in the prone and supine position are most likely due to knee flexion and the resulting variation in the angle of the fluoroscopy beam, rather than projectional differences between supine and prone views. Surgeons should be alert to this when analysing intraoperative images.

Operative vs Nonoperative Management of Unstable Medial Malleolus Fractures

Unstable ankle fractures are routinely managed operatively. However, because of soft tissue and implant-related complications, recent literature has reported on the nonoperative management of well-reduced medial malleolus fractures after fibular stabilization, but with limited evidence supporting the routine application. To assess the superiority of internal fixation of well-reduced (displacement ≤2 mm) medial malleolus fractures compared with nonfixation after fibular stabilization. This superiority, pragmatic, parallel, prospective randomized clinical trial was conducted from October 1, 2017, to August 31, 2021. A total of 154 adult participants (≥16 years) with a closed, unstable bimalleolar or trimalleolar ankle fracture requiring surgery at an academic major trauma center in the UK were assessed. Exclusion criteria included injuries with no medial-sided fracture, open fractures, neurovascular injury, and the inability to comply with follow-up. Data analysis was performed in July 2022 and confirmed in September 2023. Once the lateral (and where appropriate, posterior) malleolus had been fixed and satisfactory intraoperative reduction of the medial malleolus fracture was confirmed by the operating surgeon, participants were randomly allocated to fixation (n = 78) or nonfixation (n = 76) of the medial malleolus. Olerud-Molander Ankle Score (OMAS) 1 year after randomization (range, 0-100 points, with 0 indicating worst possible outcome and 100 indicating best possible outcome). Among 154 randomized participants (mean [SD] age, 56.5 [16.7] years; 119 [77%] female), 144 (94%) completed the trial. At 1 year, the median OMAS was 80.0 (IQR, 60.0-90.0) in the fixation group compared with 72.5 (IQR, 55.0-90.0) in the nonfixation group (P = .17). Complication rates were comparable. Significantly more patients in the nonfixation group developed a radiographic nonunion (20% vs 0%; P < .001), with 8 of 13 clinically asymptomatic; 1 patient required surgical reintervention for this. Fracture type and reduction quality appeared to influence fracture union and patient outcome. In this randomized clinical trial comparing internal fixation of well-reduced medial malleolus fractures with nonfixation, after fibular stabilization, fixation was not superior according to the primary outcome. However, 1 in 5 patients developed a radiographic nonunion after nonfixation, and although the reintervention rate to manage this was low, the future implications are unknown. These results support selective nonfixation of anatomically reduced medial malleolar fractures after fibular stabilization. ClinicalTrials.gov Identifier: NCT03362229.

Repair of deep deltoid ligament ruptures near the medial malleolar attachment or midsubstance rupture by using suture anchors into the talus combined with the transosseous suture in the medial malleolar.

For deep deltoid ligament ruptures near the medial malleolar attachment, anchors were usually placed at the posterior colliculus and intercollicular groove. However, this procedure usually requires a prolonged surgical incision to fully expose the deep deltoid ligament, causing more trauma. In order to reduce surgical trauma, we explored the treatment outcomes of suture anchor into the talus combined with transosseous suture in the medial malleolar for the treatment of deep deltoid ligament ruptures near the medial malleolar attachment or midsubstance rupture. This is a retrospective study of patients who received suture anchor into the talus combined with transosseous suture in the medial malleolar for repairing deltoid ligament ruptures near the medial malleolar attachment or midsubstance rupture. The outcome measures include the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS), and the active range of motion (ROM) of the ankle at the final follow-up visit after surgery. Medial malleolus gap was evaluated by radiographic examination. This study included 64 patients. The mean follow-up time was 36.3 ± 15.2 months. There were 43 patients with injuries on the medial malleolar side, and 21 cases on the midsubstance. The average AOFAS and VAS were 87.5 ± 4.9 and 0.7 ± 0.5, respectively. No significance in medial malleolus gap between the contralateral side and affected side was observed. For deltoid ligament ruptures near the medial malleolar attachment or midsubstance rupture, suture anchor into the talus combined with transosseous suture in the medial malleolar yields good clinical effect and outcome, is an optimal management of ankle syndesmosis injuries.

Acute traumatic subtalar dislocation: A rare but important clinical entity with 15-year retrospective radiological analysis of 23 cases.

The objectives of this study were to contribute to the limited existing knowledge about subtalar dislocations, analyze the computed tomography (CT) findings and advantages over radiography, and report the rate and potential risk factors of post-traumatic peri-talar osteoarthritis (OA). A total of 23 cases of traumatic subtalar dislocation during a 15-year period at three regional hospitals were retrospectively reviewed. All 23 cases were closed dislocations. Successful close reduction was performed in 17 patients (73.9%) and 6 patients (26.1%) required open reduction and internal fixation. Twenty patients (87%) had associated foot and ankle fractures. Fractures of calcaneal medial tubercle were the most common (75%), followed by talar head (30%), sinus tarsi (25%), and medial malleolus (25%). The radiograph's sensitivity for identifying fractures was 48.1%. The mean follow-up period is 30 months. Symptomatic OA affected 8 patients (36.4%). No post-trauatic talar avascular necrosis was noted. Fractures were present in all of those patients with post-traumatic OA (100%). Three out of five patients who sustained high-energy mechanism injury developed radiographic OA (66.7%). Three out of six patients (50%) treated with open reduction and internal fixation also developed radiographic OA. Subtalar dislocation remains a rare injury. It is strongly associated with foot and ankle fractures. Fractures of the calcaneal medial tubercle were the most common. The risk of post-traumatic symptomatic peritalar OA is high. CT is useful in detecting occult fractures and injured bony subregions. We postulated potential risk factors of post-traumatic OA (fracture, high-energy mechanism of injury, open reduction, and internal fixation); however, this requires further study.

Management of non-healing post allergic ulcers with Yashtimadhu Ghrita and adjuvant Ayurvedic drugs-A Case Report

An allergic reaction arises when the immune system responds to a harmful substance. Symptoms of drug allergy can range from mild to severe and may include skin rashes, itching on hands, inner elbows, neck, feet and around the eyes, fever, swelling in the mouth and throat. In the current scenario of human health, there is a high prevalence of allergic reaction due to increasing use of unnatural sources in Food, Medicine and other substances used in routine life. In this case report a 62 year old male patient presented in Shalya Tantra outdoor patient department with complaints of multiple ulcers in bilateral leg since one year, accompanied by severe burning sensation in bilateral leg since six months. In the presentation of allergic ulcer patient had history of trauma on medial malleolus of right foot before four years and ulcer was developed at right medial malleolus. The patient also had a previous allergic reaction to debridement (debridace) ointment. This patient was managed with Vrana Prakshalan using Panchavalkala Kwatha, followed by the local application of Yashtimadhu Ghrita twice daily. Additionally, Avipattikar Churna (5g) mixed with Sootashekhar Rasa (125mg) was administered twice daily after meals with normal water for 21 days. Within 10 days of treatment, the burning sensation subsided, and bandaging with Yashtimadhu Ghrita was initiated. By the second week of treatment, signs of ulcer healing began to appear, and complete ulcer healing was achieved in six weeks. Generally inflammatory condition is seen in allergic reactions, but in this case, ulcers developed due to allergy. This single case report shows that Yashtimadhu Ghrita and adjuvant Ayurvedic medicines have properties to treat post allergic ulcer.

Comparison of Fully Threaded Cannulated Screw, Half Threaded Cannulated Screw, and Tension-Band Wiring in the Fixation of Herscovici Type C Medial Malleolus Fractures: A Retrospective Clinical Study

Comparison of Fully Threaded Cannulated Screw, Half Threaded Cannulated Screw, and Tension-Band Wiring in the Fixation of Herscovici Type C Medial Malleolus Fractures: A Retrospective Clinical Study

Assessment of lateral malleolus weber C fractures’ outcomes in patients undergoing syndesmosis-only fixation versus syndesmosis and fibular fixation

Abstract Introduction Ankle fractures were associated with syndesmosis injuries, so it is very important to gain accurate anatomical reduction of the ankle mortise and good fixation of the disrupted syndesmosis. Aim Aim of this study was to assess lateral malleolus Weber C fractures’ outcomes in patients undergoing syndesmosis-only fixation versus syndesmosis and fibular fixation. Subjects and methods The present study was designed as a randomized controlled clinical trial study that included all patients presenting to the emergency room at Suez Canal University hospital after an ankle twisting injury causing lateral malleolus Weber C fracture. Results Patients who had performed syndesmosis-only were found to have significantly higher tibiofibular clear space (AP and mortise views) at 6 months only compared to those who had syndesmosis and fixation. Also, There was no statistically significant difference between syndesmosis-only and syndesmosis with fixation groups in regard to medial clear space, incidence of soft tissue infection, delayed union, Complex regional pain syndrome or all items of OMAS scale. Conclusions There was a significantly stability and nearby functional outcomes with a minimally invasive technique in the group managed by syndesmosis-only fixation and the group managed by syndesmosis and fibular fixation. The results are optimistic regarding the benefits of syndesmosis-only fixtion in patients with lateral malleolus Weber C fractures. However, more confirmatory studies need to be done.

Arthroscopic Modified Broström Repair with Suture-Tape Augmentation of the Calcaneofibular Ligament for Lateral Ankle Instability

Surgical repair of acute or chronic lateral instability of the ankle may be unsuccessful in the presence of associated anterior fibulotalar ligament (AFTL) and calcaneofibular ligament (CFL) injury. This Technical Note presents an arthroscopic double-row repair technique of the AFTL associated with suture tape augmentation of the CFL. The patient is in the supine position with the ankle hanging over the edge of the surgical table. The anteromedial portal is created inside the anterior tibial tendon, and the anterolateral portal is created under arthroscopic control. The ATFL is released from the capsule with a beaver blade. The calcaneal tunnel is created percutaneously at the footprint of the CFL. A soft anchor is impacted at the tip of the lateral malleolus with thread and tape. With the foot in the neutral position, the tape is then passed into the calcaneal tunnel and attached with an interference screw to strengthen the CFL. The ATFL is grasped with a Mini-Scorpion suture passer and pressed against the anchor with the foot in neutral position. A knotless anchor is impacted 5 mm above with the threads of the soft anchor, creating double-row fixation. This technique is indicated in proximal tears of the AFTL associated with a stretched CFL.

Formaldehit Fikse Kadavralarda Tarsal Tüneli Kaplayan Retinaculum Flexorum'un Anatomik Olarak İncelenmesi

Aim: The flexor retinaculum lies between the medial malleolus of the tibia and the medial process of the calcaneus. It converts grooves on the tibia and calcaneus into the tarsal tunnel. The aim of this study was to analyze the morphometry, the course, and the shape of the flexor retinaculum covering the tarsal tunnel in formaldehyde-fixed cadavers.&#x0D; Material and Methods: Six lower extremities of four formaldehyde-fixed cadavers (four right sides, and 2 left sides) were examined to evaluate the morphometry of the flexor retinaculum. The cadavers were two females and two males with an age range of 60-89 years. A digital caliper (150 mm) and a light microscope were used for measuring parameters. The central length, proximal, midpoint, and distal width, thickness, course, and shape of the flexor retinaculum were examined in this study.&#x0D; Results: The mean central length of the flexor retinaculum was found 42.26±5.18 mm. The mean proximal, midpoint, and distal width of the flexor retinaculum were 29.29±7.29 mm, 29.92±3.66 mm, and 29.76±8.13 mm, respectively. The mean of the thickness was measured at 234.94 µm. The flexor retinaculum coursed vertically in four extremities and coursed obliquely in two extremities. The shape of the retinaculum was triangular in five extremities and quadrangular in only one extremity.&#x0D; Conclusion: The morphometric data obtained from this study can help surgeons during the operations of the tarsal tunnel syndrome. To our knowledge, the width and course of the flexor retinaculum were examined for the first time in this study.