ISSN:1536-0644    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Syndesmosis injuries at the ankle are a common injury that may be missed easily as a result of the fact that normal roentgenograms fail to reveal the magnitude of soft-tissue injury. Magnetic resonance imaging or external rotational stress roentgenograms under anesthesia will assist in making the diagnosis. Syndesmosis injuries can occur with or without proximal fibular fractures, interposed deltoid ligament, or peroneal tendons. Technically demanding, accurate surgery with transfibular screw fixation, including three or four cortices, will ensure a satisfactory result.

ISSN:1536-0644    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Lisfranc injuries in the athlete can be challenging problems for the treating physician. The injury pattern can range from the very subtle ligament tear with diastasis to complicated fracture–dislocations. Proper treatment requires careful examination and use of imaging studies. Patients exhibiting fractures with displacement or subluxation generally require operative fixation because restoration of anatomic position is a key to a successful outcome. The main long-term complication is posttraumatic arthritis of the mid foot. Although the treatments vary from case to case, the goal when managing Lisfranc injuries in athletes remains universal: a return to sports at or near the preinjury level.

ISSN:1536-0644    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Injuries to the hallux metatarsophalangeal joint are not uncommon, particularly in the running athlete. One of the more common causes of hallux injuries is the product of a hyperextension force on a foot fixed to the ground. When the resultant injury is ligamentous, it has been termed “turf toe.” Unfortunately, nearly any sprain of this joint, regardless of mechanism or severity has been given this label. Furthermore, trainers and physicians may fail to recognize the potential dysfunction of this injury, thus providing inadequate care and protection from further injury. Long-term sequelae include FHL tendon tear, hallux valgus or varus, cock-up deformity with IP joint contracture, and degenerative joint disease.While the majority of these injuries can be treated nonoperatively, those with significant instability need to be recognized and surgically managed to allow for restoration of the anatomy and the opportunity for return to full function.

ISSN:1536-0644    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The diagnosis and treatment of tarsal navicular stress fractures is a perplexing problem for the physician treating the active athlete. Ill-defined symptoms, minimal physical findings, and the lack of specificity of radiographs often lead to delay in diagnosis and implementation of treatment. Both incomplete and complete fractures can occur; complete fractures may be acute or chronic, nondisplaced or displaced; and all of these variants require treatment decisions based on the injury as well as the expectations and needs of the individual athlete. Both nonsurgical care and operative treatment are effective methods of treating stress fractures of the navicular depending on these factors.

ISSN:1536-0644    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Posterior ankle pain is a common complaint in athletes who perform in the equinus position. These include swimmers, divers, figure skaters, gymnasts, soccer players, and dancers. The epitome of the “equinus athlete” is the ballet dancer, who, to conform to the “line” required by the art form, must achieve maximum plantarflexion in the foot-ankle-subtalar-midtarsal joint complex. As a consequence of such an extreme and unnatural position, posterior ankle pain may result from sudden injury or, more commonly, chronic overuse. The focus of this article is on the surgical treatment of two conditions that present as posterior ankle pain: flexor hallucis tendonitis and posterior impingement of the ankle. When conservative measures fail, surgical intervention can be considered. A medial approach to the ankle should be used when both conditions occur concurrently. A lateral approach is used to treat isolated posterior impingement. The results of the described operative treatment of these conditions performed by the senior author showed good or excellent results in thirty of forty cases at an average of 7 years follow up.

ISSN:1536-0644    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Acute Jones fractures are routinely treated operatively. A 1 cm skin incision is made just proximal to the base of the fifth metatarsal. A guide pin for a cannulated drill is inserted down the medullary canal. It is critical to check the AP lateral and oblique radiograph to make sure that the guide pin is centered perfectly within the medullary canal. Failure to obtain ideal placement could result in penetration of the medial cortex. Once the guide pin has been adequately positioned, a drill is placed over the guide pin using the soft tissue protector and the medullary canal is reamed to an appropriate diameter. I generally use a 6.5mm solid Synthes screw. After the canal has been drilled, it is imperative to use the tap that corresponds with the appropriate screw. The tap must be placed all the way to the end of where the screw will be inserted. A 6.5 mm short thread Synthes screw is ideal and provides excellent compression.

ISSN:1536-0644    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Thermal modification of tissues in orthopedics targets type I collagen. Under an appropriate amount of heat stress, intramolecular bonds are broken, leading to an uncoiling of the triple-helix collagen molecule. With careful control of mechanical forces during the postoperative period, a permanent “shrinking” of the tissues can be achieved. Thermal modification of tissues to treat joint instability has been used with promising results in the shoulder. More recently, this technology has been applied to treating patients with chronic lateral ankle instability. Between February 1999 and December 2001, 42 patients were treated with thermal-assisted capsular modification for chronic ankle instability using a bipolar radiofrequency, end-effect thermal control wand. At an average follow-up of 14 months, there was a significant pre- to postoperative difference in the modified AOFAS hindfoot score and the physical component of the SF-12. There has been no revisional surgery. Based on the authors' experience, they think that thermal modification of tissues can be applied to patients who have failed conservative treatment of chronic lateral ankle instability.

ISSN:1536-0644    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

A technique similar to the one described by Hanson for reconstruction of severe calcific Achilles' tendinosis using the flexor hallucis longus (FHL) tendon was used in 26 patients (29 tendons). This technique harvests the FHL proximally, near the tip of the medial malleolus, not from the mid foot. Follow-up on all 26 patients (mean age, 51.3 years) is provided with an average follow-up of 35 months (range, 12–58 months). All patients were evaluated postoperatively to assess pain, function, and alignment of the ankle and hindfoot. The AOFAS foot ratios for the ankle and hindfoot (total of 100 points) was used. Time to maximum improvement was 8.2 months (range, 3–20 months). Ankle-Hindfoot Scale ratings improved from 41.7 points (range, 23–63 points) preoperatively to 90.1 points (range, 49–100 points) postoperatively. All but three patients evaluated their result as good or excellent with regard to improved function and pain. No patient had marked functional deficit or deformity of the hallux after transfer of the FHL tendon. This FHL transfer technique is simpler and as effective in treating chronic Achilles' tendinosis as those techniques that harvest the FHL from the mid foot.

ISSN:1536-0644    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

External fixation has been shown to be an effective method of stabilization for tibial pilon fractures. Benefits of early external fixation include preliminary fracture reduction, maintenance of fracture length, and control of edema. These features facilitate delayed open reduction and internal fixation and allow for successful wound healing after surgery. At present, tibial pilon fractures are stabilized with placement of an external fixator in the operating room or by placement of calcaneal traction. However, expeditious application of an external fixator in the emergency department provides a superior alternative for many of these patients. We present a technique for the placement of an emergency room external fixator for the treatment of closed tibial pilon fractures. This procedure is indicated in critical (multi trauma) patients whose conditions may preclude fracture treatment in the operating room. Additional indications include delay in operative treatment in greater than 12 hours and significant soft tissue swelling requiring serial observation. Contraindications include open fractures, ipsilateral calcaneal or proximal tibial fractures, extensive soft tissue injury with contamination, and compartment syndrome. Emergency room external fixation provides a safe and effective means of stabilization for closed tibial pilon fractures.

ISSN:1536-0644    

出版商:OVID    

年代:2002

数据来源: OVID