在足踝运动创伤中,单纯下胫腓联合损伤相较于踝关节外侧副韧带损伤得到的关注较少,常导致漏诊和误诊的发生。近年来随着磁共振和关节镜技术的普及,下胫腓联合损伤的诊断和治疗水平有所提高。欧洲运动创伤、膝关节外科和关节镜学会(Europ...在足踝运动创伤中,单纯下胫腓联合损伤相较于踝关节外侧副韧带损伤得到的关注较少,常导致漏诊和误诊的发生。近年来随着磁共振和关节镜技术的普及,下胫腓联合损伤的诊断和治疗水平有所提高。欧洲运动创伤、膝关节外科和关节镜学会(European Society Sports Traumatology Knee Surgery Arthroscopy,ESSKA)在2015年发布《关于急性单纯下胫腓联合损伤的专家共识》,本文通过对共识的解读及近几年相关研究的综述,进一步加深足踝外科医师对下胫腓联合损伤分类、诊断和治疗的理解,为后续相关研究明确方向。展开更多
Ankle fractures are one of the most common injuries treated by orthopaedic surgeons. A minority of patients with ankle fractures go on to develop persistent pain following anatomical reduction. These sequelae may aris...Ankle fractures are one of the most common injuries treated by orthopaedic surgeons. A minority of patients with ankle fractures go on to develop persistent pain following anatomical reduction. These sequelae may arise as a result of untreated ligamentous or chondral injuries. This study aims to correlate acute arthroscopic ankle findings with the <i><span>Lauge-Hansen </span></i><span>fracture pattern classification. We further aim to compare subjective functional outcomes at least one year following surgery between patients who have received Open Reduction and Internal Fixation (ORIF) alone, </span><b><i><span>versus</span></i></b><i><span> </span></i><span>ORIF </span><i><span>plus</span></i><span> arthroscopy. This is a retrospective case series of patients who have undergone ankle fracture ORIF +/</span><span>-</span><span> arthroscopy from July 2014 to July 2017 inclusive. Each patient’s presenting radiograph was classified according to the </span><i><span>Lauge-Hansen</span></i><span> ankle fracture classification with subsequent correlation to intra-operative arthroscopic findings. Functional outcome at a minimum of one year was evaluated with the American Academy of Orthopaedic Surgeons (AAOS) metric. Twenty two patients underwent ankle ORIF plus arthroscopy (Group A) with a further 26 patients receiving ORIF alone (Group B). 1 in 3 supination-external-rotation type II (SER II) injuries possessed a concomitant syndesmosis injury or osteochondral lesion (OCL) on arthroscopy. 1 in 3 patients with a</span><span>n</span><span> SER IV injury had an osteochondral lesion. The mean AAOS score achieved for Group A was 89.6 (±7.9) with the mean score for Group B being 82.0 (±13.7). In conclusion, ankle arthroscopy aids the diagnosis and treatment of ligamentous and osteochondral injuries not evident on plain film with subsequent superior short-term outcomes</span><span>.</span>展开更多
BACKGROUND Acute injuries to the tibiofibular syndesmosis,often associated with high ankle sprains or malleolar fractures,require precise diagnosis and treatment to prevent long-term complications.This case report exp...BACKGROUND Acute injuries to the tibiofibular syndesmosis,often associated with high ankle sprains or malleolar fractures,require precise diagnosis and treatment to prevent long-term complications.This case report explores the use of needle arthroscopy as a minimally invasive technique for the repair of tibiofibular syndesmosis injuries.CASE SUMMARY We report on a 40-year-old male patient who presented with a trimalleolar fracture and ankle subluxation following a high ankle sprain.Due to significant swelling and poor soft tissue quality,initial management involved external stabilization.Subsequently,needle arthroscopy was employed to assess and treat the tibiofibular syndesmosis injury.The procedure,performed under spinal anesthesia and fluoroscopic control,included nanoscopic evaluation of the ankle joint and reduction of the syndesmosis using a suture button.Follow-up assessments showed significant improvement in pain levels,range of motion,and functional scores.At 26 weeks post-procedure,the patient achieved full range of motion and pain-free status.Needle arthroscopy offers a promising alternative for the management of acute tibiofibular syndesmosis injuries,combining diagnostic and therapeutic capabilities with minimal invasiveness.CONCLUSION This technique may enhance clinical outcomes and reduce recovery times,warranting further investigation and integration into clinical practice.展开更多
BACKGROUND Ankle syndesmosis injury is difficult to diagnose accurately at the initial visit.Missed diagnosis or improper treatment can lead to chronic complications.Complete syndesmosis injury with a concomitant rupt...BACKGROUND Ankle syndesmosis injury is difficult to diagnose accurately at the initial visit.Missed diagnosis or improper treatment can lead to chronic complications.Complete syndesmosis injury with a concomitant rupture of the interosseous membrane(IOM)is more unstable and severe.The relationship between this type of injury and Maisonneuve injury,in which the syndesmosis is also injured,has not been discussed in the literature previously.CASE SUMMARY A 16-year-old patient sustained left medial malleolar fracture,and the associated inferior tibiofibular syndesmotic instability was overlooked.After open reduction and internal fixation of the medial malleolar fracture,inferior tibiofibular syndesmosis diastasis with IOM rupture was detected by auxiliary imaging.Secondary surgical intervention was performed to reduce anatomically and fix with two trans-syndesmosis screws.Twelve weeks later,the screws were removed.At the 6-mo follow-up,the patient gained full range of motion of the ankle.CONCLUSION Complete syndesmosis injury with IOM rupture should be considered Maisonneuve-type injury.Open reduction and internal fixation could obtain good outcomes.展开更多
Reconstruction of unstable syndesmotic injuries is not trivial, and there is no generally accepted treatment guidelines. Thus, there still remain considerable controversies regarding diagnosis, classification and trea...Reconstruction of unstable syndesmotic injuries is not trivial, and there is no generally accepted treatment guidelines. Thus, there still remain considerable controversies regarding diagnosis, classification and treatment of syndesmotic injuries. Syndesmotic malreduction is the most common indication for early re-operation after ankle fracture surgery, and widening of the ankle mortise by only 1 mm decreases the contact area of the tibiotalar joint by 42%. Outcome of ankle fractures with syndesmosis injury is worse than without, even after surgical syndesmotic stabilization. This may be due to a high incidence of syndesmotic malreduction revealed by increasing postoperative computed tomography controls. Therefore, even open visualization of the syndesmosis during the reduction maneuver has been recommended. Thus, the most important clinical predictor of outcome is consistently reported as accuracy of anatomic reduction of the injured syndesmosis. In this context the Tight Rope~?system is reported to have advantages compared to classical syndesmotic screws. However, rotational instability of the distal fibula cannot be safely limited by use of 1 or even 2 Tight Ropes~?. Therefore, we developed a new syndesmotic Internal Brace^(TM) technique for improved anatomic distal tibiofibular ligament augmentation to protect healing of the injured native ligaments. The Internal Brace^(TM) technique was developed by Gordon Mackay from Scotland in 2012 using Swive Locks~? for knotless aperture fixation of a Fiber Tape~? at the anatomic footprints of the augmented ligaments, and augmentation of the anterior talofibular ligament, the deltoid ligament, the spring ligament and the medial collateral ligaments of the knee have been published so far. According to the individual injury pattern,patients can either be treated by the new syndesmotic Internal Brace^(TM) technique alone as a single anterior stabilization, or in combination with one posteriorly directed Tight Rope~? as a double stabilization, or in combination with one Tig展开更多
文摘在足踝运动创伤中,单纯下胫腓联合损伤相较于踝关节外侧副韧带损伤得到的关注较少,常导致漏诊和误诊的发生。近年来随着磁共振和关节镜技术的普及,下胫腓联合损伤的诊断和治疗水平有所提高。欧洲运动创伤、膝关节外科和关节镜学会(European Society Sports Traumatology Knee Surgery Arthroscopy,ESSKA)在2015年发布《关于急性单纯下胫腓联合损伤的专家共识》,本文通过对共识的解读及近几年相关研究的综述,进一步加深足踝外科医师对下胫腓联合损伤分类、诊断和治疗的理解,为后续相关研究明确方向。
文摘Ankle fractures are one of the most common injuries treated by orthopaedic surgeons. A minority of patients with ankle fractures go on to develop persistent pain following anatomical reduction. These sequelae may arise as a result of untreated ligamentous or chondral injuries. This study aims to correlate acute arthroscopic ankle findings with the <i><span>Lauge-Hansen </span></i><span>fracture pattern classification. We further aim to compare subjective functional outcomes at least one year following surgery between patients who have received Open Reduction and Internal Fixation (ORIF) alone, </span><b><i><span>versus</span></i></b><i><span> </span></i><span>ORIF </span><i><span>plus</span></i><span> arthroscopy. This is a retrospective case series of patients who have undergone ankle fracture ORIF +/</span><span>-</span><span> arthroscopy from July 2014 to July 2017 inclusive. Each patient’s presenting radiograph was classified according to the </span><i><span>Lauge-Hansen</span></i><span> ankle fracture classification with subsequent correlation to intra-operative arthroscopic findings. Functional outcome at a minimum of one year was evaluated with the American Academy of Orthopaedic Surgeons (AAOS) metric. Twenty two patients underwent ankle ORIF plus arthroscopy (Group A) with a further 26 patients receiving ORIF alone (Group B). 1 in 3 supination-external-rotation type II (SER II) injuries possessed a concomitant syndesmosis injury or osteochondral lesion (OCL) on arthroscopy. 1 in 3 patients with a</span><span>n</span><span> SER IV injury had an osteochondral lesion. The mean AAOS score achieved for Group A was 89.6 (±7.9) with the mean score for Group B being 82.0 (±13.7). In conclusion, ankle arthroscopy aids the diagnosis and treatment of ligamentous and osteochondral injuries not evident on plain film with subsequent superior short-term outcomes</span><span>.</span>
文摘BACKGROUND Acute injuries to the tibiofibular syndesmosis,often associated with high ankle sprains or malleolar fractures,require precise diagnosis and treatment to prevent long-term complications.This case report explores the use of needle arthroscopy as a minimally invasive technique for the repair of tibiofibular syndesmosis injuries.CASE SUMMARY We report on a 40-year-old male patient who presented with a trimalleolar fracture and ankle subluxation following a high ankle sprain.Due to significant swelling and poor soft tissue quality,initial management involved external stabilization.Subsequently,needle arthroscopy was employed to assess and treat the tibiofibular syndesmosis injury.The procedure,performed under spinal anesthesia and fluoroscopic control,included nanoscopic evaluation of the ankle joint and reduction of the syndesmosis using a suture button.Follow-up assessments showed significant improvement in pain levels,range of motion,and functional scores.At 26 weeks post-procedure,the patient achieved full range of motion and pain-free status.Needle arthroscopy offers a promising alternative for the management of acute tibiofibular syndesmosis injuries,combining diagnostic and therapeutic capabilities with minimal invasiveness.CONCLUSION This technique may enhance clinical outcomes and reduce recovery times,warranting further investigation and integration into clinical practice.
文摘BACKGROUND Ankle syndesmosis injury is difficult to diagnose accurately at the initial visit.Missed diagnosis or improper treatment can lead to chronic complications.Complete syndesmosis injury with a concomitant rupture of the interosseous membrane(IOM)is more unstable and severe.The relationship between this type of injury and Maisonneuve injury,in which the syndesmosis is also injured,has not been discussed in the literature previously.CASE SUMMARY A 16-year-old patient sustained left medial malleolar fracture,and the associated inferior tibiofibular syndesmotic instability was overlooked.After open reduction and internal fixation of the medial malleolar fracture,inferior tibiofibular syndesmosis diastasis with IOM rupture was detected by auxiliary imaging.Secondary surgical intervention was performed to reduce anatomically and fix with two trans-syndesmosis screws.Twelve weeks later,the screws were removed.At the 6-mo follow-up,the patient gained full range of motion of the ankle.CONCLUSION Complete syndesmosis injury with IOM rupture should be considered Maisonneuve-type injury.Open reduction and internal fixation could obtain good outcomes.
文摘Reconstruction of unstable syndesmotic injuries is not trivial, and there is no generally accepted treatment guidelines. Thus, there still remain considerable controversies regarding diagnosis, classification and treatment of syndesmotic injuries. Syndesmotic malreduction is the most common indication for early re-operation after ankle fracture surgery, and widening of the ankle mortise by only 1 mm decreases the contact area of the tibiotalar joint by 42%. Outcome of ankle fractures with syndesmosis injury is worse than without, even after surgical syndesmotic stabilization. This may be due to a high incidence of syndesmotic malreduction revealed by increasing postoperative computed tomography controls. Therefore, even open visualization of the syndesmosis during the reduction maneuver has been recommended. Thus, the most important clinical predictor of outcome is consistently reported as accuracy of anatomic reduction of the injured syndesmosis. In this context the Tight Rope~?system is reported to have advantages compared to classical syndesmotic screws. However, rotational instability of the distal fibula cannot be safely limited by use of 1 or even 2 Tight Ropes~?. Therefore, we developed a new syndesmotic Internal Brace^(TM) technique for improved anatomic distal tibiofibular ligament augmentation to protect healing of the injured native ligaments. The Internal Brace^(TM) technique was developed by Gordon Mackay from Scotland in 2012 using Swive Locks~? for knotless aperture fixation of a Fiber Tape~? at the anatomic footprints of the augmented ligaments, and augmentation of the anterior talofibular ligament, the deltoid ligament, the spring ligament and the medial collateral ligaments of the knee have been published so far. According to the individual injury pattern,patients can either be treated by the new syndesmotic Internal Brace^(TM) technique alone as a single anterior stabilization, or in combination with one posteriorly directed Tight Rope~? as a double stabilization, or in combination with one Tig
