Highlights • During supination-external rotation injury, Wagstaffe fragment might be avulsed. • Chaput fragment might be impacted by external rotation of the talus. • They would result in concomitant ...chondral injury of talus. • Fragments can be fixed by different methods depending on comminution of fragments. • After treatment, satisfactory recovery is anticipated clinically.
A comprehensive systematic literature review of the health-related quality-of-life (HRQOL) differences among individuals with chronic ankle instability (CAI), ankle-sprain copers, and healthy control ...participants has not been conducted. It could provide a better indication of the self-reported deficits that may be present in individuals with CAI.
To systematically summarize the extent to which HRQOL deficits are present in individuals with CAI.
We searched for articles in the electronic databases of EBSCO Host and PubMed Central using key words chronic, functional, mechanical, coper, instability, sprains, and patient-assessed. We also performed a hand search of reference lists, authors, and patient-reported outcomes (PROs) of the articles screened for inclusion.
Studies were included if they (1) incorporated a PRO as a participant descriptor or as a study outcome to compare adults with CAI to ankle-sprain copers or healthy controls, (2) were written in English, and (3) were published in peer-reviewed journals.
Two authors independently assessed methodologic quality using the modified Downs and Black Index. Articles were filtered into 3 categories based on between-groups comparisons: CAI and copers, CAI and healthy control participants, copers and healthy participants. We calculated Hedges g effect sizes and 95% confidence intervals to examine PRO group differences.
Of the 124 studies assessed for eligibility, 27 were included. A total of 24 articles compared PROs in individuals with CAI and healthy controls, 7 compared individuals with CAI and copers, and 4 compared copers and healthy controls. Quality scores on the modified Downs and Black Index ranged from 52.9% to 88.2%, with 8 high-, 16 moderate-, and 3 low-quality studies. Overall, we observed moderate to strong evidence that individuals with CAI displayed deficits on generic and region-specific PROs compared with copers and healthy controls. However, evidence that differences exist between copers and healthy controls was conflicting. In addition, for dimension-specific outcomes, evidence to suggest that fear of reinjury is heightened in individuals with CAI was limited.
The evidence suggested that CAI is associated with functional and HRQOL deficits, particularly when examined with region-specific PROs. However, PROs do not appear to differ between copers and healthy controls.
Background:
In patients with chronic ankle instability, it is important to repair the anterior talofibular ligament (ATFL) at the anatomic origin site. However, there are limited reports on the ...clinical outcomes according to anatomic ATFL repair.
Purpose:
To compare the clinical outcomes after arthroscopic ATFL repair according to whether the anchor is fixed at an anatomic position.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
We performed a retrospective review of consecutive patients who underwent arthroscopic ATFL repair for chronic ankle instability and were available for a minimum 2-year follow-up. The patients were divided into 3 groups according to the anchor position at the distal fibula on 3-dimensional computed tomography: anatomic arthroscopic ATFL repair (anatomic group), subanatomic arthroscopic ATFL repair (subanatomic group), and nonanatomic arthroscopic ATFL repair (nonanatomic group). The visual analog scale for pain, Foot and Ankle Outcome Score (FAOS), and Karlsson ankle functional score were measured as subjective outcomes. Posturographic analysis and radiologic evaluation using stress radiographs and axial view magnetic resonance imaging were performed as objective outcomes.
Results:
Of 96 patients, 16 were excluded per the exclusion criteria, and 80 were evaluated (anatomic group, n = 24; subanatomic group, n = 42; nonanatomic group, n = 14). The mean age of the patients was 34.5 years, and the mean follow-up period was 27.4 months. A between-group comparison revealed significant differences in FAOS, Karlsson score, and fall risk evaluated by posturography at the final follow-up. Post hoc analysis revealed that the anatomic group had better clinical scores on the FAOS than did the nonanatomic group in all 5 domains (all P < .017). Patients in the anatomic and subanatomic groups had better Karlsson scores and fall risk than those in the nonanatomic group (P = .004 and P = .013, respectively). In terms of objective outcomes, patients in the anatomic and subanatomic groups had better outcomes in fall risk than did those in the nonanatomic group (both P = .001). There were no differences in clinical scores and objective outcomes between the anatomic and subanatomic groups.
Conclusion:
Nonanatomic ATFL repair showed inferior outcomes when compared with anatomic ATFL repair. When arthroscopic ATFL repair is performed, the anchor should be fixed in the anatomic position to improve prognosis.
Background Previous studies have suggested that injury to the anterior talofibular ligament (ATFL) may be linked to altered kinematics
and the development of osteoarthritis of the ankle joint. ...However, the effects of ATFL injury on the in vivo kinematics of
the ankle joint are unclear.
Hypothesis Based on the orientation of the ATFL fibers, ATFL deficiency leads to increased anterior translation and increased internal
rotation of the talus relative to the tibia.
Study Design Descriptive laboratory study.
Methods The ankles of 9 patients with unilateral ATFL injuries were compared as they stepped onto a level surface. Kinematic measurements
were made as a function of increasing load. With use of magnetic resonance imaging and orthogonal fluoroscopy, the in vivo
kinematics of the tibiotalar joint were measured in the ATFL-deficient and intact ankles of the same individuals.
Results A statistically significant increase in internal rotation, anterior translation, and superior translation of the talus was
measured in ATFL-deficient ankles, as compared with the intact contralateral controls. For example, at 100% body weight, ATFL-deficient
ankles demonstrated an increase of 0.9 ± 0.5 mm in anterior translation ( P = .008), an increase of 5.7° ± 3.6° in internal rotation ( P = .008), and a slight increase of 0.2 ± 0.2 mm in the superior translation ( P = .02) relative to the intact contralateral ankles.
Conclusion Deficiency of the ATFL increases anterior translation, internal rotation, and superior translation of the talus.
Clinical Relevance Altered kinematics may contribute to the degenerative changes observed with chronic lateral ankle instability. These findings
might help to explain the degenerative changes frequently observed on the medial talus in patients with chronic ATFL insufficiency
and so provide a baseline for improving ankle ligament reconstructions aimed at restoring normal joint motion.
Weight-bearing computed tomography has multiple advantages in evaluating the hindfoot and ankle. It can assess hindfoot and ankle alignment, pathology in ankle arthritis, and complications related to ...total ankle replacements. It is an essential tool in ankle osteoarthritis diagnostic, preoperative planning, and total ankle replacement outcomes. It allows for better accuracy and reproducibility of alignment and implant size. In addition, it has the potential to more assertively detect complications related to weight bearing.
Background
Grade III ankle sprains that fail conservative treatment can require surgical management. Anatomic procedures have been shown to properly restore joint mechanics, and precise localization ...of insertion sites of the lateral ankle complex ligaments can be determined through radiographic techniques. Ideally, radiographic techniques that are easily reproducible intraoperatively will lead to a consistently well-placed CFL reconstruction in lateral ankle ligament surgery.
Purpose
To determine the most accurate method to locate the calcaneofibular ligament (CFL) insertion radiographically.
Methods
MRIs of 25 ankles were utilized to identify the “true” insertion of the CFL. Distances between the true insertion and three bony landmarks were measured. Three proposed methods (Best, Lopes, and Taser) for determining the CFL insertion were applied to lateral ankle radiographs.
X
and
Y
coordinate distances were measured from the insertion found on each proposed method to the three bony landmarks: the most superior point of the postero-superior surface of the calcaneus, the posterior most aspect of the sinus tarsi, and the distal tip of the fibula.
X
and
Y
distances were compared to the true insertion found on MRI. All measurements were made using a picture archiving and communication system. The average, standard deviation, minimum, and maximum were obtained. Statistical analysis was performed using repeated measures ANOVA, and a post hoc analysis was performed with the Bonferroni test.
Results
The Best and Taser techniques were found to be closest to the true CFL insertion when combining
X
and
Y
distances. For distance in the
X
direction, there was no significant difference between techniques (
P
= 0.264). For distance in the Y direction, there was a significant difference between techniques (
P
= 0.015). For distance in the combined
XY
direction, there was a significant difference between techniques (
P
= 0.001). The CFL insertion as determined by the Best method was significantly closer to the true insertion compared to the Lopes method in the
Y
(
P
= 0.042) and
XY
(
P
= 0.004) directions. The CFL insertion as determined by the Taser method was significantly closer to the true insertion compared to the Lopes method in the
XY
direction (
P
= 0.017). There was no significant difference between the Best and Taser methods.
Conclusion
If the Best and Taser techniques can be readily used in the operating room, they would likely prove the most reliable for finding the true CFL insertion.
(1) To evaluate adequacy and reproducibility of the gravity and manual stress imaging in the diagnosis of unstable ankle fractures and (2) to evaluate the diagnostic utility of lateral talar ...displacement ratio (LTDR) derived in relation to the talar body width on ankle stress imaging.
Retrospective cohort study.
Level 1 Trauma Center.
One hundred seventy consecutive patients who presented with supination-external rotation 2 ankle fractures (OTA/AO 44-B2.1) requiring dynamic stress testing.
Dynamic stress imaging to determine ankle stability.
Ankle instability and subsequent need for surgical fixation as determined by dynamic stress imaging.
No statistical significant difference was found between the adequacy of gravity stress radiographs and manual stress images in regards to surgical decision-making (P = 0.595). Using manual and gravity stress images, receiver operating characteristic curves were generated for medial clear space (MCS) (area under the curve = 0.793, 0.901) and LTDR (0.849, 0.850), corresponding to thresholds of 10.5% and 10.2% for manual and gravity, respectively. Seventy-three of 105 patients (69.5%) with MCS > 5 mm and 62 of 75 patients (82.7%) with LTDR > 10% were offered surgical intervention. Sixty-two of the 77 patients (80.5%) offered surgery had both MCS > 5 mm and LTDR > 10%.
This study shows that manual stress radiographs are just as effective as gravity stress radiographs in making an assessment of ankle fracture stability as there was no difference in diagnostic value between gravity and manual stress imaging in regards to surgical decision-making. Use of additional radiographic measurements such as the LTDR can provide additional information in determining stability when MCS is within a clinical gray area.
Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
To summarize the diagnosis and treatment of fibular fracture in ankle fracture.
Relevant literature at home and abroad in recent years was widely consulted, and various types of fractures were ...discussed and summarized according to Danis-Weber classification.
Conservative treatment is not an ideal treatment for type A avulsion fracture. The operation method should be determined according to the position and size of bone mass. For simple type B fracture, both conservative treatment and surgical treatment can achieve good results. When the position of type C fracture is high and does not affect the stability of ankle joint, it can be treated conservatively, while when the position is low and affects the stability of ankle joint, it needs surgical treatment.
First of all, whether the fibular fracture in the ankle fracture is stable or not should be determined. Whether it is treated surgically or not, the purpose is to restore the tibiofibular syndesmosis and restore the motor function of the ankle.
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