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Sample records for ankle joint fractures

  1. Inverse Dynamics Model for the Ankle Joint with Applications in Tibia Malleolus Fracture

    NASA Astrophysics Data System (ADS)

    Budescu, E.; Merticaru, E.; Chirazi, M.

    The paper presents a biomechanical model of the ankle joint, in order to determine the force and the torque of reaction into the articulation, through inverse dynamic analysis, in various stages of the gait. Thus, knowing the acceleration of the foot and the reaction force between foot and ground during the gait, determined by experimental measurement, there was calculated, for five different positions of the foot, the joint reaction forces, on the basis of dynamic balance equations. The values numerically determined were compared with the admissible forces appearing in the technical systems of osteosynthesis of tibia malleolus fracture, in order to emphasize the motion restrictions during bone healing.

  2. Ankle Fractures

    MedlinePlus

    ... breaks is covered with cartilage. Cartilage is the smooth surface that lines a joint. If the broken piece ... the surface of the joint will not be smooth. This uneven surface typically leads to increased and uneven pressure on ...

  3. Ankle Fractures Often Not Diagnosed

    MedlinePlus

    ... News, Videos & Podcasts » Articles » Text Size Print Bookmark Ankle Fractures Often Not Diagnosed Long-term Complications Result from Poor Recovery Mistaking an ankle fracture for an ankle sprain has serious consequences ...

  4. Ankle fracture - aftercare

    MedlinePlus

    ... page: //medlineplus.gov/ency/patientinstructions/000548.htm Ankle fracture - aftercare To use the sharing features on this ... Sit with your foot elevated higher than your knee at least 4 times a day Apply an ...

  5. Effectiveness of joint mobilisation after cast immobilisation for ankle fracture: a protocol for a randomised controlled trial [ACTRN012605000143628

    PubMed Central

    Lin, C Christine; Moseley, Anne M; Refshauge, Kathryn M; Haas, Marion; Herbert, Robert D

    2006-01-01

    Background Passive joint mobilisation is a technique frequently used by physiotherapists to reduce pain, improve joint movement and facilitate a return to activities after injury, but its use after ankle fracture is currently based on limited evidence. The primary aim of this trial is to determine if adding joint mobilisation to a standard exercise programme is effective and cost-effective after cast immobilisation for ankle fracture in adults. Methods/Design Ninety participants will be recruited from the physiotherapy departments of three teaching hospitals and randomly allocated to treatment or control groups using a concealed procedure. All participants will perform an exercise programme. Participants in the treatment group will also receive joint mobilisation twice a week for four weeks. Blinded follow-up assessments will be conducted four, 12 and 24 weeks after randomisation. The primary outcome measures will be the Lower Extremity Functional Scale and the Assessment of Quality of Life. Secondary outcomes will include measures of impairments, activity limitation and participation. Data on the use of physiotherapy services and participants' out-of-pocket costs will be collected for the cost-effective and cost-utility analyses. To test the effects of treatment, between-group differences will be examined with analysis of covariance using a regression approach. The primary conclusions will be based on the four-week follow-up data. Discussion This trial incorporates features known to minimise bias. It uses a pragmatic design to reflect clinical practice and maximise generalisability. Results from this trial will contribute to an evidence-based approach for rehabilitation after ankle fracture. PMID:16729880

  6. Expedited patient-specific assessment of contact stress exposure in the ankle joint following definitive articular fracture reduction.

    PubMed

    Kern, Andrew M; Anderson, Donald D

    2015-09-18

    Acute injury severity, altered joint kinematics, and joint incongruity are three important mechanical factors linked to post-traumatic osteoarthritis (PTOA). Finite element analysis (FEA) was previously used to assess the influence of increased contact stress due to joint incongruity on PTOA development. While promising agreement with PTOA development was seen, the inherent complexities of contact FEA limited the numbers of subjects that could be analyzed. Discrete element analysis (DEA) is a simplified methodology for contact stress computation, which idealizes contact surfaces as a bed of independent linear springs. In this study, DEA was explored as an expedited alternative to FEA contact stress exposure computation. DEA was compared to FEA using results from a previously completed validation study of two cadaveric human ankles, as well as a previous study of post-operative contact stress exposure in 11 patients with tibial plafond fracture. DEA-computed maximum contact stresses were within 19% of those experimentally measured, with 90% of the contact area having computed contact stress values within 1MPa of those measured. In the 11 fractured ankles, maximum contact stress and contact area differences between DEA and FEA were 0.85 ± 0.64 MPa and 22.5 ± 11.5mm(2). As a predictive measure for PTOA development, both DEA and FEA had 100% concordance with presence of OA (KL grade ≥ 2) and >95% concordance with KL grade at 2 years. These results support DEA as a reasonable alternative to FEA for computing contact stress exposures following surgical reduction of a tibial plafond fracture. PMID:26105660

  7. Paratrooper's Ankle Fracture: Posterior Malleolar Fracture

    PubMed Central

    Young, Ki Won; Cho, Jae Ho; Kim, Hyung Seuk; Cho, Hun Ki; Lee, Kyung Tai

    2015-01-01

    Background We assessed the frequency and types of ankle fractures that frequently occur during parachute landings of special operation unit personnel and analyzed the causes. Methods Fifty-six members of the special force brigade of the military who had sustained ankle fractures during parachute landings between January 2005 and April 2010 were retrospectively analyzed. The injury sites and fracture sites were identified and the fracture types were categorized by the Lauge-Hansen and Weber classifications. Follow-up surveys were performed with respect to the American Orthopedic Foot and Ankle Society ankle-hindfoot score, patient satisfaction, and return to preinjury activity. Results The patients were all males with a mean age of 23.6 years. There were 28 right and 28 left ankle fractures. Twenty-two patients had simple fractures and 34 patients had comminuted fractures. The average number of injury and fractures sites per person was 2.07 (116 injuries including a syndesmosis injury and a deltoid injury) and 1.75 (98 fracture sites), respectively. Twenty-three cases (41.07%) were accompanied by posterior malleolar fractures. Fifty-five patients underwent surgery; of these, 30 had plate internal fixations. Weber type A, B, and C fractures were found in 4, 38, and 14 cases, respectively. Based on the Lauge-Hansen classification, supination-external rotation injuries were found in 20 cases, supination-adduction injuries in 22 cases, pronation-external rotation injuries in 11 cases, tibiofibular fractures in 2 cases, and simple medial malleolar fractures in 2 cases. The mean follow-up period was 23.8 months, and the average follow-up American Orthopedic Foot and Ankle Society ankle-hindfoot score was 85.42. Forty-five patients (80.36%) reported excellent or good satisfaction with the outcome. Conclusions Posterior malleolar fractures occurred in 41.07% of ankle fractures sustained in parachute landings. Because most of the ankle fractures in parachute injuries were

  8. Diagnosing syndesmotic instability in ankle fractures

    PubMed Central

    van den Bekerom, Michel PJ

    2011-01-01

    The precise diagnosis of distal tibiofibular syndesmotic ligament injury is challenging and a distinction should be made between syndesmotic ligament disruption and real syndesmotic instability. This article summarizes the available evidence in the light of the author’s opinion. Pre-operative radiographic assessment, standard radiographs, computed tomography scanning and magnetic resonance imaging are of limited value in detecting syndesmotic instability in acute ankle fractures but can be helpful in planning. Intra-operative stress testing, in the sagittal, coronal or exorotation direction, is more reliable in the diagnosis of syndesmotic instability of rotational ankle fractures. The Hook or Cotton test is more reliable than the exorotation stress test. The lateral view is more reliable than the AP mortise view because of the larger displacement in this direction. When the Hook test is used the force should be applied in the sagittal direction. A force of 100 N applied to the fibula seems to be appropriate. In the case of an unstable joint requiring syndesmotic stabilisation, the tibiofibular clear space would exceed 5 mm on the lateral stress test. When the surgeon is able to perform an ankle arthroscopy this technique is useful to detect syndesmotic injury and can guide anatomic reduction of the syndesmosis. Many guidelines formulated in this article are based on biomechanical and cadaveric studies and clinical correlation has to be established. PMID:22474636

  9. Fatigue characteristics following ankle fractures.

    PubMed

    Behm, D G; St-Pierre, D M

    1997-09-01

    The purpose of the study was to examine the effects of surgical and nonsurgical treatment of previously immobilized ankle fractures on voluntary and evoked contractile properties before and following fatigue. Twelve control and 12 previously immobilized (4-14 wk postfracture) internally fixated and nonfixated ankles were investigated before and following an isometric, intermittent, submaximal, fatigue protocol of the plantar flexors. Before fatigue, fracture groups had significantly lower force output (42.7 vs 78.8 Nm) and muscle activation (78.3 vs 98.7%) than controls. Decreased activation may be attributed to the inhibitory effects of injured muscle and swelling. All groups had similar force and muscle activation decreases (7-10%) following fatigue; however, the internally fixated group performed significantly fewer contractions during the fatigue test (19) than the nonfixated (71) and controls (61). In contrast to the other groups, internally fixated subjects experienced increased (13%) rather than decreased EMG activity (controls: 10.9%, nonfixated: 21.1%). M-waves and twitch torques potentiated to a similar extent in the fracture groups (4.5 and 5.7%) but decreased significantly in the control group (24.2 and 9.8%). The similar fatigue durations of non-fixated subjects compared with controls may be attributed to a lack of impairment in nonfixated neuromuscular propagation and contractile kinetics, while the increased fatigability of fixated subjects with a similar lack of evoked contractile property impairments suggested a greater intrinsic fatigability. PMID:9309620

  10. Which ankle fractures require syndesmotic stabilization?

    PubMed

    van den Bekerom, Michel P J; Lamme, Bas; Hogervorst, Mike; Bolhuis, Hugo W

    2007-01-01

    Syndesmotic ruptures associated with ankle fractures are most commonly caused by external rotation of the foot, eversion of the talus within the ankle mortise, and excessive dorsiflexion. The distal tibiofibular syndesmosis consists of the anterior inferior tibiofibular ligament, posterior inferior tibiofibular ligament, and interosseous ligament, and it is essential for stability of the ankle mortise. Despite the numerous biomechanical and clinical studies pertaining to ankle fractures, there are no uniform recommendations regarding the use of the syndesmotic screw for specific injury patterns and fracture types. The objective of this review was to formulate recommendations for clinical practice related to the use of syndesmotic screw placement. PMID:17980843

  11. Beware the Emergency Ankle Fracture Referral: An Unusual Case of Lateral Subtalar Joint Dislocation Secondary to Calcaneal Fracture with associated Lateral Malleolus Fracture

    PubMed Central

    Colegate-Stone, TJ; James, SE; Koka, SR

    2015-01-01

    Introduction: The referral of a lateral malleolus fracture is one of the commonest orthopaedic trauma presentations. Failure to fully assess the patient and radiography can lead to missing associated injuries in the hindfoot. Case Report: We describe an unusual hindfoot injury with an atypical combination of lateral subtalar dislocation and calcaneal fracture with associated lateral malleolus fracture that was initially not appreciated by the referring emergency department. This case is of particular interest as subtalar dislocation is a rare injury and lateral subtalar dislocation is even rarer. Conclusion: Failure to fully assess such injuries and manage non-operatively leads to early degenerative tibia-talar, hindfoot and midfoot changes and a difficult situation for the surgeon to salvage. We advocate early CT scan and open reduction with fixation for such cases. PMID:27299009

  12. Ankle Fractures Often Not Diagnosed

    MedlinePlus

    ... side of the ankle. This condition often... Barefoot Running Barefoot running is running while barefoot, without wearing any shoes on the feet. Running in thin-soled, flexible shoes is related but ...

  13. Ankle dislocation without accompanying malleolar fracture. A case report.

    PubMed

    Hatori, Masahito; Kotajima, Satoshi; Smith, Richard A; Kokubun, Shoichi

    2006-01-01

    Dislocation of the tibiotalar joint without associated fracture is rare. We present here a 21-year-old man who sustained open posteromedial dislocation of the left ankle without malleolar facture when he jumped and sprained his right ankle while playing basketball. The most likely mechanism is forced flexion applied to the ankle joint leading to a rupture of the anterior capsule and lateral structures of the ankle followed by an accelerating inversion stress leading to a posteromedial dislocation of the talus from the tibial condyle. Transient paresthesia was noted in the area of the superficial peroneal nerve. At surgery, the anterior part of the tibiotalar joint capsule and anterior talofibular ligament were detached from their original sites. The calcaneofibular ligament was also detached with its associated periosteum and a tiny avulsed bony fragment. The articular facets of the tibia and talus were intact. The treatment consisted of wound irrigation, debridement, reduction and capsular suture followed by immobilization with a short leg cast. About 10 degrees of loss in the range of dorsiflexion was observed. The patient achieved good long-term functional results. PMID:16961183

  14. Osteochondral Allografts in the Ankle Joint

    PubMed Central

    Vannini, Francesca; Buda, Roberto; Ruffilli, Alberto; Cavallo, Marco; Giannini, Sandro

    2013-01-01

    Purpose: The aim of this systematic review is to report about the clinical use of partial and total fresh osteochondral allograft in the ankle joint. The state of the art of allografts with regard to basic science, procurement and storage methods, immunogenicity, generally accepted indications and contraindications, and the rationale of the allografting procedure have been described. Methods: All studies published in PubMed from 2000 to January 2012 addressing fresh osteochondral allograft procedures in the ankle joint were identified, including those that fulfilled the following criteria: (a) level I-IV evidence addressing the areas of interest outlined above; (b) measures of functional, clinical, or imaging outcome; and (c) outcome related to ankle cartilage lesions or ankle arthritis treated by allografts. Results: The analysis showed a progressively increasing number of articles from 2000. The number of selected articles was 14; 9 of those focused on limited dimension allografts (plugs, partial) and 5 on bipolar fresh osteochondral allografts. The evaluation of evidence level showed 14 case series and no randomized studies. Conclusions: Fresh osteochondral allografts are now a versatile and suitable option for the treatment of different degrees of osteochondral disease in the ankle joint and may even be used as total joint replacement. Fresh osteochondral allografts used for total joint replacement are still experimental and might be considered as a salvage procedure in otherwise unsolvable situations. A proper selection of the patients is therefore a key point. Moreover, the patients should be adequately informed about the possible risks, benefits, and alternatives to the allograft procedure. PMID:26069666

  15. [Unexpected revision procedures treating ankle fractures].

    PubMed

    Richter, J; Pommer, A; Breuer, R; Hullmann, S; Heyde, D V; Dávid, A

    2012-06-01

    The purpose of the present study was to analyze the risk factors associated with unexpected second procedures and strategies of revision surgery. Within a 5 year period 647 patients with closed ankle fractures AO type 44 were identified of which 77 (11.9%) needed revision surgery. Complications were addressed to 4 main groups: deep infections (IG) were seen in 29 patients (4.5%), problems with primary wound closure (WG) in 22 patients (3.4%), insufficient reduction (KG) in 22 patients (3.4%) and other causes (RG) included 4 patients (0.6%). Significant predictive factors for soft tissue complications were higher age, comorbidities with peripheral arteriosclerosis, high American Society of Anesthesiologists (ASA) score and diabetes mellitus. AO 44 type B2 and B3 fractures were often associated with soft tissue problems. The more complex fracture types AO 44 C1-C3 and A2-A3 were significantly associated with problems of insufficient congruency post-surgery. The distribution of the mean revision rate was significantly different (p<0.01) for all groups: IG 4.59, WG 3.5, KG 1.55, RG 1.25. In summary, we strongly recommend immediate reduction of displaced fractures and to consider a more detailed fracture classification. To reduce the amount of unexpected ankle procedures individual risk factors should be weighed against the advantages of optimal open reduction and internal fixation. PMID:21165587

  16. Primary Retrograde Tibiotalocalcaneal Nailing For Fragility Ankle Fractures

    PubMed Central

    Taylor, Benjamin C.; Hansen, Dane C.; Harrison, Ryan; Lucas, Douglas E; Degenova, Daniel

    2016-01-01

    Background Ankle fragility fractures are difficult to treat due to poor bone quality and soft tissues as well as the near ubiquitous presence of comorbidities including diabetes mellitus and peripheral neuropathy. Conventional open reduction and internal fixation in this population has been shown to lead to a significant rate of complications. Given the high rate of complications with contemporary fixation methods, the present study aims to critically evaluate the use of acute hindfoot nailing as a percutaneous fixation technique for high-risk ankle fragility fractures. Methods In this study, we retrospectively evaluated 31 patients treated with primary retrograde tibiotalocalcaneal nail without joint preparation for a mean of 13.6 months postoperatively from an urban Level I trauma center during the years 2006-2012. Results Overall, there were two superficial infections (6.5%) and three deep infections (9.7%) in the series. There were 28 (90.3%) patients that went on to radiographic union at a mean of 22.2 weeks with maintenance of foot and ankle alignment. There were three cases of asymptomatic screw breakage observed at a mean of 18.3 months postoperatively, which were all treated conservatively.. Conclusions This study shows that retrograde hindfoot nailing is an acceptable treatment option for treatment of ankle fragility fractures. Hindfoot nailing allows early weightbearing, limited soft tissue injury, and a relatively low rate of complications, all of which are advantages to conventional open reduction internal fixation techniques. Given these findings, larger prospective randomized trials comparing this treatment with conventional open reduction internal fixation techniques are warranted. PMID:27528840

  17. Expecting ankle tilts and wearing an ankle brace influence joint control in an imitated ankle sprain mechanism during walking.

    PubMed

    Gehring, Dominic; Wissler, Sabrina; Lohrer, Heinz; Nauck, Tanja; Gollhofer, Albert

    2014-03-01

    A thorough understanding of the functional aspects of ankle joint control is essential to developing effective injury prevention. It is of special interest to understand how neuromuscular control mechanisms and mechanical constraints stabilize the ankle joint. Therefore, the aim of the present study was to determine how expecting ankle tilts and the application of an ankle brace influence ankle joint control when imitating the ankle sprain mechanism during walking. Ankle kinematics and muscle activity were assessed in 17 healthy men. During gait rapid perturbations were applied using a trapdoor (tilting with 24° inversion and 15° plantarflexion). The subjects either knew that a perturbation would definitely occur (expected tilts) or there was only the possibility that a perturbation would occur (potential tilts). Both conditions were conducted with and without a semi-rigid ankle brace. Expecting perturbations led to an increased ankle eversion at foot contact, which was mediated by an altered muscle preactivation pattern. Moreover, the maximal inversion angle (-7%) and velocity (-4%), as well as the reactive muscle response were significantly reduced when the perturbation was expected. While wearing an ankle brace did not influence muscle preactivation nor the ankle kinematics before ground contact, it significantly reduced the maximal ankle inversion angle (-14%) and velocity (-11%) as well as reactive neuromuscular responses. The present findings reveal that expecting ankle inversion modifies neuromuscular joint control prior to landing. Although such motor control strategies are weaker in their magnitude compared with braces, they seem to assist ankle joint stabilization in a close-to-injury situation. PMID:24365326

  18. Bone alterations are associated with ankle osteoarthritis joint pain

    PubMed Central

    Nakamura, Yukio; Uchiyama, Shigeharu; Kamimura, Mikio; Komatsu, Masatoshi; Ikegami, Shota; Kato, Hiroyuki

    2016-01-01

    The etiology of ankle osteoarthritis (OA) is largely unknown. We analyzed 24 ankle OA of 21 patients diagnosed by plain radiographs using magnetic resonance imaging (MRI). Ankle joint pain disappeared in 22 out of 24 joints by conservative treatment. MRI bone signal changes in and around the ankle joints were observed in 22 of 24 joints. Bone signal changes along the joint line were seen in 10 of 11 joints as a Kellgren-Lawrence (KL) grade of II to IV. Such signal changes were witnessed in only 4 of 13 joints with KL grade 0 or I. In the talocrural joint, bone alterations occurred in both tibia and talus bones through the joint line in cases of KL grade III or IV, while focal bone alterations were present in the talus only in KL grade I or II cases. Sixteen of 24 joints exhibited intraosseous bone signal changes, which tended to correspond to joint pain of any ankle OA stage. Our results suggest that bone alterations around the ankle joint might be one of the etiologies of OA and associated with ankle joint pain. PMID:26776564

  19. Open Reduction Internal Fixation of a Bimalleolar Ankle Fracture With Syndesmotic Injury.

    PubMed

    Ostrum, Robert F; Avery, Matthew C

    2016-08-01

    Rotational ankle fractures are incredibly common, resulting in a wide spectrum of bony and ligamentous injury patterns. After open reduction of an ankle fracture, the treating surgeon must always evaluate syndesmotic stability. If the syndesmosis is determined to be unstable, a reduction of the distal tibiofibular joint should be performed. Failure to adequately identify and treat injuries to the syndesmosis may result in continued ankle instability and poor patient outcomes. Lateral fluoroscopic images are necessary to assess a closed reduction of the syndesmosis before stabilization, although the accuracy of this tool has been questioned in several studies. Significant controversy surrounds many aspects of this injury and its treatment, including methods of diagnosis, ideal reduction clamp positioning, diameter and number of syndesmotic screws, and number of tibial cortices to be engaged. In the accompanying video, we describe our approach for the treatment of a bimalleolar ankle fracture with syndesmotic injury, using a posterior fibular plate and single tricortical syndesmotic screw. PMID:27441940

  20. State-of-the-Art in Ankle Fracture Management in Chile.

    PubMed

    Ortiz, Cristián A; Wagner, Pablo; Wagner, Emilio

    2016-06-01

    The ankle represents the most commonly injured weightbearing joint in the human body. They are typically the result of low-energy, rotational injury mechanisms. However, ankle fractures represent a spectrum of injury patterns from simple to very complex, with varying incidence of posttraumatic arthritis. Stable injury patterns can be treated nonoperatively; unstable injury patterns are typically treated operatively given that they could lead to severe arthritis if not properly addressed. PMID:27261811

  1. [Advances on biomechanics and kinematics of sprain of ankle joint].

    PubMed

    Zhao, Yong; Wang, Gang

    2015-04-01

    Ankle sprains are orthopedic clinical common disease, accounting for joint ligament sprain of the first place. If treatment is not timely or appropriate, the joint pain and instability maybe develop, and even bone arthritis maybe develop. The mechanism of injury of ankle joint, anatomical basis has been fully study at present, and the diagnostic problem is very clear. Along with the development of science and technology, biological modeling and three-dimensional finite element, three-dimensional motion capture system,digital technology study, electromyographic signal study were used for the basic research of sprain of ankle. Biomechanical and kinematic study of ankle sprain has received adequate attention, combined with the mechanism research of ankle sprain,and to explore the the biomechanics and kinematics research progress of the sprain of ankle joint. PMID:26072625

  2. Ankle fracture: radiographic approach according to the Lauge-Hansen classification.

    PubMed

    Russo, A; Reginelli, A; Zappia, M; Rossi, C; Fabozzi, G; Fabozzi, O; Cerrato, M; Macarini, L; Coppolino, F

    2013-08-01

    Ankle fractures account for 9 % of fractures (Clare in Foot Ankle Clin 13(4):593-610, 1) representing a significant portion of the trauma workload; proximal femoral fractures are the only lower limb fracture to present more frequently. Ankle fractures have a bimodal age distribution with peaks in younger males and older females (Arimoto and Forrester in AJR Am J Roentgenol 135(5):1057-1063, 2). There has been threefold increase in the incidence among elderly females over the past three decades (Haraguchi and Armiger in J Bone Joint Surg Am 91(4):821-829, 3). In 1950, Lauge-Hansen devised a classification of ankle fractures based on the position of the foot and the deforming force at the time of injury. This has been widely accepted by orthopedists, but is not in general use by radiologists. Identification of the fractures and classification of the type of injury allows diagnosis of the otherwise occult ligamentous injuries. Three radiographic views of the ankle (anteroposterior, mortise, and lateral) are necessary to classify an injury with the Lauge-Hansen system. Two additional criteria are also necessary: the position of the foot at the time of injury and the direction of the deforming force. PMID:23949937

  3. [Ankle fractures in the elderly patient].

    PubMed

    Crevoisier, Xavier; Baalbaki, Rayan; Dos Santos, Tiago; Assal, Mathieu

    2014-12-17

    Ankle fractures in adults are usually managed by open reduction internal fixation. In elderly patients the surgical dilemma relates to bone quality. Osteoporosis is the enemy of internal fixation, and secure purchase of screws in osteopenic bone may be difficult to achieve. Insufficient screw purchase may lead to loss of reduction, wound breakdown, and infection. Postoperative management after osteosynthesis usually requires an extended period of restricted weight bearing. However, this is not feasible in older patients as a result of their lack of strength in the upper extremities and frequent comorbidities. Therefore, augmen- ted methods of internal fixation and specific surgical techniques have been developed using metal and bone cement. This permits this fragile population to begin early full weight bearing in a removable brace. PMID:25752013

  4. Ankle motion after external fixation of tibial fractures.

    PubMed Central

    Taylor, G J; Allum, R L

    1988-01-01

    Loss of ankle movement is a complication of severe tibial fractures. This can be exacerbated if the foot is allowed to drop into equinus, particularly when an external fixator is employed. The range of ankle motion following external fixation of tibial fractures as compared to the opposite normal ankle was studied in 40 of 55 patients treated over a ten-year period. Nine were excluded due to other causes of ankle stiffness, leaving 31 cases for analysis. The mean follow up was 2 years 7 months (range 1 year to 8 years 3 months), and union had occurred by a mean of 35 weeks (range 9-100 weeks). The mean loss of ankle movement was 8 degrees of plantar-flexion and 12 degrees of dorsiflexion (overall loss 20 degrees), the difference between the two being highly significant (P greater than 0.001, t test). Loss of ankle motion closely paralleled the degree of soft tissue trauma, being 6 degrees for closed fractures and 22 degrees for open fractures (0.05 greater than P greater than 0.02). Ankle function is therefore at risk when a severe tibial fracture is treated by external fixation, and appropriate measures should be taken to preserve movement and prevent an equinus contracture. Images Figure 1. Figure 2. Figure 3. PMID:3343667

  5. 21 CFR 888.3100 - Ankle joint metal/composite semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Ankle joint metal/composite semi-constrained... Ankle joint metal/composite semi-constrained cemented prosthesis. (a) Identification. An ankle joint... ankle joint. The device limits translation and rotation: in one or more planes via the geometry of...

  6. 21 CFR 888.3100 - Ankle joint metal/composite semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Ankle joint metal/composite semi-constrained... Ankle joint metal/composite semi-constrained cemented prosthesis. (a) Identification. An ankle joint... ankle joint. The device limits translation and rotation: in one or more planes via the geometry of...

  7. 21 CFR 888.3100 - Ankle joint metal/composite semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Ankle joint metal/composite semi-constrained... Ankle joint metal/composite semi-constrained cemented prosthesis. (a) Identification. An ankle joint... ankle joint. The device limits translation and rotation: in one or more planes via the geometry of...

  8. 21 CFR 888.3100 - Ankle joint metal/composite semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Ankle joint metal/composite semi-constrained... Ankle joint metal/composite semi-constrained cemented prosthesis. (a) Identification. An ankle joint... ankle joint. The device limits translation and rotation: in one or more planes via the geometry of...

  9. Mechanical Joint Laxity Associated With Chronic Ankle Instability

    PubMed Central

    Cordova, Mitchell L.; Sefton, JoEllen M.; Hubbard, Tricia J.

    2010-01-01

    Context: Lateral ankle sprains can manifest into chronic mechanical joint laxity when not treated effectively. Joint laxity is often measured through the use of manual stress tests, stress radiography, and instrumented ankle arthrometers. Purpose: To systematically review the literature to establish the influence of chronic ankle instability (CAI) on sagittal and frontal plane mechanical joint laxity. Data Sources: Articles were searched with MEDLINE (1966 to October 2008), CINAHL (1982 to October 2008), and the Cochrane Database of Systematic Reviews (to October 2008) using the key words chronic ankle instability and joint laxity, functional ankle instability and joint laxity, and lateral ankle sprains and joint laxity. Study Selection: To be included, studies had to employ a case control design; mechanical joint laxity had to be measured via a stress roentogram, an instrumented ankle arthrometer, or ankle/foot stress-testing device; anteroposterior inversion or eversion ankle-subtalar joint complex laxity had to be measured; and means and standard deviations of CAI and control groups had to be provided. Data Extraction: One investigator assessed each study based on the criteria to ensure its suitability for analysis. The initial search yielded 1378 potentially relevant articles, from which 8 were used in the final analysis. Once the study was accepted for inclusion, its quality was assessed with the PEDro scale. Data Synthesis: Twenty-one standardized effect sizes and their 95% confidence intervals were computed for each group and dependent variable. CAI produced the largest effect on inversion joint laxity; 45% of the effects ranged from 0.84 to 2.61. Anterior joint laxity measures were influenced second most by CAI (effects, 0.32 to 1.82). CAI had similar but less influence on posterior joint laxity (effects, −0.06 to 0.68) and eversion joint laxity (effects, 0.03 to 0.69). Conclusion: CAI has the largest effect with the most variability on anterior and

  10. Analysis of the Effects of Normal Walking on Ankle Joint Contact Characteristics After Acute Inversion Ankle Sprain.

    PubMed

    Bae, Ji Yong; Park, Kyung Soon; Seon, Jong Keun; Jeon, Insu

    2015-12-01

    To show the causal relationship between normal walking after various lateral ankle ligament (LAL) injuries caused by acute inversion ankle sprains and alterations in ankle joint contact characteristics, finite element simulations of normal walking were carried out using an intact ankle joint model and LAL injury models. A walking experiment using a volunteer with a normal ankle joint was performed to obtain the boundary conditions for the simulations and to support the appropriateness of the simulation results. Contact pressure and strain on the talus articular cartilage and anteroposterior and mediolateral translations of the talus were calculated. Ankles with ruptured anterior talofibular ligaments (ATFLs) had a higher likelihood of experiencing increased ankle joint contact pressures, strains and translations than ATFL-deficient ankles. In particular, ankles with ruptured ATFL + calcaneofibular ligaments and all ruptured ankles had a similar likelihood as the ATFL-ruptured ankles. The push off stance phase was the most likely situation for increased ankle joint contact pressures, strains and translations in LAL-injured ankles. PMID:26077988

  11. Epidemiologic study of ankle fractures in a tertiary hospital

    PubMed Central

    Sakaki, Marcos Hideyo; Matsumura, Bruno Akio Rodrigues; Dotta, Thiago De Angelis Guerra; Pontin, Pedro Augusto; dos Santos, Alexandre Leme Godoy; Fernandes, Tulio Diniz

    2014-01-01

    OBJECTIVES: To evaluate the epidemiology of ankle fractures surgically treated at the Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Universidade de São Paulo. METHODS: Medical records of patients admitted with foot and ankle fractures between 2006 and 2011 were revised. Seventy three ankle fractures that underwent surgical treatment were identified. The parameters analyzed included age, gender, injured side, AO and Gustilo & Anderson classification, associated injuries, exposure, need to urgent treatment, time to definitive treatment and early post-operative complications. Study design: retrospective epidemiological study. RESULTS: Male gender was predominant among subjects and the mean age was 27.5 years old. Thirty nine fractures resulted from traffic accidents and type B fracture according to AO classification was the most common. Twenty one were open fractures and 22 patients had associated injuries. The average time to definitive treatment was 6.5 days. Early post-operative complications were found in 21.3% of patients. CONCLUSIONS: Ankle fractures treated in a tertiary hospital of a large city in Brazil affect young people victims of high-energy accidents and present significant rates of associated injuries and post-operative complications. Level of Evidence IV, Cases Series. PMID:24868187

  12. An in Silico Analysis of Ankle Joint Loads in Secondary Ankle Osteoarthritis. Case Study.

    PubMed

    Lorkowski, Jacek; Mrzygłód, Mirosław W; Grzegorowska, Oliwia; Kotela, Ireneusz

    2015-01-01

    Secondary, post-traumatic, degenerative lesions of the ankle joint remain a serious clinical challenge. This paper presents the case of a 66-year-old patient with secondary, post-traumatic ankle osteoarthritis and subchondral cysts. The use of rapid computer modelling FEM 2D enabled optimization of surgical treatment. A FEM 2D model of biomechanical changes in bones may help in streamlining treatment as well as improve our understanding of the pathomechanism of osteoarthritis. PMID:26248632

  13. Small joint arthroscopy in foot and ankle.

    PubMed

    Lui, Tun Hing; Yuen, Chi Pan

    2015-03-01

    The clinical application of small joint arthroscopies (metatarsophalangeal joint, Lisfranc joint, Chopart joint, and interphlangeal joint) in the foot has seen significant advancements in the past decades. This article reviews the clinical indications, technical details, outcomes, and potential complications of small joint arthroscopies of the foot. PMID:25726488

  14. Design of a simple, lightweight, passive-elastic ankle exoskeleton supporting ankle joint stiffness

    NASA Astrophysics Data System (ADS)

    Kim, Seyoung; Son, Youngsu; Choi, Sangkyu; Ham, Sangyong; Park, Cheolhoon

    2015-09-01

    In this study, a passive-elastic ankle exoskeleton (PEAX) with a one-way clutch mechanism was developed and then pilot-tested with vertical jumping to determine whether the PEAX is sufficiently lightweight and comfortable to be used in further biomechanical studies. The PEAX was designed to supplement the function of the Achilles tendon and ligaments as they passively support the ankle torque with their inherent stiffness. The main frame of the PEAX consists of upper and lower parts connected to each other by tension springs (N = 3) and lubricated hinge joints. The upper part has an offset angle of 5° with respect to the vertical line when the springs are in their resting state. Each spring has a slack length of 8 cm and connects the upper part to the tailrod of the lower part in the neutral position. The tailrod freely rotates with low friction but has a limited range of motion due to the stop pin working as a one-way clutch. Because of the one-way clutch system, the tension springs store the elastic energy only due to an ankle dorsiflexion when triggered by the stop pin. This clutch mechanism also has the advantage of preventing any inconvenience during ankle plantarflexion because it does not limit the ankle joint motion during the plantarflexion phase. In pilot jumping tests, all of the subjects reported that the PEAX was comfortable for jumping due to its lightweight (approximately 1 kg) and compact (firmly integrated with shoes) design, and subjects were able to nearly reach their maximum vertical jump heights while wearing the PEAX. During the countermovement jump, elastic energy was stored during dorsiflexion by spring extension and released during plantarflexion by spring restoration, indicating that the passive spring torque (i.e., supportive torque) generated by the ankle exoskeleton partially supported the ankle joint torque throughout the process.

  15. Open ankle fractures: who gets them and why?

    PubMed

    Bugler, Kate E; Clement, Nicholas D; Duckworth, Andrew D; White, Timothy O; McQueen, Margaret M; Court-Brown, Charles M

    2015-03-01

    Open ankle fractures present a significant clinical challenge. The management and outcome of these injuries has been extensively reported, but there have been no reports of the epidemiology and how this has changed over time. We report 178 adult patients with open ankle fractures presenting to our unit over a twenty-three year period. The study centre is the only hospital receiving adult orthopaedic trauma in the region and has a defined population. The incidence of open ankle fractures was 1.5/10(5)/year, representing 1.5 % of all ankle fractures. The mean age was 55 years (range 16-96), with the highest incidence occurring in women over the age of 90. The most common mechanism was a simple fall with only 26 % of cases due to a motor vehicle collision (MVC). 82 % of cases were isolated injuries. Social deprivation had no significant influence on the incidence, but there was a difference in the mechanism with the majority of injuries in the most deprived quintile caused by MVCs and significantly fewer due to simple falls (p = 0.047). Over the twenty-three years, there was a significant increase in the mean age from 44 to 64 years (p = 0.03). The overall incidence remained constant over the two decades. In common with many traumatic injuries, open ankle fractures are increasingly low-energy insufficiency fractures affecting elderly patients, particularly older women. This has implications for service planning and training as well as the surgical intervention in these patients. PMID:25596941

  16. Ankle Injuries and Disorders

    MedlinePlus

    Your ankle bone and the ends of your two lower leg bones make up the ankle joint. Your ligaments, which connect bones to one ... muscles and tendons move it. The most common ankle problems are sprains and fractures. A sprain is ...

  17. 21 CFR 888.3120 - Ankle joint metal/polymer non-constrained cemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Ankle joint metal/polymer non-constrained cemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3120 Ankle joint metal/polymer non-constrained cemented prosthesis. (a) Identification. An ankle joint metal/polymer...

  18. 21 CFR 888.3110 - Ankle joint metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Ankle joint metal/polymer semi-constrained... Ankle joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. An ankle joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace an...

  19. 21 CFR 888.3110 - Ankle joint metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Ankle joint metal/polymer semi-constrained... Ankle joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. An ankle joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace an...

  20. 21 CFR 888.3110 - Ankle joint metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Ankle joint metal/polymer semi-constrained... Ankle joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. An ankle joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace an...

  1. 21 CFR 888.3120 - Ankle joint metal/polymer non-constrained cemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Ankle joint metal/polymer non-constrained cemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3120 Ankle joint metal/polymer non-constrained cemented prosthesis. (a) Identification. An ankle joint metal/polymer...

  2. 21 CFR 888.3120 - Ankle joint metal/polymer non-constrained cemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Ankle joint metal/polymer non-constrained cemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3120 Ankle joint metal/polymer non-constrained cemented prosthesis. (a) Identification. An ankle joint metal/polymer...

  3. 21 CFR 888.3110 - Ankle joint metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ankle joint metal/polymer semi-constrained... Ankle joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. An ankle joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace an...

  4. 21 CFR 888.3110 - Ankle joint metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Ankle joint metal/polymer semi-constrained... Ankle joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. An ankle joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace an...

  5. Ankle Joint Fusion With an Anatomically Preshaped Anterior Locking Plate.

    PubMed

    Wiewiorski, Martin; Barg, Alexej; Schlemmer, Thomas; Valderrabano, Victor

    2016-01-01

    We present a novel fixation plate for primary ankle joint fusion. A single anatomically preshaped angular stable plate was used with an anterior approach. An excellent result with good bone consolidation was present at the 1-year follow-up examination. PMID:25998475

  6. Stress Fractures of the Foot and Ankle in Athletes

    PubMed Central

    Mayer, Stephanie W.; Joyner, Patrick W.; Almekinders, Louis C.; Parekh, Selene G.

    2014-01-01

    Context: Stress fractures of the foot and ankle are a common problem encountered by athletes of all levels and ages. These injuries can be difficult to diagnose and may be initially evaluated by all levels of medical personnel. Clinical suspicion should be raised with certain history and physical examination findings. Evidence Acquisition: Scientific and review articles were searched through PubMed (1930-2012) with search terms including stress fractures and 1 of the following: foot ankle, medial malleolus, lateral malleolus, calcaneus, talus, metatarsal, cuboid, cuneiform, sesamoid, or athlete. Study Design: Clinical review. Level of Evidence: Level 5. Results: Stress fractures of the foot and ankle can be divided into low and high risk based upon their propensity to heal without complication. A wide variety of nonoperative strategies are employed based on the duration of symptoms, type of fracture, and patient factors, such as activity type, desire to return to sport, and compliance. Operative management has proven superior in several high-risk types of stress fractures. Evidence on pharmacotherapy and physiologic therapy such as bone stimulators is evolving. Conclusion: A high index of suspicion for stress fractures is appropriate in many high-risk groups of athletes with lower extremity pain. Proper and timely work-up and treatment is successful in returning these athletes to sport in many cases. Low-risk stress fracture generally requires only activity modification while high-risk stress fracture necessitates more aggressive intervention. The specific treatment of these injuries varies with the location of the stress fracture and the goals of the patient. PMID:25364480

  7. Tibiotalar joint arthrodesis for the treatment of severe ankle joint degeneration secondary to rheumatoid arthritis.

    PubMed

    Caron, M; Kron, E; Saltrick, K R

    1999-04-01

    The technical aspects of fusion of the rheumatoid ankle do not deviate from those in the post-traumatic or osteoarthritic ankle. Screw fixation can usually be achieved, and rarely is fixation failure a problem in rheumatoid ankle arthrodesis. If fixation is difficult because of deformity or bone quality, external fixation or locking intramedullary nails should be used. The placement of cannulated screws and adequacy of screw fixation has not been a problem (Fig. 13). Screw fixation provides compression and prevents rotation. The surgeon, however, needs to be assured that no screws invade the subtalar joint and that all threads are beyond the arthrodesis site. A washer may be necessary for further stability if this screw is not inserted at too great an angle. The authors have found that troughing out of the cortical surface of the tibia with a power bur aids in screw insertion. Not only does the trough act as a countersink, but it also provides a path for screw insertion and prevents palpable screw irritation. Malalignment is unforgiving. The foot must be placed neutral to dorsiflexion and plantarflexion. Equinus positioning places added stress on the tibia and a back-knee gait occurs. Approximately 5 degrees of valgus is recommended, and varus positioning is unforgiving. Internal and external rotation is determined by the position of the contralateral extremity. Nonunion does not seem to be a problem with rigid internal fixation to any greater degree in patients with RA. Despite this, patients may continue to have pain despite solid fusion, which can be caused by incomplete correction of deformity, painful internal fixation, or adjacent joint pathology. Additionally, patients may experience supramalleolar pain above the fusion site consistent with tibial stress fracture, which is more common if the subtalar or midtarsal joint is rigid or if the patient is obese. A rocker sole shoe with impact-absorbing soles used after brief periods of guarded mobilization in a

  8. [Fractures of the elbow joint].

    PubMed

    Nowak, T E; Dietz, S O; Burkhart, K J; Müller, L P; Rommens, P M

    2012-02-01

    Fractures around the elbow joint comprise fractures of the distal humerus, the radial head, the olecranon and the coronoid process. Combined lesions are particularly demanding for the surgeon. Accurate knowledge of the anatomy and of the biomechanics is an essential requirement for a specific diagnosis and therapy. A stable and painless movable elbow joint is essential for most of the activities of daily living. Risk factors for the development of posttraumatic elbow joint arthrosis are non-anatomically reconstructed joint surfaces, axial malalignment of the joint axis and untreated concomitant injuries. Modern angular stable and anatomically preshaped implants facilitate a biomechanically adequate osteosynthesis and avoid or decrease functional impairment. In consideration of an increasing number of osteoporotic elbow joint fractures, endoprosthetic replacement has gained significance. PMID:22271056

  9. Arthroscopic Anatomy of the Ankle Joint.

    PubMed

    Ray, Ronald G

    2016-10-01

    There are a number of variations in the intra-articular anatomy of the ankle which should not be considered pathological under all circumstances. The anteromedial corner of the tibial plafond (between the anterior edge of the tibial plafond and the medial malleolus) can have a notch, void of cartilage and bone. This area can appear degenerative arthroscopically; it is actually a normal variant of the articular surface. The anterior inferior tibiofibular ligament (AITF) can possess a lower, accessory band which can impinge on the anterolateral edge of the talar dome. In some cases it can cause irritation along this area of the talus laterally. If it is creating local irritation it can be removed since it does not provide any additional stabilization to the syndesmosis. There is a beveled region at the anterior leading edge of the lateral and dorsal surfaces of the talus laterally. This triangular region is void of cartilage and subchondral bone. The lack of talar structure in this region allows the lower portion of the AITF ligament to move over the talus during end range dorsiflexion of the ankle, preventing impingement. The variation in talar anatomy for this area should not be considered pathological. PMID:27599433

  10. Ankle and hip postural strategies defined by joint torques.

    PubMed

    Runge, C F; Shupert, C L; Horak, F B; Zajac, F E

    1999-10-01

    Previous studies have identified two discrete strategies for the control of posture in the sagittal plane based on EMG activations, body kinematics, and ground reaction forces. The ankle strategy was characterized by body sway resembling a single-segment-inverted pendulum and was elicited on flat support surfaces. In contrast, the hip strategy was characterized by body sway resembling a double-segment inverted pendulum divided at the hip and was elicited on short or compliant support surfaces. However, biomechanical optimization models have suggested that hip strategy should be observed in response to fast translations on a flat surface also, provided the feet are constrained to remain in contact with the floor and the knee is constrained to remain straight. The purpose of this study was to examine the experimental evidence for hip strategy in postural responses to backward translations of a flat support surface and to determine whether analyses of joint torques would provide evidence for two separate postural strategies. Normal subjects standing on a flat support surface were translated backward with a range of velocities from fast (55 cm/s) to slow (5 cm/s). EMG activations and joint kinematics showed pattern changes consistent with previous experimental descriptions of mixed hip and ankle strategy with increasing platform velocity. Joint torque analyses revealed the addition of a hip flexor torque to the ankle plantarflexor torque during fast translations. This finding indicates the addition of hip strategy to ankle strategy to produce a continuum of postural responses. Hip torque without accompanying ankle torque (pure hip strategy) was not observed. Although postural control strategies have previously been defined by how the body moves, we conclude that joint torques, which indicate how body movements are produced, are useful in defining postural control strategies. These results also illustrate how the biomechanics of the body can transform discrete control

  11. Ankle and hip postural strategies defined by joint torques

    NASA Technical Reports Server (NTRS)

    Runge, C. F.; Shupert, C. L.; Horak, F. B.; Zajac, F. E.; Peterson, B. W. (Principal Investigator)

    1999-01-01

    Previous studies have identified two discrete strategies for the control of posture in the sagittal plane based on EMG activations, body kinematics, and ground reaction forces. The ankle strategy was characterized by body sway resembling a single-segment-inverted pendulum and was elicited on flat support surfaces. In contrast, the hip strategy was characterized by body sway resembling a double-segment inverted pendulum divided at the hip and was elicited on short or compliant support surfaces. However, biomechanical optimization models have suggested that hip strategy should be observed in response to fast translations on a flat surface also, provided the feet are constrained to remain in contact with the floor and the knee is constrained to remain straight. The purpose of this study was to examine the experimental evidence for hip strategy in postural responses to backward translations of a flat support surface and to determine whether analyses of joint torques would provide evidence for two separate postural strategies. Normal subjects standing on a flat support surface were translated backward with a range of velocities from fast (55 cm/s) to slow (5 cm/s). EMG activations and joint kinematics showed pattern changes consistent with previous experimental descriptions of mixed hip and ankle strategy with increasing platform velocity. Joint torque analyses revealed the addition of a hip flexor torque to the ankle plantarflexor torque during fast translations. This finding indicates the addition of hip strategy to ankle strategy to produce a continuum of postural responses. Hip torque without accompanying ankle torque (pure hip strategy) was not observed. Although postural control strategies have previously been defined by how the body moves, we conclude that joint torques, which indicate how body movements are produced, are useful in defining postural control strategies. These results also illustrate how the biomechanics of the body can transform discrete control

  12. Quantitative biomechanical comparison of ankle fracture casting methods.

    PubMed

    Shipman, Alastair; Alsousou, Joseph; Keene, David J; Dyson, Igor N; Lamb, Sarah E; Willett, Keith M; Thompson, Mark S

    2015-06-01

    The incidence of ankle fractures is increasing rapidly due to the ageing demographic. In older patients with compromised distal circulation, conservative treatment of fractures may be indicated. High rates of malunion and complications due to skin fragility motivate the design of novel casting systems, but biomechanical stability requirements are poorly defined. This article presents the first quantitative study of ankle cast stability and hypothesises that a newly proposed close contact cast (CCC) system provides similar biomechanical stability to standard casts (SC). Two adult mannequin legs transected at the malleoli, one incorporating an inflatable model of tissue swelling, were stabilised with casts applied by an experienced surgeon. They were cyclically loaded in torsion, measuring applied rotation angle and resulting torque. CCC stiffness was equal to or greater than that of SC in two measures of ankle cast resistance to torsion. The effect of swelling reduction at the ankle site was significantly greater on CCC than on SC. The data support the hypothesis that CCC provides similar biomechanical stability to SC and therefore also the clinical use of CCC. They suggest that more frequent re-application of CCC is likely required to maintain stability following resolution of swelling at the injury site. PMID:25719278

  13. Are low-energy open ankle fractures in the elderly the new geriatric hip fracture?

    PubMed

    Toole, William P; Elliott, Mark; Hankins, David; Rosenbaum, Corey; Harris, Anthony; Perkins, Christopher

    2015-01-01

    As the geriatric population in the United States continues to increase, ankle fractures in the elderly are predicted to exponentially increase in the future. As such, these injuries will become a common injury seen by physicians in various fields. Currently, no studies discussing low-energy open ankle fractures in the elderly and/or the mortality rate associated with these devastating injuries have been published. The purpose of the present study was to retrospectively review the morality rate associated with low-energy open ankle fractures in the elderly. We retrospectively identified 11 patients >60 years old who had sustained low-energy open ankle fractures and been treated at our institution. The patient demographics, mechanism of injury, wound size, medical comorbidities, treatment, follow-up data, and outcomes were recorded. Low-energy falls were defined as ground level falls from sitting or standing. The mean age of the patients was 70.72 years, with a mean body mass index of 35.93 ± 10.24. Of the 11 patients, 9 (81.81%) had ≥3 comorbidities (i.e., hypertension, diabetes, coronary artery disease, congestive heart failure, and/or chronic obstructive pulmonary disease). The mean size of the medially based ankle wound was 14.18 ± 4.12 cm; 10 (90.90%) were Gustilo and Anderson grade IIIA open ankle fractures. In our study, low-energy open ankle fractures in the elderly, very similar to hip fractures, were associated with a high mortality incidence (27.27%) at a mean of 2.67 ± 2.02 months, and 81.81% of our patients had ≥3 medical comorbidities. PMID:25488597

  14. Unusual ankle fracture: A case report and literature review

    PubMed Central

    Mechchat, Atif; Bensaad, Soufiane; Shimi, Mohammed; Elibrahimi, Abdelhalim; Elmrini, Abdelmajid

    2014-01-01

    Fractures of the talus are uncommon, and talar body fractures in the sagittal plane are still rarer. The aim of its treatment is urgent anatomic reduction to restore congruency of the ankle and to reduce the risk of avascular necrosis by preserving any remaining blood supply. We report the case of a body talar fracture in sagittal plane associated with fracture of the medial malleolus in a young adult; the mechanism of the fracture was plantar hyperflexion, internal rotation and axial compression. We perform an open reduction and stabilization with two screws for the talus and screw the medial malleolus. At 14 months following the injury patient had good range of movement with little pain. The mechanism is discussed along with a literature review. PMID:25983480

  15. Fractures and Soft Tissue Injuries of the Feet and Ankle

    PubMed Central

    English, Edward

    1985-01-01

    An accurate clinical diagnosis of foot and ankle pain can be made by a history, physical examination and routine X-rays of the affected part. Each problem has a specific treatment; however, fractures and dislocations around the foot and ankle can be thought of in an organized fashion by proper physical examination and then the appropriate treatment. Fractures and soft tissue injuries can be treated rationally by understanding the mechanism of injury and the possibility of subsequent deformity. This article classifies specific injuries as a group and indicates a treatment program for each problem. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6Fig. 7aFig. 7bFig. 8Fig. 9Fig. 10 PMID:21274230

  16. Clinical audit of ankle fracture management in the elderly☆

    PubMed Central

    Kurar, Langhit

    2016-01-01

    Introduction Ankle fractures in the osteoporotic patient are challenging injuries to manage, due to a combination of poor soft tissue, peripheral vascular disease and increased bone fragility, often resulting in more complex fracture patterns. I aim to audit current practice and introduce change by producing recommendations to help improve longer-term functional outcomes. Patients and methods A retrospective 3-week audit was conducted reviewing results of ankle fracture management in 50 patients aged between 50 and 80 years. Patients admitted for either manipulation under anaesthesia (MUA)/application of cast or open-reduction and internal fixation (ORIF) were considered. Medical notes, including discharge summaries, were used for data extraction. Results From the 50 patients included within the cohort, forty-two patients (84%) underwent surgical intervention, with eight patients (16%) managed non-operatively. Malunion (63%) and failed fracture fixation (25%) were more commonly reported in patients managed non-operatively. Surgery performed by trainee surgeons was unlikely to prolong theatre time with no statistical significance observed with the consultant led cohort (p = 0.380). However, incidence of fracture malunion and failed fixation were significantly higher following surgery without consultant supervision in the junior trainee group (p = 0.043). Conclusions Poor bone quality and associated co-morbidity can present technical difficulties when managing patients surgically. However, our results have shown considerably improved anatomical reduction rates following internal fixation in eligible patients, irrespective of age or gender. PMID:26981239

  17. Biomechanical characteristics of human ankle-joint muscles.

    PubMed

    Aruin, A S; Zatsiorsky, V M

    1984-01-01

    Equivalent biomechanical characteristics of human ankle-joint muscles have been determined by impact and vibration tests. The estimate of the stiffness and damping coefficients has yielded, respectively, (2.67 +/- 0.48) X 10(4) N X m-1 and (811.58 +/- 201.3) N X s X m-1 by impact actions, n = 126; (1.49 +/- 0.35) X 10(4) N X m-1 and (430.1 +/- 36.1) N X s X m-1 -by vibration actions, n = 7. The characteristics of the ankle-joint muscles of subjects representing different kinds of sports have proved to be different. PMID:6540667

  18. Biomechanics of the natural, arthritic, and replaced human ankle joint

    PubMed Central

    2014-01-01

    The human ankle joint complex plays a fundamental role in gait and other activities of daily living. At the same time, it is a very complicated anatomical system but the large literature of experimental and modelling studies has not fully described the coupled joint motion, position and orientation of the joint axis of rotation, stress and strain in the ligaments and their role in guiding and stabilizing joint motion, conformity and congruence of the articular surfaces, patterns of contact at the articular surfaces, patterns of rolling and sliding at the joint surfaces, and muscle lever arm lengths. The present review article addresses these issues as described in the literature, reporting the most recent relevant findings. PMID:24499639

  19. Safety profile of sural nerve in posterolateral approach to the ankle joint: MRI study.

    PubMed

    Ellapparadja, Pregash; Husami, Yaya; McLeod, Ian

    2014-05-01

    The posterolateral approach to ankle joint is well suited for ORIF of posterior malleolar fractures. There are no major neurovascular structures endangering this approach other than the sural nerve. The sural nerve is often used as an autologous peripheral nerve graft and provides sensation to the lateral aspect of the foot. The aim of this paper is to measure the precise distance of the sural nerve from surrounding soft tissue structures so as to enable safe placement of skin incision in posterolateral approach. This is a retrospective image review study involving 64 MRI scans. All measurements were made from Axial T1 slices. The key findings of the paper is the safety window for the sural nerve from the lateral border of tendoachilles (TA) is 7 mm, 1.3 cm and 2 cm at 3 cm above ankle joint, at the ankle joint and at the distal tip of fibula respectively. Our study demonstrates the close relationship of the nerve in relation to TA and fibula in terms of exact measurements. The safety margins established in this study should enable the surgeon in preventing endangerment of the sural nerve encountered in this approach. PMID:24158742

  20. Biomechanical changes at the ankle joint after stroke.

    PubMed Central

    Thilmann, A F; Fellows, S J; Ross, H F

    1991-01-01

    The resistance of the relaxed ankle to slow displacement over the joint movement range was measured on both sides of a group of hemiparetic stroke patients, in whom spasticity had been established for at least one year and who showed no clinical signs of contractures. The ankle joints of the age-matched normal subjects were flexible over most of the movement range, showing dramatically increasing stiffness only when the foot was dorsiflexed beyond 70 degrees, with a neutral range between 90-100 degrees, and a less dramatic increase in stiffness during plantarflexion. Hemiparetic patients showed identical curves to the normal subjects on the "healthy" side, ipsilateral to the causative cerebral lesion, but were significantly stiffer in dorsiflexion on the contralateral side, without change in the minimum stiffness range or during plantarflexion. Therefore significant changes in passive biomechanical properties occur at the affected ankle of hemiparetic subjects, predominantly as the result of a loss of compliance in the Achilles tendon, although an increase in the passive stiffness of the triceps surae may also occur. The contribution of these changes to the locomotor disability of hemiparetic patients is discussed. PMID:2019838

  1. The effects of ankle joint taping on gait and balance ability of healthy adults

    PubMed Central

    Kim, Myoung-Kwon; Cha, Hyun-Gyu

    2015-01-01

    [Purpose] This study examined the effects of the application of elastic taping over the ankle joints of healthy subjects on their gait, balance ability, and muscle strength. [Subjects] Fifty healthy subjects with no orthopedic history of the ankle joint were selected and elastic taping was applied to their ankle joints. [Methods] Before and after application of the elastic taping, gait and balance ability of the subjects were evaluated. [Results] After the taping application, gait velocity significantly increased and there were significant differences in all variables of balance ability. [Conclusion] Application of elastic taping aimed at improving stability of the ankle joint had a positive effect on gait speed and balance ability. PMID:26504323

  2. Evaluating fracture risk in acute ankle sprains: Any news since the Ottawa Ankle Rules? A systematic review.

    PubMed

    Jonckheer, Pascale; Willems, Tine; De Ridder, Roel; Paulus, Dominique; Holdt Henningsen, Kirsten; San Miguel, Lorena; De Sutter, An; Roosen, Philip

    2016-03-01

    Background Ankle sprain is frequently encountered, both in primary care and in emergency departments. Since 1992, the Ottawa ankle rules (OAR) can assist clinicians in determining whether an X-ray should be performed to exclude a fracture. Several guidelines recommend the use of OAR based on a systematic review from 2003. Ten years later, one can wonder if this recommendation should be changed. Objective To review systematically the current evidence on the most accurate method to assess the fracture risk after an ankle sprain in adults. Methods A methodical search for systematic reviews, meta-analyses and primary studies was carried out in Medline, Cochrane Database of systematic reviews, Embase, Pedro, CINAHL, Medion and specific guideline search engines. At least two independent researchers performed selection, quality appraisal (with validated checklists) and data extraction. Results One systematic review and 21 primary studies were selected. Sensitivity and specificity of the OAR range from 92-100% and from 16-51%, respectively. To improve the OAR specificity, other tools are proposed such as the Bernese ankle rules. Vibrating tuning fork test and ultrasound could be useful in patient with OAR positive to decrease the need for radiographs. No evidence was found in favour of the use of magnetic resonance imaging (MRI) or computed tomography (CT) in the acute phase of ankle sprain. Conclusion The findings confirm the value of the OAR at ruling out fractures after an ankle sprain and propose other or additional tools to decrease the need for X-rays. PMID:26691309

  3. Four Weeks of Balance Training does not Affect Ankle Joint Stiffness in Subjects with Unilateral Chronic Ankle Instability

    PubMed Central

    Jain, Tarang Kumar; Wauneka, Clayton N.; Liu, Wen

    2016-01-01

    Background Balance training has been shown to be effective in preventing ankle sprain recurrences in subjects with chronic ankle instability (CAI) but the biomechanical pathways underlying the clinical outcomes are still unknown. This study was conducted to determine if a 4-week balance training intervention can alter the mechanical characteristics in ankles with CAI. Methods Twenty-two recreationally active subjects with unilateral CAI were randomized to either a control (n = 11, 35.1 ± 9.3 years) or intervention (n = 11, 33.5 ± 6.6 years) group. Subjects in the intervention group were trained on the affected limb with static and dynamic components using a Biodex balance stability system for 4-weeks. The ankle joint stiffness and neutral zone in inversion and eversion directions on the involved and uninvolved limbs was measured at baseline and post-intervention using a dynamometer. Results At baseline, the mean values of the inversion stiffness (0.69 ± 0.37 Nm/degree) in the involved ankle was significantly lower (p < 0.011, 95% CI [0.563, 0.544]) than that of uninvolved contralateral ankle (0.99 ± 0.41 Nm/degree). With the available sample size, the eversion stiffness, inversion neutral zone, and eversion neutral zone were not found to be significantly different between the involved and uninvolved contralateral ankles. The 4-week balance training intervention failed to show any significant effect on the passive ankle stiffness and neutral zones in inversion and eversion. Conclusion Decreased inversion stiffness in the involved chronic unstable ankle was found that of uninvolved contralateral ankle. The 4-week balance training program intervention was ineffective in altering the mechanical characteristics of ankles with CAI. Level of evidence Randomized controlled clinical trial; Level of evidence, 1.

  4. 21 CFR 888.3100 - Ankle joint metal/composite semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ankle joint metal/composite semi-constrained cemented prosthesis. 888.3100 Section 888.3100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3100 Ankle joint metal/composite...

  5. Hydraulic fracturing of jointed formations

    SciTech Connect

    Murphy, H.D.; Fehler, M.C.

    1986-01-01

    Measured by volume, North America's largest hydraulic fracturing operations have been conducted at Fenton Hill, New Mexico to create geothermal energy reservoirs. In the largest operation 21,000 m/sup 3/ of water were injected into jointed granitic rock at a depth of 3.5 km. Microearthquakes induced by this injection were measured with geophones placed in five wells drilled into, or very close, to the reservoir, as well as 11 surface seismometers. The large volume of rock over which the microearthquakes were distributed indicates a mechanism of hydraulic stimulation which is at odds with conventional fracturing theory, which predicts failure along a plane which is perpendicular to the least compressive earth stress. A coupled rock mechanics/fluid flow model provides much of the explanation. Shear slippage along pre-existing joints in the rock is more easily induced than conventional tensile failure, particularly when the difference between minimum and maximum earth stresses is large and the joints are oriented at angles between 30 and 60 degrees to the principal earth stresses, and a low viscosity fluid like water is injected. Shear slippage results in local redistribution of stresses, which allows a branching, or dendritic, stimulation pattern to evolve, in agreement with the patterns of microearthquake locations. These results are qualitatively similar to the controversial process known as ''Kiel'' fracturing, in which sequential injections and shut-ins are repeated to create dendritic fractures for enhanced oil and gas recovery. However, we believe that the explanation is shear slippage of pre-existing joints and stress redistribution, not proppant bridging and fluid blocking as suggested by Kiel. 15 refs., 10 figs.

  6. Ankle joint complex mobility of children 7 to 14 years old.

    PubMed

    Alanen, J T; Levola, J V; Helenius, H Y; Kvist, M H

    2001-01-01

    The ranges of motions of the ankle have been studied only rarely in children. The authors examined the mobility of the ankle joint complex of 245 healthy children. The mean age was 10.2 years. In healthy children ages 7 to 14 years, the variation of the ankle joint complex range of motion was wide. The largest gender-related difference was recorded for passive plantarflexion, which was greater in girls. Other statistically significant gender differences do exist, but they are small and probably lack clinical meaning. Some of the children had remarkable left-right difference in the range of motions of the ankle joint complex. This means that the "healthy ankle" cannot necessarily be used in clinical practice as a reference when evaluating, for example, treatments of foot and ankle injuries in children. PMID:11675545

  7. Effects of Kinesio taping on joint position sense of the ankle

    PubMed Central

    Seo, Hyun-Do; Kim, Min-Young; Choi, Jung-Eun; Lim, Ga-Hee; Jung, Seong-In; Park, So-Hyun; Cheon, Song-Hee; Lee, Hae-Yong

    2016-01-01

    [Purpose] The purpose of this study was to examine the effect of Kinesio taping on the joint position sense of the ankle. [Subjects and Methods] The subjects of this study were 26 nomal adults who had experienced ankle sprain. Kinesio taping was applied over the ankle medial ligament and ankle lateral ligament with eight pattern reinforcement taping. Joint position sense was measured using isokinetic equipment (Biodex System 4 pro dynamometer, Biodex Medical systems Inc., USA) during dorsiflexion/plantarflexion and inversion/eversion, before and after taping. Statistical analyses were performed using SPSS 21.0 for Windows. [Results] Joint position sense after Kinesio taping was improved in the dorsiflexion and inversion positions. [Conclusion] According to the results of this study, Kinesio taping of the ankle is effective for the prevention of ankle sprain. PMID:27190446

  8. Effects of Kinesio taping on joint position sense of the ankle.

    PubMed

    Seo, Hyun-Do; Kim, Min-Young; Choi, Jung-Eun; Lim, Ga-Hee; Jung, Seong-In; Park, So-Hyun; Cheon, Song-Hee; Lee, Hae-Yong

    2016-04-01

    [Purpose] The purpose of this study was to examine the effect of Kinesio taping on the joint position sense of the ankle. [Subjects and Methods] The subjects of this study were 26 nomal adults who had experienced ankle sprain. Kinesio taping was applied over the ankle medial ligament and ankle lateral ligament with eight pattern reinforcement taping. Joint position sense was measured using isokinetic equipment (Biodex System 4 pro dynamometer, Biodex Medical systems Inc., USA) during dorsiflexion/plantarflexion and inversion/eversion, before and after taping. Statistical analyses were performed using SPSS 21.0 for Windows. [Results] Joint position sense after Kinesio taping was improved in the dorsiflexion and inversion positions. [Conclusion] According to the results of this study, Kinesio taping of the ankle is effective for the prevention of ankle sprain. PMID:27190446

  9. Understanding risks and complications in the management of ankle fractures

    PubMed Central

    Mehta, Saurabh Sagar; Rees, Kishan; Cutler, Lucy; Mangwani, Jitendra

    2014-01-01

    Ankle fracture (AF) is a common injury with potentially significant morbidity associated with it. The most common age groups affected are young active patients, sustaining high energy trauma and elderly patients with comorbidities. Both these groups pose unique challenges for appropriate management of these injuries. Young patients are at risk of developing posttraumatic osteoarthritis, with a significant impact on quality of life due to pain and impaired function. Elderly patients, especially with poorly controlled diabetes and osteoporosis are at increased risk of wound complications, infection and failure of fixation. In the most severe cases, this can lead to amputation and mortality. Therefore, individualized approach to the management of AF is vital. This article highlights commonly encountered complications and discusses the measures needed to minimize them when dealing with these injuries. PMID:25298549

  10. [Arthroscopic treatment of chondral lesions of the ankle joint. Evidence-based therapy].

    PubMed

    Thomas, M; Jordan, M; Hamborg-Petersen, E

    2016-02-01

    Ankle sprains are the most relevant injuries of the lower extremities and can lead to damage to ligaments and osteochondral lesions. Up to 50 % of patients with a sprained ankle later develop a lesion of the cartilage in the ankle joint or an osteochondral lesion of the talus. This can lead to osteoarthritis of the injured ankle joint. Spontaneous healing is possible in all age groups in cases of a bone bruise in the subchondral bone but in isolated chondral injuries is only useful in pediatric patients. In many cases chondral and osteochondral injuries lead to increasing demarcation of the affected area and can result in progressive degeneration of the joint if not recognized in time. There also exist a certain number of osteochondral changes of the articular surface of the talus without any history of relevant trauma, which are collectively grouped under the term osteochondrosis dissecans. Perfusion disorders are discussed as one of many possible causes of these alterations. Nowadays, chondral and osteochondral defects can be treated earlier due to detection using very sensitive magnetic resonance imaging (MRI) and computed tomography (CT) techniques. The use of conservative treatment only has a chance of healing in pediatric patients. Conservative measures for adults should only be considered as adjuvant treatment to surgery.Based on a comprehensive analysis of the current literature, this article gives an overview and critical analysis of the current concepts for treatment of chondral and osteochondral injuries and lesions of the talus. With arthroscopic therapy curettage and microfracture of talar lesions are the predominant approaches or retrograde drilling of the defect is another option when the chondral coating is retained. Implantation of autologous chondral cells or homologous juvenile cartilage tissue is also possible with arthroscopic techniques. Osteochondral fractures (flake fracture) are usually performed as a mini-open procedure supported by

  11. Ankle sprain - Series (image)

    MedlinePlus

    The ankle joint connects the foot with the leg. The ankle joint allows the foot to move upward and ... outward motion. Muscles, tendons, and ligaments surround the ankle providing the stability the ankle joint needs for ...

  12. Predictors of Adverse Events for Ankle Fractures: An Analysis of 6800 Patients.

    PubMed

    Dodd, Ashley C; Lakomkin, Nikita; Attum, Basem; Bulka, Catherine; Karhade, Aditya V; Douleh, Diana G; Mir, Hassan; Jahangir, A Alex; Obremskey, William T; Sethi, Manish K

    2016-01-01

    Ankle fractures are one of the most common injuries seen by orthopedic surgeons. It is therefore essential to understand the risks associated with their treatment. Using the American College of Surgeons National Surgical Quality Improvement Program(®) database from 2006 to 2013, the patient demographics, comorbidities, and 30-day complications were collected for 5 types of ankle fractures. A bivariate analysis was used to compare the patient demographics, comorbidities, and complications across all Common Procedural Terminology codes. A multivariable logistic regression model was then used to assess the odds of minor and major postoperative complications within 30 days after open treatment. A total of 6865 patients were included in the analysis. Of these patients, 2507 (36.5%) had bimalleolar ankle fractures. The overall rate of adverse events for ankle fractures was low. Bimalleolar fractures had the greatest rate of major (2.6%, n = 64), minor (3.8%, n = 94), and total (5.7%, n = 143) complications. When controlling for individual patient characteristics, bimalleolar fractures were associated with 4.92 times the odds (95% confidence interval 1.80 to 13.5; p = .002) of developing a complication compared with those with a medial malleolar fracture. The risk factors driving postoperative complications for all ankle fractures were age >65 years, obesity, diabetes, American Society of Anesthesiologists score >2, and functional status (p < .05). Although the overall rate of adverse events for ankle fractures was low, bimalleolar fractures were associated with 5 times the odds of developing a complication compared with medial malleolar fractures. Orthopedic surgeons must be aware of the risk factors that increase the rate of ankle fracture complications to improve patients' quality of care. PMID:27086177

  13. Misdiagnosis of Talar Body or Neck Fractures as Ankle Sprains in Low Energy Traumas

    PubMed Central

    Young, Ki-Won; Kim, Jin-Su; Cho, Hun-Ki; Choo, Ho-Sik; Park, Jang-Ho

    2016-01-01

    Background The talus has a very complex anatomical morphology and is mainly fractured by a major force caused by a fall or a traffic accident. Therefore, a talus fracture is not common. However, many recent reports have shown that minor injuries, such as sprains and slips during sports activities, can induce a talar fracture especially in the lateral or posterior process. Still, fractures to the main parts of the talus (neck and body) after ankle sprains have not been reported as occult fractures. Methods Of the total 102 cases from January 2005 to December 2012, 7 patients had confirmed cases of missed/delayed diagnosis of a talus body or neck fracture and were included in the study population. If available, medical records, X-rays, computed tomography scans, and magnetic resonance imaging of the confirmed cases were retrospectively reviewed and analyzed. Results In the 7-patient population, there were 3 talar neck fractures and 4 talar body fractures (coronal shearing type). The mechanisms of injuries were all low energy trauma episodes. The causes of the injuries included twisting of the ankle during climbing (n = 2), jumping to the ground from a 1-m high wall (n = 2), and twisting of the ankle during daily activities (n = 3). Conclusions A talar body fracture and a talar neck fracture should be considered in the differential diagnosis of patients with acute and chronic ankle pain after a minor ankle injury. PMID:27583114

  14. Compartment syndrome of the thigh complicating surgical treatment of ipsilateral femur and ankle fractures

    NASA Technical Reports Server (NTRS)

    Moore, M. R.; Garfin, S. R.; Hargens, A. R.

    1987-01-01

    A 26-year-old man presented with ipsilateral femur and ankle fractures. The patient was treated with interlocking nail of his femur fracture, followed by open reduction and internal fixation of his ankle fracture under tourniquet control. Postoperatively, the patient developed compartment syndrome of his thigh with elevated pressures, requiring decompressive fasciotomies. This case illustrates the possible complication of treating a femur fracture with intramedullary nailing and then immediately applying a tourniquet to treat an ipsilateral extremity fracture. Because of the complication with this patient, we feel the procedure should be staged, or a tourniquet should be avoided if possible.

  15. The in vivo kinematics of the tibiotalar joint after lateral ankle instability

    PubMed Central

    Caputo, Adam M.; Lee, Jun Y.; Spritzer, Chuck E.; Easley, Mark E.; DeOrio, James K.; Nunley, James A.; DeFrate, Louis E.

    2010-01-01

    BACKGROUND Previous studies have suggested injury to the anterior talofibular ligament 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, we hypothesized that ATFL deficiency would lead to increased anterior translation and increased internal rotation of the talus relative to the tibia. STUDY DESIGN Controlled 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. Using magnetic resonance imaging and orthogonal fluoroscopy, the in vivo kinematics of the tibiotalar joint were measured in the ATFL deficient and intact ankles from 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 to intact, contralateral controls. For example, at 100% body weight, ATFL deficient ankles demonstrated a statistically significant increase in anterior translation of 0.9 ± 0.5mm (p = 0.008). At 100% body weight, the ATFL deficient ankle was internally rotated relative to the intact ankle by 5.7 ± 3.6° (p = 0.008). There was a slight increase of 0.2 ± 0.2mm in the superior translation of the ATFL deficient ankle compared to the intact ankle at 100% body weight (p = 0.02). CONCLUSIONS ATFL deficiency 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 provide a baseline for improving ankle ligament

  16. [Condylar fracture and temporomandibular joint ankylosis].

    PubMed

    Zhang, Yi

    2016-03-01

    This article summarized the advances in treatment and research of temporomandibular joint surgery in the last 5 years which was presented in "The 2nd Condyle Fracture and Temporomandibular Joint Ankylosis Symposium". The content includes 5 parts: non-surgical treatment of children condyle fracture and long-term follow-up, the improvement of operative approach for condyle fracture and key techniques, the importance and the method for the simultanesous reduction of disc in condylar fracture treatment, the development of traumatic temporomandibular joint ankylosis similar to hypertrophic non-union and the improved safety and accuracy by applying digital surgery in joint surgery. PMID:26980648

  17. Effects of focal ankle joint cooling on unipedal static balance in individuals with and without chronic ankle instability.

    PubMed

    Kim, Kyung-Min; Hart, Joseph M; Saliba, Susan A; Hertel, Jay

    2015-01-01

    Application of cryotherapy over an injured joint has been shown to improve muscle function, yet it is unknown how ankle cryotherapy affects postural control. Our purpose was to determine the effects of a 20-min focal ankle joint cooling on unipedal static stance in individuals with and without chronic ankle instability (CAI). Fifteen young subjects with CAI (9 males, 6 females) and 15 healthy gender-matched controls participated. All subjects underwent two intervention sessions on different days in which they had a 1.5L plastic bag filled with either crushed ice (active treatment) or candy corn (sham) applied to the ankle. Unipedal stance with eyes closed for 10s were assessed with a forceplate before and after each intervention. Center of pressure (COP) data were used to compute 10 specific dependent measures including velocity, area, standard deviation (SD), and percent range of COP excursions, and mean and SD of time-to-boundary (TTB) minima in the anterior-posterior (AP) and mediolateral directions. For each measure a three-way (Group-Intervention-Time) repeated ANOVAs found no significant interactions and main effects involving intervention (all Ps > 0.05). There were group main effects found for mean velocity (F(1,28) = 6.46, P = .017), area (F(1,28) = 12.83, P = .001), and mean of TTB minima in the AP direction (F(1,28) = 5.19, P = .031) indicating that the CAI group demonstrated greater postural instability compared to the healthy group. Postural control of unipedal stance was not significantly altered following focal ankle joint cooling in groups both with and without CAI. Ankle joint cryotherapy was neither beneficial nor harmful to single leg balance. PMID:25468685

  18. Life impact of ankle fractures: Qualitative analysis of patient and clinician experiences

    PubMed Central

    2012-01-01

    Background Ankle fractures are one of the more commonly occurring forms of trauma managed by orthopaedic teams worldwide. The impacts of these injuries are not restricted to pain and disability caused at the time of the incident, but may also result in long term physical, psychological, and social consequences. There are currently no ankle fracture specific patient-reported outcome measures with a robust content foundation. This investigation aimed to develop a thematic conceptual framework of life impacts following ankle fracture from the experiences of people who have suffered ankle fractures as well as the health professionals who treat them. Methods A qualitative investigation was undertaken using in-depth semi-structured interviews with people (n=12) who had previously sustained an ankle fracture (patients) and health professionals (n=6) that treat people with ankle fractures. Interviews were audio-recorded and transcribed. Each phrase was individually coded and grouped in categories and aligned under emerging themes by two independent researchers. Results Saturation occurred after 10 in-depth patient interviews. Time since injury for patients ranged from 6 weeks to more than 2 years. Experience of health professionals ranged from 1 year to 16 years working with people with ankle fractures. Health professionals included an Orthopaedic surgeon (1), physiotherapists (3), a podiatrist (1) and an occupational therapist (1). The emerging framework derived from patient data included eight themes (Physical, Psychological, Daily Living, Social, Occupational and Domestic, Financial, Aesthetic and Medication Taking). Health professional responses did not reveal any additional themes, but tended to focus on physical and occupational themes. Conclusions The nature of life impact following ankle fractures can extend beyond short term pain and discomfort into many areas of life. The findings from this research have provided an empirically derived framework from which a

  19. Medial malleolus fracture of the ankle combined with rupture of the Achilles tendon

    PubMed Central

    Lu, Jike; Maruo Holledge, Masumi

    2016-01-01

    A 59-year-old man fell off a 60-cm-high step, with his ankle in a twisted position, and sustained a closed fracture of the medial malleolus, with an ipsilateral complete Achilles tendon (TA) rupture. The TA rupture was initially missed but diagnosed by ultrasound examination, 2 weeks post-operatively. The ankle fracture was diagnosed from routine radiographs. Such a combination of injuries has been reported infrequently in the literature, but significant similarities have been described in the mechanism of injury and fracture patterns. Nevertheless, three of five reported cases with combined medial malleolus fractures were initially misdiagnosed. PMID:27141047

  20. Medial malleolus fracture of the ankle combined with rupture of the Achilles tendon.

    PubMed

    Lu, Jike; Maruo Holledge, Masumi

    2016-01-01

    A 59-year-old man fell off a 60-cm-high step, with his ankle in a twisted position, and sustained a closed fracture of the medial malleolus, with an ipsilateral complete Achilles tendon (TA) rupture. The TA rupture was initially missed but diagnosed by ultrasound examination, 2 weeks post-operatively. The ankle fracture was diagnosed from routine radiographs. Such a combination of injuries has been reported infrequently in the literature, but significant similarities have been described in the mechanism of injury and fracture patterns. Nevertheless, three of five reported cases with combined medial malleolus fractures were initially misdiagnosed. PMID:27141047

  1. The Effects of Sex, Joint Angle, and the Gastrocnemius Muscle on Passive Ankle Joint Complex Stiffness

    PubMed Central

    DeMont, Richard G.; Ryu, Keeho; Lephart, Scott M.

    2001-01-01

    Objective: To assess the effects of sex, joint angle, and the gastrocnemius muscle on passive ankle joint complex stiffness (JCS). Design and Setting: A repeated-measures design was employed using sex as a between-subjects factor and joint angle and inclusion of the gastrocnemius muscle as within-subject factors. All testing was conducted in a neuromuscular research laboratory. Subjects: Twelve female and 12 male healthy, physically active subjects between the ages of 18 and 30 years volunteered for participation in this study. The dominant leg was used for testing. No subjects had a history of lower extremity musculoskeletal injury or circulatory or neurologic disorders. Measurements: We determined passive ankle JCS by measuring resistance to passive dorsiflexion (5°·s−1) from 23° plantar flexion (PF) to 13° dorsiflexion (DF). Angular position and torque data were collected from a dynamometer under 2 conditions designed to include or reduce the contribution of the gastrocnemius muscle. Separate fourth-order polynomial equations relating angular position and torque were constructed for each trial. Stiffness values (Nm·degree−1) were calculated at 10° PF, neutral (NE), and 10° DF using the slope of the line at each respective position. Results: Significant condition-by-position and sex-by-position interactions and significant main effects for sex, position, and condition were revealed by a 3-way (sex-by-position, condition-by-position) analysis of variance. Post hoc analyses of the condition-by-position interaction revealed significantly higher stiffness values under the knee-straight condition compared with the knee-bent condition at both ankle NE and 10° DF. Within each condition, stiffness values at each position were significantly higher as the ankle moved into DF. Post hoc analysis of the sex-by-position interaction revealed significantly higher stiffness values at 10° DF in the male subjects. Post hoc analysis of the position main effect revealed

  2. EXACT: EXercise or Advice after ankle fraCTure. Design of a randomised controlled trial

    PubMed Central

    2011-01-01

    Background Ankle fractures are common. Management of ankle fractures generally involves a period of immobilisation followed by rehabilitation to reduce pain, stiffness, weakness and swelling. The effects of a rehabilitation program are still unclear. However, it has been shown that important components of rehabilitation programs may not confer additional benefits over exercise alone. The primary aim of this trial is to determine the effectiveness and cost-effectiveness of an exercise-based rehabilitation program after ankle fracture, compared to advice alone. Methods/Design A pragmatic randomised trial will be conducted. Participants will be 342 adults with stiff, painful ankles after ankle fracture treated with immobilisation. They will be randomly allocated using a concealed randomisation procedure to either an Advice or Rehabilitation group. Participants in the Advice group will receive verbal and written advice about exercise at the time of removal of immobilisation. Participants in the Rehabilitation group will be provided with a 4-week rehabilitation program that is designed, monitored and progressed by a physiotherapist, in addition to verbal and written advice. Outcomes will be measured by a blinded assessor at 1, 3 and 6 months. The primary outcomes will be activity limitation and quality-adjusted life years. Discussion This pragmatic trial will determine if a rehabilitation program reduces activity limitation and improves quality of life, compared to advice alone, after immobilisation for ankle fracture. PMID:21726463

  3. Intra-Articular Giant Synovial Osteochondroma: Case Reports of the Ankle and Knee Joint

    PubMed Central

    Fornaciari, Paolo; Schai, Pascal A.; Niehaus, Richard; Exner, Ulrich G.

    2015-01-01

    Two cases of giant intra-articular osteochondromas (knee and ankle joint) are reported; pathologically they are rare representations of synovial chondromatosis. A 17-year-old man presented with a tumorous mass which had been localized in his left ankle for many years, increasing in volume during the last months. The lesion was removed by posteromedial ankle arthrotomy. The second case was observed in a 39-year-old woman with a slow-growing mass in her right knee joint. The lesion was removed from the Hoffa fat pad by open anteromedial arthrotomy. PMID:25785214

  4. Intra-articular giant synovial osteochondroma: case reports of the ankle and knee joint.

    PubMed

    Fornaciari, Paolo; Schai, Pascal A; Niehaus, Richard; Exner, Ulrich G

    2015-01-01

    Two cases of giant intra-articular osteochondromas (knee and ankle joint) are reported; pathologically they are rare representations of synovial chondromatosis. A 17-year-old man presented with a tumorous mass which had been localized in his left ankle for many years, increasing in volume during the last months. The lesion was removed by posteromedial ankle arthrotomy. The second case was observed in a 39-year-old woman with a slow-growing mass in her right knee joint. The lesion was removed from the Hoffa fat pad by open anteromedial arthrotomy. PMID:25785214

  5. The Costs of Operative Complications for Ankle Fractures: A Case Control Study

    PubMed Central

    Avilucea, Frank R.; Greenberg, Sarah E.; Grantham, W. Jeffrey; Sathiyakumar, Vasanth; Thakore, Rachel V.; Nwosu, Samuel K.; Archer, Kristin R.; Obremskey, William T.; Mir, Hassan R.; Sethi, Manish K.

    2014-01-01

    As our healthcare system moves towards bundling payments, it is vital to understand the potential financial implications associated with treatment of surgical complications. Considering that surgical treatment of ankle fractures is common, there remains minimal data relating costs to postsurgical intervention. We aimed to identify costs associated with ankle fracture complications through case-control analysis. Using retrospective analysis at a level I trauma center, 28 patients with isolated ankle fractures who developed complications (cases) were matched with 28 isolated ankle fracture patients without complications (controls) based on ASA score, age, surgery type, and fracture type. Patient charts were reviewed for demographics and complications leading to readmission/reoperation and costs were obtained from the financial department. Wilcoxon tests measured differences in the costs between the cases and controls. 28 out of 439 patients (6.4%) developed complications. Length of stay and median costs were significantly higher for cases than controls. Specifically, differences in total costs existed for infection and hardware-related pain. This is the first study to highlight the considerable costs associated with the treatment of complications due to isolated ankle fractures. Physicians must therefore emphasize methods to control surgical and nonsurgical factors that may impact postoperative complications, especially under a global payment system. PMID:25525521

  6. Fatigue Stress Fracture of the Talar Body: An Uncommon Cause of Ankle Pain.

    PubMed

    Kim, Young Sung; Lee, Ho Min; Kim, Jong Pil; Moon, Han Sol

    2016-01-01

    Fatigue stress fractures of the talus are rare and usually involve the head of the talus in military recruits. We report an uncommon cause of ankle pain due to a fatigue stress fracture of the body of the talus in a 32-year-old male social soccer player. Healing was achieved after weightbearing suppression for 6 weeks. Although rare, a stress fracture of the body of the talus should be considered in an athlete with a gradual onset of chronic ankle pain. Magnetic resonance imaging and bone scan are useful tools for early diagnosis. PMID:26961416

  7. Tillaux fracture of the ankle in an adult: a rare injury.

    PubMed

    Kumar, Narinder; Prasad, Manish

    2014-01-01

    The Tillaux fracture of the ankle is an external rotation ankle injury resulting in an avulsion fracture of the anterolateral tibial plafond. This injury is known to occur in adolescents, although it has rarely been reported in adults. We report a case of a Tillaux fracture in an adult. A brief description of the history, mechanism of injury, required imaging, and treatment and other management options are provided in the present report. Anatomic reduction, rigid fixation, and early mobilization are emphasized to obtain a satisfactory functional outcome, shown by the long-term follow-up findings. PMID:25128312

  8. Diagnostic Ultrasonography of an Ankle Fracture Undetectable by Conventional Radiography: A Case Report

    PubMed Central

    Daniels, Clinton J.; Welk, Aaron B.; Enix, Dennis E.

    2016-01-01

    Objective The purpose of this study is to present diagnostic ultrasonography assessment of an occult fracture in a case of persistent lateral ankle pain. Clinical Features A 35-year-old woman presented to a chiropractic clinic with bruising, swelling, and pain along the distal fibula 3 days following an inversion ankle trauma. Prior radiographic examination at an urgent care facility was negative for fracture. Conservative care over the next week noted improvement in objective findings, but the pain persisted. Intervention and Outcome Diagnostic ultrasonography was ordered to assess her persistent ankle pain and showed a minimally displaced fracture of the fibula 4 cm proximal to the lateral malleolus. The patient was referred to her primary care physician and successfully managed with conservative care. Conclusion In this case, diagnostic ultrasonography was able to identify a Danis-Weber subtype B1 fracture that was missed by plain film radiography. PMID:27069430

  9. Synovial Chondromatosis of the Ankle Joint: Clinical, Radiological, and Intraoperative Findings

    PubMed Central

    Sedeek, Sedeek Mohamed; Choudry, Q.; Garg, S.

    2015-01-01

    Synovial chondromatosis, also termed synovial osteochondromatosis, is a rare benign disorder characterized by the presence of cartilaginous nodules in the synovium of the joints, tendon sheaths, and bursae. It most commonly involves large joints, such as the knee, hip, and shoulder, but its presence in smaller joints has also been reported. Nevertheless, ankle involvement is unusual. The diagnosis is commonly made following a thorough history, clinical, physical, and radiographic examination. We report a case of a young patient with primary synovial chondromatosis of the ankle joint and present the clinical, radiographic, and intraoperative findings. PMID:26177002

  10. Synovial Chondromatosis of the Ankle Joint: Clinical, Radiological, and Intraoperative Findings.

    PubMed

    Sedeek, Sedeek Mohamed; Choudry, Q; Garg, S

    2015-01-01

    Synovial chondromatosis, also termed synovial osteochondromatosis, is a rare benign disorder characterized by the presence of cartilaginous nodules in the synovium of the joints, tendon sheaths, and bursae. It most commonly involves large joints, such as the knee, hip, and shoulder, but its presence in smaller joints has also been reported. Nevertheless, ankle involvement is unusual. The diagnosis is commonly made following a thorough history, clinical, physical, and radiographic examination. We report a case of a young patient with primary synovial chondromatosis of the ankle joint and present the clinical, radiographic, and intraoperative findings. PMID:26177002

  11. Design and simulation of a cable-pulley-based transmission for artificial ankle joints

    NASA Astrophysics Data System (ADS)

    Liu, Huaxin; Ceccarelli, Marco; Huang, Qiang

    2016-05-01

    In this paper, a mechanical transmission based on cable pulley is proposed for human-like actuation in the artificial ankle joints of human-scale. The anatomy articular characteristics of the human ankle is discussed for proper biomimetic inspiration in designing an accurate, efficient, and robust motion control of artificial ankle joint devices. The design procedure is presented through the inclusion of conceptual considerations and design details for an interactive solution of the transmission system. A mechanical design is elaborated for the ankle joint angular with pitch motion. A multi-body dynamic simulation model is elaborated accordingly and evaluated numerically in the ADAMS environment. Results of the numerical simulations are discussed to evaluate the dynamic performance of the proposed design solution and to investigate the feasibility of the proposed design in future applications for humanoid robots.

  12. Design and simulation of a cable-pulley-based transmission for artificial ankle joints

    NASA Astrophysics Data System (ADS)

    Liu, Huaxin; Ceccarelli, Marco; Huang, Qiang

    2016-06-01

    In this paper, a mechanical transmission based on cable pulley is proposed for human-like actuation in the artificial ankle joints of human-scale. The anatomy articular characteristics of the human ankle is discussed for proper biomimetic inspiration in designing an accurate, efficient, and robust motion control of artificial ankle joint devices. The design procedure is presented through the inclusion of conceptual considerations and design details for an interactive solution of the transmission system. A mechanical design is elaborated for the ankle joint angular with pitch motion. A multi-body dynamic simulation model is elaborated accordingly and evaluated numerically in the ADAMS environment. Results of the numerical simulations are discussed to evaluate the dynamic performance of the proposed design solution and to investigate the feasibility of the proposed design in future applications for humanoid robots.

  13. The effects of axial preload and dorsiflexion on the tolerance of the ankle/subtalar joint to dynamic inversion and eversion.

    PubMed

    Funk, James R; Srinivasan, Sreebala C M; Crandall, Jeff R; Khaewpong, Nopporn; Eppinger, Rolf H; Jaffredo, Anna S; Potier, Pascal; Petit, Philippe Y

    2002-11-01

    Forced inversion or eversion of the foot is considered a common mechanism of ankle injury in vehicle crashes. The objective of this study was to model empirically the injury tolerance of the human ankle/subtalar joint to dynamic inversion and eversion under three different loading conditions: neutral flexion with no axial preload, neutral flexion with 2 kN axial preload, and 30 degrees of dorsiflexion with 2 kN axial preload. 44 tests were conducted on cadaveric lower limbs, with injury occurring in 30 specimens. Common injuries included malleolar fractures, osteochondral fractures of the talus, fractures of the lateral process of the talus, and collateral ligament tears, depending on the loading configuration. The time of injury was determined either by the peak ankle moment or by a sudden drop in ankle moment that was accompanied by a burst of acoustic emission. Characteristic moment-angle curves to injury were generated for each loading configuration. Neutrally flexed ankles with no applied axial preload sustained injury at 21 +/- 5 Nm and 38 degrees +/- 8 degrees in inversion, and 47 +/- 21 Nm and 28 degrees +/- 4 degrees in eversion. For ankles tested in neutral flexion with 2 kN of axial preload, inversion failure occurred at 77 +/- 27 Nm and 40 degrees +/- 12 degrees , and eversion failure occurred at 142 +/- 100 Nm and 41 degrees +/- 14 degrees . Ankles dorsiflexed 30 degrees and axially preloaded to 2 kN sustained inversion injury at 62 +/- 31 Nm and 33 degrees +/- 4 degrees , and eversion injury at 140 +/- 53 Nm and 40 degrees +/- 6 degrees . Survival analyses were performed to generate injury risk curves in terms of joint moment and rotation angle. PMID:17096228

  14. Online estimation algorithm for a biaxial ankle kinematic model with configuration dependent joint axes.

    PubMed

    Tsoi, Y H; Xie, S Q

    2011-02-01

    The kinematics of the human ankle is commonly modeled as a biaxial hinge joint model. However, significant variations in axis orientations have been found between different individuals and also between different foot configurations. For ankle rehabilitation robots, information regarding the ankle kinematic parameters can be used to estimate the ankle and subtalar joint displacements. This can in turn be used as auxiliary variables in adaptive control schemes to allow modification of the robot stiffness and damping parameters to reduce the forces applied at stiffer foot configurations. Due to the large variations observed in the ankle kinematic parameters, an online identification algorithm is required to provide estimates of the model parameters. An online parameter estimation routine based on the recursive least-squares (RLS) algorithm was therefore developed in this research. An extension of the conventional biaxial ankle kinematic model, which allows variation in axis orientations with different foot configurations had also been developed and utilized in the estimation algorithm. Simulation results showed that use of the extended model in the online algorithm is effective in capturing the foot orientation of a biaxial ankle model with variable joint axis orientations. Experimental results had also shown that a modified RLS algorithm that penalizes a deviation of model parameters from their nominal values can be used to obtain more realistic parameter estimates while maintaining a level of estimation accuracy comparable to that of the conventional RLS routine. PMID:21280877

  15. Ankle Bracing and the Neuromuscular Factors Influencing Joint Stiffness

    PubMed Central

    Zinder, Steven M; Granata, Kevin P; Shultz, Sandra J; Gansneder, Bruce M

    2009-01-01

    Context: Health care professionals commonly prescribe external stabilization to decrease the incidence and severity of ankle sprains. The mechanism for this decrease is not clearly understood. Examining the effects of ankle bracing on biomechanical stability and influencing factors may provide important information regarding the neuromuscular effects of bracing. Objective: To study the effects of 2 different ankle braces on the neuromuscular factors influencing ankle stiffness. Design: Mixed-model repeated-measures design. Setting: Research laboratory. Patients or Other Participants: Twenty-eight physically active participants composing 2 groups: 14 with unilateral functional ankle instability (age  =  26.19 ± 6.46 years, height  =  166.07 ± 12.90 cm, mass  =  69.90 ± 13.46 kg) and 14 with bilaterally stable ankles (age  =  23.76 ± 5.82 years, height  =  174.00 ± 11.67 cm, mass  =  68.60 ± 13.12 kg). Intervention(s): Participants were fitted with surface electromyography electrodes over the peroneus longus, peroneus brevis, tibialis anterior, and soleus muscles. Each participant received transient motion oscillations to his or her ankle on a custom-built medial-lateral swaying cradle in each of 3 conditions: no ankle brace (NB), lace-up brace (LU), and semirigid brace (SR). Main Outcome Measure(s): Ankle stiffness as measured by the cradle and preactivation levels (percentage of maximal voluntary isometric contraction) of the 4 test muscles. Results: Stiffness levels increased across brace conditions (NB  =  24.79 ± 6.59 Nm/rad, LU  =  28.29 ± 7.05 Nm/rad, SR  =  33.22 ± 8.78 Nm/rad; F2,52  =  66.185, P < .001). No differences were found between groups for rotational stiffness (stable  =  27.36 ± 6.17 Nm/rad, unstable  =  30.18 ± 8.21 Nm/rad; F1,26  =  1.084, P  =  .307). Preactivation levels did not change for any of the tested muscles with the application of an ankle brace (F2,52  =  1.326, P

  16. Arthroscopically assisted reduction of type 1A ankle Fractures in Children: Case Report

    PubMed Central

    Al-Aubaidi, Zaid

    2013-01-01

    Introduction: The risk of growth arrest following paediatric ankle fractures type 1 A is very high. Therefore all attempts should be done to anatomically reduce this kind of fracture. The advances in ankle arthroscopy have brought the possibility to reduce these fractures under direct vision, without the need of capsulotomy. The purpose of this paper is to stress the importance of the use of arthroscopically assisted reduction of type 1 A fractures. Case Report: We describe two cases with SH type IV fractures of the distal medial tibia, one treated with open reduction and percutaneous screw fixation and the other treated with arthroscopically assisted reduction and percutaneous screw fixation. The first case ended with severe growth disturbance, while the second gave a very good result. Conclusion: The use of arthroscopically assisted reduction of type 1 A fractures should be considered to ensure anatomical reduction. PMID:27298899

  17. Analysis of minor fractures associated with joints and faulted joints

    NASA Astrophysics Data System (ADS)

    Cruikshank, Kenneth M.; Zhao, Guozhu; Johnson, Arvid M.

    In this paper, we use fracture mechanics to interpret conditions responsible for secondary cracks that adorn joints and faulted joints in the Entrada Sandstone in Arches National Park, U.S.A. Because the joints in most places accommodated shearing offsets of a few mm to perhaps 1 dm, and thus became faulted joints, some of the minor cracks are due to faulting. However, in a few places where the shearing was zero, one can examine minor cracks due solely to interaction of joint segments at the time they formed. We recognize several types of minor cracks associated with subsequent faulting of the joints. One is the kink, a crack that occurs at the termination of a straight joint and whose trend is abruptly different from that of the joint. Kinks are common and should be studied because they contain a great deal of information about conditions during fracturing. The sense of kinking indicates the sense of shear during faulting: a kink that turns clockwise with respect to the direction of the main joint is a result of right-lateral shear, and a kink that turns counterclockwise is a result of left-lateral shear. Furthermore, the kink angle is related to the ratio of the shear stress responsible for the kinking to the normal stress responsible for the opening of the joint. The amount of opening of a joint at the time it faulted or even at the time the joint itself formed can be estimated by measuring the kink angle and the amount of strike-slip at some point along the faulted joint. Other fractures that form near terminations of pre-existing joints in response to shearing along the joint are horsetail fractures. Similar short fractures can occur anywhere along the length of the joints. The primary value in recognizing these fractures is that they indicate the sense of faulting accommodated by the host fracture and the direction of maximum tension. Even where there has been insignificant regional shearing in the Garden Area, the joints can have ornate terminations. Perhaps

  18. Ibuprofen in the treatment of acute ankle joint injuries. A double-blind study.

    PubMed

    Fredberg, U; Hansen, P A; Skinhøj, A

    1989-01-01

    Sixty-eight patients who presented to the casualty ward with acute ankle joint injuries were studied to examine the effect of ibuprofen on pain and ankle swelling. Thirty-two patients were treated with placebo tablets and 36 with 600 mg ibuprofen tablets taken four times a day for 4 to 6 days. All of the patients were immobilized and requested to keep the foot elevated. The results showed that ibuprofen had no effect on the ankle swelling. The need for additional analgesics was not influenced by treatment with ibuprofen, which means that ibuprofen has no effect on pain. The time elapsed from occurrence of the injury to arrival at the casualty ward was negatively correlated to the reduction of ankle joint swelling during the treatment period. Treatment with ice-sprays, icebags, or cold water during the acute stage of injury did not influence the reduction of swelling during the treatment period. PMID:2675651

  19. Associations between static and functional measures of joint function in the foot and ankle.

    PubMed

    Wrobel, James S; Connolly, John E; Beach, Michael L

    2004-01-01

    Clinicians have traditionally assessed range of motion of the first metatarsophalangeal and ankle joints in a static position. It is unclear, however, if these measurements accurately reflect functional sagittal plane limitations of these joints during gait. For 50 patients (100 feet), we assessed available dorsiflexion at the first metatarsophalangeal and ankle joints, as well as the presence of pinch callus. We then compared these findings with 11 functional gait parameters, as measured using a pressure sensor system. After adjusting for age, weight, smoking status, glycosylated hemoglobin, and insensitivity to monofilament, we found that patients with pinch callus demonstrated statistically significant compensatory gait patterns in 7 of 11 measures. Hallux limitus and equinus patients demonstrated six and three statistically significant associations, respectively. Pinch callus seems to be as predictive of functional gait alterations as static first metatarsophalangeal joint and ankle dorsiflexion. PMID:15547120

  20. Tendon entrapments and dislocations in ankle and hindfoot fractures: evaluation with multidetector computed tomography.

    PubMed

    Ballard, David H; Campbell, Kevin J; Blanton, Lee E; Williams, Jason T; Sangster, Guillermo; Hollister, Anne M; Simoncini, Alberto A

    2016-08-01

    The purpose of this study was to assess the incidence of tendon entrapments and tendon dislocations associated with ankle and hindfoot fractures in patients studied by multidetector computed tomography (MDCT). Additionally, we describe particular tendon injuries associated with specific fractures. This was a retrospective review of all individuals with a trauma-protocol CT for suspected ankle and/or hindfoot fractures during a consecutive 41-month time period at a single Level I Trauma Center. Each patient's images were evaluated by two radiologists and an orthopedic surgeon for tendon entrapment, tendon dislocation, and bone(s) fractured or dislocated. There were 398 patients with ankle and/or hindfoot fractures that showed tendon entrapment or dislocation in 64 (16.1 %) patients. There were 30 (46.9 %) patients with 40 tendon entrapments, 31 (48.4 %) patients with 59 tendon dislocations, and three (4.7 %) patients with both tendon entrapment and dislocation. All patients with tendon entrapments were seen with either pilon fractures and/or a combination of posterior, medial, or lateral malleolar fractures. The most frequently entrapped tendon was the posterior tibialis tendon (PTT) in 27 patients (27/30, 90.0 %). The peroneal tendons were the most frequently dislocated, representing 27 (87.1 %) of patients with tendon dislocation; all resulted from a talar or calcaneal fracture or subluxation. This study demonstrates that tendon entrapments and tendon dislocations are commonly seen in complex fractures of the ankle and hindfoot. Pilon fractures were associated with the majority of tendon entrapments, whereas calcaneus fractures were associated with the majority of tendon dislocations. PMID:27234977

  1. The unexpected with ankle fracture: traumatic tibialis posterior tendon dislocation: a case report and literature review.

    PubMed

    Al Khudairy, A; Zafar, M M; Padinjarathala, B A

    2013-12-01

    Traumatic dislocation of tibialis posterior is infrequently reported in the literature. It is rare but potential cause of persistent pain that can be easily missed. Concomitant ankle fracture may obscure the clinical picture and if unsuspected, consequences such as iatrogenic injury to tibialis posterior tendon while fixing the medial malleolus may occur. We report our experience in the management of a tibialis posterior tendon dislocation associated with ankle fracture. A review of all English literature had been carried with a focus on treatment options. PMID:24026087

  2. Ankle Joint Angle and Lower Leg Musculotendinous Unit Responses to Cryotherapy.

    PubMed

    Akehi, Kazuma; Long, Blaine C; Warren, Aric J; Goad, Carla L

    2016-09-01

    Akehi, K, Long, BC, Warren, AJ, and Goad, CL. Ankle joint angle and lower leg musculotendinous unit responses to cryotherapy. J Strength Cond Res 30(9): 2482-2492, 2016-The use of cold application has been debated for its influence on joint range of motion (ROM) and stiffness. The purpose of this study was to determine whether a 30-minute ice bag application to the plantarflexor muscles or ankle influences passive ankle dorsiflexion ROM and lower leg musculotendinous stiffness (MTS). Thirty-five recreationally active college-aged individuals with no history of lower leg injury 6 months before data collection volunteered. On each testing day, we measured maximum passive ankle dorsiflexion ROM (°) and plantarflexor torque (N·m) on an isokinetic dynamometer to calculate the passive plantarflexor MTS (N·m per degree) at 4 joint angles before, during, and after a treatment. Surface electromyography amplitudes (μV), and skin surface and ambient air temperature (°C) were also measured. Subjects received an ice bag to the posterior lower leg, ankle joint, or nothing for 30 minutes in different days. Ice bag application to the lower leg and ankle did not influence passive ROM (F(12,396) = 0.67, p = 0.78). Passive torque increased after ice bag application to the lower leg (F(12,396) = 2.21, p = 0.011). Passive MTS at the initial joint angle increased after ice bag application to the lower leg (F(12,396) = 2.14, p = 0.014) but not at the other joint angles (p > 0.05). Surface electromyography amplitudes for gastrocnemius and soleus muscles increased after ice application to the lower leg (F(2,66) = 5.61, p = 0.006; F(12,396) = 3.60, p < 0.001). Ice bag application to the lower leg and ankle joint does not alter passive dorsiflexion ROM but increases passive ankle plantarflexor torque in addition to passive ankle plantarflexor MTS at the initial joint angle. PMID:26863585

  3. Identification of the contribution of the ankle and hip joints to multi-segmental balance control

    PubMed Central

    2013-01-01

    Background Human stance involves multiple segments, including the legs and trunk, and requires coordinated actions of both. A novel method was developed that reliably estimates the contribution of the left and right leg (i.e., the ankle and hip joints) to the balance control of individual subjects. Methods The method was evaluated using simulations of a double-inverted pendulum model and the applicability was demonstrated with an experiment with seven healthy and one Parkinsonian participant. Model simulations indicated that two perturbations are required to reliably estimate the dynamics of a double-inverted pendulum balance control system. In the experiment, two multisine perturbation signals were applied simultaneously. The balance control system dynamic behaviour of the participants was estimated by Frequency Response Functions (FRFs), which relate ankle and hip joint angles to joint torques, using a multivariate closed-loop system identification technique. Results In the model simulations, the FRFs were reliably estimated, also in the presence of realistic levels of noise. In the experiment, the participants responded consistently to the perturbations, indicated by low noise-to-signal ratios of the ankle angle (0.24), hip angle (0.28), ankle torque (0.07), and hip torque (0.33). The developed method could detect that the Parkinson patient controlled his balance asymmetrically, that is, the right ankle and hip joints produced more corrective torque. Conclusion The method allows for a reliable estimate of the multisegmental feedback mechanism that stabilizes stance, of individual participants and of separate legs. PMID:23433148

  4. The perils of spinning class: an open ankle fracture following a spinning exercise session.

    PubMed

    Butler, Daniel P; Henry, Francis P; Ghali, Shadi

    2013-12-01

    Spinning is an increasingly popular form of cycle-based exercise. The workouts are often of high-intensity and participants are intermittently encouraged to achieve a high crank-set-cadence rate. We report a unique case of an open ankle fracture requiring free flap coverage, which highlights the potential perils of spinning class. PMID:23773931

  5. Ankle rehabilitation device with two degrees of freedom and compliant joint

    NASA Astrophysics Data System (ADS)

    Racu (Cazacu, C.-M.; Doroftei, I.

    2015-11-01

    We propose a rehabilitation device that we intend to be low cost and easy to manufacture. The system will ensure functionality but also have a small dimensions and low mass, considering the physiological dimensions of the foot and lower leg. To avoid injure of the ankle joint, this device is equipped with a compliant joint between the motor and mechanical transmission. The torque of this joint is intended to be adjustable, according to the degree of ankle joint damage. To choose the material and the dimensions of this compliant joint, in this paper we perform the first stress simulation. The minimum torque is calculated, while the maximum torque is given by the preliminary chosen actuator.

  6. Estimation of ligament strains and joint moments in the ankle during a supination sprain injury.

    PubMed

    Wei, Feng; Fong, Daniel Tik-Pui; Chan, Kai-Ming; Haut, Roger C

    2015-01-01

    This study presents the ankle ligament strains and ankle joint moments during an accidental injury event diagnosed as a grade I anterior talofibular ligament (ATaFL) sprain. A male athlete accidentally sprained his ankle while performing a cutting motion in a laboratory setting. The kinematic data were input to a three-dimensional rigid-body foot model for simulation analyses. Maximum strains in 20 ligaments were evaluated in simulations that investigated various combinations of the reported ankle joint motions. Temporal strains in the ATaFL and the calcaneofibular ligament (CaFL) were then compared and the three-dimensional ankle joint moments were evaluated from the model. The ATaFL and CaFL were highly strained when the inversion motion was simulated (10% for ATaFL and 12% for CaFL). These ligament strains were increased significantly when either or both plantarflexion and internal rotation motions were added in a temporal fashion (up to 20% for ATaFL and 16% for CaFL). Interestingly, at the time strain peaked in the ATaFL, the plantarflexion angle was not large but apparently important. This computational simulation study suggested that an inversion moment of approximately 23 N m plus an internal rotation moment of approximately 11 N m and a small plantarflexion moment may have generated a strain of 15-20% in the ATaFL to produce a grade I ligament injury in the athlete's ankle. This injury simulation study exhibited the potentially important roles of plantarflexion and internal rotation, when combined with a large inversion motion, to produce a grade I ATaFL injury in the ankle of this athlete. PMID:23654290

  7. Posterior ankle impingement syndrome.

    PubMed

    Maquirriain, Javier

    2005-10-01

    Posterior ankle impingement syndrome is a clinical disorder characterized by posterior ankle pain that occurs in forced plantar flexion. The pain may be acute as a result of trauma or chronic from repetitive stress. Pathology of the os trigonum-talar process is the most common cause of this syndrome, but it also may result from flexor hallucis longus tenosynovitis, ankle osteochondritis, subtalar joint disease, and fracture. Patients usually report chronic or recurrent posterior ankle pain caused or exacerbated by forced plantar flexion or push-off maneuvers, such as may occur during dancing, kicking, or downhill running. Diagnosis of posterior ankle impingement syndrome is based primarily on clinical history and physical examination. Radiography, scintigraphy, computed tomography, and magnetic resonance imaging depict associated bone and soft-tissue abnormalities. Symptoms typically improve with nonsurgical management, but surgery may be required in refractory cases. PMID:16224109

  8. 38 CFR 4.45 - The joints.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... (from flail joint, resections, nonunion of fracture, relaxation of ligaments, etc.). (c) Weakened... the purpose of rating disability from arthritis, the shoulder, elbow, wrist, hip, knee, and ankle...

  9. 38 CFR 4.45 - The joints.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... (from flail joint, resections, nonunion of fracture, relaxation of ligaments, etc.). (c) Weakened... the purpose of rating disability from arthritis, the shoulder, elbow, wrist, hip, knee, and ankle...

  10. 38 CFR 4.45 - The joints.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... (from flail joint, resections, nonunion of fracture, relaxation of ligaments, etc.). (c) Weakened... the purpose of rating disability from arthritis, the shoulder, elbow, wrist, hip, knee, and ankle...

  11. 38 CFR 4.45 - The joints.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... (from flail joint, resections, nonunion of fracture, relaxation of ligaments, etc.). (c) Weakened... the purpose of rating disability from arthritis, the shoulder, elbow, wrist, hip, knee, and ankle...

  12. Effects of immobilization and remobilization on the ankle joint in Wistar rats

    PubMed Central

    Kunz, R.I.; Coradini, J.G.; Silva, L.I.; Bertolini, G.R.F.; Brancalhão, R.M.C.; Ribeiro, L.F.C.

    2014-01-01

    A sprained ankle is a common musculoskeletal sports injury and it is often treated by immobilization of the joint. Despite the beneficial effects of this therapeutic measure, the high prevalence of residual symptoms affects the quality of life, and remobilization of the joint can reverse this situation. The aim of this study was to analyze the effects of immobilization and remobilization on the ankle joint of Wistar rats. Eighteen male rats had their right hindlimb immobilized for 15 days, and were divided into the following groups: G1, immobilized; G2, remobilized freely for 14 days; and G3, remobilized by swimming and jumping in water for 14 days, performed on alternate days, with progression of time and a series of exercises. The contralateral limb was the control. After the experimental period, the ankle joints were processed for microscopic analysis. Histomorphometry did not show any significant differences between the control and immobilized/remobilized groups and members, in terms of number of chondrocytes and thickness of the articular cartilage of the tibia and talus. Morphological analysis of animals from G1 showed significant degenerative lesions in the talus, such as exposure of the subchondral bone, flocculation, and cracks between the anterior and mid-regions of the articular cartilage and the synovial membrane. Remobilization by therapeutic exercise in water led to recovery in the articular cartilage and synovial membrane of the ankle joint when compared with free remobilization, and it was shown to be an effective therapeutic measure in the recovery of the ankle joint. PMID:25140815

  13. Effects of immobilization and remobilization on the ankle joint in Wistar rats.

    PubMed

    Kunz, R I; Coradini, J G; Silva, L I; Bertolini, G R F; Brancalhão, R M C; Ribeiro, L F C

    2014-10-01

    A sprained ankle is a common musculoskeletal sports injury and it is often treated by immobilization of the joint. Despite the beneficial effects of this therapeutic measure, the high prevalence of residual symptoms affects the quality of life, and remobilization of the joint can reverse this situation. The aim of this study was to analyze the effects of immobilization and remobilization on the ankle joint of Wistar rats. Eighteen male rats had their right hindlimb immobilized for 15 days, and were divided into the following groups: G1, immobilized; G2, remobilized freely for 14 days; and G3, remobilized by swimming and jumping in water for 14 days, performed on alternate days, with progression of time and a series of exercises. The contralateral limb was the control. After the experimental period, the ankle joints were processed for microscopic analysis. Histomorphometry did not show any significant differences between the control and immobilized/remobilized groups and members, in terms of number of chondrocytes and thickness of the articular cartilage of the tibia and talus. Morphological analysis of animals from G1 showed significant degenerative lesions in the talus, such as exposure of the subchondral bone, flocculation, and cracks between the anterior and mid-regions of the articular cartilage and the synovial membrane. Remobilization by therapeutic exercise in water led to recovery in the articular cartilage and synovial membrane of the ankle joint when compared with free remobilization, and it was shown to be an effective therapeutic measure in the recovery of the ankle joint. PMID:25140815

  14. Foot and ankle problems in dancers.

    PubMed

    Kadel, Nancy

    2014-11-01

    The dancer's foot and ankle are subjected to high forces and unusual stresses in training and performance. Injuries are common in dancers, and the foot and ankle are particularly vulnerable. Ankle sprains, ankle impingement syndromes, flexor hallucis longus tendonitis, cuboid subluxation, stress fractures, midfoot injuries, heel pain, and first metatarsophalangeal joint problems including hallux valgus, hallux rigidus, and sesamoid injuries will be reviewed. This article will discuss these common foot and ankle problems in dancers and give typical clinical presentation and diagnostic and treatment recommendations. PMID:25442161

  15. Ankle fracture configuration following treatment with and without arthroscopic-assisted reduction and fixation

    PubMed Central

    Angthong, Chayanin

    2016-01-01

    AIM: To report ankle fracture configurations and bone quality following arthroscopic-assisted reduction and internal-fixation (ARIF) or open reduction and internal-fixation (ORIF). METHODS: The patients of ARIF (n = 16) or ORIF (n = 29) to treat unstable ankle fracture between 2006 and 2014 were reviewed retrospectively. Baseline data, including age, sex, type of injury, immediate postoperative fracture configuration (assessed on X-rays and graded by widest gap and largest step-off of any intra-articular site), bone quality [assessed with bone mineral density (BMD) testing] and arthritic changes on X-rays following surgical treatments were recorded for each group. RESULTS: Immediate-postoperative fracture configurations did not differ significantly between the ARIF and ORIF groups. There were anatomic alignments as 8 (50%) and 8 (27.6%) patients in ARIF and ORIF groups (P = 0.539) respectively. There were acceptable alignments as 12 (75%) and 17 (58.6%) patients in ARIF and ORIF groups (P = 0.341) respectively. The arthritic changes in follow-up period as at least 16 wk following the surgeries were shown as 6 (75%) and 10 (83.3%) patients in ARIF and ORIF groups (P = 0.300) respectively. Significantly more BMD tests were performed in patients aged > 60 years (P < 0.001), ARIF patients (P = 0.021), and female patients (P = 0.029). There was no significant difference in BMD test t scores between the two groups. CONCLUSION: Ankle fracture configurations following surgeries are similar between ARIF and ORIF groups, suggesting that ARIF is not superior to ORIF in treatment of unstable ankle fractures. PMID:27114933

  16. Effects of Strength Training on Strength Development and Joint Position Sense in Functionally Unstable Ankles

    PubMed Central

    Docherty, Carrie L.; Moore, Josef H.; Arnold, Brent L.

    1998-01-01

    Objective: To examine the effects of ankle-strengthening exercises on joint position sense and strength development in subjects with functionally unstable ankles. Design and Setting: Subjects were randomly assigned to a training or control group. The training group participated in a 6-week strength-training protocol using rubber tubing 3 times a week throughout the training period. The control group did not participate in the strength-training protocol. Subjects: Twenty healthy college students (10 females, 10 males, age = 20.6 ± 2.23 years; ht = 176.40 ± 7.14 cm; wt = 74.18 ± 10.17 kg) with a history of functional ankle instability volunteered to participate in this study. Measurements: We pretested and posttested dorsiflexor and evertor isometric strength with a handheld dynamometer and collected joint position sense (JPS) data at 20° for inversion and plantar flexion and at 10° for eversion and dorsiflexion. Results: Statistical tests for strength and JPS revealed significant group-by-time interactions for dorsiflexion strength, eversion strength, inversion JPS, and plantar flexion JPS. Simple main-effects testing revealed improvements in training group strength and JPS at posttesting. There were no significant effects for eversion JPS, but the group main effect for dorsiflexion JPS was significant, with the experimental group having better scores than the control group. Conclusions: Ankle-strengthening exercises improved strength, inversion JPS, dorsiflexion JPS, and plantar flexion JPS in subjects with functionally unstable ankles. Imagesp311-a PMID:16558526

  17. Quadruple-component superficial circumflex iliac artery perforator (SCIP) flap: A chimeric SCIP flap for complex ankle reconstruction of an exposed artificial joint after total ankle arthroplasty.

    PubMed

    Yamamoto, Takumi; Saito, Takafumi; Ishiura, Ryohei; Iida, Takuya

    2016-09-01

    Total ankle arthroplasty (TAA) is becoming popular in patients with rheumatoid arthritis (RA)-associated ankle joint degeneration. However, ankle wound complications can occur after TAA, which sometimes requires challenging reconstruction due to anatomical complexity of the ankle. Superficial circumflex iliac artery (SCIA) perforator (SCIP) flap has been reported to be useful for various reconstructions, but no case has been reported regarding a chimeric SCIP flap for complex ankle reconstruction. We report a case of complex ankle defect successfully reconstructed with a free quadruple-component chimeric SCIP flap. A 73-year-old female patient with RA underwent TAA, and suffered from an extensive ankle soft tissue defect (13 × 5 cm) with exposure of the implanted artificial joint and the extensor tendons. A chimeric SCIP flap was raised based on the deep branch and the superficial branch of the SCIA, which included chimeric portions of the sartorius muscle, the deep fascia, the inguinal lymph node (ILN), and the skin/fat. The flap was transferred to the recipient ankle. The sartorius muscle was used to cover the artificial joint, the deep fascia to reconstruct the extensor retinaculum, the ILN to prevent postoperative lymphedema, and the adiposal tissue to put around the extensor tendons for prevention of postoperative adhesion. Postoperatively, the patient could walk by herself without persistent leg edema or bowstringing of the extensor tendons, and was satisfied with the concealable donor scar. Although further studies are required to confirm efficacy, multicomponent chimeric SCIP has a potential to be a useful option for complex defects of the ankle. PMID:27423250

  18. Open Axial and True Vertical Ankle Dislocation Without Malleolar Fractures: A Case Report.

    PubMed

    Bakshi, Kapil

    2016-01-01

    Tibiotalar dislocation is rare and usually associated with a high-velocity, high-energy impact or extreme sporting injuries. I describe complete tibiotalar dislocation from an unusual mechanism. A 22-year-old mechanic was sitting under a hydraulic lift when it began to leak, lowering the engine on which he was working onto his right lower thigh. This heavy load, without rotational force or high-velocity impact, was transmitted down his foreleg. Because his foot was fixed to the ground, the talus was proximally and vertically displaced, and the distal tibia was forced to the ground, beside his foot, and was contaminated with sand and grease. The circumferential ligament complexes and capsule were completely transected, but, despite a severely disrupted dorsal and capsular blood supply, talar vasculature remained adequate. In the emergency department, gentle traction restored impaired circulation. No malleolar fractures were seen. The wound was meticulously irrigated with saline and povidone-iodine and debrided. Cefepime, 2 g, was given twice daily. In surgery, the unstable joint was transfixed with two thick Kirschner wires, passed retrograde. Interrupted sutures were placed in the anterior capsule and anterior third of the lateral ligament without additional incisions. The wound healed aseptically. The Kirschner wires were removed at 6 weeks. The joint space was only minimally reduced. He returned to work after 4 months. His ankle-hindfoot score was 90/100 at 18 months, he could jog at 24 months, and he was still asymptomatic at 36 months. The case illustrates the importance of preserving talar circulation and treatment within the "golden hour." PMID:25524434

  19. Irreducible Fracture-Dislocation of the Ankle Associated With Interposition of the Tibialis Posterior Tendon in the Syndesmosis: A Case Report.

    PubMed

    Lacasse, Jean-Simon; Laflamme, Melissa; Penner, Murray J

    2015-01-01

    Although ankle fracture-dislocations are common orthopedic injuries, it is very uncommon for them to be irreducible, and such cases require special attention. We report the case of a closed fracture-dislocation of the ankle in a 17-year-old male that required 3 surgeries because of persistent anterior subluxation of the talus on the postoperative radiographs. After advanced radiologic investigations, tibialis posterior tendon interposition in the syndesmosis was identified as the cause of the subluxation. This is a very rare event, reported in only 5 patients in published studies. Once the diagnosis was identified by magnetic resonance imaging, the tendon was relocated to its anatomic position, and the tibiofibular and tibiotalar joints were reduced adequately. The patient was then able to regain a satisfactory level of function many months after the initial trauma. PMID:24846161

  20. Different effects of age, adiposity and physical activity on the risk of ankle, wrist and hip fractures in postmenopausal women.

    PubMed

    Armstrong, Miranda E G; Cairns, Benjamin J; Banks, Emily; Green, Jane; Reeves, Gillian K; Beral, Valerie

    2012-06-01

    While increasing age, decreasing body mass index (BMI), and physical inactivity are known to increase hip fracture risk, whether these factors have similar effects on other common fractures is not well established. We used prospectively-collected data from a large cohort to examine the role of these factors on the risk of incident ankle, wrist and hip fractures in postmenopausal women. 1,155,304 postmenopausal participants in the Million Women Study with a mean age of 56.0 (SD 4.8) years, provided information about lifestyle, anthropometric, and reproductive factors at recruitment in 1996-2001. All participants were linked to National Health Service cause-specific hospital records for day-case or overnight admissions. During follow-up for an average of 8.3 years per woman, 6807 women had an incident ankle fracture, 9733 an incident wrist fracture, and 5267 an incident hip fracture. Adjusted absolute and relative risks (RRs) for incident ankle, wrist, and hip fractures were calculated using Cox regression models. Age-specific rates for wrist and hip fractures increased sharply with age, whereas rates for ankle fracture did not. Cumulative absolute risks from ages 50 to 84 years per 100 women were 2.5 (95%CI 2.2-2.8) for ankle fracture, 5.0 (95%CI 4.4-5.5) for wrist fracture, and 6.2 (95%CI 5.5-7.0) for hip fracture. Compared with lean women (BMI<20 kg/m(2)), obese women (BMI≥30 kg/m(2)) had a three-fold increased risk of ankle fracture (RR=3.07; 95%CI 2.53-3.74), but a substantially reduced risk of wrist fracture and especially of hip fracture (RR=0.57; 0.51-0.64 and 0.23; 0.21-0.27, respectively). Physical activity was associated with a reduced risk of hip fracture but was not associated with ankle or wrist fracture risk. Ankle, wrist and hip fractures are extremely common in postmenopausal women, but the associations with age, adiposity, and physical activity differ substantially between the three fracture sites. PMID:22465850

  1. Comparative study of therapies for fibular ligament rupture of the lateral ankle joint in competitive basketball players.

    PubMed

    Klein, J; Höher, J; Tiling, T

    1993-01-01

    This retrospective study compares the results of different therapies for fibular ligament rupture in a homogenous group of professional athletes. The endpoint "competitive sports" was an outcome consideration. Subjects were examined by means of a standardized questionnaire and a structured interview. One hundred and seventy-nine of the questionnaires were completed and returned for evaluation. All of the basketball players with severe ankle sprain (supination trauma with swelling, pain, and inability to bear stress) were included. Those players with fractures of the foot, pronation trauma, or additional distal fibula or tibia fractures were excluded from this study. Of the 179 basketball players 160 (89%) had suffered severe ankle sprain. The treatment was divided into three groups: primary surgery (N = 35), plaster cast (N = 39), and functional treatment (N = 89). While simple ligament injuries (Grade I and II) were mostly treated functionally, complex ligament injuries (Grade III) were usually operated on. A total of 119 (74%) of the players reported no further pain. For pain reduction surgical and functional treatments showed advantages over plaster treatment. In the surgical group 63% of the players judged their regained stability to be equivalent to that of their healthy leg. Only 50% of the players in the plaster and functional groups believed their ankle joints to have regained the same stability as before their injuries. Despite the achievement of good results through surgery, there were clear differences in the players' assessments of their performance in competitive sports. Most subjects (92%) did not have any problems in everyday life regardless of which kind of therapy had been chosen.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8406246

  2. Functional Comparison of Immediate and Late Weight Bearing after Ankle Bimalleolar Fracture Surgery

    PubMed Central

    Ağır, İsmail; Tunçer, Nejat; Küçükdurmaz, Fatih; Gümüstaş, Seyitali; Akgül, Esra Demirel; Akpinar, Fuat

    2015-01-01

    Aim : The aim of the study is to compare immediate weight bearing with below-knee cast or immobilization with plaster splint in 6 weeks in patients after operative treatment for ankle bimalleolar fractures. Methods : Fifty-three patients with ankle bimalleolar fractures were treated operatively in 2005 to 2010 and then were randomly allocated to two groups. Immediately weight bearing in a below-knee cast (26 patients) and immobilization in a plaster splint for the first six postoperative weeks (27 patients). A mean age 37.9 (min 17; max 72). An average follow-up 26.1 months. (min 14; max 55). All fractures were classified with Lauge-Hansen classification. Functional results of both groups were evaluated with AOFAS for the postoperative one year after surgical treatment. Results : According to the AOFAS scoring system, results were excellent and good in 17 patients in group 1. On the other hand, results were excellent and good in 14 patients in group 2. Conclusion : As a result we think that weight bearing protocol should be advantaged for patients with ankle bimalleolar fractures after surgical treatment immediately. PMID:26069513

  3. Management of chronic ankle pain using joint mobilization and ASTYM® treatment: a case report

    PubMed Central

    Slaven, Emily J; Mathers, Jessie

    2011-01-01

    Treatment of ankle sprains predominately focuses on the acute management of this condition; less emphasis is placed on the treatment of ankle sprains in the chronic phase of recovery. Manual therapy, in the form of joint mobilization and manipulation, has been shown to be effective in the management of this condition, but the combination of joint mobilization and manipulation in tandem with ASTYM® treatment has not been explored. The purpose of this case report is to chronicle the management of a patient with chronic ankle pain who was treated with manual therapy including manipulation and ASTYM treatment. As a result of a fall down stairs 6 months previously, the patient sustained a severe ankle sprain. The soft tissue damage was accompanied by bony disruptions which warranted the patient spending 3 weeks in a walking boot. At the initial evaluation, the patient reported difficulty with descending stairs reciprocally and not being able to run more than 4 minutes on the treadmill before the pain escalated to the level that she had to stop running. After five sessions of therapy consisting of joint mobilization, manipulation and ASTYM, the patient was able to descend stairs and run 40 minutes without pain. PMID:22547921

  4. Ankle Problems

    MedlinePlus

    ... intense you're unable to walk on the ankle? Yes You may have a FRACTURE or a severe SPRAIN. Don't walk on the injured foot. Raise the leg and place ice on the swollen area. See your doctor promptly. No ... but you're still able to walk on the ankle? Yes You may have a SPRAINED ANKLE, or ...

  5. Factors affecting the range of motion of the ankle and first metatarsophalangeal joints in patients undergoing hemodialysis who walk daily

    PubMed Central

    Matsui, Nobumasa; Shoji, Morio; Kitagawa, Takashi; Terada, Shigeru

    2016-01-01

    [Purpose] Increased plantar pressure during walking is a risk factor for foot ulcers because of reduced range of motion at the ankle and first metatarsophalangeal joints. However, the range of motion in patients undergoing hemodialysis has not yet been determined. A cross-sectional study was performed to investigate the factors affecting the range of motion of the ankle and first metatarsophalangeal joints in patients undergoing hemodialysis who walk daily. [Subjects and Methods] Seventy feet of 35 patients receiving hemodialysis therapy were examined. Measurements included the passive range of motion of plantar flexion and dorsiflexion of the ankle joint, and flexion and extension of the first metatarsophalangeal joint. [Results] Hemodialysis duration was not associated with ankle and first metatarsophalangeal joint range of motion in patients undergoing hemodialysis. Diabetes duration was significantly associated with limited ankle joint mobility. Finally, blood hemoglobin levels, body mass index, and age were associated with first metatarsophalangeal joint range of motion. [Conclusion] The present study identified age, diabetes, and decreased physical activity, but not hemodialysis duration, to be risk factors for limited joint mobility of the ankle and first metatarsophalangeal joints in patients undergoing hemodialysis. PMID:27313371

  6. Foot and ankle compression improves joint position sense but not bipedal stance in older people.

    PubMed

    Hijmans, Juha M; Zijlstra, Wiebren; Geertzen, Jan H B; Hof, At L; Postema, Klaas

    2009-02-01

    This study investigates the effects of foot and ankle compression on joint position sense (JPS) and balance in older people and young adults. 12 independently living healthy older persons (77-93 years) were recruited from a senior accommodation facility. 15 young adults (19-24 years) also participated. Compression was applied at the ankles and feet using medical compression hosiery. The mean velocity of the centre of pressure (CoP) displacements and the root mean square of the CoP velocity in both anteroposterior and mediolateral directions, were measured with a foot pressure plate. In older people, ankle compression was associated with an improvement of JPS towards normal values. However, a concurrent deterioration of their balance was found. In young adults compression had no effect on either JPS or balance. PMID:19019679

  7. Examination of knee joint moments on the function of knee-ankle-foot orthoses during walking.

    PubMed

    Andrysek, Jan; Klejman, Susan; Kooy, John

    2013-08-01

    The goal of this study was to investigate clinically relevant biomechanical conditions relating to the setup and alignment of knee-ankle-foot orthoses and the influence of these conditions on knee extension moments and orthotic stance control during gait. Knee moments were collected using an instrumented gait laboratory and concurrently a load transducer embedded at the knee-ankle-foot orthosis knee joint of four individuals with poliomyelitis. We found that knee extension moments were not typically produced in late stance-phase of gait. Adding a dorsiflexion stop at the orthotic ankle significantly decreased the knee flexion moments in late stance-phase, while slightly flexing the knee in stance-phase had a variable effect. The findings suggest that where users of orthoses have problems initiating swing-phase flexion with stance control orthoses, an ankle dorsiflexion stop may be used to enhance function. Furthermore, the use of stance control knee joints that lock while under flexion may contribute to more inconsistent unlocking of the stance control orthosis during gait. PMID:23182738

  8. Unilateral Adolescent Pes Planus After a Bimalleolar Ankle Fracture: A Case Report.

    PubMed

    Phillips, Staton L; Williams, Daniel; Jeyaseelan, Luckshmana; Bryce, Elaine; Alyas, Faisal; Vemulapalli, Krishna

    2016-01-01

    We present the case of a 14-year-old female who presented with unilateral pes planus 30 months after a bimalleolar ankle fracture dislocation. At surgery, the tibialis posterior tendon was encased in fracture callus within the syndesmosis and required reconstruction using flexor digitorum longus transfer. Dislocation of the tibialis posterior tendon and entrapment within the tibiofibular syndesmosis has been previously reported. To our knowledge, this is the first case report tibialis posterior tendon syndesmotic entrapment presenting with unilateral pes planus. PMID:25648274

  9. Effects of changing speed on knee and ankle joint load during walking and running.

    PubMed

    de David, Ana Cristina; Carpes, Felipe Pivetta; Stefanyshyn, Darren

    2015-01-01

    Joint moments can be used as an indicator of joint loading and have potential application for sports performance and injury prevention. The effects of changing walking and running speeds on joint moments for the different planes of motion still are debatable. Here, we compared knee and ankle moments during walking and running at different speeds. Data were collected from 11 recreational male runners to determine knee and ankle joint moments during different conditions. Conditions include walking at a comfortable speed (self-selected pacing), fast walking (fastest speed possible), slow running (speed corresponding to 30% slower than running) and running (at 4 m · s(-1) ± 10%). A different joint moment pattern was observed between walking and running. We observed a general increase in joint load for sagittal and frontal planes as speed increased, while the effects of speed were not clear in the transverse plane moments. Although differences tend to be more pronounced when gait changed from walking to running, the peak moments, in general, increased when speed increased from comfortable walking to fast walking and from slow running to running mainly in the sagittal and frontal planes. Knee flexion moment was higher in walking than in running due to larger knee extension. Results suggest caution when recommending walking over running in an attempt to reduce knee joint loading. The different effects of speed increments during walking and running should be considered with regard to the prevention of injuries and for rehabilitation purposes. PMID:25105739

  10. Does ankle joint power reflect type of muscle action of soleus and gastrocnemius during walking in cats and humans?

    PubMed

    Cronin, Neil J; Prilutsky, Boris I; Lichtwark, Glen A; Maas, Huub

    2013-04-26

    The main objective of this paper is to highlight the difficulties of identifying shortening and lengthening contractions based on analysis of power produced by resultant joint moments. For that purpose, we present net ankle joint powers and muscle fascicle/muscle-tendon unit (MTU) velocities for medial gastrocnemius (MG) and soleus (SO) muscles during walking in species of different size (humans and cats). For the cat, patterns of ankle joint power and MTU velocity of MG and SO during stance were similar: negative power (ankle moment×angular velocity<0), indicating absorption of mechanical energy, was associated with MTU lengthening, and positive power (generation of mechanical energy) was found during MTU shortening. This was also found for the general fascicle velocity pattern in SO. In contrast, substantial differences between ankle joint power and fascicle velocity patterns were observed for MG muscle. In humans, like cats, the patterns of ankle joint power and MTU velocity of SO and MG were similar. Unlike the cat, there were substantial differences between patterns of fascicle velocity and ankle joint power during stance in both muscles. These results indicate that during walking, only a small fraction of mechanical work of the ankle moment is either generated or absorbed by the muscle fascicles, thus confirming the contribution of in-series elastic structures and/or energy transfer via two-joint muscles. We conclude that ankle joint negative power does not necessarily indicate eccentric action of muscle fibers and that positive power cannot be exclusively attributed to muscle concentric action, especially in humans. PMID:23538001

  11. Dynamic Evaluation of the Contact Characteristics and Three-Dimensional Motion for the Ankle Joint with Lateral Ligament Injuries

    NASA Astrophysics Data System (ADS)

    Kawakami, Kensaku; Omori, Go; Terashima, Shojiro; Sakamoto, Makoto; Hara, Toshiaki

    The purpose of this study was to clarify the dynamic changes in contact pressure distribution and three-dimensional ankle joint motion before and after lateral ligament injuries. Five fresh and frozen intact cadaveric ankles were examined. Each ankle was mounted on a specially designed frame that preserved five degrees of freedom motion. The direct linear transformation technique was used to measure the three-dimensional ankle motion, and a pressure-sensitive conductive rubber sensor was inserted into the talocrural joint space to determine the contact pressure distribution. The contact area on the talus for intact ankle moved anteriorly and laterally with increasing dorsiflexion. An area of high pressure was observed in the medial aspect of the articular surface after the ligament was cut. Supination significantly increased after a combined anterior talofibular ligament (ATF) and calcaneofibular ligament (CF) were cut in comparison with after only an ATF was cut, and no significant differences were observed in motional properties under each experimental condition.

  12. Contemporary demographics and complications of patients treated for open ankle fractures.

    PubMed

    Ovaska, Mikko T; Madanat, Rami; Honkamaa, Maija; Mäkinen, Tatu J

    2015-08-01

    Open ankle fractures are rare injuries with a high likelihood of wound complications and subsequent infections. There is limited information about the complications and outcomes of these injuries in different age groups. The aim of this study was to assess the contemporary demographics and complications related to this injury. We performed a chart review of all the 3030 patients treated for ankle fractures at a Level 1 trauma centre from 2006 to 2011. 137 (4.5%) patients had an open ankle fracture. The demographic data, injury mechanism, comorbidities, and fracture type were collected. Treatment, complications, length of stay and number of outpatient visits were also recorded. The mean age of the patients was 60 years and 56% were women. Most fractures were Weber type B with a medial sided wound (93%). Only 20% of the fractures were the result of high-energy trauma, and 31% were Gustilo grade III injuries. Immediate internal fixation was performed in 82% of patients, and the wound was primarily closed in most cases (80%). The incidence of postoperative wound necrosis and deep infection was 18% and 17%, respectively. There were more deep infections if pulsatile lavage was used during the wound debridement (p=0.029). About 14 (10%) patients required a flap reconstruction to cover the soft-tissue defect. Every other patient (54%) had a complication, and 21 patients (15%) suffered a long-term disability related to the injury. The number complications did not differ for nighttime and daytime operations (p=0.083). High-energy injuries were more common in younger patients (p<0.001) and these patients also had more lateral sided open wounds than older patients (p=0.002). Interestingly, younger patients also had significantly more complications (p=0.024), suffered more often from chronic pain (p=0.003), and required more flap reconstructions (p=0.026), reoperations (p=0.026), and outpatient clinic visits (p=0.006). Open ankle fractures have a high complication rate and

  13. Differences in Injury Pattern and Prevalence of Cartilage Lesions in Knee and Ankle Joints: A Retrospective Cohort Study

    PubMed Central

    Aurich, Matthias; Hofmann, Gunther O.; Rolauffs, Bernd; Gras, Florian

    2014-01-01

    Osteoarthritis (OA) is more common in the knee compared to the ankle joint. This can not be explained exclusively by anatomical and biomechanical differences. The aim of this study is to analyze and compare the injury pattern (clinically) and the cartilage lesions (arthroscopically) of knee and ankle joints in a cohort of patients from the same catchment area. A retrospective study of the clinical data of 3122 patients (2139 outpatients and 983 inpatients) was performed, who were treated due to an injury of the knee and ankle joint. Statistical analysis was performed using SigmaStat 3.0 (SPSS Inc, Chicago, USA). There is a higher prevalence of injuries in the ankle as compared to the knee joint in this population from the same catchment area. In contrast, high-grade cartilage lesions are more prevalent in the knee, whereas low grade cartilage lesions are equally distributed between knee and ankle. From this data it can be concluded that the frequency of injuries and the injury pattern of knee versus ankle joints do not correlate with the severity of cartilage lesions and may therefore have no direct influence on the differential incidence of OA in those two joints. PMID:25568732

  14. Differences in injury pattern and prevalence of cartilage lesions in knee and ankle joints: a retrospective cohort study.

    PubMed

    Aurich, Matthias; Hofmann, Gunther O; Rolauffs, Bernd; Gras, Florian

    2014-10-27

    Osteoarthritis (OA) is more common in the knee compared to the ankle joint. This can not be explained exclusively by anatomical and biomechanical differences. The aim of this study is to analyze and compare the injury pattern (clinically) and the cartilage lesions (arthroscopically) of knee and ankle joints in a cohort of patients from the same catchment area. A retrospective study of the clinical data of 3122 patients (2139 outpatients and 983 inpatients) was performed, who were treated due to an injury of the knee and ankle joint. Statistical analysis was performed using SigmaStat 3.0 (SPSS Inc, Chicago, USA). There is a higher prevalence of injuries in the ankle as compared to the knee joint in this population from the same catchment area. In contrast, high-grade cartilage lesions are more prevalent in the knee, whereas low grade cartilage lesions are equally distributed between knee and ankle. From this data it can be concluded that the frequency of injuries and the injury pattern of knee versus ankle joints do not correlate with the severity of cartilage lesions and may therefore have no direct influence on the differential incidence of OA in those two joints. PMID:25568732

  15. Modeling and simulating the neuromuscular mechanisms regulating ankle and knee joint stiffness during human locomotion.

    PubMed

    Sartori, Massimo; Maculan, Marco; Pizzolato, Claudio; Reggiani, Monica; Farina, Dario

    2015-10-01

    This work presents an electrophysiologically and dynamically consistent musculoskeletal model to predict stiffness in the human ankle and knee joints as derived from the joints constituent biological tissues (i.e., the spanning musculotendon units). The modeling method we propose uses electromyography (EMG) recordings from 13 muscle groups to drive forward dynamic simulations of the human leg in five healthy subjects during overground walking and running. The EMG-driven musculoskeletal model estimates musculotendon and resulting joint stiffness that is consistent with experimental EMG data as well as with the experimental joint moments. This provides a framework that allows for the first time observing 1) the elastic interplay between the knee and ankle joints, 2) the individual muscle contribution to joint stiffness, and 3) the underlying co-contraction strategies. It provides a theoretical description of how stiffness modulates as a function of muscle activation, fiber contraction, and interacting tendon dynamics. Furthermore, it describes how this differs from currently available stiffness definitions, including quasi-stiffness and short-range stiffness. This work offers a theoretical and computational basis for describing and investigating the neuromuscular mechanisms underlying human locomotion. PMID:26245321

  16. Comparative study on isokinetic capacity of knee and ankle joints by functional injury

    PubMed Central

    Jeon, Kyoungkyu; Seo, Byoung-Do; Lee, Sang-Ho

    2016-01-01

    [Purpose] To collect basic data for exercise programs designed to enhance functional knee and ankle joint stability based on isokinetic measurement and muscle strength evaluations in normal and impaired functional states. [Subjects and Methods] Twenty-four subjects were randomly assigned to the athlete group and the control group (n = 12 each). Data were collected of isokinetic knee extensor and flexor strength at 60°/sec, 180°/sec, and 240°/sec and ankle plantar and dorsiflexor strength at 30°/sec and 120°/sec. [Results] Significant intergroup differences were observed in peak torque of the right extensors at 60°/sec, 180°/sec, and 240°/sec and the right flexors at 240°/sec. Significant differences were observed in peak torque/body weight in the right extensors at 60°/sec, 180°/sec, and 240°/sec and in the right flexors at 180°/sec and 240°/sec. Significant peak torque differences were noted in the left ankle joint dorsiflexor at 30°/sec and 120°/sec, right plantar flexor at 120°/sec, left plantar flexor at 30°/sec, left dorsiflexor at 30°/sec and 120°/sec, and right dorsiflexor at 120°/sec. [Conclusion] Isokinetic evaluation stimulates muscle contraction at motion-dependent speeds and may contribute to the development of intervention programs to improve knee and ankle joint function and correct lower-extremity instability. PMID:26957768

  17. Muscular tendinous junction rupture of the posterior tibial tendon after closed bimalleolar ankle fracture.

    PubMed

    Jasqui-Remba, Salomon; Rodriguez-Corlay, Ruy Ernesto

    2016-01-01

    In this case report, we present an acute rupture in the muscular tendinous junction of a posterior tibialis muscle in a bimalleolar closed ankle fracture after a high-energy trauma in a 30-year-old patient with no significant medical history. Fracture was confirmed by simple X-rays, and was treated with an open reduction in which both of the fractures were treated with osteosynthesis material and reparation of the syndesmosis. If left untreated, this uncommon finding can result in a bad postsurgical outcome; we believe this injury is more common but under-reported in the literature. The surgeon should be aware and look specifically for this type of lesion during the procedure. Finding and treating this injury requires special postoperative care, non-weight-bearing instructions and balanced physiotherapy. PMID:26843223

  18. The Effects of a Lateral Wedge Insole on Knee and Ankle Joints During Slope Walking.

    PubMed

    Uto, Yuki; Maeda, Tetsuo; Kiyama, Ryoji; Kawada, Masayuki; Tokunaga, Ken; Ohwatashi, Akihiko; Fukudome, Kiyohiro; Ohshige, Tadasu; Yoshimoto, Yoichi; Yone, Kazunori

    2015-12-01

    The purpose of this study was to determine whether a lateral wedge insole reduces the external knee adduction moment during slope walking. Twenty young, healthy subjects participated in this study. Subjects walked up and down a slope using 2 different insoles: a control flat insole and a 7° lateral wedge insole. A three-dimensional motion analysis system and force plate were used to examine the knee adduction moment, the ankle valgus moment, and the moment arm of the ground reaction force to the knee joint center in the frontal plane. The lateral wedge insole significantly decreased the moment arm of the ground reaction force, resulting in a reduction of the knee adduction moment during slope walking, similar to level walking. The reduction ratio of knee adduction moment by the lateral wedge insole during the early stance of up-slope walking was larger than that of level walking. Conversely, the lateral wedge insole increased the ankle valgus moment during slope walking, especially during the early stance phase of up-slope walking. Clinicians should examine the utilization of a lateral wedge insole for knee osteoarthritis patients who perform inclined walking during daily activity, in consideration of the load on the ankle joint. PMID:26252560

  19. The estimated mechanical advantage of the prosimian ankle joint musculature, and implications for locomotor adaptation.

    PubMed

    Goto, Ryosuke; Kumakura, Hiroo

    2013-05-01

    In this study we compared the power arm lengths and mechanical advantages attributed to 12 lower leg muscles across three prosimian species. The origins and insertions of the lower leg muscles in Garnett's galago, the ring-tailed lemur, and the slow loris were quantified and correlated with positional behaviour. The ankle joint of the galago has a speed-oriented mechanical system, in contrast to that of the slow loris, which exhibits more power-oriented mechanics. The lemur ankle joint exhibited intermediate power arm lengths and an intermediate mechanical advantage relative to the other primates. This result suggests that the mechanical differences in the ankle between the galago and the lemur, taxa that exhibit similar locomotory repertoires, reflect a difference in the kinematics and kinetics of leaping (i.e. generalised vs. specialised leapers). In contrast to leaping primates, lorises have developed a more power-oriented mechanical system as a foot adaptation for positional behaviours such as bridging or cantilevering in their arboreal habitat. PMID:23489408

  20. Finite Element Analysis of Foot and Ankle Impact Injury: Risk Evaluation of Calcaneus and Talus Fracture

    PubMed Central

    Wong, Duo Wai-Chi; Niu, Wenxin; Wang, Yan; Zhang, Ming

    2016-01-01

    Introduction Foot and ankle impact injury is common in geriatric trauma and often leads to fracture of rearfoot, including calcaneus and talus. The objective of this study was to assess the influence of foot impact on the risk of calcaneus and talus fracture via finite element analysis. Methods A three-dimensional finite element model of foot and ankle was constructed based on magnetic resonance images of a female aged 28. The foot sustained a 7-kg passive impact through a foot plate. The simulated impact velocities were from 2.0 to 7.0 m/s with 1.0 m/s interval. Results At 5.0 m/s impact velocity, the maximum von Mises stress of the trabecular calcaneus and talus were 3.21MPa and 2.41MPa respectively, while that of the Tresca stress were 3.46MPa and 2.55MPa. About 94% and 84% of the trabecular calcaneus and talus exceeded the shear yielding stress, while 21.7% and 18.3% yielded the compressive stress. The peak stresses were distributed around the talocalcaneal articulation and the calcaneal tuberosity inferiorly, which corresponded to the common fracture sites. Conclusions The prediction in this study showed that axial compressive impact at 5.0 m/s could produce considerable yielding of trabecular bone in both calcaneus and talus, dominantly by shear and compounded with compression that predispose the rearfoot in the risk of fracture. This study suggested the injury pattern and fracture mode of high energy trauma that provides insights in injury prevention and fracture management. PMID:27119740

  1. Effects of a training program after surgically treated ankle fracture: a prospective randomised controlled trial

    PubMed Central

    Nilsson, Gertrud M; Jonsson, Kjell; Ekdahl, Charlotte S; Eneroth, Magnus

    2009-01-01

    Background Despite conflicting results after surgically treated ankle fractures few studies have evaluated the effects of different types of training programs performed after plaster removal. The aim of this study was to evaluate the effects of a 12-week standardised but individually suited training program (training group) versus usual care (control group) after plaster removal in adults with surgically treated ankle fractures. Methods In total, 110 men and women, 18-64 years of age, with surgically treated ankle fracture were included and randomised to either a 12-week training program or to a control group. Six and twelve months after the injury the subjects were examined by the same physiotherapist who was blinded to the treatment group. The main outcome measure was the Olerud-Molander Ankle Score (OMAS) which rates symptoms and subjectively scored function. Secondary outcome measures were: quality of life (SF-36), timed walking tests, ankle mobility tests, muscle strength tests and radiological status. Results 52 patients were randomised to the training group and 58 to the control group. Five patients dropped out before the six-month follow-up resulting in 50 patients in the training group and 55 in the control group. Nine patients dropped out between the six- and twelve-month follow-up resulting in 48 patients in both groups. When analysing the results in a mixed model analysis on repeated measures including interaction between age-group and treatment effect the training group demonstrated significantly improved results compared to the control group in subjects younger than 40 years of age regarding OMAS (p = 0.028), muscle strength in the plantar flexors (p = 0.029) and dorsiflexors (p = 0.030). Conclusion The results of this study suggest that when adjusting for interaction between age-group and treatment effect the training model employed in this study was superior to usual care in patients under the age of 40. However, as only three out of nine outcome

  2. Weber B Fracture of the Lateral Malleolus with Concomitant Anterior Talofibular Ligament Injury following an Ankle Supination Injury.

    PubMed

    Faqi, Mohammed Khalid; AlJawder, Abdulla; Alkhalifa, Fahad; Almajed, Ali H

    2016-01-01

    The Lauge-Hansen (LH) classification attempts to predict patterns of ankle injuries based upon the preceding mechanism of injury. Although it is widely used in clinical practice, it has been criticized mainly due to numerous reports of cases conflicting the prediction system. Here, we report a case of a 32-year-old male who sustained a Weber B fracture of the lateral malleolus following a supination ankle injury, which was treated conservatively, following which the patient presented with ankle instability and was found to have concurrent anterior talofibular ligament tear. Critical review of the LH classification along with its shortcomings is discussed. PMID:27313928

  3. Weber B Fracture of the Lateral Malleolus with Concomitant Anterior Talofibular Ligament Injury following an Ankle Supination Injury

    PubMed Central

    AlJawder, Abdulla; Almajed, Ali H.

    2016-01-01

    The Lauge-Hansen (LH) classification attempts to predict patterns of ankle injuries based upon the preceding mechanism of injury. Although it is widely used in clinical practice, it has been criticized mainly due to numerous reports of cases conflicting the prediction system. Here, we report a case of a 32-year-old male who sustained a Weber B fracture of the lateral malleolus following a supination ankle injury, which was treated conservatively, following which the patient presented with ankle instability and was found to have concurrent anterior talofibular ligament tear. Critical review of the LH classification along with its shortcomings is discussed. PMID:27313928

  4. Muscle imbalance and reduced ankle joint motion in people with hammer toe deformity

    PubMed Central

    Kwon, OY; Tuttle, LJ; Johnson, JE; Mueller, MJ

    2009-01-01

    Background Multiple factors may contribute to hammer toe deformity at the metatarsophalangeal joint. The purposes of this study were to (1) compare the ratio of toe extensor/flexor muscle strength in toes 2-4 among groups with and without hammer toe deformity, (2) to determine correlations between the ratio of toe extensor/flexor muscle strength in toes 2-4, and metatarsophalangeal joint deformity (3) to determine if other clinical measures differ between groups and if these measures are correlated with metatarsophalangeal joint angle. Methods 27 feet with visible hammer toe deformity and 31 age matched feet without hammer toe deformity were tested. Toe muscle strength was measured using a dynamometer and the ratio of toe extensor muscle strength to flexor muscle strength was calculated. Metatarsophalangeal joint angle was measured from a computerized tomography image. Ankle and subtalar joint range of motion, and tibial torsion were measured using goniometry. Findings Extensor/flexor toe muscle strength ratio was 2.3-3.0 times higher in the hammer toe group compared to the non-hammer toe group, in toes 2-4. The ratios of extensor/flexor toe muscle strength for toes 2-4 and metatarsophalangeal joint angle were highly correlated (r=0.69-0.80). Ankle dorsiflexion and metatarsophalangeal joint angle were negatively correlated for toes 2-4 (r= -0.38- -0.56) as were eversion and metatarsophalangeal joint angle. Interpretation These results provide insight into potential risk factors for the development of hammer toe deformity. Additional research is needed to determine the causal relationship between hammer toe deformity and the ratio of toe extensor/flexor muscle strength in toes 2-4. PMID:19535185

  5. Impact extractive fracture of jointed steel plates of a bolted joint

    NASA Astrophysics Data System (ADS)

    Daimaruya, M.; Fujiki, H.; Ambarita, H.

    2012-08-01

    This study is concerned with the development of a fracture criterion for the impact fracture of jointed steel plates of a bolted joint used in a car body. For the accurate prediction of crash characteristics of car bodies by computer-aided engineering (CAE), it is also necessary to examine the behavior and fracture of jointed steel plates subjected to impact loads. Although the actual impact fracture of jointed steel plates of a bolted joint used in cars is complicated, for simplifying the problem it might be classified into the shear fracture and the extractive fracture of jointed steel plates. Attention is given to the extractive fracture of jointed steel plates in this study. The extractive behavior and fracture of three kinds of steel plates used for cars are examined in experiments and numerical simulations. The impact extraction test of steel plates jointed by a bolt is performed using the one-bar method, together with the static test. In order to understand the mechanism of extractive fracture process of jointed steel plates, numerical simulations by a FEM code LS-DYNA are also carried out. The obtained results suggest that a stress-based fracture criterion may be developed for the impact extractive fracture of jointed steel plates of a bolted joint used in a car body.

  6. Transfer of mechanical energy between ankle and knee joints by gastrocnemius and plantaris muscles during cat locomotion.

    PubMed

    Prilutsky, B I; Herzog, W; Leonard, T

    1996-04-01

    The purposes of this study were (1) to define and estimate the direction and amount of the energy transfer between the knee and ankle through gastrocnemius (GA) and plantaris (PL) muscles during cat locomotion, and (2) to test the assumption that the force and activity patterns of soleus (SO), GA, and PL are mechanically and physiologically advantageous for providing the transfer of energy between these joints. The direction, amount and rate of the energy transfer through a two-joint muscle were defined using a theoretical analysis of movements in two adjacent joints spanned by the two-joint muscle. The energy transferred between the ankle and the knee was calculated using the time integration of the difference between the power developed by the moments of SO, GA, and PL at the ankle joint and the total power of these muscles. The total power of SO, GA, and PL muscles, and the power of their movements about the ankle and knee, were obtained using the experimentally determined muscle forces, the rates of change in muscle length, and the angular velocities at the knee and ankle which were calculated from the kinematics and the geometry of the cat hindlimb. Muscular forces and hindlimb kinematics of the cats were recorded during normal walking and trotting on a treadmill at speeds of 0.4, 0.8, 1.2, 1.5, and 1.8 ms-1 using 'E'-shaped tendon transducers and high-speed video, respectively. It was found that during the early phase of support, there was a transfer of mechanical energy from the ankle to the knee through GA and PL. During the late phase of support, mechanical energy was transferred from the knee to the ankle. The amount of energy transferred increased with increasing speeds of locomotion. The energy transferred from the ankle to the knee was 3-60 mJ (7-22% of the negative work done by the moments of SO, GA, and PL at the ankle), and the energy transferred from the knee to the ankle was 10-67 mJ (7-14% of the positive work done by the moments of SO, GA, and

  7. A Novel Ultrasound Technique for Detection of Osteochondral Defects in the Ankle Joint: A Parametric and Feasibility Study

    PubMed Central

    Sarkalkan, Nazli; Loeve, Arjo J.; van Dongen, Koen W. A.; Tuijthof, Gabrielle J. M.; Zadpoor, Amir A.

    2015-01-01

    (Osteo)chondral defects (OCDs) in the ankle are currently diagnosed with modalities that are not convenient to use in long-term follow-ups. Ultrasound (US) imaging, which is a cost-effective and non-invasive alternative, has limited ability to discriminate OCDs. We aim to develop a new diagnostic technique based on US wave propagation through the ankle joint. The presence of OCDs is identified when a US signal deviates from a reference signal associated with the healthy joint. The feasibility of the proposed technique is studied using experimentally-validated 2D finite-difference time-domain models of the ankle joint. The normalized maximum cross correlation of experiments and simulation was 0.97. Effects of variables relevant to the ankle joint, US transducers and OCDs were evaluated. Variations in joint space width and transducer orientation made noticeable alterations to the reference signal: normalized root mean square error ranged from 6.29% to 65.25% and from 19.59% to 8064.2%, respectively. The results suggest that the new technique could be used for detection of OCDs, if the effects of other parameters (i.e., parameters related to the ankle joint and US transducers) can be reduced. PMID:25609040

  8. Atypical stress-avulsion fracture of the Lisfranc joint complex.

    PubMed

    O'Neill, Barry J; Sweeney, Laura A; Moroney, Paul J; Mulhall, Kevin J

    2014-04-01

    Antiphospholipid syndrome and systemic erythematosus have been associated with metatarsal stress fractures. Stress fractures of the Lisfranc joint complex are uncommon injuries but have been reported to occur most frequently in ballet dancers. We present a case of an avulsion fracture of the Lisfranc joint complex that occurred spontaneously. We have reviewed the association between systemic conditions and metatarsal fractures and proposed a series of hypothetical pathological events that may have contributed to this unusual injury. PMID:24521754

  9. Acute ankle sprain: an update.

    PubMed

    Ivins, Douglas

    2006-11-15

    Acute ankle injury, a common musculoskeletal injury, can cause ankle sprains. Some evidence suggests that previous injuries or limited joint flexibility may contribute to ankle sprains. The initial assessment of an acute ankle injury should include questions about the timing and mechanism of the injury. The Ottawa Ankle and Foot Rules provide clinical guidelines for excluding a fracture in adults and children and determining if radiography is indicated at the time of injury. Reexamination three to five days after injury, when pain and swelling have improved, may help with the diagnosis. Therapy for ankle sprains focuses on controlling pain and swelling. PRICE (Protection, Rest, Ice, Compression, and Elevation) is a well-established protocol for the treatment of ankle injury. There is some evidence that applying ice and using nonsteroidal antiinflammatory drugs improves healing and speeds recovery. Functional rehabilitation (e.g., motion restoration and strengthening exercises) is preferred over immobilization. Superiority of surgical repair versus functional rehabilitation for severe lateral ligament rupture is controversial. Treatment using semirigid supports is superior to using elastic bandages. Support devices provide some protection against future ankle sprains, particularly in persons with a history of recurrent sprains. Ankle disk or proprioceptive neuromuscular facilitation exercise regimens also may be helpful, although the literature supporting this is limited. PMID:17137000

  10. Numerical simulation of strain-adaptive bone remodelling in the ankle joint

    PubMed Central

    2011-01-01

    Background The use of artificial endoprostheses has become a routine procedure for knee and hip joints while ankle arthritis has traditionally been treated by means of arthrodesis. Due to its advantages, the implantation of endoprostheses is constantly increasing. While finite element analyses (FEA) of strain-adaptive bone remodelling have been carried out for the hip joint in previous studies, to our knowledge there are no investigations that have considered remodelling processes of the ankle joint. In order to evaluate and optimise new generation implants of the ankle joint, as well as to gain additional knowledge regarding the biomechanics, strain-adaptive bone remodelling has been calculated separately for the tibia and the talus after providing them with an implant. Methods FE models of the bone-implant assembly for both the tibia and the talus have been developed. Bone characteristics such as the density distribution have been applied corresponding to CT scans. A force of 5,200 N, which corresponds to the compression force during normal walking of a person with a weight of 100 kg according to Stauffer et al., has been used in the simulation. The bone adaptation law, previously developed by our research team, has been used for the calculation of the remodelling processes. Results A total bone mass loss of 2% in the tibia and 13% in the talus was calculated. The greater decline of density in the talus is due to its smaller size compared to the relatively large implant dimensions causing remodelling processes in the whole bone tissue. In the tibia, bone remodelling processes are only calculated in areas adjacent to the implant. Thus, a smaller bone mass loss than in the talus can be expected. There is a high agreement between the simulation results in the distal tibia and the literature regarding. Conclusions In this study, strain-adaptive bone remodelling processes are simulated using the FE method. The results contribute to a better understanding of the

  11. Effects of balance training by knee joint motions on muscle activity in adult men with functional ankle instability

    PubMed Central

    Nam, Seung-min; Kim, Won-bok; Yun, Chang-kyo

    2016-01-01

    [Purpose] This study examined the effects of balance training by applying knee joint movements on muscle activity in male adults with functional ankle instability. [Subjects and Methods] 28 adults with functional ankle instability, divided randomly into an experimental group, which performed balance training by applying knee joint movements for 20 minutes and ankle joint exercises for 10 minutes, and a control group, which performed ankle joint exercise for 30 minutes. Exercises were completed three times a week for 8 weeks. Electromyographic values of the tibialis anterior, peroneus longus, peroneus brevis, and the lateral gastrocnemius muscles were obtained to compare and analyze muscle activity before and after the experiments in each group. [Results] The experimental group had significant increases in muscle activity in the tibialis anterior, peroneus longus, and lateral gastrocnemius muscles, while muscle activity in the peroneus brevis increased without significance. The control group had significant increases in muscle activity in the tibialis anterior and peroneus longus, while muscle activity in the peroneus brevis and lateral gastrocnemius muscles increased without significance. [Conclusion] In conclusion, balance training by applying knee joint movements can be recommended as a treatment method for patients with functional ankle instability. PMID:27313386

  12. Ligament fibre recruitment at the human ankle joint complex in passive flexion.

    PubMed

    Stagni, Rita; Leardini, Alberto; Ensini, Andrea

    2004-12-01

    Knowledge of ligament fibre recruitment at the human ankle joint complex is a fundamental prerequisite for analysing mobility and stability. Previous experimental and modelling studies have shown that ankle motion must be guided by fibres within the calcaneofibular and tibiocalcaneal ligaments, which remain approximately isometric during passive flexion. The purpose of this study was to identify these fibres. Three below-knee amputated specimens were analysed during passive flexion with combined radiostereometry for bone pose estimation and 3D digitisation for ligament attachment area identification. A procedure based on singular value decomposition enabled matching bone pose with digitised data and therefore reconstructing position in space of ligament attachment areas in each joint position. Eleven ordered fibres, connecting corresponding points on origin and insertion curves, were modelled for each of the following ligaments: posterior talofibular, calcaneofibular, anterior talofibular, posterior tibiotalar, tibiocalcaneal, and anterior tibiotalar. The measured changes in length for the ligament fibres revealed patterns of tightening and slackening. The most anterior fibre of the calcaneofibular and the medio-anterior fibre of the tibiocalcaneal ligament exhibited the most isometric behaviour, as well as the most posterior fibre of the anterior talofibular ligament. Fibres within the calcaneofibular ligament remain parallel in the transverse plane, while those within the tibiocalcaneal ligament become almost parallel in joint neutral position. For both these ligaments, fibres maintain their relative inclination in the sagittal plane throughout the passive flexion range. The observed significant change in both shape and orientation of the ankle ligaments suggest that this knowledge is fundamental for future mechanical analysis of their response to external forces. PMID:15519590

  13. Differentiation between non-neural and neural contributors to ankle joint stiffness in cerebral palsy

    PubMed Central

    2013-01-01

    Background Spastic paresis in cerebral palsy (CP) is characterized by increased joint stiffness that may be of neural origin, i.e. improper muscle activation caused by e.g. hyperreflexia or non-neural origin, i.e. altered tissue viscoelastic properties (clinically: “spasticity” vs. “contracture”). Differentiation between these components is hard to achieve by common manual tests. We applied an assessment instrument to obtain quantitative measures of neural and non-neural contributions to ankle joint stiffness in CP. Methods Twenty-three adolescents with CP and eleven healthy subjects were seated with their foot fixated to an electrically powered single axis footplate. Passive ramp-and-hold rotations were applied over full ankle range of motion (RoM) at low and high velocities. Subject specific tissue stiffness, viscosity and reflexive torque were estimated from ankle angle, torque and triceps surae EMG activity using a neuromuscular model. Results In CP, triceps surae reflexive torque was on average 5.7 times larger (p = .002) and tissue stiffness 2.1 times larger (p = .018) compared to controls. High tissue stiffness was associated with reduced RoM (p < .001). Ratio between neural and non-neural contributors varied substantially within adolescents with CP. Significant associations of SPAT (spasticity test) score with both tissue stiffness and reflexive torque show agreement with clinical phenotype. Conclusions Using an instrumented and model based approach, increased joint stiffness in CP could be mainly attributed to higher reflexive torque compared to control subjects. Ratios between contributors varied substantially within adolescents with CP. Quantitative differentiation of neural and non-neural stiffness contributors in CP allows for assessment of individual patient characteristics and tailoring of therapy. PMID:23880287

  14. IINCIDENCE OF ANKLE SPRAINS IN SOCCER PLAYERS WITH JOINT HYPERMOBILITY SYNDROME

    PubMed Central

    Vieira, Rodrigo Barreiros; Bertolini, Fabricio Melo; Vieira, Tallys Campos; Aguiar, Rodrigo Manso; Pinheiro, Guilherme Baldez; Lasmar, Rodrigo Campos Pace

    2015-01-01

    Objective: Eighty-three soccer players aged between 14 and 19 years, in the basic category of a professional soccer club in the city of Belo Horizonte, were followed up during the 2009 season. Methods: A prospective observational cohort study was conducted, in which these soccer players were divided randomly into two groups. The first consisted of individuals with joint hypermobility syndrome (JHS), totaling 22 players, and the second was a control group with 61 players without this syndrome, determined through a physical examinati. Results: Both groups were studied with regard to incidence of ankle sprains. At the end of this period, the data were compiled and statistical analysis was performed. A total of 43 cases of ankle injury due to sprains were recorded, of which nine episodes were in players with JHS, thus making p = 0.106. The significance level was 5%. Conclusion: We were able to conclude that in our study there was insufficient evidence to assert that there is an association with increased incidence of ankle sprains among patients with JHS. PMID:27047888

  15. Human ankle joint stiffness over the full range of muscle activation levels.

    PubMed

    Weiss, P L; Hunter, I W; Kearney, R E

    1988-01-01

    System identification techniques have been used to track changes in dynamic stiffness of the human ankle joint over a wide range of muscle contraction levels. Subjects lay supine on an experimental table with their left foot encased in a rigid, low-inertia cast which was fixed to an electro-hydraulic actuator operating as a position servo. Subjects generated tonic plantarflexor or dorsiflexor torques of different magnitudes ranging from rest to maximum voluntary contractions (MVC) during repeated presentations of a stochastic ankle angular position perturbation. Compliance impulse response functions (IRF) were determined from every 2.5 s perturbation sequence. The gain (G), natural frequency (omega n), and damping (zeta) parameters of the second-order model providing the best fit to each IRF were determined and used to compute the corresponding inertial (I), viscous (B) and elastic (K) stiffness parameters. The behaviour of these parameters with mean torque was found to follow two simple rules. First, the elastic parameter (K) increased in proportion to mean ankle torque as it was varied from rest to MVC; these changes were considerable involving increases of more than an order of magnitude. Second, the damping parameter (zeta) remained almost invariant over the entire range of contractions despite the dramatic changes in K. PMID:3410857

  16. Extended indications for foot and ankle arthroscopy.

    PubMed

    Hsu, Andrew R; Gross, Christopher E; Lee, Simon; Carreira, Dominic S

    2014-01-01

    Advances in foot and ankle arthroscopy have allowed surgeons to diagnose and treat a broadening array of disorders that were previously limited to open procedures. Arthroscopy of the posterior ankle, subtalar joint, and first metatarsophalangeal joint and tendoscopy can be used to address common foot and ankle ailments, with the potential benefits of decreased pain, fast recovery, and low complication rates. Posterior ankle and subtalar arthroscopy can be used to manage impingement, arthrofibrosis, synovitis, arthritis, fractures, and osteochondral defects. First metatarsophalangeal joint arthroscopy can address osteophytes, chronic synovitis, osteochondral defects, and degenerative joint disease. Tendoscopy is a minimally invasive alternative for evaluation and débridement of the Achilles, posterior tibial, flexor hallucis longus, and peroneal tendons. PMID:24382875

  17. Motion control of the ankle joint with a multiple contact nerve cuff electrode: a simulation study.

    PubMed

    Park, Hyun-Joo; Durand, Dominique M

    2014-08-01

    The flat interface nerve electrode (FINE) has demonstrated significant capability for fascicular and subfascicular stimulation selectivity. However, due to the inherent complexity of the neuromuscular skeletal systems and nerve-electrode interface, a trajectory tracking motion control algorithm of musculoskeletal systems for functional electrical stimulation using a multiple contact nerve cuff electrode such as FINE has not yet been developed. In our previous study, a control system was developed for multiple-input multiple-output (MIMO) musculoskeletal systems with little prior knowledge of the system. In this study, more realistic computational ankle/subtalar joint model including a finite element model of the sciatic nerve was developed. The control system was tested to control the motion of ankle/subtalar joint angles by modulating the pulse amplitude of each contact of a FINE placed on the sciatic nerve. The simulation results showed that the control strategy based on the separation of steady state and dynamic properties of the system resulted in small output tracking errors for different reference trajectories such as sinusoidal and filtered random signals. The proposed control method also demonstrated robustness against external disturbances and system parameter variations such as muscle fatigue. These simulation results under various circumstances indicate that it is possible to take advantage of multiple contact nerve electrodes with spatial selectivity for the control of limb motion by peripheral nerve stimulation even with limited individual muscle selectivity. This technology could be useful to restore neural function in patients with paralysis. PMID:24939581

  18. An unusual cause of ankle pain: fracture of a talocalcaneal coalition as a differential diagnosis in an acute ankle sprain: a case report and literature review

    PubMed Central

    2013-01-01

    Background The acute ankle sprain is one of the most common injuries seen in trauma departments. Ankle sprains have an incidence of about one injury per 10 000 people a day. In contrast tarsal coalition is a rare condition occurring in not more than one percent of the population. Case presentation We present the case of a 23 year old male patient with pain and local swelling after an acute ankle sprain. Initial clinical and radiological examination showed no pathologies. Due to prolonged pain, swelling and the inability of the patient to weight bear one week after trauma further diagnostics was performed. Imaging studies (MRI and CT) revealed a fracture of a talocalcaneal coalition. To the knowledge of the authors no fracture of a coalition was reported so far. Conclusion This report highlights the presentation of symptomatic coalitions following trauma and furthermore, it points out the difficulties in the diagnosis and treatment of a rare entity after a common injury. A diagnostic algorithm has been developed to ensure not to miss a severe injury. PMID:23530869

  19. The Immediate Effects of Different Types of Ankle Support Introduced 6 Weeks After Surgical Internal Fixation for Ankle Fracture on Gait and Pain: A Randomized Crossover Trial.

    PubMed

    Keene, David J; Willett, Keith; Lamb, Sarah E

    2016-03-01

    Study Design Randomized 3-treatment, 3-period crossover trial. Background There is variation in clinical practice regarding the type of ankle support used to aid recovery after ankle fracture internal fixation surgery. Objective To determine the immediate effects of different ankle supports commonly issued to patients 6 weeks after surgery. Methods Participants were 18 adults, 6 weeks after internal fixation for transsyndesmotic/infrasyndesmotic fracture, in a major trauma center in the UK. Interventions were a stirrup brace and walker boot compared with Tubigrip. Outcomes were (1) step-length and single-limb support time asymmetry (percentage comparing injured and uninjured limbs), (2) step width, (3) gait velocity, and (4) pain during walking (visual analog scale, 0-100). Results Participants (mean ± SD age, 47 ± 14 years) included 8 women and 10 men, 6 weeks after surgical internal fixation for ankle fracture. Single-limb support time asymmetry reduced by 3% (95% confidence interval [CI]: 0%, 6%; P = .02) in the stirrup brace and by 5% (95% CI: 2%, 7%; P = .001) in the walker boot compared with Tubigrip. Step width was 1.2 cm (95% CI: 0.6, 1.7; P<.001) wider in the walker boot than in Tubigrip. Self-reported pain was lower in the walker boot (5/100) and in the stirrup brace (13/100) compared to the Tubigrip (18/100, P = .03). No significant differences were found in the effects of the supports on step-length asymmetry between the walker boot or stirrup brace and Tubigrip. Conclusion At 6 weeks after surgical internal fixation for ankle fracture, pain and single-limb support time asymmetry over a short distance and for a short-term walk were immediately reduced with the use of a walker boot use and, to a lesser extent, a stirrup-brace compared to Tubigrip. Step width also widened in a walker boot, which may confer some additional gait stability. These results apply to immediate effects, so studies with longer-term follow-up are now indicated. The trial was

  20. Joint sparing treatments in early ankle osteoarthritis: current procedures and future perspectives.

    PubMed

    Castagnini, Francesco; Pellegrini, Camilla; Perazzo, Luca; Vannini, Francesca; Buda, Roberto

    2016-12-01

    Ankle osteoarthritis (AOA) is a severe pathology, mostly affecting a post-traumatic young population. Arthroscopic debridement, arthrodiastasis, osteotomy are the current joint sparing procedures, but, in the available studies, controversial results were achieved, with better outcomes in case of limited degeneration. Only osteotomy in case of malalignment is universally accepted as a joint sparing procedure in case of partial AOA. Recently, the biological mechanism of osteoarthritis has been intensively studied: it is a whole joint pathology, affecting cartilage, bone and synovial membrane. In particular, the first stage is characterized by a reversible catabolic activity with a state of chondropenia. Thus, biological procedures for early AOA were proposed in order to delay or to avoid end stage procedures. Mesenchymal stem cells (MSCs) may be a good solution to prevent or reverse degeneration, due to their immunomodulatory features (able to control the catabolic joint environment) and their regenerative osteochondral capabilities (able to treat the chondral defects). In fact, MSCs may regulate the cytokine cascade and the metalloproteinases release, restoring the osteochondral tissue as well. After interesting reports of mesenchymal stem cells seeded on scaffold and applied to cartilage defects in non-degenerated joints, bone marrow derived cells transplantation appears to be a promising technique in order to control the degenerative pathway and restore the osteochondral defects. PMID:26915003

  1. Microneurographically recorded Ia discharge from the tibial nerve mainly transmits the angular velocity of the ankle joint in humans.

    PubMed

    Miyazaki, S; Iwase, S; Mano, T; Fukuda, H; Mochida, J

    2004-08-01

    Investigations of the Ia afferent discharge in clarifying problems in disused and malused skeletal muscles have been carried out mainly in muscles of the upper extremities. However, such problems actually occur more frequently in the antigravity muscles of the lower extremities, such as the triceps surae muscle. An analysis of microneurographically recorded Ia discharges from the tibial nerve innervating the triceps surae muscle during dynamic movement of the ankle joint indicated that they mainly transmitted information on the angular velocity of the joint. However, the information on the position sense of the joint was not as well transmitted through Ia discharges. There was no correlation between the joint angle and the static response. However, the dynamic response of a Ia afferent was well correlated to the angular velocity. It is concluded that the human proprioception of the triceps surae muscle was not dependent on the position of the ankle joint, but largely on its movement by the stretching of the muscle. PMID:15631694

  2. Ankle impingement.

    PubMed

    Lavery, Kyle P; McHale, Kevin J; Rossy, William H; Theodore, George

    2016-01-01

    Ankle impingement is a syndrome that encompasses a wide range of anterior and posterior joint pathology involving both osseous and soft tissue abnormalities. In this review, the etiology, pathoanatomy, diagnostic workup, and treatment options for both anterior and posterior ankle impingement syndromes are discussed. PMID:27608626

  3. Sprained Ankles

    MedlinePlus

    ... Body I think my child has sprained her ankle. How can I tell for sure? Sprains are injuries to the ligaments that connect bones ... away before the ligament is injured. Types of Sprains In young children, the ankle is the most commonly sprained joint, followed by ...

  4. COMPARATIVE STUDY BETWEEN OSTEOSYNTHESIS IN CONVENTIONAL AND BIOABSORBABLE IMPLANTS IN ANKLE FRACTURES

    PubMed Central

    Gaiarsa, Guilherme Pelosini; dos Reis, Paulo Roberto; Mattar, Rames; Silva, Jorge dos Santos; Fernandez, Túlio Diniz

    2015-01-01

    ABSTRACT Objective: To compare the functional results of ankle fractures treated with metallic and absorbable plates. Twenty patients were randomized into two groups (metallic and absorbable implant groups) and followed prospectively. In the immediate postoperative period, patients were immobilized with plaster casts for one week, which was replaced by a removable cast for another four weeks. Partial weight-bearing was allowed after three weeks, and full weight-bearing after six weeks. Functional recovery was similar in both groups. At six months, three patients in the metallic group complained of local pain, and had their implants removed. One patient in the absorbable group exhibited early dehiscence of the suture and underwent debridement and suturing with good evolution. The American Orthopaedic Foot and Ankle Society (AOFAS) score was similar between the two groups after six and nine months of follow-up. The absorbable implants showed clinical and functional results that were similar to those of metallic implants. Level of Evidence II, Prospective Comparative Study. PMID:26981035

  5. Ankle Fracture Surgery on a Pregnant Patient Complicated by Intraoperative Emergency Caesarian Section

    PubMed Central

    Schwarzkopf, Ran; Gross, Steven C.; Coopersmith, Allen; Gidumal, Ramesh

    2013-01-01

    We report the case of a woman in the third trimester of pregnancy who sustained an ankle fracture dislocation that could not be adequately closed reduced. After discussions with the patient, her obstetrician, and the anesthesiologists, she was indicated for surgical fixation. A heart tone monitor was used to assess fetal health during the procedure. During surgical incision, the fetus went into distress, and an emergency caesarian section was performed. After delivery of the infant and abdominal closer, surgery was completed. Due to a cohesive team effort, both the patient and her infant had excellent outcomes. There are many important considerations in the surgical management of the pregnant patient with traumatic orthopaedic injuries. Of especial importance to the orthopaedic surgeon is the impact of patient positioning on uteroplacental blood flow. This report discusses factors that should be taken into account by any orthopaedist who plans to operate on a pregnant patient. PMID:23819091

  6. Ankle fracture surgery on a pregnant patient complicated by intraoperative emergency caesarian section.

    PubMed

    Schwarzkopf, Ran; Gross, Steven C; Coopersmith, Allen; Gidumal, Ramesh

    2013-01-01

    We report the case of a woman in the third trimester of pregnancy who sustained an ankle fracture dislocation that could not be adequately closed reduced. After discussions with the patient, her obstetrician, and the anesthesiologists, she was indicated for surgical fixation. A heart tone monitor was used to assess fetal health during the procedure. During surgical incision, the fetus went into distress, and an emergency caesarian section was performed. After delivery of the infant and abdominal closer, surgery was completed. Due to a cohesive team effort, both the patient and her infant had excellent outcomes. There are many important considerations in the surgical management of the pregnant patient with traumatic orthopaedic injuries. Of especial importance to the orthopaedic surgeon is the impact of patient positioning on uteroplacental blood flow. This report discusses factors that should be taken into account by any orthopaedist who plans to operate on a pregnant patient. PMID:23819091

  7. Control of torque direction by spinal pathways at the cat ankle joint.

    PubMed

    Nichols, T R; Lawrence, J H; Bonasera, S J

    1993-01-01

    To study the biomechanics of the calcaneal tendon's complex insertion onto the calcaneus, we measured torque-time trajectories exerted by the triceps surae and tibialis anterior muscles in eight unanesthetized decerebrate cats using a multi-axis force-moment sensor placed at the ankle joint. The ankle was constrained to an angle of 110 degrees plantarflexion. Muscles were activated using crossed-extension (XER), flexion (FWR), and caudal cutaneous sural nerve (SNR) reflexes. Torque contributions of other muscles activated by these reflexes were eliminated by denervation or tenotomy. In two animals, miniature pressure transducers were implanted among tendon fibers from the lateral gastrocnemius (LG) muscle that insert straight into the calcaneus or among tendon fibers from the medial gastrocnemius (MG) that cross over and insert on the lateral aspect of calcaneus. Reflexively evoked torques had the following directions: FWR, dorsiflexion and adduction; SNR, plantarflexion and abduction; and XER, plantarflexion and modest abduction or adduction. The proportion of abduction torque to plantarflexion torque was always greater for SNR than XER; this difference was about 50% of the magnitude of abduction torque generated by tetanic stimulation of the peronei. During SNR, pressures were higher in regions of the calcaneal tendon originating from MG than regions originating from LG. Similarly, pressures within the MG portion of the calcaneal tendon were higher during SNR than during XER, although these two reflexes produced matched ankle plantarflexion forces. Selective tenotomies and electromyographic recordings further demonstrated that MG generated most of the torque in response to SNR, while soleus, LG, and MG all generated torques in response to XER.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8150057

  8. Balance in single-limb stance after surgically treated ankle fractures: a 14-month follow-up

    PubMed Central

    Nilsson, Gertrud; Ageberg, Eva; Ekdahl, Charlotte; Eneroth, Magnus

    2006-01-01

    Background The maintenance of postural control is fundamental for different types of physical activity. This can be measured by having subjects stand on one leg on a force plate. Many studies assessing standing balance have previously been carried out in patients with ankle ligament injuries but not in patients with ankle fractures. The aim of this study was to evaluate whether patients operated on because of an ankle fracture had impaired postural control compared to an uninjured age- and gender-matched control group. Methods Fifty-four individuals (patients) operated on because of an ankle fracture were examined 14 months postoperatively. Muscle strength, ankle mobility, and single-limb stance on a force-platform were measured. Average speed of centre of pressure movements and number of movements exceeding 10 mm from the mean value of centre of pressure were registered in the frontal and sagittal planes on a force-platform. Fifty-four age- and gender-matched uninjured individuals (controls) were examined in the single-limb stance test only. The paired Student t-test was used for comparisons between patients' injured and uninjured legs and between side-matched legs within the controls. The independent Student t-test was used for comparisons between patients and controls. The Chi-square test, and when applicable, Fisher's exact test were used for comparisons between groups. Multiple logistic regression was performed to identify factors associated with belonging to the group unable to complete the single-limb stance test on the force-platform. Results Fourteen of the 54 patients (26%) did not manage to complete the single-limb stance test on the force-platform, whereas all controls managed this (p < 0.001). Age over 45 years was the only factor significantly associated with not managing the test. When not adjusted for age, decreased strength in the ankle plantar flexors and dorsiflexors was significantly associated with not managing the test. In the 40 patients who

  9. Effect of Solder Joint Length on Fracture Under Bending

    NASA Astrophysics Data System (ADS)

    Akbari, Saeed; Nourani, Amir; Spelt, Jan K.

    2016-01-01

    Fracture tests were conducted on copper-solder-copper joints of various lengths using double-cantilever-beam (DCB) specimens under mode I loading conditions. The thickness and length of the solder joints were large enough to neglect any anisotropy associated with the solder microstructure. It was found that the critical strain energy release rate at crack initiation, G ci, was insensitive to the length of the solder joint; however, for joints shorter than a characteristic length which was a function of the thickness and the mechanical properties of the solder layer and the substrates, the fracture load increased with increasing solder joint length. A sandwich model was developed for the analysis of the stress and strain in solder joints, taking into account the influence of both the bending deformation and the shear deformation of the substrates on the solder joint stresses. Consistent with the experimental results, it was found that solder joints longer than the characteristic length have a maximum peel stress that remains unchanged with joint length, causing the joint strength to become independent of the joint length. A closed-form analytical solution was developed for the characteristic length of DCB specimens under mode I loading. The experimental results were in good agreement with the analytical model and with finite element results. The generality of the G ci failure criterion was demonstrated by comparing the experimental results and the fracture load predictions of mode I DCB solder joints with different lengths.

  10. Charcot neuroarthropathy of the foot and ankle.

    PubMed

    Schon, L C; Easley, M E; Weinfeld, S B

    1998-04-01

    The goal of this study was to characterize Charcot neuroarthropathy of the foot and ankle by specific sites of involvement (ankle, hindfoot, midfoot, and forefoot), modes of presentation, methods of management, and outcome. A summary of treatment and results for 50 ankles, 22 hindfeet, 131 midfeet, and 18 forefeet is presented. Nondisplaced neuropathic ankle fractures typically healed uneventfully with casting and bracing. For displaced ankle fractures, closed reduction and casting generally resulted in loss of reduction and progressive deterioration; better results were obtained with open reduction and internal fixation, using supplemental Kirschner wires and screws. Ankles with Charcot neuroarthropathy and preexisting arthritis typically required arthrodesis. Of the ankles with neuropathic avascular talar necrosis, approximately 1/3 did well with nonoperative intervention and 2/3 required surgery. Chronic, unstable, malaligned Charcot ankles often required arthrodesis. Neuropathic calcaneal fractures were managed successfully nonoperatively. For feet with transverse tarsal joint involvement (Schon Type IV), management was more complex. Nonoperative treatment was successful for less than 1/2. Two thirds of the feet with midtarsus involvement (Schon Types I, II, and III) were managed successfully nonoperatively; 1/3 required surgery for recurrent ulceration, instability, or osteomyelitis. Half of the feet with forefoot neuroarthropathy required surgery for malalignment, ulceration, and/or difficulty with shoewear or braces. This review has established patterns of Charcot involvement of the foot and ankle with corresponding methods of treatment and subsequent responses. From this extensive clinical experience with 221 neuropathic fractures or Charcot joints, recommendations were derived to assist in selecting appropriate management options. PMID:9584374

  11. A Patient-Specific Foot Model for the Estimate of Ankle Joint Forces in Patients with Juvenile Idiopathic Arthritis.

    PubMed

    Prinold, Joe A I; Mazzà, Claudia; Di Marco, Roberto; Hannah, Iain; Malattia, Clara; Magni-Manzoni, Silvia; Petrarca, Maurizio; Ronchetti, Anna B; Tanturri de Horatio, Laura; van Dijkhuizen, E H Pieter; Wesarg, Stefan; Viceconti, Marco

    2016-01-01

    Juvenile idiopathic arthritis (JIA) is the leading cause of childhood disability from a musculoskeletal disorder. It generally affects large joints such as the knee and the ankle, often causing structural damage. Different factors contribute to the damage onset, including altered joint loading and other mechanical factors, associated with pain and inflammation. The prediction of patients' joint loading can hence be a valuable tool in understanding the disease mechanisms involved in structural damage progression. A number of lower-limb musculoskeletal models have been proposed to analyse the hip and knee joints, but juvenile models of the foot are still lacking. This paper presents a modelling pipeline that allows the creation of juvenile patient-specific models starting from lower limb kinematics and foot and ankle MRI data. This pipeline has been applied to data from three children with JIA and the importance of patient-specific parameters and modelling assumptions has been tested in a sensitivity analysis focused on the variation of the joint reaction forces. This analysis highlighted the criticality of patient-specific definition of the ankle joint axes and location of the Achilles tendon insertions. Patient-specific detection of the Tibialis Anterior, Tibialis Posterior, and Peroneus Longus origins and insertions were also shown to be important. PMID:26374518

  12. Manual Stress Ankle Radiography Has Poor Ability to Predict Deep Deltoid Ligament Integrity in a Supination External Rotation Fracture Cohort.

    PubMed

    Schottel, Patrick C; Fabricant, Peter D; Berkes, Marschall B; Garner, Matthew R; Little, Milton T M; Hentel, Keith D; Mintz, Douglas N; Helfet, David L; Lorich, Dean G

    2015-01-01

    Stress ankle radiographs are routinely performed to determine deep deltoid ligament integrity in supination external rotation (SER) ankle fractures. However, variability is present in the published data regarding what medial clear space (MCS) value constitutes a positive result. The purposes of the present study were to evaluate the diagnostic accuracy of different MCS cutoff values and determine whether this clinical test could accurately discriminate between patients with and without a deep deltoid ligament disruption. MCS measurements were recorded for stress ankle injury radiographs in an SER ankle fracture cohort. Preoperative ankle magnetic resonance imaging studies, obtained for all patients, were then read independently by 2 musculoskeletal attending radiologists to determine deep deltoid ligament integrity. The MCS measurements were compared with the magnetic resonance imaging diagnosis using receiver operating characteristic analyses to determine the sensitivity, specificity, and optimal data-driven cutoff values. SER II-III patients demonstrated a mean stress MCS distance of 4.3 ± 0.98 mm compared with 5.8 ± 1.76 mm in the SER IV cohort (p < .001). An analysis of differing MCS positive cutoff thresholds revealed that a stress MCS of 5.0 mm maximized the combined sensitivity and specificity of the external rotation test: 65.8% sensitive and 76.5% specific. Using the receiver operating characteristic curve analysis of the MCS measurement, the calculated area under the curve was 0.77, indicating inadequate discriminative ability for diagnosing SER pattern fractures with or without a deep deltoid ligament tear. Judicious use of additional diagnostic testing in patients with a stress MCS result between 4.0 mm and 5.5 mm is warranted. PMID:25189335

  13. Is immobilization of the ankle and metatarsophalangeal joint effective in suppressing the spread of infection in diabetic foot ulcers?

    PubMed

    Sakakibara, Shunsuke; Tsuji, Yoriko; Hashikawa, Kazunobu; Terashi, Hiroto

    2014-09-01

    Diabetics with foot-related problems might eventually need to undergo major or minor amputation because of infection or cellulites. It has been suggested that immobilization of the ankle and the metatarsophalangeal joint suppresses the spread of infection; however, there is no evidence to support this inference. Here, we demonstrate by histological analysis how the immobilization works. The tendon from the amputated toe is harvested, and a hematoxylin-eosin stained paraffin-embedded section is prepared and analyzed. Necrosis occurred in only a single fiber of the tendon, and intact and necrotic or infected tendon fibers were found intermingled. The reciprocal movements of the tendon and the joint (extension and flexion) may be the pathogenic cause of cellulites and infection, leading to the massage effect and the spread of bacteria along the tendon itself. We suggest that immobilizing the ankle and the metatarsophalangeal joint with a removable contacting cast would suppress the spread of infection in foot ulcers. PMID:25106445

  14. Arthroscopic Ankle Arthrodesis.

    PubMed

    Hutchinson, Byron

    2016-10-01

    Arthroscopic ankle arthrodesis is a cost-effective option for many patients with posttraumatic arthritis of the ankle joint. Rehabilitation is generally quicker than conventional open techniques, and rates of fusion are comparable or better than traditional open techniques. Unless the arthroscopic surgeon has considerable experience, the best results are seen in patients with very little deformity in the ankle joint. PMID:27599442

  15. Metatarsal Shaft Fracture with Associated Metatarsophalangeal Joint Dislocation.

    PubMed

    Tung, Taranjit Singh

    2016-01-01

    Metatarsophalangeal joint dislocations of lesser toes are often seen in the setting of severe claw toes. Traumatic irreducible dislocations have been reported in rare cases following both low-energy and high-energy injuries to the forefoot. In this case report, I present a previously unreported association of a metatarsal shaft fracture with metatarsophalangeal joint dislocation of a lesser toe. PMID:27597914

  16. Metatarsal Shaft Fracture with Associated Metatarsophalangeal Joint Dislocation

    PubMed Central

    2016-01-01

    Metatarsophalangeal joint dislocations of lesser toes are often seen in the setting of severe claw toes. Traumatic irreducible dislocations have been reported in rare cases following both low-energy and high-energy injuries to the forefoot. In this case report, I present a previously unreported association of a metatarsal shaft fracture with metatarsophalangeal joint dislocation of a lesser toe. PMID:27597914

  17. Shear fracture of jointed steel plates of bolted joints under impact load

    NASA Astrophysics Data System (ADS)

    Daimaruya, M.; Fujiki, H.; Ambarita, H.; Kobayashi, H.; Shin, H.-S.

    2013-07-01

    The present study is concerned with the development of a fracture criterion for the impact fracture of jointed steel plates of bolted joints used in a car body, which contributes to crash simulations by CAE. We focus our attention on the shear fracture of the jointed steel plates of lap-bolted joints in the suspension of a car under impact load. Members of lap-bolted joints are modelled as a pair of steel plates connected by a bolt. One of the plates is a specimen subjected to plastic deformation and fracture and the other is a jig subjected to elastic deformation only. Three kinds of steel plate specimens are examined, i.e., a common steel plate with a tensile strength of 270 MPa and high tensile strength steel plates of 440 and 590 MPa used for cars. The impact shear test was performed using the split Hopkinson bar technique for tension impact, together with the static test using a universal testing machine INSTRON 5586. The behaviour of the shear stress and deformation up to rupture taking place in the joint was discussed. The obtained results suggest that a stress-based fracture criterion may be developed for the impact fracture of jointed steel plates of a lap-bolted joint.

  18. Ankle sprain - slideshow

    MedlinePlus

    ... this page: //medlineplus.gov/ency/presentations/100209.htm Ankle sprain - Series To use the sharing features on ... 4 out of 4 Normal anatomy Overview The ankle joint connects the foot with the leg. The ...

  19. Ankle replacement

    MedlinePlus

    Ankle arthroplasty - total; Total ankle arthroplasty; Endoprosthetic ankle replacement; Ankle surgery ... Ankle replacement surgery is most often done while you are under general anesthesia. This means you will ...

  20. Effect of passive stretching and jogging on the series elastic muscle stiffness and range of motion of the ankle joint

    PubMed Central

    McNair, Peter J; Stanley, Stephen N

    1996-01-01

    Objective To determine the effect of stretching and jogging on the series elastic muscle stiffness of the plantar flexors and on the range of dorsiflexion at the ankle joint. Methods 24 healthy subjects participated in this study. Each subject undertook all of the following protocols, in random order: (1) stretching protocol: five 30 s static stretches with 30 s rest between stretches; (2) aerobic jogging protocol: subjects ran on a treadmill for 10 min at 60% of their maximum age predicted heart rate; (3) combined protocol: subjects ran first and then stretched. A damped oscillation technique was used to measure the series elastic stiffness of the plantar flexors. Dorsiflexion of the ankle was assessed with a weights and pulley system that moved the ankle joint from a neutral position into dorsiflexion passively. Electromyography was used to monitor the activity of the plantar and dorsiflexors during these procedures. The statistical analysis of these data involved an analysis of covariance Results For decreasing series elastic muscle stiffness running was more effective than stretching (P<0.05). In contrast, the results for range of motion showed that the combination protocol and the stretching only protocol were more effective than the running only protocol (P < 0.05) for increasing dorsiflexion range of motion at the ankle. Conclusions Both jogging and static stretching exercises appear to be beneficial to individuals participating in sporting activities. ImagesFigure 2Figure 3Figure 4Figure 5Figure 6 PMID:9015593

  1. Plantar-flexion of the ankle joint complex in terminal stance is initiated by subtalar plantar-flexion: A bi-planar fluoroscopy study.

    PubMed

    Koo, Seungbum; Lee, Kyoung Min; Cha, Young Joo

    2015-10-01

    Gross motion of the ankle joint complex (AJC) is a summation of the ankle and subtalar joints. Although AJC kinematics have been widely used to evaluate the function of the AJC, the coordinated movements of the ankle and subtalar joints are not well understood. The purpose of this study was to accurately quantify the individual kinematics of the ankle and subtalar joints in the intact foot during ground walking by using a bi-planar fluoroscopic system. Bi-planar fluoroscopic images of the foot and ankle during walking and standing were acquired from 10 healthy subjects. The three-dimensional movements of the tibia, talus, and calcaneus were calculated with a three-dimensional/two-dimensional registration method. The skeletal kinematics were quantified from 9% to 86% of the full stance phase because of the limited camera speed of the X-ray system. At the beginning of terminal stance, plantar-flexion of the AJC was initiated in the subtalar joint on average at 75% ranging from 62% to 76% of the stance phase, and plantar-flexion of the ankle joint did not start until 86% of the stance phase. The earlier change to plantar-flexion in the AJC than the ankle joint due to the early plantar-flexion in the subtalar joint was observed in 8 of the 10 subjects. This phenomenon could be explained by the absence of direct muscle insertion on the talus. Preceding subtalar plantar-flexion could contribute to efficient and stable ankle plantar-flexion by locking the midtarsal joint, but this explanation needs further investigation. PMID:26238571

  2. Anterior fracture dislocation of sacroiliac joint: A rare type of crescent fracture

    PubMed Central

    Trikha, Vivek; Singh, Vivek; Kumar, V Senthil

    2015-01-01

    Crescent fractures of the pelvis are usually described as posterior sacro iliac fracture dislocations. Rarely anterior displacement of the fractured iliac fragment along with dislocation has been reported in crescent fractures. Four cases of anterior fracture dislocation of the sacro iliac joint managed in the last two years by a single surgeon are presented. The injury mechanism, radiological diagnosis, management protocol along with functional outcomes of all the four patients have been discussed. CT scan is essential in the diagnosis and preoperative planning of this injury pattern. Early fixation along with proper reduction leads to excellent functional outcome in this subset of lateral compression injuries of the pelvis. PMID:26015619

  3. Joint Stability Characteristics of the Ankle Complex in Female Athletes With Histories of Lateral Ankle Sprain, Part II: Clinical Experience Using Arthrometric Measurement

    PubMed Central

    Kovaleski, John E.; Heitman, Robert J.; Gurchiek, Larry R.; Hollis, J. M.; Liu, Wei; IV, Albert W. Pearsall

    2014-01-01

    Context: This is part II of a 2-part series discussing stability characteristics of the ankle complex. In part I, we used a cadaver model to examine the effects of sectioning the lateral ankle ligaments on anterior and inversion motion and stiffness of the ankle complex. In part II, we wanted to build on and apply these findings to the clinical assessment of ankle-complex motion and stiffness in a group of athletes with a history of unilateral ankle sprain. Objective: To examine ankle-complex motion and stiffness in a group of athletes with reported history of lateral ankle sprain. Design: Cross-sectional study. Setting: University research laboratory. Patients or Other Participants: Twenty-five female college athletes (age = 19.4 ± 1.4 years, height = 170.2 ± 7.4 cm, mass = 67.3 ± 10.0 kg) with histories of unilateral ankle sprain. Intervention(s): All ankles underwent loading with an ankle arthrometer. Ankles were tested bilaterally. Main Outcome Measure(s): The dependent variables were anterior displacement, anterior end-range stiffness, inversion rotation, and inversion end-range stiffness. Results: Anterior displacement of the ankle complex did not differ between the uninjured and sprained ankles (P = .37), whereas ankle-complex rotation was greater for the sprained ankles (P = .03). The sprained ankles had less anterior and inversion end-range stiffness than the uninjured ankles (P < .01). Conclusions: Changes in ankle-complex laxity and end-range stiffness were detected in ankles with histories of sprain. These results indicate the presence of altered mechanical characteristics in the soft tissues of the sprained ankles. PMID:24568223

  4. The effects of ankle joint strategy exercises with and without visual feedback on the dynamic balance of stroke patients

    PubMed Central

    Jeon, Si-Nae; Choi, Jung-Hyun

    2015-01-01

    [Purpose] The aim of this study was to examine the effects of visual feedback training on the balance of stroke patients performing ankle joint strategy exercises. [Subjects and Methods] In this study, 26 stroke patients were randomly and equally assigned to a visual feedback group (VFG) and a visual disuse group (VDG). They performed ankle joint strategy exercises for 30 minutes, three times per week for six weeks. The patients’ balance ability was measured before and after the exercises to compare the effects of visual feedback. To assess balance ability, the limits of stability (LOS) and the distance the center of pressure (CoP) moved were measured using a BT4 portable force platform. The Berg balance scale (BBS) and the timed up and go (TUG) test were also used to assess balance before and after the exercises. [Results] Changes in LOS were significant in the anterior, posterior, left, and right directions in each group, and the interactions between the two groups were significant in the posterior, left, and right directions. The changes in TUG and BBS results between pre-test and the post-test were statistically significant in the two groups, and also between the groups. [Conclusion] Visual feedback training had a positive effect on balance when ankle joint strategy exercises were performed by stroke patients to improve balance. PMID:26355721

  5. Fracture Characterization through Multi-Physics Joint Inversion

    NASA Astrophysics Data System (ADS)

    Finsterle, S.; Edmiston, J. K.; Zhang, Y.

    2014-12-01

    Natural and man-made fractures tend to significantly impact the behavior of a subsurface system - with both desirable and undesirable consequences. Thus, the description, characterization, and prediction of fractured systems requires careful conceptualization and a defensible modeling approach that is tailored to the objectives of a specific application. We review some of these approaches and the related data needs, and discuss the use of multi-physics joint inversion techniques to identify and characterize the relevant features of the fracture system. In particular, we demonstrate the potential use of a non-isothermal, multiphase flow simulator coupled to a thermo-poro-elastic model for the calculation of observable deformations during injection-production operations. This model is integrated into a joint inversion framework for the estimation of geometrical, hydrogeological, rockmechanical, thermal, and statistical parameters representing the fractured porous medium.

  6. Total ankle replacement. Early experiences with STAR prosthesis.

    PubMed Central

    Murnaghan, J. M.; Warnock, D. S.; Henderson, S. A.

    2005-01-01

    Early designs of Total Ankle Replacement (TAR) had a high failure rate. More recent experience with the 3-piece, meniscal bearing, total ankle replacement has been more promising. We report a review of the early results of our first 22 prostheses in 20 patients undergoing Scandinavian Total Ankle Replacement (STAR) in Northern Ireland. There was a mean follow-up time of 26 months. Seventeen patients are pain-free at the ankle joint during normal daily activities. Two of the early cases have required revision surgery due to technical errors. Other complications have included malleolar fractures, poor wound healing and postoperative stiffness. These early results show high levels of patient satisfaction, and we are encouraged to continue with total ankle arthroplasty. There is a steep initial learning curve and use of TAR should be restricted to foot and ankle surgeons. Images Fig 1 Figs 2a and b Figs 2 c and d PMID:16022128

  7. Total ankle replacement. Early experiences with STAR prosthesis.

    PubMed

    Murnaghan, J M; Warnock, D S; Henderson, S A

    2005-05-01

    Early designs of Total Ankle Replacement (TAR) had a high failure rate. More recent experience with the 3-piece, meniscal bearing, total ankle replacement has been more promising. We report a review of the early results of our first 22 prostheses in 20 patients undergoing Scandinavian Total Ankle Replacement (STAR) in Northern Ireland. There was a mean follow-up time of 26 months. Seventeen patients are pain-free at the ankle joint during normal daily activities. Two of the early cases have required revision surgery due to technical errors. Other complications have included malleolar fractures, poor wound healing and postoperative stiffness. These early results show high levels of patient satisfaction, and we are encouraged to continue with total ankle arthroplasty. There is a steep initial learning curve and use of TAR should be restricted to foot and ankle surgeons. PMID:16022128

  8. An EMG-Controlled SMA Device for the Rehabilitation of the Ankle Joint in Post-Acute Stroke

    NASA Astrophysics Data System (ADS)

    Pittaccio, S.; Viscuso, S.

    2011-07-01

    The capacity of flexing one's ankle is an indispensible segment of gait re-learning, as imbalance, wrong compensatory use of other joints and risk of falling may depend on the so-called drop-foot. The rehabilitation of ankle dorsiflexion may be achieved through active exercising of the relevant musculature (especially tibialis anterior, TA). This can be troublesome for patients affected by weakness and flaccid paresis. Thus, as needs evolve during patient's improvements, a therapeutic device should be able to guide and sustain gradual recovery by providing commensurate aid. This includes exploiting even initial attempts at voluntary motion and turns those into effective workout. An active orthosis powered by two rotary actuators containing NiTi wire was designed to obtain ankle dorsiflexion. A computer routine that analyzes the electromyographic (sEMG) signal from TA muscle is used to control the orthosis and trigger its activation. The software also provides instructions and feed-back for the patient. Tests on the orthosis proved that it can produce strokes up to 36° against resisting torques exceeding 180 Ncm. Three healthy subjects were able to control the orthosis by modulating their TA sEMG activity. The movement produced in the preliminary tests is interesting for lower limb rehabilitation, and will be further improved by optimizing body-orthosis interface. It is hoped that this device will enhance early rehabilitation and recovery of ankle mobility in stroke patients.

  9. Clinical results of resection arthrodesis by triangular external fixation for posttraumatic arthrosis of the ankle joint in 89 cases

    PubMed Central

    2009-01-01

    The methods for ankle arthrodesis differ significantly, probably a sign that no method is clearly superior to others. In the last ten years there is a clear favour toward internal fixation. We retrospectively evaluate the technique and evaluate the clinical long term results of external fixation in a triangular frame. Patients and Methods From 1994 to 2001 a consecutive series of 95 patients with end stage arthritis of the ankle joint were treated. Retrospectively the case notes were evaluated regarding trauma history, medical complaints, further injuries and illnesses, walking and pain status and occupational issues and the clinical examination before arthrodesis. Mean age at the index procedure was 45.4 years (18-82), 67 patients were male (70.5%). Via a bilateral approach the malleoli and the joint surfaces were resected. An AO fixator was applied with two Steinmann-nails inserted with approximately 8 cm distance in the distal tibia, one in the neck of the talus and one in the dorsal calcaneus. The fixator was removed after approximately 12 weeks. Follow up examination at mean 4.4 years included a standardised questionnaire and a clinical examination including the criteria of the AOFAS-Score and radiographs. Results: Due to different complications, 8 (8.9%) further surgical procedures were necessary including 1 below knee amputation. In 4 patients a non-union of the ankle arthrodesis developed (4.5%). The mean AOFAS score improved from 20.8 to 69.3 points. Conclusion Non-union rates and clinical results of arthrodesis by triangular external fixation of the ankle joint do not differ to internal fixation methods. The complication rate and the reduced patient comfort reserve this method mainly for infected arthritis and complicated soft tissue situations. PMID:19258207

  10. Oscillation of the human ankle joint in response to applied sinusoidal torque on the foot

    PubMed Central

    Agarwal, Gyan C.; Gottlieb, Gerald L.

    1977-01-01

    1. Low-frequency (3-30 Hz) oscillatory rotation of the ankle joint in plantarflexion—dorsiflexion was generated with a torque motor. Torque, rotation about the ankle and electromyograms (e.m.g.s) for the gastrocnemius—soleus and the anterior tibial muscles were recorded. 2. Fourier coefficients at each drive frequency were used to calculate the effective compliance (ratio of rotation and torque). The compliance has a sharp resonance when tonic, voluntary muscle activity is present. 3. The resonant frequency of compliance is between 3 and 8 Hz. The location of the resonant frequency and the magnitude of the compliance at resonance depend upon both the degree of tonic muscle activity and the amplitude of the driving torque. The resonant frequency increases with increasing tonic activity. 4. With tonic muscle activity, the compliance in the frequency range below resonance increases with increasing amplitudes of driving torque. 5. The e.m.g., when evoked by the rhythmic stretch, lags the start of stretching by between 50 and 70 msec. 6. When tonic muscle activity is present, the resonant frequency of the stretch reflex is between 5 and 6·5 Hz. 7. Following the start of driven oscillation at frequencies near resonance, slowly increasing amplitudes of angular rotation (to a limit) are observed. 8. Distortion (from the sinusoidal wave shape) of angular rotation is frequently observed with drive frequencies between 8 and 12 Hz during which there sometimes occur spontaneous recurrences of oscillation at the drive frequency. For the angular rotation, a significant portion of the power may be in subharmonic frequency components of the drive frequency when that frequency is between 8 and 12 Hz. 9. Self-sustaining oscillation (clonus) near the resonant frequency of the compliance is sometimes observed after the modulation signal to the motor is turned off. This is most often seen when the gastrocnemius—soleus muscles are fatigued. Clonus may be evoked by driven

  11. [Osteosynthesis after periprosthetic fractures of the knee joint].

    PubMed

    von Matthey, F; Ruchholtz, S; Biberthaler, P; Hanschen, M

    2016-04-01

    Periprosthetic fractures around the knee joint are of increasing relevance due to increasing numbers of total knee replacements and increasing life expectations. These fractures can be a real challenge due to an often limited patient compliance, reduced bone quality and impaired bone perfusion of potential intramedullary shafts resulting in poor healing and lack of fixation options for screws. These fractures necessitate special knowledge and approaches, which are systematically dealt with in this article, beginning with the correct diagnostics through to the most recent developments in the field of osteosynthetic techniques. The trends of minimally invasive techniques are presented and the options and limitations are described. PMID:26992714

  12. The Effect of Velocity of Joint Mobilization on Corticospinal Excitability in Individuals With a History of Ankle Sprain.

    PubMed

    Fisher, Beth E; Piraino, Andrew; Lee, Ya-Yun; Smith, Jo Armour; Johnson, Sean; Davenport, Todd E; Kulig, Kornelia

    2016-07-01

    Study Design Controlled laboratory study. Background Joint mobilization and manipulation decrease pain and improve patient function. Yet, the processes underlying these changes are not well understood. Measures of corticospinal excitability provide insight into potential mechanisms mediated by the central nervous system. Objectives To investigate the differential effects of joint mobilization and manipulation at the talocrural joint on corticospinal excitability in individuals with resolved symptoms following ankle sprain. Methods Twenty-seven participants with a history of ankle sprain were randomly assigned to the control, joint mobilization, or thrust manipulation group. The motor-evoked potential (MEP) and cortical silent period (CSP) of the tibialis anterior and gastrocnemius were obtained with transcranial magnetic stimulation at rest and during active contraction of the tibialis anterior. The slopes of MEP/CSP input/output curves and the maximal MEP/CSP values were calculated to indicate corticospinal excitability. Behavioral measures, including ankle dorsiflexion and dynamic balance, were evaluated. Results A repeated-measures analysis of variance of the MEP slope showed a significant group-by-time interaction for the tibialis anterior at rest (P = .002) and during active contraction (P = .042). After intervention, the thrust manipulation group had an increase in corticospinal excitability, while the corticospinal excitability decreased in the mobilization group. The thrust manipulation group, but not other groups, also demonstrated a significant increase in the maximal MEP amplitude of the tibialis anterior after intervention. Conclusion The findings suggest that joint manipulation and mobilization have different effects on corticospinal excitability. The increased corticospinal excitability following thrust manipulation may provide a window for physical therapists to optimize muscle recruitment and subsequently movement. The trial was registered at

  13. Effects of ankle joint mobilization with movement and weight-bearing exercise on knee strength, ankle range of motion, and gait velocity in patients with stroke: a pilot study

    PubMed Central

    An, Chang-Man; Won, Jong-Im

    2016-01-01

    [Purpose] The purpose of this study was to investigate the effects of ankle joint mobilization with movement on knee strength, ankle range of motion, and gait velocity, compared with weight-bearing exercise in stroke patients. [Subjects and Methods] Thirty subjects with chronic stroke were divided into three groups: MWM (n = 12), WBE (n = 8), and control (n = 10). All groups attended physical therapy sessions 3 times a week for 5 weeks. Subjects in the MWM group performed mobilization with movement exercises, whilst participants in the WBE group performed weight-bearing exercises. Knee peak torque, ankle range of motion, and spatiotemporal gait parameters were evaluated before and after the interventions. [Results] Knee extensor peak torque increased significantly in both MWM and WBE groups. However, only the MWM group showed significant improvement in passive and active ankle range of motion and gait velocity, among the three groups. [Conclusion] Ankle joint mobilization with movement intervention is more effective than simple weight-bearing intervention in improving gait speed in stroke patients with limited ankle motion. PMID:27065565

  14. Fracture dislocation of carpometacarpal joints: a missed injury.

    PubMed

    Gaheer, Rajinder Singh; Ferdinand, Rupert D

    2011-05-01

    Fracture dislocation of the carpometacarpal joints on the ulnar side of the hand is an uncommon injury. These are high-energy injuries seen in motorcyclists and boxers. The mechanism of injury involves violent, forceful dorsiflexion of the wrist combined with longitudinal impact on the closed hand. This article reports a case of fracture of the base of the middle finger with dislocation of the ring and little finger carpometacarpal joints. On first examination, a diagnosis of isolated, minimally-displaced, middle-metacarpal base fracture was made and deemed suitable for nonoperative management. The hand was splinted in a plaster-of-Paris slab. Later, a true lateral radiograph showed the exact nature of the injury. The fracture was successfully treated with closed reduction under general anesthesia and transfixation using Kirschner wires. Functional results were excellent with return to work at 10 weeks and excellent grip strength at 14 weeks. This injury may be missed in an acute setting in a busy accident and emergency unit. Swelling around the wrist with shortening of the knuckle should alert the clinician towards the possibility of such an injury. On routine anteroposterior view, overlap of joint surfaces, loss of parallelism, and asymmetry at the carpometacarpal joints should raise suspicion of the possibility of a subtle carpometacarpal injury. This article highlights the importance of a high index of suspicion, a true lateral radiograph, and careful evaluation of radiographs in diagnosing these injuries. Intensive postoperative physiotherapy is vital to achieving a satisfactory outcome. PMID:21598884

  15. Ankle arthroscopy

    MedlinePlus

    Ankle surgery; Arthroscopy - ankle; Surgery - ankle - arthroscopy; Surgery - ankle - arthroscopic ... You will likely receive general anesthesia before this surgery. This means you will be asleep and unable ...

  16. Military Exercises, Knee and Ankle Joint Position Sense, and Injury in Male Conscripts: A Pilot Study

    PubMed Central

    Mohammadi, Farshid; Azma, Kamran; Naseh, Iman; Emadifard, Reza; Etemadi, Yasaman

    2013-01-01

    Context: The high incidence of lower limb injuries associated with physical exercises in military conscripts suggests that fatigue may be a risk factor for injuries. Researchers have hypothesized that lower limb injuries may be related to altered ankle and knee joint position sense (JPS) due to fatigue. Objective: To evaluate if military exercises could alter JPS and to examine the possible relation of JPS to future lower extremity injuries in military service. Design: Cohort study. Setting: Laboratory. Patients or Other Participants: A total of 50 male conscripts (age = 21.4 ± 2.3 years, height = 174.5 ± 6.4 cm, mass = 73.1 ± 6.3 kg) from a unique military base were recruited randomly. Main Outcome Measure(s): Participants performed 8 weeks of physical activities at the beginning of a military course. In the first part of the study, we instructed participants to recognize predetermined positions before and after military exercises so we could examine the effects of military exercise on JPS. The averages of the absolute error and the variable error of 3 trials were recorded. We collected data on the frequency of lower extremity injuries over 8 weeks. Next, the participants were divided into 2 groups: injured and uninjured. Separate 2 × 2 × 2 (group-by-time-by-joint) mixed-model analyses of variance were used to determine main effects and interactions of these factors for each JPS measure. In the second part of the study, we examined whether the effects of fatigue on JPS were related to the development of injury during an 8-week training program. We calculated Hedges effect sizes for JPS changes postexercise in each group and compared change scores between groups. Results: We found group-by-time interactions for all JPS variables (F range = 2.86–4.05, P < .01). All participants showed increases in JPS errors postexercise (P < .01), but the injured group had greater changes for all the variables (P < .01). Conclusions: Military conscripts who sustained lower

  17. Effects of Deep Brain Stimulation and Medication on Strength, Bradykinesia, and Electromyographic Patterns of the Ankle Joint in Parkinson’s Disease

    PubMed Central

    Vaillancourt, David E.; Prodoehl, Janey; Sturman, Molly M.; Bakay, Roy A.E.; Metman, Leo Verhagen; Corcos, Daniel M.

    2008-01-01

    We investigated the control of movement in 12 patients with Parkinson’s disease (PD) after they received surgically implanted high-frequency stimulating electrodes in the subthalamic nucleus (STN). The experiment studied ankle strength, movement velocity, and the associated electromyographic patterns in PD patients, six of whom had tremor at the ankle. The patients were studied off treatment, ON STN deep brain stimulation (DBS), on medication, and on medication plus STN DBS. Twelve matched control subjects were also examined. Medication alone and STN DBS alone increased patients’ ankle strength, ankle velocity, agonist muscle burst amplitude, and agonist burst duration, while reducing the number of agonist bursts during movement. These findings were similar for PD patients with and without tremor. The combination of medication plus STN DBS normalized maximal strength at the ankle joint, but ankle movement velocity and electromyographic patterns were not normalized. The findings are the first to demonstrate that STN DBS and medication increase strength and movement velocity at the ankle joint. PMID:16124011

  18. Assessment of Ankle and Hindfoot Stability and Joint Pressures Using a Human Cadaveric Model of a Large Lateral Talar Process Excision

    PubMed Central

    Sands, Andrew; White, Charles; Blankstein, Michael; Zderic, Ivan; Wahl, Dieter; Ernst, Manuela; Windolf, Markus; Hagen, Jennifer E.; Richards, R. Geoff; Stoffel, Karl; Gueorguiev, Boyko

    2015-01-01

    Abstract Lateral talar process fragment excision may be followed by hindfoot instability and altered biomechanics. There is controversy regarding the ideal fragment size for internal fixation versus excision and a concern that excision of a large fragment may lead to significant instability. The aim of this study was to assess the effect of a simulated large lateral talar process excision on ankle and subtalar joint stability. A custom-made seesaw rig was designed to apply inversion/eversion stress loading on 7 fresh-frozen human cadaveric lower legs and investigate them in pre-excision, 5 cm3 and 10 cm3 lateral talar process fragment excision states. Anteroposterior radiographs were taken to assess ankle and subtalar joint tilt and calculate angular change from neutral hindfoot alignment to 10-kg forced inversion/eversion. Ankle joint pressures and contact areas were measured under 30-kg axial load in neutral hindfoot alignment. In comparison to the pre-excision state, no significantly different mediolateral angular change was observed in the subtalar joint after 5 and 10 cm3 lateral talar process fragment excision in inversion and eversion. With respect to the ankle joint, 10-cm3 fragment excision produced significantly bigger inversion tibiotalar tilt compared with the pre-excision state, P = .04. No significant change of the ankle joint pressure and contact area was detected after 5 and 10-cm3 excision in comparison with the pre-excison state. An excision of up to 10 cm3 of the lateral talar process does not cause a significant instability at the level of the subtalar joint but might be a destabilizing factor at the ankle joint under inversion stress. The latter could be related to extensive soft tissue dissection required for resection. PMID:25789950

  19. A MULTIDISCIPLINARY APPROACH TO THE REHABILITATION OF A COLLEGIATE FOOTBALL PLAYER FOLLOWING ANKLE FRACTURE: A CASE REPORT

    PubMed Central

    Kaplan, Lee D.; Musto, Tony; Gaunaurd, Ignacio A.; Gailey, Robert S.; Kelley, William P.; Alemi, Timothy J.; Espinosa, Braulio; Mandler, Eli; Scavo, Vincent A.; West, Dustin C.

    2016-01-01

    ABSTRACT Background and Purpose Multiple rehabilitation factors including overall wellness need to be considered when an athlete returns to sport after an injury. The purpose of this case report is to describe a multidisciplinary approach for return to sport of a Division I collegiate football player following a traumatic ankle fracture requiring surgical repair. The assessment and treatment approach included the use of a performance-based physical therapy outcome measure, self-reported functional abilities, body composition assessments, and nutritional counseling. Case Description A 21 year-old running back fractured his lateral malleolus due to a mechanism of injury of excessive eversion with external rotation of the ankle. Surgical intervention included an open reduction internal fixation (ORIF) of the fibula and syndesmosis. In addition to six months of rehabilitation, the patient received consultations from the team sports nutritionist specialist to provide dietary counseling and body composition testing. The Comprehensive High-level Activity Mobility Predictor-Sport (CHAMP-S), a performance-based outcome measure, self-report on the Foot and Ankle Disability Index (FADI-ADL, FADI-S), and body composition testing using whole body densitometry (BOD POD®), were administered throughout rehabilitation. Outcomes The subject was successfully rehabilitated, returned to his starting role, and subsequently was drafted by a National Football League (NFL) franchise. High-level mobility returned to above pre-injury values, achieving 105% of his preseason CHAMP-S score at discharge. Self-reported function on the FADI-ADL and FADI-Sport improved to 100% at discharge. Body fat percentages decreased (13.3% to 11.9%) and fat mass decreased (12.0 kg to 11.0kg). Lean body mass (78.1 kg to 81.5 kg) and lbm/in increased (1.14 kg/in to 1.19 kg/in). His BMI changed from 29.8 kg/m2 to 30.6 kg/m2. Discussion This case report illustrates the positive effects of a

  20. Functional outcome of tarsometatarsal joint fracture dislocation managed according to Myerson classification

    PubMed Central

    YU, Xiao; PANG, Qing-Jiang; YANG, Chang-Chun

    2014-01-01

    Objective : To summarize the functional outcome of tarsometatarsal joint fracture-dislocation managed according to Myerson classification. Methods : Total eighty cases of tarsometatarsal joint fracture-dislocation were treated from Mar 2004 to Feb 2012. According to the Myerson classification, there were 14 cases in type A, 12 cases in type B1, 28 cases in type B2, 11 cases in type C1 and 15 cases in type C2. All the cases were treated with open reduction and internal fixation and the incisions and implants were also selected according to the Myerson classification. X-ray was examined during the follow-up period and functional evaluation was carried out by American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score system. Analysis of variance was used to test the different types of Myerson classification. Results : Sixty eight patients got a mean follow-up of 24 months (15-36 months). No patient suffered from infection, skin flap necrosis and X-ray showed there were no implants loosening or breakage. The mean AOFAS score was 88.4(47-100) and excellent and good result was 89.7%. The differences among Myerson classifications showed that there were statistical significance between type B and type A, type C (P<0.05) Three patients suffered from severe pain and difficult walking, X-ray showed the ambiguity of the joint space, which can be diagnosed as posttraumatic arthritis. One patient had arthrodesis finally. Conclusion : The Myerson classification is helpful to make preoperative plan and judging prognosis to the tarsometatarsal joint injuries. In type B, single or double incisions with screw or plate fixation is enough, while in type A and type C, double or triple incisions with screw or plate fixation in medial joints and Kirschner wire fixation in lateral joints are needed. Postoperatively, the type B patients had better prognosis than type A and type C patients. However, the concomitant injuries around the tarsometatarsal joint were not included in Myerson

  1. Fracturing behavior of aluminum alloys with welded joints

    NASA Astrophysics Data System (ADS)

    Polyakov, V. V.; Kolubaev, E. A.; Salita, D. S.; Dmitriev, A. A.; Lependin, A. A.

    2015-10-01

    In this paper, properties of aluminum-magnesium alloys with welded joints are investigated. The joints are produced by the friction stir welding under various conditions. This fact is used for studying the principles and patterns of defect structure development. Mechanical properties are evaluated by static tension tests. The impact of welding process conditions on loading curves and strength properties is analysed. Fracture surface structures for samples with and without welded joints are studied, and results are compared. It is revealed, that differences in deformation behavior and mechanical properties of aluminum-magnesium alloys produced under different welding process conditions are caused by developing of structure defects in a welded joints, mostly, nonuniformities/discontinuities of various types. The obtained results can be used for improvement and development of new welding process conditions for aluminum-magnesium alloys.

  2. Talus fractures: surgical principles.

    PubMed

    Rush, Shannon M; Jennings, Meagan; Hamilton, Graham A

    2009-01-01

    Surgical treatment of talus fractures can challenge even the most skilled foot and ankle surgeon. Complicated fracture patterns combined with joint dislocation of variable degrees require accurate assessment, sound understanding of principles of fracture care, and broad command of internal fixation techniques needed for successful surgical care. Elimination of unnecessary soft tissue dissection, a low threshold for surgical reduction, liberal use of malleolar osteotomy to expose body fracture, and detailed attention to fracture reduction and joint alignment are critical to the success of treatment. Even with the best surgical care complications are common and seem to correlate with injury severity and open injuries. PMID:19121756

  3. Effects of muscle strength asymmetry between left and right on isokinetic strength of the knee and ankle joints depending on athletic performance level

    PubMed Central

    Jeon, Kyoungkyu; Chun, Sungyung; Seo, Byoungdo

    2016-01-01

    [Purpose] The aim of this study was to collect basic data on the effect of asymmetry on the muscle strength of the left and right knee and ankle joints of soccer players at varying athletic performance levels, to guide the development of improved exercise programs. [Subjects and Methods] Forty-nine soccer players at three athletic performance levels participated: 15 professional, 16 amateur, and 18 college. Knee extensor and flexor strength were measured at 60°/sec and 180°/sec, and ankle plantar flexor and dorsiflexor strength were measured at 30°/sec and at 120°/sec. Variables were analyzed by one-way ANOVA. [Results] College soccer players showed greater muscle strength at 60°/sec and 180°/sec in the knee extension muscles of both the right and the left sides, lower muscle strength at 30°/sec and 120°/sec in the dorsiflexor of the right ankle, and similar levels of asymmetry between left and right. The maximum muscle strength on the same side significantly differed in the right ankle joint, with asymmetry between left and right at 30°/sec and 120°/sec. [Conclusion] These findings suggest that muscle strength asymmetry in the ankle joint may lead to counterbalancing muscle strengthening of the knee joint to maintain the center of body mass. PMID:27190469

  4. Effects of muscle strength asymmetry between left and right on isokinetic strength of the knee and ankle joints depending on athletic performance level.

    PubMed

    Jeon, Kyoungkyu; Chun, Sungyung; Seo, Byoungdo

    2016-04-01

    [Purpose] The aim of this study was to collect basic data on the effect of asymmetry on the muscle strength of the left and right knee and ankle joints of soccer players at varying athletic performance levels, to guide the development of improved exercise programs. [Subjects and Methods] Forty-nine soccer players at three athletic performance levels participated: 15 professional, 16 amateur, and 18 college. Knee extensor and flexor strength were measured at 60°/sec and 180°/sec, and ankle plantar flexor and dorsiflexor strength were measured at 30°/sec and at 120°/sec. Variables were analyzed by one-way ANOVA. [Results] College soccer players showed greater muscle strength at 60°/sec and 180°/sec in the knee extension muscles of both the right and the left sides, lower muscle strength at 30°/sec and 120°/sec in the dorsiflexor of the right ankle, and similar levels of asymmetry between left and right. The maximum muscle strength on the same side significantly differed in the right ankle joint, with asymmetry between left and right at 30°/sec and 120°/sec. [Conclusion] These findings suggest that muscle strength asymmetry in the ankle joint may lead to counterbalancing muscle strengthening of the knee joint to maintain the center of body mass. PMID:27190469

  5. [Fractures of the proximal interphalangeal joint: Diagnostic and operative therapy options].

    PubMed

    Unglaub, F; Langer, M F; Hahn, P; Müller, L P; Ahrens, C; Spies, C K

    2016-02-01

    Joint fractures of the fingers often entail operative interventions in contrast to extra-articular fractures. These types of fracture are inclined to dislocate in addition to the actual fracture. The proximal interphalangeal (PIP) joint in particular often shows comminuted fractures due to the long leverage of the finger and a relatively small diameter of the joint. The clinical examination, X-ray diagnostics and if necessary computed tomography allow the classification into stable and unstable fractures. Unstable fractures must be treated by surgical reduction and fixation. A multitude of operative techniques are available for these mostly complicated fractures. The foremost goal is a stable osteosynthesis of the fracture with repositioning of the dislocation, which enables early physiotherapy in order to prevent tendon adhesion and contracture. This article presents the different types of PIP joint fractures, their specific surgical treatment and postoperative treatment regimens. PMID:26826026

  6. Shoe collar height effect on athletic performance, ankle joint kinematics and kinetics during unanticipated maximum-effort side-cutting performance.

    PubMed

    Lam, Gilbert Wing Kai; Park, Eun Jung; Lee, Ki-Kwang; Cheung, Jason Tak-Man

    2015-01-01

    Side-step cutting manoeuvres comprise the coordination between planting and non-planting legs. Increased shoe collar height is expected to influence ankle biomechanics of both legs and possibly respective cutting performance. This study examined the shoe collar height effect on kinematics and kinetics of planting and non-planting legs during an unanticipated side-step cutting. Fifteen university basketball players performed maximum-effort side-step cutting to the left 45° direction or a straight ahead run in response to a random light signal. Seven successful cutting trials were collected for each condition. Athletic performance, ground reaction force, ankle kinematics and kinetics of both legs were analysed using paired t-tests. Results indicated that high-collar shoes resulted in less ankle inversion and external rotation during initial contact for the planting leg. The high-collar shoes also exhibited a smaller ankle range of motion in the sagittal and transverse planes for both legs, respectively. However, no collar effect was found for ankle moments and performance indicators including cutting performance time, ground contact time, propulsion ground reaction forces and impulses. These findings indicated that high-collar shoes altered ankle positioning and restricted ankle joint freedom movements in both legs, while no negative effect was found for athletic cutting performance. PMID:25671398

  7. Use of dual Euler angles to quantify the three-dimensional joint motion and its application to the ankle joint complex.

    PubMed

    Ying, Ning; Kim, Wangdo

    2002-12-01

    This paper presents a modified Euler angles method, dual Euler angles approach, to describe general spatial human joint motions. In dual Euler angles approach, the three-dimensional joint motion is considered as three successive screw motions with respect to the axes of the moving segment coordinate system; accordingly, the screw motion displacements are represented by dual Euler angles. The algorithm for calculating dual Euler angles from coordinates of markers on the moving segment is also provided in this study. As an example, the proposed method is applied to describe motions of ankle joint complex during dorsiflexion-plantarflexion. A Flock of Birds electromagnetic tracking device (FOB) was used to measure joint motion in vivo. Preliminary accuracy tests on a gimbal structure demonstrate that the mean errors of dual Euler angles evaluated by using source data from FOB are less than 1 degrees for rotations and 1mm for translations, respectively. Based on the pilot study, FOB is feasible for quantifying human joint motions using dual Euler angles approach. PMID:12445618

  8. Current concepts: tissue engineering and regenerative medicine applications in the ankle joint

    PubMed Central

    Correia, S. I.; Pereira, H.; Silva-Correia, J.; Van Dijk, C. N.; Espregueira-Mendes, J.; Oliveira, J. M.; Reis, R. L.

    2014-01-01

    Tissue engineering and regenerative medicine (TERM) has caused a revolution in present and future trends of medicine and surgery. In different tissues, advanced TERM approaches bring new therapeutic possibilities in general population as well as in young patients and high-level athletes, improving restoration of biological functions and rehabilitation. The mainstream components required to obtain a functional regeneration of tissues may include biodegradable scaffolds, drugs or growth factors and different cell types (either autologous or heterologous) that can be cultured in bioreactor systems (in vitro) prior to implantation into the patient. Particularly in the ankle, which is subject to many different injuries (e.g. acute, chronic, traumatic and degenerative), there is still no definitive and feasible answer to ‘conventional’ methods. This review aims to provide current concepts of TERM applications to ankle injuries under preclinical and/or clinical research applied to skin, tendon, bone and cartilage problems. A particular attention has been given to biomaterial design and scaffold processing with potential use in osteochondral ankle lesions. PMID:24352667

  9. Design of a Robotic Ankle Joint for a Microspine-Based Robot

    NASA Technical Reports Server (NTRS)

    Thatte, Nitish

    2011-01-01

    Successful robotic exploration of near-Earth asteroids necessitates a method of securely anchoring to the surface of these bodies without gravitational assistance. Microspine grip- per arrays that can grasp rock faces are a potential solution to this problem. A key component of a future microspine-based rover will be the ankle used to attach each microspine gripper to the robot. The ankle's purpose is twofold: 1) to allow the gripper to conform to the rock so a higher percentage of microspines attach to the surface, and 2) to neutralize torques that may dislodge the grippers from the wall. Parts were developed using computer aided design and manufactured using a variety of methods including selective laser sintering, CNC milling, and traditional manual machining techniques. Upon completion of the final prototype, the gripper and ankle system was tested to demonstrate robotic engagement and disengagement of the gripper and to determine load bearing ability. The immediate application of this project is to out t the Lemur IIb robot so it can climb and hang from rock walls.

  10. Dorsal Buttress Plate Fixation of Ulnar Carpometacarpal Joint Fracture Dislocations.

    PubMed

    Tan, En Si; Chao, Tay Shian

    2016-06-01

    We propose a method for open reduction and internal fixation of early and unstable ulnar (fourth and/or fifth) carpometacarpal joint (CMCJ) fracture subluxations or dislocations using a dorsal buttress plate. In ulnar CMCJ fracture dislocations, the metacarpal has a tendency to displace dorsally and proximally when there is an axial load. Using the dorsal buttress plate method of fixation, a plate is fixed proximally to the hamate, aligned parallel and dorsal to the metacarpal to act as a buttress, to resist this movement. To preserve the fourth and the fifth CMCJ mobility, the distal end of the plate is not fixed to the metacarpal base. We illustrate the use of this technique on 4 patients who had different patterns of injury at the ulnar CMCJ. All patients regained excellent range of motion and function. None of the patients had redisplacement or nonunion of fracture. The dorsal buttress plate is a viable option for fixation of early and unstable ulnar CMCJ fracture subluxations or dislocations. PMID:27077465

  11. Can Chronic Ankle Instability be Prevented? Rethinking Management of Lateral Ankle Sprains.

    ERIC Educational Resources Information Center

    Denegar, Craig R.; Miller, Sayers J., III

    2002-01-01

    Investigates whether chronic ankle instability can be prevented, discussing: the relationship between mechanical and functional instability; normal ankle mechanics, sequelae to lateral ankle sprains, and abnormal ankle mechanics; and tissue healing, joint dysfunction, and acute lateral ankle sprain management. The paper describes a treatment model…

  12. Posterior talar fracture with dislocation of both talo-navicular and subtalar joints: a variant type II of the Sneppens classification

    PubMed Central

    Galanopoulos, Ilias; Fogg, Quentin; Ashwood, Neil

    2012-01-01

    A 63-year-old man fell from a ladder, thus causing an axial compression injury to the right ankle. Severe deformity was evident and the ankle could not be reduced by simple manipulation. The skin was tented and appearing critically contused. Radiographs revealed an oblique fracture of the posterior aspect of the talar body with dislocation of both the talo-navicular and subtalar joints, an injury previously not described in the literature. The fracture–dislocation was anatomically reduced within 3 h of presentation and stability achieved with two headless buried compression screws. CT scan confirmed anatomical reduction and the patient remained non-weight bearing in a cast for 6 weeks. One year postoperatively, the patient remains pain-free with no radiological signs of avascular necrosis of the talus. This injury is unique and despite its severity and soft tissue compromise good quality reduction and internal fixation resulted in an excellent clinical outcome. PMID:22847568

  13. Comparisons of knee and ankle joint angles and ground reaction force according to functional differences during single-leg drop landing

    PubMed Central

    Kim, Kewwan; Jeon, Kyoungkyu

    2016-01-01

    [Purpose] The purpose of this study was to determine potential predictors of functional instability of the knee and ankle joints during single-leg drop landing based on the prior history of injury. [Subjects and Methods] The subjects were 24 collegiate soccer players without pain or dysfunction. To compare the differences between the stable and unstable sides during single-leg drop landing, 8 motion analysis cameras and a force plate were used. The Cortex 4 software was used for a biomechanical analysis of 3 events. An independent t-test was used for statistical comparison between both sides; p<0.05 indicated significance. [Results] The knee joint movements showed gradual flexion in the sagittal plane. The unstable-side ankle joint showed plantar flexion of approximately 2° relative to the stable side. In the coronal plane, the unstable-side knee joint differed from the stable side in its tendency for valgus movement. The unstable-side ankle joint showed contrasting movement compared with the stable side, and the difference was significant. Regarding the vertical ground reaction force, the stable side showed maximum knee flexion that was approximately 0.1 BW lower than that of the unstable side. [Conclusion] Increasing the flexion angle of the knee joint can help prevent injury during landing. PMID:27190444

  14. Models of fracture lineaments - Joint swarms, fracture corridors and faults in crystalline rocks, and their genetic relations

    NASA Astrophysics Data System (ADS)

    Gabrielsen, Roy H.; Braathen, Alvar

    2014-07-01

    Fracture lineaments in crystalline and metamorphic rocks of southern Norway can be subdivided into joint swarms, fracture corridors and faults, depending on displacement, the fracture mode and patterns, and the presence of fault rocks. Their physical appearance as lineaments seen by remote sensing is not discernible, as they define km-long and narrow tabular zones of high fracture intensity. Intrinsically, fracture zonation becomes better expressed from joint swarms to fracture corridors and especially faults as a consequence of increasing accumulate strain. Joint swarms and fracture corridors commonly reveal a symmetric fracture zonation on both sides of its core, whereas inclined extensional faults tend to have asymmetric patterns with enhanced strain and a wider damage zone in the hanging wall. Fracture lineament can be mapped in subzones A-B (core), which are typically some cm up to some tens of meters wide. Common structural elements are fault rocks/shear zones, lenses, and a network of fractures often with very high fracture frequency. Secondary minerals are common. Outside this, subzones C-D (damage zone) are commonly 20-50-m\\ wide with lower fracture intensity of lineament-parallel fracturing, defining the topographic boundary of the lineament. Mineralisation is rarer. The transitional subzone E of multi-orientation fractures defines the transition to the background fracture system. We propose a model for the classification and development of fracture lineaments, applying their architecture (intrinsic geometry, spatial fracture pattern and spatial distribution of fault rocks) as tools for the systematic description. This links fault growth processes and mechanisms that can be ascribed to strain hardening and softening scenarios in a model of fault architecture.

  15. The contribution of anterior deltoid ligament to ankle stability in isolated lateral malleolar fractures.

    PubMed

    Lee, Tae Hoon; Jang, Kyu Sun; Choi, Gi Won; Jeong, Chan Dong; Hong, Suk Joo; Yoon, Min A; Kim, Hak Jun

    2016-07-01

    The treatment of isolated lateral malleolar fractures with deltoid ligament rupture remains controversial. We prospectively analysed 35 patients with isolated lateral malleolar fractures during 2006-2013. Radiography and magnetic resonance imaging (MRI) were performed to assess the degree of reduction, ligament damage, and stability. Internal fixation was performed for all unstable valgus fractures with unacceptable fracture parameters. Fractures with residual valgus instability after fixation underwent anterior deltoid repair. The mean anterior deltoid ligament grade based on MRI was significantly different between the high-grade unstable group and the stable and low-grade unstable groups (p=0.037 and 0.004, respectively). Postoperative medial clear space measurements were not significantly different between groups. MRI was shown to be a useful tool in the preoperative identification of isolated lateral malleolus fractures prone to valgus instability. In the case of high-grade unstable fractures of the lateral malleolus, repair of the anterior deltoid ligament is adequate for restoring medial stability. PMID:27133289

  16. Changes in the radiological measurements of the tibiofibular syndesmal area in patients with Weber C ankle fractures who were treated with open reduction, internal fixation, and transyndesmal screw.

    PubMed

    Jasqui-Remba, S; Torres-Gómez, A; Salas-Morales, G A; Hernández-Martínez, A

    2015-01-01

    The tibiofibular syndesmosis provides stability to the ankle mortise. The ankle syndesmosis is compromised in all Weber C type injuries. The radiographic method described by Merle DAubigné considers the bony relationships as a measure of syndesmotic widening. We sought to investigate whether the patients with a C type ankle fracture treated with ORIF and placement of a transyndesmal screw have an increment of the tibiofibular space and decrease of the tibiofibular overlap after the transyndesmal screw is removed. Our sample included 52 patients with Weber C ankle fractures treated by ORIF and transyndesmal screw at a level II trauma center. We measured the tibiofibular clear space and tibiofibular overlap in each phase of the treatment. The transyndesmal screw was removed at day 55.56 (± 21.83). We found an increase of the tibiofibular overlap of 0.20 mm (± 2.29, p = 0.532); and 0.21 mm (± 0.97, p = 0.146) in the tibiofibular clear space. The changes of 2.38% in the tibiofibular overlap and 5.29% in the tibiofibular clear space between the postoperative and post-removal periods were not statistically significant. After removal of the syndesmal screw, there is a slight radiographic broadening of the syndesmosis; however, it is small and statistically not significant. PMID:27403518

  17. [Talus fractures--fractures of the most important tarsal bone].

    PubMed

    Klaue, K

    2004-07-01

    The talus is the key bone of the foot due to its location between the ankle and the subtalar joints. Through the flexion and extension of the ankle joint, the talus is the "propulsive bone" situated at the root of the first ray and the hallux. Through the subtalar and talo-navicular joints, the talus allows the foot to be "suspended" using a fancy spring mechanism involving ligaments and tendons. The talus thus transmits forces through two important joints without any direct muscular constraint. The talo-calcaneo-navicular joint may be called the "coxa pedis" due to the anatomical and functional similitudes with the coxofemoral joint ("coxa pelvis"). Fractures of the talus are rare. Talus fractures can be classified in "central" and "peripheral" fractures. Central fractures occur through a strong axial blow provided that the ankle and coxa pedis are locked by extrinsic muscular contraction. Peripheral fractures instead occur in an extreme position of the ankle or the coxa pedis, with a subluxation or complete dislocation of one or more of those joints. Central fractures produce a bony solution of continuity in between at least two of the ankle, subtalar and talo-navicular joints. Peripheral fractures mostly do implement joint surfaces which are sheared off. Aim of treating talus fractures is precise and stable reduction of the fragments because most often, the fractures cross the articular layers. The surgical approaches are critical, especially in displaced central fractures, because the reduction may require visual control all around the bone. There are three approaches which might be used as single approaches or combined simultaneously: the anteromedial approach along the subtalar joint from the navicular to the retro-malleolar region, the anterolateral approach centered on the sinus tarsi (Ollier) and the postero-lateral approach (Gallie). In many cases, a joint distraction device may help visualization of the different joint spaces as well as assist reduction

  18. Ankle injuries in basketball players.

    PubMed

    Leanderson, J; Nemeth, G; Eriksson, E

    1993-01-01

    We carried out a retrospective study of the frequency of ankle sprains in basketball players. A questionnaire about previous ankle injuries, time off after such injuries, current ankle problems, personal data, number of practice hours and the use of prophylactic measures was sent out to 102 basketball players in a second division league in Sweden. Ninety-six players answered. 92% of them had suffered an ankle sprain while playing basketball, and of these 83% reported repeated sprains of one ankle. In the last two seasons, 78% of the players had injured at least one ankle. The injury frequency in the investigation was 5.5 ankle injuries per 1000 activity hours. 22% of the players used some kind of prophylactic support of their ankle joints. Because of the great number of ankle sprains and the disability in terms of time away from sports that they cause, prevention of these injuries is essential. PMID:8536029

  19. The effect of ankle joint muscle strengthening training and static muscle stretching training on stroke patients' C.o.p sway amplitude.

    PubMed

    Kim, Tae Ho; Yoon, Joo Soo; Lee, Jin Hwan

    2013-12-01

    [Purpose] This study implement ankle joint dorsiflexion training for ankle muscle the weakness that impairs stroke patients' gait performance, to examine the effect of the training on stroke patients' plantar pressure and gait ability. [Subjects and Methods] In this study, 36 stroke patients diagnosed with stroke due to cerebral infarction or cerebral hemorrhage performed the training. Static muscle stretching was performed four times a week for 20 minutes at a time for 6 weeks by the training group. Ankle dorsiflexor training was performed four times a week, two sets per time in the case of females and three sets per time in the case of males for 6 weeks, by another group. Center of pressure sway amplitude was measured using the F-scan system during gait. All subjects were assessed with the same measurements at a pre-study examination and reassessed at eight weeks. Data were analyzed statistically using the paired t-test and one-way ANOVA. [Results] Among the between ankle dorsiflexor training group, static muscle stretching group, and control group, the difference before and after the training were proven to be statistically significant. [Conclusion] Compared to other training groups, the ankle muscle strength training group showed statistically significant increases of forward thrust at stroke patients' toe-off which positively affected stroke patients' ability to perform gait. PMID:24409032

  20. Bilateral Ankle and Subtalar Joint Fusion Secondary to Guillain Barré-Induced Foot Drop.

    PubMed

    Seidel, Jay; Mathew, Bindu; Marks, Jeffrey

    2016-01-01

    Guillain-Barré syndrome is a serious disorder that occurs when the body's immune system mistakenly attacks the peripheral nervous system. This leads to nerve inflammation and damage that can cause muscle weakness and/or paralysis, including foot drop. Therapy ranges from supportive measures, such as physical therapy, to surgical intervention. It appears from the published data that these patients, generally, have been left to their own devices, because no known cure is available, necessitating reliance on others for their daily activities and ambulation. We present a unique surgical option, with a follow-up period of 24 months, in which bilateral subtalar and ankle fusion allowed unassisted ambulation to a patient who might otherwise have never walked again. PMID:25128306

  1. Topography of human ankle joint: focused on posterior tibial artery and tibial nerve.

    PubMed

    Kim, Deog-Im; Kim, Yi-Suk; Han, Seung-Ho

    2015-06-01

    Most of foot pain occurs by the entrapment of the tibial nerve and its branches. Some studies have reported the location of the tibial nerve; however, textbooks and researches have not described the posterior tibial artery and the relationship between the tibal nerve and the posterior tibial artery in detail. The purpose of this study was to analyze the location of neurovascular structures and bifurcations of the nerve and artery in the ankle region based on the anatomical landmarks. Ninety feet of embalmed human cadavers were examined. All measurements were evaluated based on a reference line. Neurovascular structures were classified based on the relationship between the tibial nerve and the posterior tibial artery. The bifurcation of arteries and nerves were expressed by X- and Y-coordinates. Based on the reference line, 9 measurements were examined. The most common type I (55.6%), was the posterior tibial artery located medial to the tibial nerve. Neurovascular structures were located less than 50% of the distance between M and C from M at the reference line. The bifurcation of the posterior tibial artery was 41% in X-coordinate, -38% in Y-coordinate, and that of the tibial nerve was 48%, and -10%, respectively. Thirteen measurements and classification showed statistically significant differences between both sexes (P<0.05). It is determined the average position of neurovascular structures in the human ankle region and recorded the differences between the sexes and amongst the populations. These results would be helpful for the diagnosis and treatment of foot pain. PMID:26140224

  2. Therapeutic Experience on Stance Control Knee-Ankle-Foot Orthosis With Electromagnetically Controlled Knee Joint System in Poliomyelitis

    PubMed Central

    Kim, Jung-Hwan; Ji, Sang-Goo; Jung, Kang-Jae

    2016-01-01

    A 54-year-old man with poliomyelitis had been using a conventional, passive knee-ankle-foot orthosis (KAFO) with a drop ring lock knee joint for about 40 years. A stance control KAFO (SCKAFO) with an electromagnetically controlled (E-MAG) knee joint system was prescribed. To correct his gait pattern, he also underwent rehabilitation therapy, which included muscle re-education, neuromuscular electrical stimulation, strengthening exercises for the lower extremities, and balance training twice a week for about 4 months. Both before and after rehabilitation, we conducted a gait analysis and assessed the physiological cost index in energy expended during walking in a locked-knee state and while he wore a SCKAFO with E-MAG. When compared with the pre-rehabilitation data, the velocity, step length, stride length, and knee kinematic data were improved after rehabilitation. Although the SCKAFO with E-MAG system facilitated the control of knee motion during ambulation, appropriate rehabilitative therapy was also needed to achieve a normal gait pattern. PMID:27152288

  3. Therapeutic Experience on Stance Control Knee-Ankle-Foot Orthosis With Electromagnetically Controlled Knee Joint System in Poliomyelitis.

    PubMed

    Kim, Jung-Hwan; Ji, Sang-Goo; Jung, Kang-Jae; Kim, Jae-Hyung

    2016-04-01

    A 54-year-old man with poliomyelitis had been using a conventional, passive knee-ankle-foot orthosis (KAFO) with a drop ring lock knee joint for about 40 years. A stance control KAFO (SCKAFO) with an electromagnetically controlled (E-MAG) knee joint system was prescribed. To correct his gait pattern, he also underwent rehabilitation therapy, which included muscle re-education, neuromuscular electrical stimulation, strengthening exercises for the lower extremities, and balance training twice a week for about 4 months. Both before and after rehabilitation, we conducted a gait analysis and assessed the physiological cost index in energy expended during walking in a locked-knee state and while he wore a SCKAFO with E-MAG. When compared with the pre-rehabilitation data, the velocity, step length, stride length, and knee kinematic data were improved after rehabilitation. Although the SCKAFO with E-MAG system facilitated the control of knee motion during ambulation, appropriate rehabilitative therapy was also needed to achieve a normal gait pattern. PMID:27152288

  4. Ankle Fractures and Modality of Hospital Transport at a Single Level 1 Trauma Center: Does Transport by Helicopter or Ground Ambulance Influence the Incidence of Complications?

    PubMed

    Greenberg, Sarah E; Ihejirika, Rivka C; Sathiyakumar, Vasanth; Lang, Maximilian F; Estevez-Ordonez, Dagoberto; Prablek, Marc A; Chern, Alexander Y; Thakore, Rachel V; Obremskey, William T; Joyce, David; Sethi, Manish K

    2015-01-01

    In an era of concern over the rising cost of health care, cost-effectiveness of auxiliary services merits careful evaluation. We compared costs and benefits of Helicopter Emergency Medical Service (HEMS) with Ground Emergency Medical Service (GEMS) in patients with an isolated ankle fracture. A medical record review was conducted for patients with an isolated ankle fracture who had been transported to a level 1 trauma center by either HEMS or GEMS from January 1, 2000 to December 31, 2010. We abstracted demographic data, fracture grade, complications, and transportation mode. Transportation costs were obtained by examining medical center financial records. A total of 303 patients was included in the analysis. Of 87 (28.71%) HEMS patients, 53 (60.92%) had sustained closed injuries and 34 (39.08%) had open injuries. Of the 216 (71.29%) GEMS patients, 156 (72.22%) had closed injuries and 60 (27.78%) had open injuries. No significant difference was seen between the groups regarding the percentage of patients with open fractures or the grade of the open fracture (p = .07). No significant difference in the rate of complications was found between the 2 groups (p = 18). The mean baseline cost to transport a patient via HEMS was $10,220 + a $108/mile surcharge, whereas the mean transport cost using GEMS was $976 per patient + $16/mile. Because the HEMS mode of emergency transport did not significantly improve patient outcomes, health systems should reconsider the use of HEMS for patients with isolated ankle fractures. PMID:25840759

  5. A retrospective study of temporomandibular joint ankylosis secondary to surgical treatment of mandibular condylar fractures.

    PubMed

    Xiang, Guo-lin; Long, Xing; Deng, Mo-hong; Han, Qian-chao; Meng, Qing-gong; Li, Bo

    2014-03-01

    We investigated the incidence of ankylosis of the temporomandibular joint (TMJ) after open operations for fractures of the mandibular condyle, and analysed possible risk factors in a total of 385 patients with 492 condylar fractures who had been operated on in our department from 2001 to 2010. Sixteen patients developed postoperative ankylosis of the TMJ with 26 joints (5%) affected during a follow-up of 6 months-10 years. Of the 492 condylar fractures, the most common ones that were associated with postoperative ankylosis were those of the condylar head (20/248), followed by the condylar neck (6/193). Subcondylar fractures did not cause postoperative ankylosis (0/51). Among the 16 patients with postoperative ankylosis, 13 had associated anterior mandibular fractures. Long-screw (bicortical screw) fixation of fractures of the condylar head seemed to be associated with a lower incidence of postoperative ankylosis than fixation by miniplate and wire or removal of the fractured fragment. The articular discs were damaged in all ankylosed joints, and the remaining fractured fragment was found in 10 ankylosed joints after fractures of the condylar head. The results suggest that fractures of the condylar head are more prone to lead to postoperative ankylosis of the TMJ, and that the possible risk factors seem to include the technique used for fixation and damage to the disc, together with an anterior mandibular fracture with the fractured fragment remaining. PMID:24485809

  6. Differences Regarding Branded HA in Italy, Part 2: Data from Clinical Studies on Knee, Hip, Shoulder, Ankle, Temporomandibular Joint, Vertebral Facets, and Carpometacarpal Joint

    PubMed Central

    Migliore, A.; Bizzi, E.; De Lucia, O.; Delle Sedie, A.; Tropea, S.; Bentivegna, M.; Mahmoud, A.; Foti, C.

    2016-01-01

    OBJECTIVES The aim of the current study is to collect scientific data on all branded hyaluronic acid (HA) products in Italy that are in use for intra-articular (IA) injection in osteoarthritis (OA) compared with that reported in the leaflet. METHODS An extensive literature research was performed for all articles reporting data on the IA use of HA in OA. Selected studies were taken into consideration only if they are related to products based on HAs that are currently marketed in Italy with the specific joint indication for IA use in patients affected by OA. RESULTS Sixty-two HA products are marketed in Italy: 30 products are indicated for the knee but only 8 were proved with some efficacy; 9 products were effective for the hip but only 6 had hip indication; 7 products proved to be effective for the shoulder but only 3 had the indication; 5 products proved effective for the ankle but only one had the indication; 6 products were effective for the temporomandibular joint but only 2 had the indication; only 2 proved effective for vertebral facet joints but only 1 had the indication; and 5 products proved effective for the carpometacarpal joint but only 2 had the indication. CONCLUSIONS There are only a few products with some evidences, while the majority of products remain without proof. Clinicians and regulators should request postmarketing studies from pharmaceuticals to corroborate with that reported in the leaflet and to gather more data, allowing the clinicians to choose the adequate product for the patient. PMID:27279754

  7. Doctor, I sprained my ankle.

    PubMed

    How, Choon How; Tan, Ken Jin

    2014-10-01

    Ankle sprains constitute the majority of ankle injuries, and result in pain, limited mobility/exercise and loss of school/work days. Ankle sprains involve at least one of the ankle ligaments and range from a micro tear to complete tear of the ligament or group of ligaments. The most common mechanism of ankle sprains is inversion stress of a plantar-flexed foot, while the most frequently injured ligament is the anterior talofibular ligament. The attending clinician needs to stratify the risk of fracture through history-taking and physical examination, manage the pain, assess long‑term complications and provide certification for rest and recovery. The Ottawa ankle rules may be useful. Graduated exercises to maintain the ankle's range of motion should be started early, after the resolution of initial pain and swelling. The risk of recurrent ankle injuries is often a combination of both mechanical and functional disabilities. PMID:25631892

  8. Fracture toughness of thick section dissimilar electron beam weld joints

    SciTech Connect

    Kocak, M.; Junghans, E.

    1994-12-31

    Microstructural investigations as well as crack tip opening displacement (CTOD) fracture toughness test based on elastic-plastic fracture mechanics were performed on single pass, full penetration similar and dissimilar electron beam (EB) welds of 40 mm thick 316L type austenitic steel and high alloyed fine tempered martensitic 9Cr 1Mo Nb V (P91 -ASTM A213) steel. The latter modified steel has been developed to fill up the gap between 12Cr steel and austenitic stainless steels with respect to the high temperature properties and better weldability. Furthermore, it shows a small thermal expansion coefficient and is not susceptible to stress corrosion cracking like the austenitic steel. The weldment properties were evaluated by microstructural analysis, microhardness, Charpy V- notch impact, and by newly developed flat microtensile specimens (0.5 mm thick). The dissimilar EB weld metal and HAZ of P91 steel has been shown to be microstructurally and mechanically distinct from both austenitic and martenistic parent metals. The use of microsized rectangular tensile specimens provides unique solution to the problem of the mechanical property determination of the narrow EB weld joint. The HAZ of the 9Cr1Mo steel exhibits extremely poor CTOD toughness properties in as-welded condition at room temperature. The CTOD values obtained were believed to be represent the intrinsic property of this zone, since the distance of the crack tip to the austenitic steel part was too large to receive a stress relaxation effect from low strength side on the crack tip (by accommodating the applied strains in the high toughness, lower strength 316L plate).

  9. SUBJECT-SPECIFIC MODELS REVEAL THE EXISTANCE OF A RELATIONSHIP BETWEEN MORPHOLOGY OF THE ANKLE JOINT COMPLEX AND ITS PASSIVE MECHANICAL PROPERTIES

    PubMed Central

    Imhauser, Carl W.; Siegler, Sorin; Udupa, Jayaram K.; Toy, Jason

    2008-01-01

    The morphology of the bones, articular surfaces and ligaments and the passive mechanical characteristics of the ankle complex were reported to vary greatly among individuals. The goal of this study was to test the hypothesis that the variations observed in the passive mechanical properties of the healthy ankle complex are strongly influenced by morphological variations. To evaluate this hypothesis six numerical models of the ankle joint complex were developed from morphological data obtained from MRI of six cadaver lower limbs, and from average reported data on the mechanical properties of ligaments and articular cartilage. The passive mechanical behavior of each model, under a variety of loading conditions, was found to closely match the experimental data obtained from each corresponding specimen. Since all models used identical material properties and were subjected to identical loads and boundary conditions, it was concluded that the observed variations in passive mechanical characteristics were due to variations in morphology, thus confirming the hypothesis. In addition, the average and large variations in passive mechanical behavior observed between the models were similar to those observed experimentally between cadaver specimens. The results suggest that individualized subject-specific treatment procedures for ankle complex disorders are potentially superior to one-size-fits-all approach. PMID:18316088

  10. Effect of Ankle Joint Contact Angle and Ground Contact Time on Depth Jump Performance.

    PubMed

    Phillips, Joshua H; Flanagan, Sean P

    2015-11-01

    Athletes often need to both jump high and get off the ground quickly, but getting off the ground quickly can decrease the vertical ground reaction force (VGRF) impulse, impeding jump height. Energy stored in the muscle-tendon complex during the stretch-shortening cycle (SSC) may mitigate the effects of short ground contact times (GCTs). To take advantage of the SSC, several coaches recommend "attacking" the ground with the foot in a dorsiflexed (DF) position at contact. However, the efficacy of this technique has not been tested. This investigation tested the hypotheses that shorter GCTs would lead to smaller vertical depth jump heights (VDJH), and that this difference could be mitigated by instructing the athletes to land in a DF as opposed to a plantar flexed (PF) foot position. Eighteen healthy junior college athletes performed depth jumps from a 45-cm box onto force platforms under instruction to achieve one of the 2 objectives (maximum jump height [hmax] or minimal GCT [tmin]), with one of the 2 foot conditions (DF or PF). These variations created 4 distinct jump conditions: DF-hmax, DF-tmin, PF-hmax, and PF-tmin. For all variables examined, there were no significant interactions. For all 4 conditions, the ankle was PF during landing, but the DF condition was 28.87% less PF than the PF condition. The tmin conditions had a 23.48% shorter GCT than hmax. There were no significant main effects for jump height. The peak impact force for tmin was 22.14% greater than hmax and 19.11% greater for DF compared with PF conditions. A shorter GCT did not necessitate a smaller jump height, and a less PF foot did not lead to improvements in jump height or contact time during a depth jump from a 45-cm box. The same jump height was attained in less PF and shorter GCT conditions by larger impact forces. To decrease contact time while maintaining jump height, athletes should be instructed to "get off the ground as fast as possible." This cue seems to be more important than foot

  11. Use of noninvasive interactive neurostimulation to improve short-term recovery in patients with surgically repaired bimalleolar ankle fractures: a prospective, randomized clinical trial.

    PubMed

    Gorodetskyi, Igor G; Gorodnichenko, Anatolyi I; Tursin, Petr S; Reshetnyak, Vitalyi K; Uskov, Oleg N

    2010-01-01

    We undertook a trial with 60 patients who had undergone operative reduction and internal fixation of bimalleolar, AO type B2 ankle fractures with comminution. Patients were randomized into 2 groups, one of which received postoperative treatment using a noninvasive interactive neurostimulation device (InterX) and the other with a sham device. The trial was designed to test the hypothesis that incorporation of noninvasive interactive neurostimulation into the rehabilitation protocol would result in reduced pain, increased range of motion, reduced edema, and reduced consumption of pain medication, in comparison with the sham therapy group. Outcome measurements included the patient's subjective assessment of level of pain, range of motion, and the extent of edema in the involved ankle, and the use of ketorolac for postoperative control of pain. The results showed significantly better results in the patients receiving treatment with active neurostimulation (repeated measures analysis of variance, P < .001). PMID:20688546

  12. Doctor, I sprained my ankle

    PubMed Central

    How, Choon How; Tan, Ken Jin

    2014-01-01

    Ankle sprains constitute the majority of ankle injuries, and result in pain, limited mobility/exercise and loss of school/work days. Ankle sprains involve at least one of the ankle ligaments and range from a micro tear to complete tear of the ligament or group of ligaments. The most common mechanism of ankle sprains is inversion stress of a plantar-flexed foot, while the most frequently injured ligament is the anterior talofibular ligament. The attending clinician needs to stratify the risk of fracture through history-taking and physical examination, manage the pain, assess long-term complications and provide certification for rest and recovery. The Ottawa ankle rules may be useful. Graduated exercises to maintain the ankle’s range of motion should be started early, after the resolution of initial pain and swelling. The risk of recurrent ankle injuries is often a combination of both mechanical and functional disabilities. PMID:25631892

  13. Ankle Arthroscopic Reconstruction of Lateral Ligaments (Ankle Anti-ROLL)

    PubMed Central

    Takao, Masato; Glazebrook, Mark; Stone, James; Guillo, Stéphane

    2015-01-01

    Ankle instability is a condition that often requires surgery to stabilize the ankle joint that will improve pain and function if nonoperative treatments fail. Ankle stabilization surgery may be performed as a repair in which the native existing anterior talofibular ligament or calcaneofibular ligament (or both) is imbricated or reattached. Alternatively, when native ankle ligaments are insufficient for repair, a reconstruction of the ligaments may be performed in which an autologous or allograft tendon is used to reconstruct the anterior talofibular ligament or calcaneofibular ligament (or both). Currently, ankle stabilization surgery is most commonly performed through an open incision, but arthroscopic ankle stabilization using repair techniques has been described and is being used more often. We present our technique for anatomic ankle arthroscopic reconstruction of the lateral ligaments (anti-ROLL) performed in an all–inside-out manner that is likely safe for patients and minimally invasive. PMID:26900560

  14. Joint evaluation of fracture azimuth by electromagnetic wave and elastic wave

    NASA Astrophysics Data System (ADS)

    Feng, Xuan; Liu, Cai; Wang, Qiao; Wang, Kai; Lu, Qi; Xue, Jian; Liang, Wenjing; Yu, Yue; Ren, Qianci

    2013-12-01

    With the multi-wave, multi-component seismic wave exploration, one can apply the anisotropy of fracture media to analyze the attributes of the fracture media, including the fracture azimuth. In the meantime, the techniques of full-polarimetric electromagnetic wave, including full-polarimetric borehole radar, can also be used to analyze the attributes of the fracture. However, the analysis precision of both the multi-component elastic wave exploration and full-polarimetric electromagnetic wave exploration is prone to the influence of noise and other factors. So far, some researchers have conducted studies on the joint inversion of electromagnetic waves and seismic waves. This paper develops evaluation techniques of fracture azimuth by electromagnetic wave, elastic wave, and joint analysis of coincident elastic reflection and electromagnetic data. Firstly, based on the shear wave splitting of elastic waves, this paper develops a statistical analysis technique which applies Pearson correlation coefficient to count and analyze the azimuth angle of fracture. Secondly, based on the information of electromagnetic polarization rotated by fracture, this paper develops a statistical analysis method of full-polarimetric electromagnetic waves which applies the maximum amplitude ratio between the co-polarization and cross-polarization to analyze the azimuth angle of fracture. Furthermore, based on the analysis result of the elastic wave and full-polarimetric electromagnetic wave, this paper develops a joint analysis technique which adopts the standard deviation. At last, authors in this study conduct joint detection experiments on the coincident fracture medium by using the ultrasonic and full-polarimetric ground penetrating radar. The experimental result indicates that both single geophysical methods are capable of analyzing the fracture azimuth angle, but the joint analysis is more accurate.

  15. Radial sesamoid fracture of the second MCP joint – a case report

    PubMed Central

    Walentowska-Janowicz, Marta; Nowicki, Paweł; Płaza, Mateusz; Sudoł-Szopińska, Iwona

    2015-01-01

    A fracture of the sesamoid bone of the hand is rarely seen. In most cases, it is strictly associated with the trauma. The patient complains of a long-lasting, due to unclear diagnosis, painful swelling of the joint with an inability to flex the affected finger. Limited blood supply makes the untreated fracture prone to avascular necrosis. Thus, it is extremely important to make a proper diagnosis early. Bilateral comparing the affected areas with ultrasonography seems to be the method of choice. The treatment is conservative or surgical when needed. We present a case of a radial sesamoid fracture of the second metacarpophalangeal joint without a history of trauma. PMID:26675122

  16. [The supinator fat pad in fractures of the elbow joint].

    PubMed

    Schunk, K; Grossholz, M; Schild, H

    1989-03-01

    The position of the supinator fat pad is regarded as a valuable sign in fractures of the elbow. In our patients the pad was visible in 277 out of 337 cases (82%). The sign was positive in only 27 out of 55 proximal fractures of the radius (sensitivity 0.49). There was no correlation between the severity of the fracture and the sign. There was marked variation in the distance between the pad and the radius, depending on age, build and projection. Our results indicate that the sign is not suitable for the diagnosis of fracture of the elbow. PMID:2538879

  17. Temporomandibular joint ankylosis caused by chondroid hyperplasia from the callus of condylar neck fracture.

    PubMed

    Kim, Soung Min; Park, Jung Min; Kim, Ji Hyuck; Kwon, Kwang Jun; Park, Young Wook; Lee, Jong Ho; Lee, Sang Shin; Lee, Suk Keun

    2009-01-01

    A patient who complained of difficulty in opening his mouth after condylar neck fracture 1 year ago presented typical features of temporomandibular joint ankylosis in clinical and radiologic examinations. To demonstrate a possible pathogenesis of temporomandibular joint ankylosis after condylar neck fracture, the fractured condylar portion removed was examined by histologic and immunohistochemical stainings. Interpositional gap arthroplasty was performed by removing the inferomesially displaced fractured condyle, and reconstruction with subcutaneous dermis to the previous vertical height was performed immediately. The fractured condylar portion was almost intact with slight erosion of the condylar cartilage. In the hematoxylin and eosin and Masson trichrome stainings, an extensive chondroid hyperplasia with abundant hyaline cartilage was shown in the removed condylar portion. There were also hyperplastic features of the synovial membrane, which were abnormally distributed throughout the chondroid tissues. In the immunohistochemical stainings of proliferating cell nuclear antigen (PCNA) and bone morphogenetic protein (BMP)-2 and BMP-4, the chondroid tissues were conspicuously hyperplastic and strongly positive for BMP-4 but sparse for BMP-2. From these results, we think that the hyperplastic chondroid tissue was derived from the callus of the primary fractured site of the condylar neck and propose that the chondroid tissue could proliferate continuously because of synovial tissue support from around the temporomandibular joint, resulting in temporomandibular joint ankylosis. This pathogenesis is quite different from those of other diaphyseal fracture of long bones. PMID:19165036

  18. Fracture of the articular disc in the temporomandibular joint: two case reports

    PubMed Central

    An, S-Y

    2015-01-01

    Disc fracture of the temporomandibular joint (TMJ) is a little-known pathological condition owing to its extreme rarity. We report two cases of elderly patients who were diagnosed with disc fracture of the TMJ based on MRI, and we review related reports. On physical examination, an incomplete bite and mild joint pain were observed on the affected side in both patients. An MRI showed a complete fracture in the intermediate zone of the articular disc in the TMJ; the posterior fragment was displaced posteriorly, causing occlusal change in the closed position of the condyle and an incomplete bite. Conservative treatment including manual manipulation, physical therapy and oral appliance had no effect on the occlusal abnormality. Although the inciting cause of the disc fracture remained unclear, the degenerative changes in the joint may have been a factor by increasing the brittleness and reducing the elasticity of the disc. PMID:25308829

  19. ANKLE JOINT CONTROL DURING SINGLE-LEGGED BALANCE USING COMMON BALANCE TRAINING DEVICES – IMPLICATIONS FOR REHABILITATION STRATEGIES

    PubMed Central

    Strøm, Mark; Thorborg, Kristian; Bandholm, Thomas; Tang, Lars; Zebis, Mette; Nielsen, Kristian

    2016-01-01

    ABSTRACT Background A lateral ankle sprain is the most prevalent musculoskeletal injury in sports. Exercises that aim to improve balance are a standard part of the ankle rehabilitation process. In an optimal progression model for ankle rehabilitation and prevention of future ankle sprains, it is important to characterize different balance exercises based on level of difficulty and sensori-motor training stimulus. Purpose The purpose of this study was to investigate frontal-plane ankle kinematics and associated peroneal muscle activity during single-legged balance on stable surface (floor) and three commonly used balance devices (Airex®, BOSU® Ball and wobble board). Design Descriptive exploratory laboratory study. Methods Nineteen healthy subjects performed single-legged balance with eyes open on an Airex® mat, BOSU® Ball, wobble board, and floor (reference condition). Ankle kinematics were measured using reflective markers and 3-dimensional recordings and expressed as inversion-eversion range of motion variability, peak velocity of inversion and number of inversion-eversion direction changes. Peroneus longus EMG activity was averaged and normalized to maximal activity during maximum voluntary contraction (MVC), and in addition amplitude probability distribution function (APDF) between 90 and 10% was calculated as a measure of muscle activation variability. Results Balancing on BOSU® Ball and wobble board generally resulted in increased ankle kinematic and muscle activity variables, compared to the other surfaces. BOSU® Ball was the most challenging in terms of inversion-eversion variability while wobble board was associated with a higher number of inversion-eversion direction changes. No differences in average muscle activation level were found between these two surfaces, but the BOSU® Ball did show a more variable activation pattern in terms of APDF. Conclusion The results showed large kinematic variability among different balance training devices and

  20. The surface geometry of inherited joint and fracture trace patterns resulting from active and passive deformation

    NASA Technical Reports Server (NTRS)

    Podwysocki, M. H.; Gold, D. P.

    1974-01-01

    Hypothetical models are considered for detecting subsurface structure from the fracture or joint pattern, which may be influenced by the structure and propagated to the surface. Various patterns of an initially orthogonal fracture grid are modeled according to active and passive deformation mechanisms. In the active periclinal structure with a vertical axis, fracture frequency increased both over the dome and basin, and remained constant with decreasing depth to the structure. For passive periclinal features such as a reef or sand body, fracture frequency is determined by the arc of curvature and showed a reduction over the reefmound and increased over the basin.

  1. Measurement of adhesive joint fracture properties as a function of environmental degradation

    SciTech Connect

    Wylde, J.W.; Spelt, J.K.

    1996-12-31

    The increased use of structural adhesives in industry would benefit from a comprehensive failure load prediction tool to ensure competent design. The work of Fernlund and Spelt has proposed a fracture envelope that relates the critical strain energy release rate to the nominal phase angle of loading. The work of Plasinus and Spelt extended this work to incorporate the viscoelastic effect of the adhesive. The objective of the present research is to incorporate the effects of temperature and water absorption into the prediction of adhesive joint fracture. Ample evidence exists to demonstrate the notion that absorbed water has an effect predominantly detrimental, on the strength of an adhesive joint. Past work was concentrated on degrading typical, in service joints such as the Single Lap Shear (SLS) joint or the Cracked Lap Shear (CLS) joint. Since water is absorbed through the exposed edges, typically small in area compared to the volume of the joint, degradation times are usually long and the water concentration varies both with time and spatially throughout the joint. In this research, a novel method of degrading adhesive fracture specimens to a spatially constant degradation condition is being used to incorporate environmental effects into the fracture load prediction tool of Spelt et al.

  2. Movement within foot and ankle joint in children with spastic cerebral palsy: a 3-dimensional ultrasound analysis of medial gastrocnemius length with correction for effects of foot deformation

    PubMed Central

    2013-01-01

    Background In spastic cerebral palsy (SCP), a limited range of motion of the foot (ROM), limits gait and other activities. Assessment of this limitation of ROM and knowledge of active mechanisms is of crucial importance for clinical treatment. Methods For a comparison between spastic cerebral palsy (SCP) children and typically developing children (TD), medial gastrocnemius muscle-tendon complex length was assessed using 3-D ultrasound imaging techniques, while exerting externally standardized moments via a hand-held dynamometer. Exemplary X-ray imaging of ankle and foot was used to confirm possible TD-SCP differences in foot deformation. Results SCP and TD did not differ in normalized level of excitation (EMG) of muscles studied. For given moments exerted in SCP, foot plate angles were all more towards plantar flexion than in TD. However, foot plate angle proved to be an invalid estimator of talocrural joint angle, since at equal foot plate angles, GM muscle-tendon complex was shorter in SCP (corresponding to an equivalent of 1 cm). A substantial difference remained even after normalizing for individual differences in tibia length. X-ray imaging of ankle and foot of one SCP child and two typically developed adults, confirmed that in SCP that of total footplate angle changes (0-4 Nm: 15°), the contribution of foot deformation to changes in foot plate angle (8) were as big as the contribution of dorsal flexion at the talocrural joint (7°). In typically developed individuals there were relatively smaller contributions (10 -11%) by foot deformation to changes in foot plate angle, indicating that the contribution of talocrural angle changes was most important. Using a new estimate for position at the talocrural joint (the difference between GM muscle–tendon complex length and tibia length, GM relative length) removed this effect, thus allowing more fair comparison of SCP and TD data. On the basis of analysis of foot plate angle and GM relative length as a function

  3. Search the Foot and Ankle: Interactive Foot Diagram

    MedlinePlus

    ... Text Size Print Bookmark Search the Foot and Ankle Foot conditions in this region: Bunions (Hallux Valgus) » ... Injuries » Posterior Tibial Tendon Dysfunction (PTTD) » Tarsal Coalition » Ankle Fractures » Ankle Sprain » Chronic Ankle Instability » Equinus » Gout » ...

  4. Closed Talar Dislocation without Associated Fracture a Very Rare Injury, a Case Report

    PubMed Central

    Kumar, Yashavntha C; Reddy, Sandeep; Golla, Dinesh Kumar; Ganesh, Niranthara

    2014-01-01

    Introduction: Total talar dislocations are uncommon injuries and usually seen following high velocity injuries. Total talar dislocations (missing talus) without fractures around the ankle are extremely rare. There are no consensuses on the best treatment of such injuries. To best of our knowledge very few cases have been reported in literature. We hereby report a closed total talar dislocation in a 25 year old male without an associated fracture around ankle. He was managed with emergency closed reduction and below knee splint. At one year follow up there were no complications. Case Report: A 25 year old male presented to orthopaedic causality with injury to right ankle following a road traffic accident. Patient complained of severe pain and deformity of ankle following injury. On examination ankle was deformed and swollen. Plain radiographs of right ankle joint revealed total anterolateral dislocation of talus without any accompanying ankle fracture. CT scan with 3D reconstruction also confirmed our radiographic findings. Under spinal anaesthesia and fluoroscopic guidance closed reduction was performed. To maintain reduction a 3mm K-wire was passed from calcaneum to tibia through talus. A posterior below knee splint was applied. Patient was followed every three months till one year. At one year follow up patient had good range of motion at ankle and subtalar joint. Conclusion: Total talar dislocations are very rare injuries and should be treated as impending open fractures. There is no consensus on treatment of such complex injuries as very few cases have been reported in literature. PMID:27298950

  5. [The Use of Pedobarographic Examination to Biomechanical Evaluation of Foot and Ankle Joint in Adult - Own Experience].

    PubMed

    Lorkowski, Jacek; Grzegorowska, Oliwia; Kotela, Ireneusz

    2015-01-01

    A non-invasive method, that can be used to describe the underfoot pressure distribution during stance and gait, is pedobarography. This examination helps to describe biomechanics of foot and ankle. It has been used to diagnose foot disorders, assess the disease progression, monitor the progress of rehabilitation and also evaluate the effectivness of undergone surgical treatment. In this article we describe chosen issues of pedobarographic examination in diagnostics and treatment of foot and ankle in adults. We base on our own experience (about 10 thousand examinations) and review of literature. In our opinion, pedobarography should be used in diagnostics and treatment of foot and ankle more often and widely than now. PMID:26248765

  6. Joints and Mineral Veins in Limestone-Marl Alternations: Arrest and Fracture Frequencies

    NASA Astrophysics Data System (ADS)

    Philipp, S. L.; Reyer, D.

    2009-05-01

    Layering is a common feature of many rock masses. In particular, many sedimentary rocks are layered because of depositional changes (stratification), and diagenetic processes. Mechanical layering, where the mechanical properties, particularly the Young's moduli (stiffness), change between layers, may coincide with changes in grain size, mineral content or facies. The mechanical layering of the rock is important because layering commonly results in abrupt changes in local stress fields that may lead to fracture arrest. However, if all the beds in a rock mass have essentially the same Young's modulus and their contacts are welded together (sealed or healed) the beds may function mechanically as a single layer. Here we explore how mechanical layers relate to sedimentary layers in limestone-marl alternations. This we do by investigating the effects of sedimentary layering of the host rock, on the emplacement and geometries of extension fractures such as joints and mineral veins. Detailed field studies were carried out at two localities of well-exposed limestone-marl alternations: (1) the Jurassic Blue Lias at the Glamorgan Coast of South Wales, UK, and (2) the Triassic Muschelkalk in the Kraichgau area, Southwest Germany. In both study areas, calcite veins occur almost exclusively in the cores and damage zones of faults, whereas jointing is pervasive. Fracture arrest, common in mechanically layered host rocks, is primarily controlled by local variations in the stress field, mainly due to three factors: discontinuities (fractures and contacts), changes in host rock mechanical properties, and stress barriers, where the local stress field is unfavorable to fracture propagation. These factors are related in that changes in stiffness and stress barriers are common at contacts between different rock types. A fourth mechanism, namely the material toughness (critical strain energy release rate) of the contact in relation to that of the adjacent layers has been much studied in

  7. Ipsilateral Closed Clavicle and Scapular spine Fracture with Acromioclavicular Joint Disruption

    PubMed Central

    Kembhavi, Raghavendra s; James, Boblee

    2015-01-01

    Introduction: Injuries around shoulder and clavicle are quite common. Injuries involving lateral end of clavicle involving acromioclavicular joints are commoner injuries. In this rare injury, we report about a case involving clavicle and scapular spine fracture with acromioclavicular disruption which has never been described in English literature as per our knowledge. Case Report: A patient with closed clavicle and scapular spine fracture with acromioclavicular joint disruption was treated with open reduction and internal fixation of clavicle and scapular spine as a staged procedures. Six months post operatively, patient had excellent functional recovery with near full range of movements. Conclusion: Though rare complex injury, clavicle fracture with scapular spine fracture with acromioclavicular disruption, when managed properly with good physiotherapy protocol post operatively will result in good clinical and functional outcome. PMID:27299047

  8. DIAGNOSIS OF AN ISOLATED POSTERIOR MALLEOLAR FRACTURE IN A YOUNG FEMALE MILITARY CADET: A RESIDENT CASE REPORT

    PubMed Central

    Svoboda, Steven J.; Gerber, J. Parry

    2012-01-01

    Background and Purpose: The ankle is the most commonly injured joint during athletic activity. While ankle sprains are certainly the most common injury, ankle fractures can occur frequently. One type of ankle fracture with a reportedly low incidence is the isolated posterior malleolar fracture. Because of the low incidence, isolated posterior malleolar fractures can present a diagnostic challenge. The purpose of this case report is to describe the diagnostic process used for this rare injury that occurred in a physically active college-aged female who injured her ankle when landing from a fall during performance on a military obstacle course. Case Description: A 19 year old female United States Military Academy cadet presented to a direct access physical therapy clinic. She was limping, not using any assistive device, and was wearing an ace bandage around her right ankle/foot. Two days earlier she fell from a “10 foot high” structure while performing the military obstacle course. She did not recall details of impact, but she was told by several bystanders that it appeared that she landed on her right foot followed immediately by a transition to her buttocks and then to her back. Outcomes: Ottawa Ankle Rules and ligamentous testing were negative; however, she was tender to palpation just anterior to the achilles tendon and lateral to the posterior edge of the medial malleolus. Based on mechanism of injury and tenderness of the posterior ankle, a potential posterior ankle fracture was suspected and subsequently confirmed by radiographic studies of the ankle including standard radiographs and computerized tomography. Discussion: While the Ottawa Ankle Rules are generally effective in detecting many types of ankle fractures, clinicians should not rely solely on such prediction rules. This case highlights the importance of completing a thorough history and performing a thorough physical examination. This case report focuses on differential diagnosis. It is important

  9. Fracture Behaviour of Nickel-Titanium Laser Welded Joints

    NASA Astrophysics Data System (ADS)

    Maletta, C.; Falvo, A.; Furgiuele, F.; Barbieri, G.; Brandizzi, M.

    2009-08-01

    In this study, the effects of Nd:YAG laser welding on the fracture behavior of Ni-rich nickel-titanium sheets are analyzed by experimental investigations. The welding was carried out in open air conditions by using a special shielding/clamping system to avoid the chemical contamination of the molten zone and the formation of hot cracks. Mechanical tests of standard dog bone-shaped and single edge crack specimens were carried out to measure the stress-strain response and the fracture resistance of both the base and the welded materials. Furthermore, scanning electron microscopy observations of the fracture surfaces were carried out in order to better understand the failure mechanisms. Finally, systematic comparative studies between base and laser-welded materials were carried out.

  10. A joint fracture toughness evaluation of hot-pressed beryllium

    NASA Technical Reports Server (NTRS)

    Conrad, H.; Sargent, G. A.; Brown, W. F., Jr.

    1977-01-01

    Fracture toughness tests at room temperature were made on three-point bend specimens cut from hot-pressed beryllium obtained from two suppliers. The test specimens had dimensions conforming to ASTM fracture toughness standard E399-72. A total of 42 specimens were machined from each batch of material. Six specimens from each batch were then distributed to seven independent laboratories for testing. The test data from the laboratories were collected and analyzed for differences between the laboratories and the two batches of material. It is concluded that ASTM 399-72 can be used as a valid test procedure for determining the fracture toughness of beryllium, providing that Kf(max) in fatigue cracking could be up to 80 percent of the K(0) value.

  11. Incorporation of Interfacial Intermetallic Morphology in Fracture Mechanism Map for Sn-Ag-Cu Solder Joints

    NASA Astrophysics Data System (ADS)

    Huang, Z.; Kumar, P.; Dutta, I.; Sidhu, R.; Renavikar, M.; Mahajan, R.

    2014-01-01

    A fracture mechanism map (FMM) is a powerful tool which correlates the fracture behavior of a material to its microstructural characteristics in an explicit and convenient way. In the FMM for solder joints, an effective thickness of the interfacial intermetallic compound (IMC) layer ( t eff) and the solder yield strength ( σ ys,eff) are used as abscissa and ordinate axes, respectively, as these two predominantly affect the fracture behavior of solder joints. Earlier, a definition of t eff, based on the uniform thickness of IMC ( t u) and the average height of the IMC scallops ( t s), was proposed and shown to aptly explain the fracture behavior of solder joints on Cu. This paper presents a more general definition of t eff that is more widely applicable to a range of metallizations, including Cu and electroless nickel immersion gold (ENIG). Using this new definition of t eff, mode I FMM for SAC387/Cu joints has been updated and its validity was confirmed. A preliminary FMM for SAC387/Cu joints with ENIG metallization is also presented.

  12. A Practical Test Method for Mode I Fracture Toughness of Adhesive Joints with Dissimilar Substrates

    SciTech Connect

    Boeman, R.G.; Erdman, D.L.; Klett, L.B.; Lomax, R.D.

    1999-09-27

    A practical test method for determining the mode I fracture toughness of adhesive joints with dissimilar substrates will be discussed. The test method is based on the familiar Double Cantilever Beam (DCB) specimen geometry, but overcomes limitations in existing techniques that preclude their use when testing joints with dissimilar substrates. The test method is applicable to adhesive joints where the two bonded substrates have different flexural rigidities due to geometric and/or material considerations. Two specific features discussed are the use of backing beams to prevent substrate damage and a compliance matching scheme to achieve symmetric loading conditions. The procedure is demonstrated on a modified DCB specimen comprised of SRIM composite and thin-section, e-coat steel substrates bonded with an epoxy adhesive. Results indicate that the test method provides a practical means of characterizing the mode I fracture toughness of joints with dissimilar substrates.

  13. Joint-Preserving Osteotomies for Malaligned Intraarticular Calcaneal Fractures.

    PubMed

    Benirschke, Stephen K; Kramer, Patricia A

    2016-03-01

    Intraarticular calcaneal fracture treatments that result in malalignment often require reconstructive surgery. Seven cases are used to demonstrate the intricacies of reconstructive case management. Reestablishment of calcaneal height, length, orientation, and position relative to the other tarsals is necessary to reestablish appropriate foot function. Inherent or acquired gastrocnemius equinus should be treated with recession to reduce destructive forces on the reconstruction. PMID:26915782

  14. [Ankle sprains: from diagnosis to management. the physiatric view].

    PubMed

    Moreira, Vítor; Antunes, Filipe

    2008-01-01

    Ankle injuries are the most frequently encountered injuries in clinical practice. They are often managed by general practicians, and not only by orthopaedic or physiatric physicians. This injury is usually non-complicated, but some care should be taken to assure an adequate management and to exclude severe lesions. The stability of the ankle is necessary for functional activity of lower extremity, allowing walking and participation in other high demanding activities like running or jumping. There is a constant concern in adopting the best diagnostic and treatment procedures to enhance the recovery and to prevent the chronic joint instability. According to this, there should be proposed comprehensive strategies focusing the rehabilitation view. The ankle is a complex articular structure with contributions from the talocrural, subtalar, and inferior tibiofibular joints. The full understanding of the functional anatomy and biomechanics is the first step for the evaluation of the etiologic factors. The recognition of the mechanism of injury, and the risk factors, should be carefully addressed to make an accurate diagnosis, proper management and to implement prophylactic measures, knowing that the lateral ligamentous complex is the most commonly injured. As always, diagnosis can be made taking an adequate history, performing a thorough physical examination, and when necessary, requesting complementary studies. The priority in initial assessment it's to clear out some severe complications, like fractures, that can mimic or that can be associated with ankle sprains. Although the conventional radiology is suitable for most cases, that has been greatly improved through the institution of the Ottawa Rules, in selected patients the severity of the damage is best evaluated with other imaging resources. Treatment of acute ankle sprains depends on the severity of the injury. Most acute lateral ligament injuries are best treated nonsurgically and will regain satisfactory ankle

  15. Strength and fracture toughness of heterogeneous blocks with joint lognormal modulus and failure strain

    NASA Astrophysics Data System (ADS)

    Dimas, Leon S.; Veneziano, Daniele; Buehler, Markus J.

    2016-07-01

    We obtain analytical approximations to the probability distribution of the fracture strengths of notched one-dimensional rods and two-dimensional plates in which the stiffness (Young's modulus) and strength (failure strain) of the material vary as jointly lognormal random fields. The fracture strength of the specimen is measured by the elongation, load, and toughness at two critical stages: when fracture initiates at the notch tip and, in the 2D case, when fracture propagates through the entire specimen. This is an extension of a previous study on the elastic and fracture properties of systems with random Young's modulus and deterministic material strength (Dimas et al., 2015a). For 1D rods our approach is analytical and builds upon the ANOVA decomposition technique of (Dimas et al., 2015b). In 2D we use a semi-analytical model to derive the fracture initiation strengths and regressions fitted to simulation data for the effect of crack arrest during fracture propagation. Results are validated through Monte Carlo simulation. Randomness of the material strength affects in various ways the mean and median values of the initial strengths, their log-variances, and log-correlations. Under low spatial correlation, material strength variability can significantly increase the effect of crack arrest, causing ultimate failure to be a more predictable and less brittle failure mode than fracture initiation. These insights could be used to guide design of more fracture resistant composites, and add to the design features that enhance material performance.

  16. Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 2: Immobilisation of stable ankle fractures: plaster cast or functional brace?

    PubMed

    Thackray, Anna J; Taylor, Jonathan

    2013-06-01

    A short-cut review of the literature was carried out to establish whether a functional brace was as good as a traditional plaster of Paris to immobilise a stable ankle fracture in terms of functionality and recovery speed. A total of 260 papers was found using the below outlined search method, of which five were thought to represent the best evidence to answer the specific clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these are shown in table 2. The clinical bottom line is that the limited evidence seems to suggest that a functional brace appears to give more favourable outcomes. Good quality studies involving large populations are, however, needed to delineate a clear answer to this specific question. PMID:23673785

  17. Update on acute ankle sprains.

    PubMed

    Tiemstra, Jeffrey D

    2012-06-15

    Ankle sprains are a common problem seen by primary care physicians, especially among teenagers and young adults. Most ankle sprains are inversion injuries to the lateral ankle ligaments, although high sprains representing damage to the tibiofibular syndesmosis are becoming increasingly recognized. Physicians should apply the Ottawa ankle rules to determine whether radiography is needed. According to the Ottawa criteria, radiography is indicated if there is pain in the malleolar or midfoot zone, and either bone tenderness over an area of potential fracture (i.e., lateral malleolus, medial malleolus, base of fifth metatarsal, or navicular bone) or an inability to bear weight for four steps immediately after the injury and in the emergency department or physician's office. Patients with ankle sprain should use cryotherapy for the first three to seven days to reduce pain and improve recovery time. Patients should wear a lace-up ankle support or an air stirrup brace combined with an elastic compression wrap to reduce swelling and pain, speed recovery, and protect the injured ligaments as they become more mobile. Early mobilization speeds healing and reduces pain more effectively than prolonged rest. Pain control options for patients with ankle sprain include nonsteroidal anti-inflammatory drugs, acetaminophen, and mild opioids. Because a previous ankle sprain is the greatest risk factor for an acute ankle sprain, recovering patients should be counseled on prevention strategies. Ankle braces and supports, ankle taping, a focused neuromuscular training program, and regular sport-specific warm-up exercises can protect against ankle injuries, and should be considered for patients returning to sports or other high-risk activities. PMID:22962897

  18. Effect of Joint Scale and Processing on the Fracture of Sn-3Ag-0.5Cu Solder Joints: Application to Micro-bumps in 3D Packages

    NASA Astrophysics Data System (ADS)

    Talebanpour, B.; Huang, Z.; Chen, Z.; Dutta, I.

    2016-01-01

    In 3-dimensional (3D) packages, a stack of dies is vertically connected to each other using through-silicon vias and very thin solder micro-bumps. The thinness of the micro-bumps results in joints with a very high volumetric proportion of intermetallic compounds (IMCs), rendering them much more brittle compared to conventional joints. Because of this, the reliability of micro-bumps, and the dependence thereof on the proportion of IMC in the joint, is of substantial concern. In this paper, the growth kinetics of IMCs in thin Sn-3Ag-0.5Cu joints attached to Cu substrates were analyzed, and empirical kinetic laws for the growth of Cu6Sn5 and Cu3Sn in thin joints were obtained. Modified compact mixed mode fracture mechanics samples, with adhesive solder joints between massive Cu substrates, having similar thickness and IMC content as actual micro-bumps, were produced. The effects of IMC proportion and strain rate on fracture toughness and mechanisms were investigated. It was found that the fracture toughness G C decreased with decreasing joint thickness ( h Joint). In addition, the fracture toughness decreased with increasing strain rate. Aging also promoted alternation of the crack path between the two joint-substrate interfaces, possibly proffering a mechanism to enhance fracture toughness.

  19. Treatment of seawater immersion-complicated open-knee joint fracture.

    PubMed

    Ai, J G; Zhao, F; Gao, Z M; Dai, W; Zhang, L; Chen, H B; Zhou, J G

    2014-01-01

    The current study aimed to select suitable remedies for seawater immersion-complicated open-knee joint fracture by exploring the effects of different treatment methods. Forty adult rabbits weighing 2.20 ± 0.25 kg were divided equally into internal fracture fixation group (A), seawater-immersed group with primary internal fixation (B), seawater-immersed group with secondary internal fixation (C), and seawater-immersed group with external fixation (D), using the random-digit table method. Open-femoral internal condylar fracture models were established. Group A was left untreated for 2 h, whereas the other three groups were subjected to seawater immersion for 2 h. Afterwards, groups A and B underwent debridement and steel plate and screw internal fixation. Group C underwent debridement and external fixation, which was followed by secondary steel plate and screw internal fixation after the wound healed. Group D underwent transarticular arthrodesis. Wound infection, joint functional rehabilitation, and radiological and histopathological changes in fracture healing in each group were assessed. The results showed that delayed internal fixation effectively reduces the infection rate of seawater immersion-complicated open fracture and benefits joint function rehabilitation. PMID:25117308

  20. Modeling the Progressive Failure of Jointed Rock Slope Using Fracture Mechanics and the Strength Reduction Method

    NASA Astrophysics Data System (ADS)

    Zhang, Ke; Cao, Ping; Meng, Jingjing; Li, Kaihui; Fan, Wenchen

    2015-03-01

    The fracturing process during the progressive failure of a jointed rock slope is numerically investigated by using fracture mechanics and the strength reduction method (SRM). A displacement discontinuity method containing frictional elements is developed for the calculation of the stress intensity factor (SIF). The failure initiation of the jointed rock slope is analyzed by evaluating the SIF. A new joint model is proposed by combining solid elements with interface elements in the commercial software FLAC3D. These represent the discontinuous planes in a rock mass on which sliding or separation can occur. The progressive failure process is simulated by reducing the shear strength of the rock mass, which includes the process of stress concentration, crack initiation, crack propagation, slip weakening, and coalescence of failure surfaces. The factor of safety (FS) and location of the critical failure surface are determined by the SRM. The influence of the joint inclination is investigated using the FS and the SIF. Laboratory experiments on specimens containing an inclined flaw under compression-shear stress are also conducted to investigate the effect of the angle between the shear direction and the flaw inclination, which provides an experimental explanation for the shear behavior of jointed rock. The results show that the joint inclination dominates the failure behavior of jointed rock slope, and two failure patterns have been classified.

  1. Arthroscopic ankle arthrodesis.

    PubMed

    Elmlund, Anna O; Winson, Ian G

    2015-03-01

    Arthroscopic ankle arthrodesis is a good option for the treatment of end-stage ankle arthritis. The surgical technique involving the use of a standard 4.5-mm arthroscope is described. Standard anteromedial and anterolateral portals are used. Joint surfaces except the lateral gutter are prepared to point bleeding with motorized burr, abraider, and curettes. Rigid fixation is achieved with cannulated screws. The postoperative regime includes 12 weeks protection, staged from non-weight bearing through partial to full weight bearing. Advantages compared with the open procedure include shorter hospital stay and shorter time to union with similar or better union rates. PMID:25726484

  2. Evaluation of fracture strength of metal/epoxy joint by interface mechanics

    SciTech Connect

    Nakai, Yoshikazu

    1995-11-01

    Tension tests of metal/epoxy joints with or without interface cracks were conducted and fracture criteria of the joints were discussed based on interface mechanics. The variation of the fracture strength of each specimen was large, and the strength showed Gaussian distribution. The fracture strength of smooth specimens was lower for wider specimens, but the cumulative probability of fracture of smooth specimens was not controlled by the stress singularity parameter. In interface cracked specimens, the cracks were propagated either along the interface or in epoxy resin, depending on crack length. When cracks propagated along the interface, the cumulative probability of the fracture of the specimen was controlled by the real part of the complex stress intensity factor along the interface, K{sub 1}. When cracks kinked to epoxy resin, the angle was almost identical to that of the maximum tangential stress, {sigma}{sub {theta}max}. In this case, the cumulative probability of fracture was controlled by the value of K{sub {theta}max}.

  3. Ankle sprain (image)

    MedlinePlus

    An ankle sprain is a common injury to the ankle. The most common way the ankle is injured is when ... swelling, inflammation, and bruising around the ankle. An ankle sprain injury may take a few weeks to many ...

  4. A tension-mode fracture model for bolted joints in laminated composites

    SciTech Connect

    Schulz, K.C.; Packman, P.F.; Eisenmann, J.R.

    1995-06-01

    A failure prediction model for bolted joints in generally orthotropic laminated composite plates that fail in the tension mode under bearing loading conditions has been developed. The plate is analyzed as a bulk orthotropic plate whose material properties are determined through the application of classical lamination theory to facilitate practical application of the model. Ply-by-ply laminated analysis is not required. Fracture mechanics concepts are applied to a pseudo-flaw which is related to the physical cracking of the laminate at the joint. The maximum circumferential stress concept is extended to orthotropic materials where both the fracture toughness and stress intensity vary with orientation. Excellent correlation between experimental tests conducted on single-bolt joints for two laminate layups and analytical prediction was found.

  5. A fracture mechanics approach for designing adhesively bonded joints

    NASA Technical Reports Server (NTRS)

    Johnson, W. S.; Mall, S.

    1983-01-01

    An analytical and experimental investigation was undertaken to determine if the adhesive debond initiation stress could be predicted for arbitrary joint geometries. The analysis was based upon a threshold total strain-energy-release rate (Gth) concept. Two bonded systems were tested: T300/5208 graphite/epoxy adherends bonded with either EC-3445 or FM-300 adhesive. The Gth for each adhesive was determined from cracked-lap-shear (CLS) specimens by initiation tests. Finite-element analyses of various tapered CLS specimen geometries predicted the specimen stress at which the total strain-energy-release rate (GT) equaled Gth at the joint tip. Experiments verified the predictions. The approach described herein predicts the maximum stress at which an adhesive joint can be cycled yet not debond. Furthermore, total strain-energy-release rate appeared to be the driving parameter for cyclic debonding and debond initiation in structural adhesives. In addition, debond initiation and growth were found to occur with virtually no peel stress present.

  6. Simultaneous Volar Dislocation of Distal Interphalangeal Joint and Volar Fracture-Subluxation of Proximal Interphalangeal Joint of Little Finger: A New Mechanism of Injury.

    PubMed

    Mozaffarian, Kamran; Bayatpour, Abdollah; Vosoughi, Amir Reza

    2016-10-01

    Simultaneous volar dislocation of distal interphalangeal (DIP) joint and volar fracture-subluxation of proximal interphalangeal (PIP) joint of the same finger has not been reported yet. A 19-year-old man was referred due to pain on the deformed left little finger after a ball injury. Radiographs showed volar dislocation of the DIP joint and dorsal lip fracture of the middle phalanx with volar subluxation of PIP joint of the little finger. This case was unique in terms of the mechanism of injury which was hyperflexion type in two adjacent joints of the same finger. The patient was treated by closed reduction of DIP joint dislocation and open reduction and internal fixation of the PIP joint fracture-subluxation and application of dorsal external fixator due to instability. Finally, full flexion of the PIP joint and full extension of the DIP joint were obtained but with 10 degree extension lag at the PIP joint and DIP joint flexion ranging from 0 degree to 30 degrees. Some loss of motion in small joints of the fingers after hyperflexion injuries should be expected. PMID:27595966

  7. Lisfranc Dislocation having Bimalleolar Fracture with Syndesmotic Injury

    PubMed Central

    Ghate Sushant, D; Ashwin, Babar; Sistla, Vidyasagar M; Atul, Bhaskar

    2011-01-01

    Introduction: Fracture-dislocations of tarsometatarsal joints are rare. Association of these fractures with ankle injuries is very rare; to our knowledge not reported in the literature. Here, we report a rare case of Tarso-metatarsal (Lisfranc) dislocation with bimalleolar fracture with syndesmotic injury. Case report: Patient was treated with closed reduction and fixation of Lisfranc injury with combination of screws and k wires and also fixation of bimalleolar and syndesmotic injury. At follow up patient achieved excellent function as assessed by AOFAS (American Orthopaedic Society Foot and Ankle Society Midfoot Score). Conclusion: Even though extremely uncommon, early recognition of ankle injuries with uncommon lisfranc fractures & dislocations is important as prompt and simultaneous treatment of both injuries results in excellent clinical outcome.

  8. Special Features of Fracture of a Solid-State Titanium Alloy - Nickel - Stainless Steel Joint

    NASA Astrophysics Data System (ADS)

    Khazgaliev, R. G.; Mukhametrakhimov, M. Kh.; Imaev, M. F.; Shayakhmetov, R. U.; Mulyukov, R. R.

    2015-10-01

    Microstructure, nanohardness, and special features of fracture of three-phase titanium alloy and stainless steel joint through a nanostructural nickel foil are investigated. Uniformly distributed microcracks are observed in Ti2Ni and TiN3 layers joined at temperatures above T = 700°C, whereas no microcracks are observed in the TiNi layer. This suggests that the reason for microcracking is an anomalously large change in the linear expansion coefficient of the TiNi layer during austenitic-martensitic transformation. Specimens subjected to mechanical tests at T = 20°C are fractured along different layers of the material, namely, in the central part of the specimen they are fractured along the Ti2Тi/TiNi interface, whereas at the edge they are fractured along the TiNi/TiNi3 interface.

  9. Ankle Sprains

    MedlinePlus

    ... What's the Treatment for a Sprained Ankle? More Serious Sprains en español Esguinces de tobillo As a field hockey player, Jill was used to twisting her ankle. She'd always been able to walk it off and get back in the game. But one day she stepped on another player's ...

  10. Percutaneous Screw Fixation of Crescent Fracture-Dislocation of the Sacroiliac Joint.

    PubMed

    Shui, Xiaolong; Ying, Xiaozhou; Mao, Chuanwan; Feng, Yongzeng; Chen, Linwei; Kong, Jianzhong; Guo, Xiaoshan; Wang, Gang

    2015-11-01

    Crescent fracture-dislocation of the sacroiliac joint (CFDSIJ) is a type of lateral compression pelvic injury associated with instability. Open reduction and internal fixation is a traditional treatment of CFDSIJ. However, a minimally invasive method has never been reported. The purpose of this study was to assess the outcome of closed reduction and percutaneous fixation for different types of CFDSIJ and present their clinical outcome. The authors reviewed 117 patients diagnosed with CFDSIJ between July 2003 and July 2013. Closed reduction and percutaneous fixation was performed in 73 patients. Treatment selection was based on Day's fracture classification. For type I fractures, fixation perpendicular to the fracture line were performed. For type II fractures, crossed fixation was performed. For type III fractures, fixation was performed with iliosacral screws. Forty-four patients were treated by open reduction and plate fixation. Demographics, fracture pattern distribution, blood loss, incision lengths, revision surgeries, radiological results, and functional scores were compared. All 117 patients were followed for more than 6 months (mean, 14 months [range, 6-24 months]). Blood loss, extensive exposure, duration of posterior ring surgery, duration of hospital stay, and infection rates were lower in the closed group (P<.01). Patients in the closed group achieved better functional performance (P<.01). There were no significant differences in reduction quality (P=.32), revision surgery rates (P=.27), and iatrogenic neurologic injuries (P=.2) between the 2 groups. The authors' results indicate that closed reduction and percutaneous fixation is a safe and effective surgical method for CFDSIJ. PMID:26558677

  11. Bilateral Anterior Fracture-Dislocation of Shoulder Joint- A rare case with Delayed Presentation

    PubMed Central

    Sunku, Nithin; Kalaiah, Kiran; Marulasidappa, G.; Gopinath, P.

    2012-01-01

    Introduction: The shoulder is the most frequently dislocated joint. Bilateral glenohumeral dislocations are rare and almost always posterior. Bilateral anterior fracture dislocations of humeral neck in a patient with seizure are extremely rare. We report one such case of delayed presentation of bilateral anterior fracture dislocation of shoulder after an epileptic attack. Case Report: We describe a rare case of 30 year old gentleman who presented with first episode of seizure following alcohol withdrawal. Physical examination and radiographic assessment revealed fracture dislocation of bilateral proximal humeri (4 part fracture on right side and two part fracture on left). Patient presented 20 days after injury during which he was treated by local osteopath by immobilization and massage. Open reduction and internal fixation with simple T plate was done on right side and multiple K – wires were used on left side. At one year follow up the patient had acceptable range and was able to carry out daily activities. Conclusions: Bilateral anterior fracture dislocation of shoulder behave similar to unilateral fracture dislocations and treatment needs to be planned appropriately. Even in cases with delayed presentation good results can be achieved

  12. Fracture strengths of HIPed DS-Cu/SS joints for ITER shielding blanket/first wall

    NASA Astrophysics Data System (ADS)

    Hatano, T.; Kanari, M.; Sato, S.; Gotoh, M.; Furuya, K.; Kuroda, T.; Saito, M.; Enoeda, M.; Takatsu, H.

    1998-10-01

    Fracture toughness and crack propagation tests were performed to investigate the effect of HIP temperature and fracture behavior of HIPed DS-Cu/SS joints. Test specimens of DS-Cu/SS HIPed joints were manufactured by bonding flat plates of DS-Cu and SS under HIP temperatures of 980°C, 1030°C and 1050°C. JQ of the joint at HIP temperature of 1050°C was larger than the other two joints. For the crack propagation test, two types of test specimens were prepared. One had a notch along the HIPed interface and the other in DS-Cu and normal to the interface. The crack in the former specimen propagated along the interface. On the other hand, the crack in the latter specimen propagated in the DS-Cu perpendicular to the loading direction, stopped at the interface, and then exfoliated along the HIPed interface. In the fracture tests, the crack was observed propagating in DS-Cu side at approximately 5-10 μm away from the interface.

  13. Probabilistic Simulation of Progressive Fracture in Bolted-Joint Composite Laminates

    NASA Technical Reports Server (NTRS)

    Minnetyan, L.; Singhal, S. N.; Chamis, C. C.

    1996-01-01

    This report describes computational methods to probabilistically simulate fracture in bolted composite structures. An innovative approach that is independent of stress intensity factors and fracture toughness was used to simulate progressive fracture. The effect of design variable uncertainties on structural damage was also quantified. A fast probability integrator assessed the scatter in the composite structure response before and after damage. Then the sensitivity of the response to design variables was computed. General-purpose methods, which are applicable to bolted joints in all types of structures and in all fracture processes-from damage initiation to unstable propagation and global structure collapse-were used. These methods were demonstrated for a bolted joint of a polymer matrix composite panel under edge loads. The effects of the fabrication process were included in the simulation of damage in the bolted panel. Results showed that the most effective way to reduce end displacement at fracture is to control both the load and the ply thickness. The cumulative probability for longitudinal stress in all plies was most sensitive to the load; in the 0 deg. plies it was very sensitive to ply thickness. The cumulative probability for transverse stress was most sensitive to the matrix coefficient of thermal expansion. In addition, fiber volume ratio and fiber transverse modulus both contributed significantly to the cumulative probability for the transverse stresses in all the plies.

  14. Joint Use of PP and PS AVOA Data to Estimate Fluid Indicator in Vertically Fractured Medium

    NASA Astrophysics Data System (ADS)

    Pan, B.; Sen, M. K.; Gu, H.

    2015-12-01

    The existence of fractures induces anisotropy in medium. This anisotropy might be a comprehensive result of fractures' properties, such as the direction, spacing, apertures, intensity, microstructure, fluid infill, and so on. Among these properties, the preferential orientation of fracture networks makes the medium azimuthally anisotropic with respect to seismic wave propagation. To the medium containing a set of vertical fractures, the tangential weakness does not vary with the fluid content, however on which the normal weakness shows great dependence. Based on the theory of linear slip model and the sensitivity to fracture weakness of PP- and PS-reflection coefficients which can be derived by a Born formula, we did both the PP-AVOA and PS-AVOA numerical experiment and also the joint inversion of fluid indicator. Results show that when the fractures have low saturation of gas, the fluid indicator estimated from PP-AVOA data is precise enough; when gas saturation goes up to 70%, joint inversion can help to improve the poor quality of PP-AVOA data inversion. Under high gas-saturated case, both PP inversion and joint inversion are sensitive to the errors in g, where g is the square of the ratio of S- and P- wave velocity in the unfractured medium. This dependency can be reduced by adding a different weight to PP and PS data during the inversion.Based on the result of numerical experiment, we processed field data in Sichuan Basin in China. The inversion result is consistent with the well interpretation. The first column in figure represents the PP- and PS-reflectivity computed by matrix method(Fryer and Frazer,1984). The second column is the result of Born linearized method. In the last column, upper one shows the estimated fluid indicator in different gas saturation case and the below one consider the effect of error in g on the inversion results.

  15. Numerical Simulation of the Process of Fracture of Echelon Rock Joints

    NASA Astrophysics Data System (ADS)

    Sarfarazi, V.; Ghazvinian, A.; Schubert, W.; Blumel, M.; Nejati, H. R.

    2014-07-01

    The effect of joint overlap on the full failure behavior of a rock bridge in the shear-box test was numerically investigated by means of the particle flow code in two dimensions (PFC2D). Initially, the PFC2D was calibrated by use of data obtained from experimental laboratory tests to ensure the conformity of the simulated numerical model's response. Furthermore, validation of the simulated models was cross-checked with the results from direct shear tests performed on non-persistent jointed physical models. By use of numerical direct shear tests, the failure process was visually observed and the failure patterns were seen to be in reasonable accordance with experimental results. Discrete element simulations demonstrated that macro shear fractures in rock bridges are because of microscopic tensile breakage of a large number of bonded discs. The failure pattern is mostly affected by joint overlap whereas the shear strength is closely related to the failure pattern. The results show that non-overlapping joints lost their loading capacity when nearly 50 % of total cracks developed within the rock bridge whereas the overlapping joints lost their loading capacity as soon as cracks initiated from the joint walls. Furthermore, progressive failure or stable crack growth was seen to develop for non-overlapped joints whereas brittle failure or unstable crack growth was seen to develop in overlapped joints.

  16. Can Chronic Ankle Instability Be Prevented? Rethinking Management of Lateral Ankle Sprains

    PubMed Central

    Denegar, Craig R.; Miller, Sayers J.

    2002-01-01

    Objective: To pose the question, “Can chronic ankle instability be prevented?” The evaluation and treatment of chronic ankle instability is a significant challenge in athletic health care. The condition affects large numbers of athletes and is associated with reinjury and impaired performance. The management of acute injuries varies widely but in athletic training has traditionally focused on initial symptom management and rapid return to activity. A review of practice strategies and philosophies suggests that a more detailed evaluation of all joints affected by the injury, correction of hypomobility, and protection of healing structures may lead to a more optimal long-term outcome. Background: Sprains to the lateral ankle are common in athletes, and the reinjury rate is high. These injuries are often perceived as being isolated to the anterior talofibular and calcaneofibular ligaments. It is, however, becoming apparent that a lateral ankle sprain can injure other tissues and result in joint dysfunction throughout the ankle complex. Description: We begin by addressing the relationship between mechanical and functional instability. We then discuss normal ankle mechanics, sequelae to lateral ankle sprains, and abnormal ankle mechanics. Finally, tissue healing, joint dysfunction, and the management of acute lateral ankle sprain are reviewed, with an emphasis on restoring normal mechanics of the ankle-joint complex. A treatment model based on assessment of joint function, treatment of hypomobile segments, and protection of healing tissues at hypermobile segments is described. PMID:12937564

  17. Incidence and Severity of Foot and Ankle Injuries in Men’s Collegiate American Football

    PubMed Central

    Lievers, W. Brent; Adamic, Peter F.

    2015-01-01

    Background: American football is an extremely physical game with a much higher risk of injury than other sports. While many studies have reported the rate of injury for particular body regions or for individual injuries, very little information exists that compares the incidence or severity of particular injuries within a body region. Such information is critical for prioritizing preventative interventions. Purpose: To retrospectively analyze epidemiological data to identify the most common and most severe foot and ankle injuries in collegiate men’s football. Study Design: Descriptive epidemiology study. Methods: Injury data were obtained from the National Collegiate Athletic Association (NCAA) Injury Surveillance System (ISS) for all foot and ankle injuries during the 2004-2005 to 2008-2009 seasons. Injuries were analyzed in terms of incidence and using multiple measures of severity (time loss, surgeries, medical disqualifications). This frequency and severity information is summarized in tabular form as well as in a 4 × 4 quantitative injury risk assessment matrix (QIRAM). Results: The rate of foot and ankle injuries was 15 per 10,000 athletic exposures (AEs). Five injuries were found to be responsible for more than 80% of all foot and ankle injuries: lateral ankle ligament sprains, syndesmotic (high ankle) sprains, medial ankle ligament sprains, midfoot injuries, and first metatarsophalangeal joint injuries. Ankle dislocations were found to be the most severe in terms of median time loss (100 days), percentage of surgeries (83%), and percentage of medical disqualifications (94%), followed by metatarsal fractures (38 days, 36%, and 49%, respectively) and malleolus fractures (33 days, 41%, and 59%, respectively). Statistical analysis suggests that the 3 measures of severity are highly correlated (r > 0.94), thereby justifying the use of time loss as a suitable proxy for injury severity in the construction of the QIRAM. Conclusion: Based on the QIRAM analysis

  18. Intraarticular Entrapment of Os Subfibulare Following a Severe Inversion Injury of the Ankle: A Case Report

    PubMed Central

    Kose, Ozkan; Kilicaslan, Omer Faruk; Guler, Ferhat; Aktan, Cemil

    2015-01-01

    Introduction: Anterior Talofibular Ligament (ATFL) rupture is the most commonly injured anatomic structure in lateral ankle sprain. In some cases, ATFL avulsion fracture from the lateral malleolus may occur instead of purely ligamentous injuries. The ATFL avulsion fracture is detected as a small ossicle at the tip of lateral malleolus on direct radiographs, which is called os subfibulare in chronic cases. Case Presentation: Severe displacement of this ossicle to the tibiotalar joint space is an extremely rare injury. Herein, a case of intra-articular entrapment of os subfibulare following a severe inversion injury of the ankle, which caused a diagnostic challenge was presented. Conclusions: To the best of our knowledge, this is the first case of entrapment of os subfibulare in the talotibial joint space. Fixation of the os subfibulare to lateral malleolus resulted in union and excellent functional results. PMID:26101763

  19. [Lesions of the distal radio-ulnar joint associated with isolated fractures of the radial shaft].

    PubMed

    Hattoma, N; Rafai, M; Zahar, A; Largab, A; Trafeh, M

    2002-12-01

    The authors have performed a retrospective study of 49 Galeazzi fractures treated between 1990 and 1998. This lesion is considered rare because it is often misdiagnosed as an isolated fracture of the radius. The mean age of the patients was 31 years. There was a male predominance with a sex ratio of 4/1. Road traffic accidents were the main etiology (45%). Galeazzi fracture type III in Mansat's classification represented 53%, followed by type II (33%), type I (8%) and equivalents of Galeazzi fracture (6%). The treatment was surgical in all cases. The radial fracture was internally fixed with a plate. Reduction of the distal radio-ulnar instability, achieved by manipulation, was maintained with radio-ulnar pin fixation in 53% and with plaster cast immobilization 45%. The results, evaluated according to Mikic's criteria were excellent in 87%. The prognosis of Galeazzi's fracture depends mainly on the initial treatment of the lesions of the distal radio-ulnar joint, which require for their diagnosis a meticulous clinical evaluation and a good radiological analysis. PMID:12584977

  20. Conservative and surgical treatment of the chronic Charcot foot and ankle

    PubMed Central

    Güven, Mehmet Fatih; Karabiber, Atakan; Kaynak, Gökhan; Öğüt, Tahir

    2013-01-01

    Charcot neuroarthropathy (CN) is a severe joint disease in the foot and ankle that can result in fracture, permanent deformity, and limb loss. It is a serious and potentially limb-threatening lower-extremity late complication of diabetes mellitus. The aim of this manuscript was to evaluate modern concepts of chronic CN through a review of the available literature and to integrate a perspective of management from the authors’ extensive experience. PMID:23919114

  1. Atypical Presentation of Tuberculosis of Elbow Joint in Operated Case of Distal Humerus Fracture

    PubMed Central

    Gaikwad, Yogesh; Khadilkar, Madhav; Ranade, Ashish S.; Vartak, Devendra N.

    2015-01-01

    Introduction: A typical presentations of tuberculosis are not uncommon. Periprosthetic infection with tuberculosis after total joint replacement has well published. Tuberculosis of the elbow following open reduction internal fixation of a distal humerus fraeture is extremely rare. Case Report: We report case of a healthy, immunocompetenet 49-year-old male who underwent open reduction and internal fixation with bicolumnar plating for distal humerus fracture and presented after 18 month with cystic swelling over medial aspect of operated site. There was no wound dehiscence and the underlying fracture was healed well without any signs of implant loosening or bony involvement. Cystic swelling was excised and histopathology provided the diagnosis of tuberculosis. Patient was treated with anti tubercular chemotherapy and patient made uneventful recovery. Conclusion: Although synovial tuberculosis after fracture fixation is a rare entity, tuberculosis should be kept as a differential diagnosis. Surgeons should have high index of suspicion to diagnose atypical presentations of tuberculosis. PMID:27299044

  2. The relationship between unilateral mandibular angle fracture and temporomandibular joint function.

    PubMed

    Baltrusaityte, Ausra; Surna, Algimantas; Pileicikiene, Gaivile; Kubilius, Ricardas; Gleiznys, Alvydas; Zilinskas, Juozas

    2014-01-01

    PURPOSE. Aim of this study was to analyze relation of occlusal correction and alterations of temporomandibular joint function during treatment of unilateral mandibular fractures. MATERIALS AND METHODS. We compared 49 patients treated for unilateral mandibular fracture without occlusal correction with 21 patient treated for unilateral mandibular fracture along with early and consequent occlusal analysis and correction and with 49 control subjects. Patients' complaints, mandibular movements and occlusal parameters were evaluated during the period of healing. ZEBRIS ultrasound system (Jaw Motion Analyzer, Zebris Medical GmbH, Isny, Germany) was used for analysis of mandibular movements and T-Scan analyzer (Tekscan, Inc., Boston, MA, USA) was used for occlusal analysis. RESULTS. Findings of our study showed statistically significant (p<0.05) diminution of patients complaints, mandibular movement alterations and occlusal disturbances in patients who received occlusal correction during MF treatment if compared to patients treated without occlusal correction, except noises from the joint in the injured side and mandibular lateral track to the injured side in the final stage of investigation. Despite applied treatment recovery of the TMJ function was not complete and the investigated parameters remained worse if compared to the control group. CONCLUSIONS. Results of this study confirmed positive influence of early and subsequent occlusal analysis and correction during stages of MF treatment on diminution of functional alterations of the temporomandibular joint function. Timely occlusal correction improves and hastens process of rehabilitation therefore it is indispensable part of MF treatment. PMID:25471992

  3. Effect of weld metal mismatch on joint efficiency and measured fracture toughness

    SciTech Connect

    Yee, R.; Malik, L.; Morrison, J.

    1997-12-31

    Fracture toughness tests of deep-notched and shallow-notched SENB specimens at various sub-zero temperatures were conducted to study the effect of weld metal mismatch on measured fracture toughness. Tensile tests of cross-weld tensile specimens were also conducted to study the effect of weld metal mismatch on joint efficiency. These specimens were machined from butt welds that were fabricated with the same welding consumable and welding procedure using HSLA 100 steel plates heat treated to different tensile strengths. No significant differences were found between the joint efficiencies and ductilities of the cross-weld tensile specimens with overmatching weld metal and those of specimens with up to 9% weld metal undermatch in terms of yield strength (3% in terms of ultimate tensile strength). Furthermore, 100% joint efficiency was still achieved in the cross-weld tensile specimens with intact reinforcements and 17% undermatching weld metal in terms of yield strength (9% in terms of ultimate tensile strength). No correlation was found between the degree of weld metal mismatch and the measured fracture toughness of the SENB specimens.

  4. A rare combined injury of dorsal fracture-dislocation of four carpometacarpal joints and trapezium, trapezoid and distal radius bone fractures.

    PubMed

    Touloupakis, Georgios; Stuflesser, Wilfried; Antonini, Guido; Ferrara, Fabrizio; Crippa, Cornelio; Lettera, Maria Gabriella

    2016-01-01

    Incorrect or delayed diagnosis and treatment of the carpometacarpal fracture-dislocations is often associated with poor prognosis. We present a rare case of unusual pattern of injury, involving dorsal dislocation of four ulnar carpometacarpal joints, associated with fracture of the trapezium, a burst fracture of the trapezoid  bone and an extra-articular fracture of the third distal  of the radius. The first surgical intervention was followed by unsatisfactory results, confirmed by the CT scans. A second surgery followed and an open reduction and pinning with K wires performed. Post-operative follow up lasting for nine months revealed a very good surgical outcome. PMID:27163903

  5. Ankle replacement

    MedlinePlus

    ... to the cut bony surfaces. A special glue/bone cement may be used to hold them in place. A piece of plastic is then inserted between the two metal parts. Screws maybe placed to stabilize your ankle. The surgeon ...

  6. Independent and Joint Effect of Brachial-Ankle Pulse Wave Velocity and Blood Pressure Control on Incident Stroke in Hypertensive Adults.

    PubMed

    Song, Yun; Xu, Benjamin; Xu, Richard; Tung, Renee; Frank, Eric; Tromble, Wayne; Fu, Tong; Zhang, Weiyi; Yu, Tao; Zhang, Chunyan; Fan, Fangfang; Zhang, Yan; Li, Jianping; Bao, Huihui; Cheng, Xiaoshu; Qin, Xianhui; Tang, Genfu; Chen, Yundai; Yang, Tianlun; Sun, Ningling; Li, Xiaoying; Zhao, Lianyou; Hou, Fan Fan; Ge, Junbo; Dong, Qiang; Wang, Binyan; Xu, Xiping; Huo, Yong

    2016-07-01

    Pulse wave velocity (PWV) has been shown to influence the effects of antihypertensive drugs in the prevention of cardiovascular diseases. Data are limited on whether PWV is an independent predictor of stroke above and beyond hypertension control. This longitudinal analysis examined the independent and joint effect of brachial-ankle PWV (baPWV) with hypertension control on the risk of first stroke. This report included 3310 hypertensive adults, a subset of the China Stroke Primary Prevention Trial (CSPPT) with baseline measurements for baPWV. During a median follow-up of 4.5 years, 111 participants developed first stroke. The risk of stroke was higher among participants with baPWV in the highest quartile than among those in the lower quartiles (6.3% versus 2.4%; hazard ratio, 1.66; 95% confidence interval, 1.06-2.60). Similarly, the participants with inadequate hypertension control had a higher risk of stroke than those with adequate control (5.1% versus 1.8%; hazard ratio, 2.32; 95% confidence interval, 1.49-3.61). When baPWV and hypertension control were examined jointly, participants in the highest baPWV quartile and with inadequate hypertension control had the highest risk of stroke compared with their counterparts (7.5% versus 1.3%; hazard ratio, 3.57; 95% confidence interval, 1.88-6.77). There was a significant and independent effect of high baPWV on stroke as shown among participants with adequate hypertension control (4.2% versus 1.3%; hazard ratio, 2.29, 95% confidence interval, 1.09-4.81). In summary, among hypertensive patients, baPWV and hypertension control were found to independently and jointly affect the risk of first stroke. Participants with high baPWV and inadequate hypertension control had the highest risk of stroke compared with other groups. PMID:27217412

  7. Function of anterior talofibular and calcaneofibular ligaments during in-vivo motion of the ankle joint complex

    PubMed Central

    de Asla, Richard J; Kozánek, Michal; Wan, Lu; Rubash, Harry E; Li, Guoan

    2009-01-01

    Background Despite the numerous in-vitro studies on the mechanical properties and simulated injury mechanisms of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), the in-vivo biomechanical behavior of these two ligaments has not yet been described. Methods Apparent length of the ATFL and CFL was measured in four ankles in healthy male subjects between 32 and 45 years of age (two left and two right) during a dorsiflexion-plantarflexion and supination-pronation arc of motion using a combined dual-orthogonal fluoroscopic and magnetic resonance imaging technique. Results The ATFL elongated from the neutral position at 16.3 +/- 3.0 mm to 20.8 +/- 2.7 mm at maximal plantarflexion and shortened significantly from the neutral position to 13.9 +/- 2.9 mm at maximal dorsiflexion (p = 0.01). The CFL shortened from the neutral position at 28.0 +/- 2.9 mm to 26.6 +/- 2.2 mm at maximal plantarflexion (p = 0.08) and elongated significantly from the neutral position to 29.9 +/- 3.0 mm at maximal dorsiflexion (p = 0.003). The ATFL elongated significantly from 14.8 +/- 2.5 mm at maximal pronation to 17.4 +/- 3.0 mm at maximal supination (p = 0.08). At the same time, the CFL shortened from 31.0 +/- 3.8 mm at maximal pronation to 26.9 +/- 3.6 mm at maximal supination (p = 0.02). Conclusion The results showed that the ATFL elongates more during plantarflexion and supination whereas the CFL increases in length with dorsiflexion and pronation. Concurrently, these data also demonstrated the reciprocal function between the two ligaments. While one shortens, the other one elongates. The different elongation of the ATFL and CFL during the same motion arc suggests that under excessive loading conditions the ATFL might be more vulnerable in plantarflexion and supination while the CFL might be more susceptible to injury in dorsiflexion and pronation. Furthermore, in the case of surgical reconstruction the grafts used to reconstruct the two ligaments may need to be

  8. Bidirectional Dislocation of the Distal Radioulnar Joint After Distal Radius Fracture: Case Report.

    PubMed

    Arimitsu, Sayuri; Moritomo, Hisao

    2016-02-01

    We report a patient with bidirectional dislocation of the distal radioulnar joint after malunited distal radius fracture, in which the ulnar head dislocated dorsally during forearm pronation and palmarly during supination without manual compression of the ulnar head. The patient had chronic ulnar wrist pain and experienced a painful clunk during forearm rotation. The distal radioulnar joint ballottement test was positive in both the dorsal and palmar directions. Her distal radius was malunited with a 20° dorsal angulation and 18° pronation deformity. A corrective osteotomy of the radius with open repair of the triangular fibrocartilage complex foveal avulsion yielded success. At the 7-year follow-up, there was almost a normal range of wrist and forearm motion, 83% grip strength, no arthritis, and a stable distal radioulnar joint. PMID:26723478

  9. Postural control and torque of the knee joint after healed tibial shaft fracture.

    PubMed

    Karladani, A H; Svantesson, U; Granhed, H; Styf, J

    2001-01-01

    Muscular atrophy occurs as a consequence of trauma and immobilisation. This cohort comparison study was conducted to evaluate the limb function after healed tibial shaft fractures, which were treated by casting versus nailing. Balance (as centre of pressure) and muscle strength (as torque of the knee joint during knee extension) have been measured in 27 patients with tibial shaft fractures with a mean age of 39 (19-73) years, 1 year after fracture healing. Fourteen patients were treated by intramedullary nailing 'nailed group' and 13 by plaster cast with or without minimal internal fixation 'casted group'. Centre of pressure was measured on a force platform. Knee extension torque was measured during isometric and concentric muscle actions by an isokinetic dynamometer. Centre of pressure tended to be more towards the uninjured leg in patients who had been treated by plaster cast (P<0.05). Side-to-side differences for isometric torque were significantly higher within the casted group (P<0.05). Patients with tibial shaft fractures treated by intramedullary nailing showed better postural control, one-leg standing test, and side-to-side differences for isometric muscle strength compared with patients treated by cast. Therefore, we recommend intramedullary nailing as a better method of treatment for tibial shaft fractures, with regard to recovery of muscle function. PMID:11164404

  10. Joint seismic, hydrogeological, and geomechanical investigations of a fracture zone in the Grimsel Rock Laboratory, Switzerland

    SciTech Connect

    Majer, E.L.; Myer, L.R.; Peterson, J.E. Jr.; Karasaki, K.; Long, J.C.S.; Martel, S.J. ); Bluemling, P.; Vomvoris, S. )

    1990-06-01

    This report is one of a series documenting the results of the Nagra-DOE Cooperative (NDC-I) research program in which the cooperating scientists explore the geological, geophysical, hydrological, geochemical, and structural effects anticipated from the use of a rock mass as a geologic repository for nuclear waste. From 1987 to 1989 the United States Department of Energy (DOE) and the Swiss Cooperative for the Storage of Nuclear Waste (Nagra) participated in an agreement to carryout experiments for understanding the effect of fractures in the storage and disposal of nuclear waste. As part of this joint work field and laboratory experiments were conducted at a controlled site in the Nagra underground Grimsel test site in Switzerland. The primary goal of these experiments in this fractured granite was to determine the fundamental nature of the propagation of seismic waves in fractured media, and to relate the seismological parameters to the hydrological parameters. The work is ultimately aimed at the characterization and monitoring of subsurface sites for the storage of nuclear waste. The seismic experiments utilizes high frequency (1000 to 10,000 Hertz) signals in a cross-hole configuration at scales of several tens of meters. Two-, three-, and four-sided tomographic images of the fractures and geologic structure were produced from over 60,000 raypaths through a 10 by 21 meter region bounded by two nearly horizontal boreholes and two tunnels. Intersecting this region was a dominant fracture zone which was the target of the investigations. In addition to these controlled seismic imaging experiments, laboratory work using core from this region were studied for the relation between fracture content, saturation, and seismic velocity and attenuation. In-situ geomechanical and hydrologic tests were carried out to determine the mechanical stiffness and conductivity of the fractures. 20 refs., 90 figs., 6 tabs.

  11. Joint flow-seismic inversion for characterizing fractured reservoirs: theoretical approach and numerical modeling

    NASA Astrophysics Data System (ADS)

    Brown, S. R.; Kang, P. K.; Zheng, Y.; Fang, X.; Fehler, M. C.; Burns, D.; Juanes, R.

    2013-12-01

    Characterizing fractured geologic formations is essential in exploration geophysics, petroleum engineering, and in the assessment of deep geologic nuclear waste disposal. Traditionally, seismic interpretation and flow modeling have been performed independently, typically following a unidirectional workflow. Here, we present a methodology to characterize fractured geologic media by integrating flow and seismic data. The goal of our work is twofold: on one hand, reduce that uncertainty by incorporating dynamic flow measurements into the seismic interpretation; on the other, improve the predictability of groundwater flow and transport models by making joint use of seismic and flow data. The basic tenet of our proposed framework is that there is a strong dependence between fracture permeability (which drives the flow response) and fracture compliance (which drives the seismic response). This connection has long been recognized [1], and recent works have pointed to the potential of exploiting that connection [2-3]. By means of synthetic models, we show that: (1) owing to the strong (but highly uncertain) dependence of fracture permeability on fracture compliance, the modeled flow response in a fractured reservoir is highly sensitive to the geophysical interpretation; and (2) by incorporating flow data (well pressures and production curves) into the inversion workflow, we can simultaneously reduce the error in the seismic interpretation and improve predictions of the reservoir flow dynamics. [1] L. J. Pyrak-Nolte and J. P. Morris, Int. J. Rock. Mech. Min. 37, 245 (2000). [2] S. Brown and X. Fang, SEG Technical Program Expanded Abstracts , 1 (2012). [3] C. L. Petrovitch, L. J. Pyrak-Nolte, and D. D. Nolte, Geophys. Res. Lett. (2013).

  12. Conservative Treatment Is Sufficient for Acute Distal Radioulnar Joint Instability With Distal Radius Fracture.

    PubMed

    Lee, Sang Ki; Kim, Kap Jung; Cha, Yong Han; Choy, Won Sik

    2016-09-01

    Treatments for acute distal radioulnar joint (DRUJ) instability with distal radius fracture vary from conservative to operative treatment, although it seems to be no consensus regarding which treatment is optimal. This prospective randomized study was designed to compare the clinical outcomes for operative and conservative treatment of acute DRUJ instability with distal radius fracture, according to the presence or absence and type of ulnar styloid process fracture and the degree of its displacement. Between July 2008 and February 2013, we enrolled 157 patients who exhibited an unstable DRUJ during intraoperative manual stress testing (via the ballottement test) after fixation of the distal radius. Patients were classified according to the type of the ulnar styloid process fracture, using preoperative wrist radiography, and each group was divided into subgroups, according to their treatment method. We then compared the clinical outcomes between the conservative and operative treatments, using their range of motion; Disabilities of the Arm, Shoulder, and Hand score; modified Mayo wrist score; and grip strength. At 3 months after surgery, among patients without ulnar styloid process fracture, the flexion-extension range was 79 ± 15° after supination sugar-tong splinting (group A-1), 91 ± 14° after DRUJ transfixation (group A-2), and 89 ± 10° after arthroscopic triangular fibrocartilage complex repair (group A-3); the operative treatments provided greater joint motion ranges than conservative treatment. The groups with ulnar styloid process fractures at the tip (group B) or base (group C) also exhibited better clinical outcomes after the operative treatments, compared with after the conservative treatment. However, at the final follow-up, groups A-1, A-2, and A-3 exhibited similar flexion-extension ranges (122 ± 25°, 119° ± 18°, and 120° ± 16°, respectively) and modified Mayo wrist scores (87 ± 7, 89 ± 8, and 85 ± 9). Thus, the conservative and

  13. Basketball injuries of the foot and ankle.

    PubMed

    McDermott, E P

    1993-04-01

    Foot and ankle injuries in basketball are discussed in three unrelated categories in this article. This includes a practical differential diagnosis of ankle sprains, acute conditions of the mid and hindfoot, overuse syndromes of nerve entrapment, fascial strain, synovitis, joint subluxation, and inflammation resulting from repetitive stress. The diagnosis and treatment of tendon inflammation of the extrinsic foot musculature is also reviewed. PMID:8097679

  14. Interfacial fracture resistance of the joint of a solid oxide fuel cell glass-ceramic sealant with metallic interconnect

    NASA Astrophysics Data System (ADS)

    Lin, Chih-Kuang; Shiu, Wei-Hong; Wu, Si-Han; Liu, Chien-Kuo; Lee, Ruey-Yi

    2014-09-01

    Interfacial cracking resistance of a joint between a glass-ceramic sealant (GC-9) and interconnect stainless steel (Crofer 22 H) for planar solid oxide fuel cells is investigated. Interfacial fracture energy is measured at room temperature to 800 °C using a four-point bending test technique. A heat treatment of 100 h or 1000 h at 800 °C is applied for studying the thermal aging effect. Results show the variation trend of interfacial fracture energy with temperature is similar for all given material conditions. Interfacial fracture energy increases with temperature to reach a peak value at 700 °C and then drops at temperature above 700 °C. A 100-h aging treatment does not change the interfacial fracture energy significantly, compared to the non-aged condition. The 1000 h-aged joint, however, has greater interfacial fracture energy than the non-aged and 100 h-aged joints at 700 °C-800 °C. Two types of cracking path in the interior of fracture surface are identified. Firstly, delamination takes place at the interface between the glass-ceramic substrate and chromate layer. Secondly, cracking occurs within the chromate layer. However, for the 1000 h-aged joints tested at 700 °C-800 °C, fracture at the highly oxidized, peripheral regions takes place within the glass-ceramic layer.

  15. Does Metaphyseal Cement Augmentation in Fracture Management Influence the Adjacent Subchondral Bone and Joint Cartilage?

    PubMed Central

    Goetzen, Michael; Hofmann-Fliri, Ladina; Arens, Daniel; Zeiter, Stephan; Stadelmann, Vincent; Nehrbass, Dirk; Richards, R. Geoff; Blauth, Michael

    2015-01-01

    Abstract Augmentation of implants with polymethylmethacrylate (PMMA) bone cement in osteoporotic fractures is a promising approach to increase implant purchase. Side effects of PMMA for the metaphyseal bone, particularly for the adjacent subchondral bone plate and joint cartilage, have not yet been studied. The following experimental study investigates whether subchondral PMMA injection compromises the homeostasis of the subchondral bone and/or the joint cartilage. Ten mature sheep were used to simulate subchondral PMMA injection. Follow-ups of 2 (4 animals) and 4 (6 animals) months were chosen to investigate possible cartilage damage and subchondral plate alterations in the knee. Evaluation was completed by means of high-resolution peripheral quantitative computed tomography (HRpQCT) imaging, histopathological osteoarthritis scoring, and determination of glycosaminoglycan content in the joint cartilage. Results were compared with the untreated contralateral knee and statistically analyzed using nonparametric tests. Evaluation of the histological osteoarthritis score revealed no obvious cartilage damage for the treated knee; median histological score after 2 months 0 (range 4), after 4 months 1 (range 5). There was no significant difference when compared with the untreated control site after 2 and 4 months (P = 0.23 and 0.76, respectively). HRpQCT imaging showed no damage to the metaphyseal trabeculae. Glycosaminoglycan measurements of the treated joint cartilage after 4 months revealed no significant difference compared with the untreated cartilage (P = 0.24). The findings of this study support initial clinical observation that PMMA implant augmentation of metaphyseal fractures appears to be a safe procedure for fixation without harming the subchondral bone plate and adjacent joint cartilage. PMID:25621690

  16. Outcome of ankle arthrodesis in posttraumatic arthritis

    PubMed Central

    Gowda, BS Narayana; Kumar, J Mohan

    2012-01-01

    Background: Ankle arthrodesis is still a gold standard salvage procedure for the management of ankle arthritis. There are several functional and mechanical benefits of ankle arthrodesis, which make it a viable surgical procedure in the management of ankle arthritis. The functional outcomes following ankle arthrodesis are not very well known. The purpose of this study was to perform a clinical and radiographic evaluation of ankle arthrodesis in posttraumatic arthritis performed using Charnley's compression device. Materials and Methods: Between January 2006 and December 2009 a functional assessment of 15 patients (10 males and 5 females) who had undergone ankle arthrodesis for posttraumatic arthritis and/or avascular necrosis (AVN) talus (n=6), malunited bimalleolar fracture (n=4), distal tibial plafond fractures (n=3), medial malleoli nonunion (n=2). All the patients were assessed clinically and radiologically after an average followup of 2 years 8 months (range 1–5.7 years). Results: All patients had sound ankylosis and no complications related to the surgery. Scoring the patients with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale, we found that 11 of the 15 had excellent results, two had good, and two showed fair results. They were all returned to their preinjury activities. Conclusion: We conclude that, the ankle arthrodesis can still be considered as a standard procedure in ankle arthritis. On the basis of these results, patients should be counseled that an ankle fusion will help to relieve pain and to improve overall function. Still, one should keep in mind that it is a salvage procedure that will cause persistent alterations in gait with a potential for deterioration due to the development of subtalar arthritis. PMID:22719119

  17. Surgical treatment of the arthritic varus ankle.

    PubMed

    Easley, Mark E

    2012-12-01

    Within the past several years, the arthritic varus ankle has been addressed extensively in Foot and Ankle Clinics, with numerous excellent reviews by particularly knowledgeable authors. To support these outstanding contributions, this article provides a practical approach to this challenging constellation of foot and ankle abnormalities. Varus ankle arthritis exists on a continuum that prompts the treating surgeon to be familiar with a spectrum of surgical solutions, including joint-sparing realignment, arthroplasty, and arthrodesis. Each of these treatment options is addressed with several expanded case examples and supports the management approaches with the available pertinent literature. PMID:23158376

  18. Biomechanical Evaluation of a Prototype Foot/Ankle Prosthesis

    PubMed Central

    Quesada, P. M.; Pitkin, M.; Colvin, J.

    2016-01-01

    In this paper, we report on our pilot evaluation of a prototype foot/ankle prosthesis. This prototype has been designed and fabricated with the intention of providing decreased ankle joint stiffness during the middle portion of the stance phase of gait, and increased (i.e., more normal) knee range of motion during stance. Our evaluation involved fitting the existing prototype foot/ankle prosthesis, as well as a traditional solid ankle cushioned heel (SACH) foot, to an otherwise healthy volunteer with a below-knee (BK) amputation. We measured this individual’s lower extremity joint kinematics and kinetics during walking using a video motion analysis system and force platform. These measurements permitted direct comparison of prosthetic ankle joint stiffness and involved side knee joint motion, as well as prosthetic ankle joint moment and power. PMID:10779119

  19. Ankle Injury Management (AIM): design of a pragmatic multi-centre equivalence randomised controlled trial comparing Close Contact Casting (CCC) to Open surgical Reduction and Internal Fixation (ORIF) in the treatment of unstable ankle fractures in patients over 60 years

    PubMed Central

    2014-01-01

    Background Ankle fractures account for 9% of all fractures with a quarter of these occurring in adults over 60 years. The short term disability and long-term consequences of this injury can be considerable. Current opinion favours open reduction and internal fixation (ORIF) over non-operative treatment (fracture manipulation and the application of a standard moulded cast) for older people. Both techniques are associated with complications but the limited published research indicates higher complication rates of fracture malunion (poor position at healing) with casting. The aim of this study is to compare ORIF with a modification of existing casting techniques, Close Contact Casting (CCC). We propose that CCC may offer an equivalent functional outcome to ORIF and avoid the risks associated with surgery. Methods/Design This study is a pragmatic multi-centre equivalence randomised controlled trial. 620 participants will be randomised to receive ORIF or CCC after sustaining an isolated displaced unstable ankle fracture. Participants will be recruited from a minimum of 20 National Health Service (NHS) acute hospitals throughout England and Wales. Participants will be aged over 60 years and be ambulatory prior to injury. Follow-up will be at six weeks and six months after randomisation. The primary outcome is the Olerud & Molander Ankle Score, a functional patient reported outcome measure, at 6 months. Follow-up will also include assessments of mobility, ankle range of movement, health related quality of life and complications. The six-month follow-up will be conducted face-to-face by an assessor blinded to the allocated intervention. A parallel economic evaluation will consider both a health service and a broader societal perspective including the individual and their family. In order to explore patient experience of their treatment and recovery, a purposive sample of 40 patients will also be interviewed using a semi-structured interview schedule between 6-10

  20. Stress fractures of the sesamoid bones of the first metatarsophalangeal joint in athletes.

    PubMed

    Hulkko, A; Orava, S; Pellinen, P; Puranen, J

    1985-01-01

    Over a period of 11 years 15 cases of stress fractures of the sesamoid bones of the first metatarsophalangeal (MTP) joint were treated in athletes. The mean age of the patients was 22.3 years, and there were 9 males and 6 females in the series. All patients were athletes, who began to suffer from the symptoms during training without any trauma. Eight fractures were located in the medial, six in the lateral sesamoid bone, and in one case both sesamoids were affected. The diagnosis was performed on the basis of the history, symptoms, clinical examination, and radiological, or isotope scanning findings. Ten of the patients were treated conservatively by prescribing an avoidance of excessive physical activity and better training shoes. In five cases surgical excision of the fragmented painful sesamoid bone was performed. There were no complications in the series and the athletes could start gradually training 6-8 weeks after the operation. The histology showed fibrotic non-union at the fracture site and supported the diagnosis of stress fracture. Three of the conservatively treated athletes had mild symptoms in intensive training, others had a good end result. PMID:4051695

  1. Newly developed anatomical and functional ligament reconstruction for the Lisfranc joint fracture dislocations: a case report.

    PubMed

    Hirano, Takaaki; Niki, Hisateru; Beppu, Moroe

    2014-09-01

    A 15-year-old male complained of pain in the left foot that occurred when changing direction while running and at presentation, he had difficulty in walking due to pain and swelling. Plain X-ray of the foot revealed a Myerson Type B2 Lisfranc fracture dislocation, and 3-D computed tomography (CT) revealed proximal fractures of the 2nd-4th metatarsals. The Lisfranc ligament was anatomically reconstructed using a graft of the gracilis tendon. During aftercare, partial weight bearing was permitted at 6 weeks postoperatively and full weight bearing at 8 weeks postoperatively. The patient resumed sporting activities 3 months postoperatively. A plain X-ray taken 12 months postoperatively showed favorable joint congruency, and the patient scored 100 points on the Japanese Society for Surgery of the Foot standard rating system midfoot scale. Our anatomical ligament reconstruction is a useful new method of anatomical reduction and maintenance, and it shortens the duration of aftercare. PMID:25103712

  2. Negative magnetic resonance imaging in femoral neck stress fracture with joint effusion: a case report.

    PubMed

    Seki, Nobutoshi; Okuyama, Koichiro; Kamo, Keiji; Chiba, Mitsuho; Shimada, Yoichi

    2016-06-01

    Femoral neck stress fracture (FNSF) is well documented in the orthopedic literature and is generally associated with strenuous activities such as long-distance running and military training. The diagnostic yield of magnetic resonance imaging (MRI) for FNSF was reported to be 100 %, and early MRI is recommended when this fracture is suspected. We encountered a 16-year-old male long-distance runner with FNSF in whom the left femoral neck showed no signal changes on MRI although an effusion was detected in the left hip joint. One month later, roentgenograms revealed periosteal callus and oblique consolidation of the left femoral neck, confirming the diagnosis of compression FNSF. Because FNSF with a normal bone marrow signal on MRI is very rare, this patient is presented here. PMID:27020451

  3. The surgical dilemma of the malunited calcaneal joint depression fracture: the VAMC Miami experience.

    PubMed

    Cohen, M

    1996-01-01

    During the period of October 1985 through March 1995, 25 patients presented to the Veterans Affairs Medical Center, Miami with a chief complaint of chronic pain status post calcaneal joint depression fracture. Their acute injury was treated conservatively at this and various other institutions. Nine patients were managed conservatively with orthotics, University of California Biomechanics Laboratory braces (UCBLs), shoe modification, or prosthetics. Sixteen patients underwent hindfoot fusions. Good to excellent results were obtained in 15 of the 16 fusions. The remaining patient, having an isolated subtalar fusion, was later diagnosed with multiple sclerosis. Proper evaluation of the chronic pain patient is critical when mapping out an appropriate treatment plan. Hindfoot arthrodesis with soft tissue decompression is a successful tool in eliminating chronic pain due to malunited depression fractures. PMID:8722881

  4. [Disorders of the distal radioulnar joint following fractures of the distal end of the radius].

    PubMed

    Prommersberger, K-J; van Schoonhoven, J

    2008-03-01

    After a fracture of the distal radius, whether healed in an anatomic position or malunited, many patients complain about problems on the ulnar side of the wrist with pain and decreased range of forearm rotation. In addition many patients are unhappy with the unpleasant appearance of the wrist joint. The complaints are related to tears of the triangular fibrocartilaginous complex, instability, and/or incongruity of the distal radioulnar joint and degenerative changes. Malunion of the distal radius must be taken into account when discussing treatment options. The purpose of this paper is to describe a treatment algorithm with respect to the clinical symptoms, the pathology as well as the presence or absence of a deformity of the distal radius. PMID:18283425

  5. Suspension Arthroplasty for Old Fracture-Dislocations of the Fifth Carpometacarpal Joint.

    PubMed

    Kato, Naoki; Fukumoto, Keizo

    2016-06-01

    It is well known that treatment of the old fracture-dislocations of the fifth carpometacarpal (CMC) joint is challenging. For patients with persistent pain due to this condition, numerous surgical techniques have been proposed. Here, we present a novel surgical technique, CMC joint suspension arthroplasty, using a partial slip of the extensor carpi ulnaris tendon. This procedure follows principles similar to the procedure of trapeziectomy with suspension arthroplasty for treatment of thumb CMC joint arthritis. We believe this suspension arthroplasty has several advantages compared with other surgical procedures. First, mobility of the fifth metacarpal is greatly preserved because the fifth metacarpal is stabilized only by the ligament against the fourth metacarpal. Second, the length of the fifth ray can be maintained by adjusting the level of the drill hole of the fourth metacarpal. Third, malrotation of the little finger can be prevented by drilling the holes of the fifth and fourth metacarpals in the proper direction. We believe this surgical technique could be a better treatment option for degenerative arthrosis of the fifth CMC joint. PMID:27077466

  6. Coracoid Process Avulsion Fracture at the Coracoclavicular Ligament Attachment Site in an Osteoporotic Patient with Acromioclavicular Joint Dislocation

    PubMed Central

    Umemoto, Takahisa; Fukuda, Kimitaka; Kajino, Tomomichi

    2016-01-01

    Coracoid fractures are uncommon, mostly occur at the base or neck of the coracoid process (CP), and typically present with ipsilateral acromioclavicular joint (ACJ) dislocation. However, CP avulsion fractures at the coracoclavicular ligament (CCL) attachment with ACJ dislocation have not been previously reported. A 59-year-old woman receiving glucocorticoid treatment fell from bed and complained of pain in her shoulder. Radiographs revealed an ACJ dislocation with a distal clavicle fracture. Three-dimensional computed tomography (3D-CT) reconstruction showed a small bone fragment at the medial apex of the CP. She was treated conservatively and achieved a satisfactory outcome. CP avulsion fractures at the CCL attachment can occur in osteoporotic patients with ACJ dislocations. Three-dimensional computed tomography is useful for identifying this fracture type. CP avulsion fractures should be suspected in patients with ACJ dislocations and risk factors for osteoporosis or osteopenia. PMID:27493819

  7. Coracoid Process Avulsion Fracture at the Coracoclavicular Ligament Attachment Site in an Osteoporotic Patient with Acromioclavicular Joint Dislocation.

    PubMed

    Onada, Yoshihiro; Umemoto, Takahisa; Fukuda, Kimitaka; Kajino, Tomomichi

    2016-01-01

    Coracoid fractures are uncommon, mostly occur at the base or neck of the coracoid process (CP), and typically present with ipsilateral acromioclavicular joint (ACJ) dislocation. However, CP avulsion fractures at the coracoclavicular ligament (CCL) attachment with ACJ dislocation have not been previously reported. A 59-year-old woman receiving glucocorticoid treatment fell from bed and complained of pain in her shoulder. Radiographs revealed an ACJ dislocation with a distal clavicle fracture. Three-dimensional computed tomography (3D-CT) reconstruction showed a small bone fragment at the medial apex of the CP. She was treated conservatively and achieved a satisfactory outcome. CP avulsion fractures at the CCL attachment can occur in osteoporotic patients with ACJ dislocations. Three-dimensional computed tomography is useful for identifying this fracture type. CP avulsion fractures should be suspected in patients with ACJ dislocations and risk factors for osteoporosis or osteopenia. PMID:27493819

  8. Adhesive capsulitis of the ankle (frozen ankle).

    PubMed

    van Moppes, F I; van den Hoogenband, C R; Greep, J M

    1979-09-01

    Adhesive capsulitis or "frozen ankle" is a syndrome resulting from repeated ankle sprains, or perhaps following immobilization after trauma. Ankle arthrography is a useful and safe diagnostic procedure in this syndrome. Typical arthrographic features are described together with case histories of two patients with frozen ankle. We suggest that early mobilization of the patient following trauma is particularly important in preventing the development of a forzen ankle syndrome. PMID:508071

  9. Talar neck fractures.

    PubMed

    Berlet, G C; Lee, T H; Massa, E G

    2001-01-01

    Clinical management of talar neck fractures is complex and fraught with complications. As Gaius Julius Caesar stated: "The die is cast"; often the outcome of a talar neck fracture is determined at the time of injury. The authors believe, however, that better results can be achieved by following some simple guidelines. The authors advocate prompt and precise anatomic surgical reduction, preferring the medial approach with secondary anterolateral approach. Preservation of blood supply can be achieved by a thorough understanding of vascular pathways and efforts to stay within appropriate surgical intervals. The authors advocate bone grafting of medial neck comminution (if present) to prevent varus malalignment and rigid internal fixation to allow for joint mobilization postoperatively. These guidelines may seem simple, but when dealing with the complexity of talar neck fractures, the foot and ankle surgeon needs to focus and rely on easily grasped concepts to reduce poor outcomes. PMID:11465133

  10. Evidence-based treatment for ankle injuries: a clinical perspective

    PubMed Central

    Lin, Chung-Wei Christine; Hiller, Claire E; de Bie, Rob A

    2010-01-01

    The most common ankle injuries are ankle sprain and ankle fracture. This review discusses treatments for ankle sprain (including the management of the acute sprain and chronic instability) and ankle fracture, using evidence from recent systematic reviews and randomized controlled trials. After ankle sprain, there is evidence for the use of functional support and non-steroidal anti-inflammatory drugs. There is weak evidence suggesting that the use of manual therapy may lead to positive short-term effects. Electro-physical agents do not appear to enhance outcomes and are not recommended. Exercise may reduce the occurrence of recurrent ankle sprains and may be effective in managing chronic ankle instability. After surgical fixation for ankle fracture, an early introduction of activity, administered via early weight-bearing or exercise during the immobilization period, may lead to better outcomes. However, the use of a brace or orthosis to enable exercise during the immobilization period may also lead to a higher rate of adverse events, suggesting that this treatment regimen needs to be applied judiciously. After the immobilization period, the focus of treatment for ankle fracture should be on a progressive exercise program. PMID:21655420

  11. Total ankle replacement – surgical treatment and rehabilitation

    PubMed Central

    Krogulec, Zbigniew; Turski, Piotr; Przepiórski, Emil; Małdyk, Paweł; Księżopolska-Orłowska, Krystyna

    2015-01-01

    Functions of the ankle joint are closely connected with the gait and ability to maintain an upright position. Degenerative lesions of the joint directly contribute to postural disorders and greatly restrict propulsion of the foot, thus leading to abnormal gait. Development of total ankle replacement is connected with the use of the method as an efficient treatment of joint injuries and continuation of achievements in hip and knee surgery. The total ankle replacement technique was introduced as an alternative to arthrodesis, i.e. surgical fixation, which made it possible to preserve joint mobility and to improve gait. Total ankle replacement is indicated in post-traumatic degenerative joint disease and joint destruction secondary to rheumatoid arthritis. In this paper, total ankle replacement and various types of currently used endoprostheses are discussed. The authors also describe principles of early postoperative rehabilitation as well as rehabilitation in the outpatient setting. PMID:27407223

  12. Joint Problems

    MedlinePlus

    ... ankles and toes. Other types of arthritis include gout or pseudogout. Sometimes, there is a mechanical problem ... for more information on osteoarthritis, rheumatoid arthritis and gout. How Common are Joint Problems? Osteoarthritis, which affects ...

  13. Evaluation of an Image-Based Tool to Examine the Effect of Fracture Alignment and Joint Congruency on Outcomes after Wrist Fracture

    PubMed Central

    Lalone, Emily A; Grewal, Ruby; King, Graham W; MacDermid, Joy C

    2015-01-01

    Some mal-alignment of the wrist occurs in up to 71% of patients following a distal radius fracture. A multiple case study was used to provide proof of principle of an image-based technique to investigate the evolution and impact of post-traumatic joint changes at the distal radioulnar joint. Participants who had a unilateral distal radius fracture who previously participated in a prospective study were recruited from a single tertiary hand center. Long term follow-up measures of pain, disability, range of motion and radiographic alignment were obtained and compared to joint congruency measures. The inter-bone distance, a measure of joint congruency was quantified from reconstructed CT bone models of the distal radius and ulna and the clinical outcome was quantified using the patient rated wrist evaluation. In all four cases, acceptable post-reduction alignment and minimal pain/disability at 1-year suggested good clinical outcomes. However, 10 years following injury, 3 out of 4 patients had radiographic signs of degenerative changes occurring in their injured wrist (distal radioulnar joint/radio-carpal joint). Proximity maps displaying inter-bone distances showed asymmetrical congruency between wrists in these three patients. The 10-year PRWE (patient rated wrist evaluation) varied from 4 to 60, with 3 reporting minimal pain/disability and one experiencing high pain/disability. These illustrative cases demonstrate long-term joint damage post-fracture is common and occurs despite positive short-term clinical outcomes. Imaging and functional outcomes are not necessarily correlated. A novel congruency measure provides an indicator of the overall impact of joint mal-alignment that can be used to determine predictors of post-traumatic arthritis and is viable for clinical or large cohort studies. PMID:26157534

  14. Fracturing in upper Cretaceous Selma group Chalky marls, inner coastal plain of Alabama: stratigraphic (facies) control of joint development and regional joint-strike orientations

    SciTech Connect

    Bittner, E.; King, D.T. Jr.; Holston, I.

    1988-09-01

    In the inner coastal plain of Alabama, chalky marl is a distinctive sedimentary facies that contains more original biogenic calcareous-nannofossil components than the adjacent marls. The chalky marl is one facies in the cyclically arranged genetic packages that comprise the Mooreville and Demopolis Chalks of the lower part of the Upper Cretaceous Selma Group. Analysis of genetic-package stratigraphy shows that the chalky marls were deposited during relative sea level highstands. The chalky marls are selectively cemented by calcium carbonate, thus making a relatively well-indurated brittle rock. The chalky marls, in three sections over 15 m thick, host most of the systematic joints in the Mooreville and Demopolis. As a result, fracture-density mapping clearly delineates the outcrop belts of the thick fracture-prone chalky marls. Joint systems in the marls and chalky marls have two main strike trends (N30/degrees/E to N70/degrees/E and N20/degrees/W to N50/degrees/W) and two secondary strike trends (north to N10/degrees/E and east-west), which are nearly parallel and perpendicular, respectively, to crystalline bedrock structural trends and fracture zones. Thus, bedrock structural trends and fracture patterns appear to have propagated through the overlying Mesozoic rocks, dictating the orientation of joints in the chalky marls.

  15. Conversion of ankle autofusion to total ankle replacement using the Salto XT revision prosthesis.

    PubMed

    Williamson, Emilie R C; Demetracopoulos, Constantine A; Ellis, Scott J

    2016-09-01

    Few reports in the literature have described the conversion of a surgically fused ankle to a total ankle replacement. The takedown of an autofusion and conversion to a prosthesis has not been described. We report the case of a patient with severe rheumatoid arthritis with an ankle autofusion fixed in equinus and severe talonavicular arthritis that was converted to ankle replacement using the Salto XT revision system. We describe the reasons why the decision was made to perform total ankle arthroplasty while concomitantly fusing the talonavicular joint, and discuss the rationale of the various surgical treatment options considered. We describe the clinical and radiographic outcomes achieved in this case. At 12 months post-operatively the patient reported significant reduction of pain, increased FAOS scores and had increased ankle range of motion. PMID:27502236

  16. Arthroscopic-assisted fibular synthesis and syndesmotic stabilization of a complex unstable ankle injury.

    PubMed

    Salvi, Andrea Emilio; Metelli, Giovanni Pietro; Bettinsoli, Rosita; Hacking, Steven Adam

    2009-03-01

    Traditional treatment of complex ankle fracture consists of open reduction and internal fixation. Nevertheless, this treatment can delay fracture healing and cause prolonged oedema. The surgeon should consider necessity of early recovery when treating athletes, especially football players. In this light, it was decided to perform an arthroscopy-assisted percutaneous minimal osteosynthesis of a fibular fracture together with a syndesmotic disruption in order to permit the patient, a 24-year-old male, to resume quicker and easier full sport activities. The outcome was good and allowed patient to play soccer since 6 months following surgery. The complete and detailed articular evaluation provided by the arthroscope permitted to manage carefully a complex articular traumatism, avoiding the necessity of plating the fracture and improving a rapid full recovery of the joint function. PMID:18368413

  17. Fracture testing and analysis of adhesively bonded joints for automotive applications

    SciTech Connect

    Boeman, R.G.; Warren, C.D.

    1994-12-31

    In 1992, the Oak Ridge National Laboratory (ORNL) began a cooperative effort with the Automotive Composites Consortium (ACC) to conduct research and development that would overcome technological hurdles to the adhesive bonding of current and future automotive materials. This effort is part of a larger Department of Energy (DOE) program to promote the use of lighter weight materials in automotive structures for the purpose of increasing fuel efficiency and reducing environmental pollutant emissions. In accomplishing this mission, the bonding of similar and dissimilar materials was identified as being of primary importance to the automotive industry since this enabling technology would give designers the freedom to choose from an expanded menu of low mass materials for component weight reduction. This paper concentrates on the details of developing accurate fracture test methods for adhesively bonded joints in the automotive industry. The test methods being developed are highly standardized and automated so that industry suppliers will be able to pass on reliable data to automotive designers in a timely manner. Mode I fracture tests have been developed that are user friendly and automated for easy data acquisition, data analysis, test control and test repeatability. The development of this test is discussed. In addition, materials and manufacturing issues are addressed which are of particular importance when designing adhesive and composite material systems.

  18. Diagnostic dilemmas in foot and ankle injuries

    SciTech Connect

    Keene, J.S.; Lange, R.H.

    1986-07-11

    Differential diagnosis of foot and ankle injuries should include (1) stress fractures of the great toe sesamoids, the shaft of the fifth metatarsal, and the tarsal navicular bone; (2) transchondral talar-dome fractures; (3) fractures of the os trigonum; and (4) dislocating peroneal tendons. Diagnosis of these injuries is challenging because the initial roentgenograms often are normal, and special clinical tests and ancillary studies are required.

  19. Iatrogenic posterior tibial nerve division during a combined anterior ankle arthroscopy with an additional posterolateral portal.

    PubMed

    Abdul-Jabar, Hani B; Bhamra, Jagmeet; Quick, Tom J; Fox, Michael

    2016-01-01

    Ankle arthroscopy is an important diagnostic and therapeutic technique in the management of ankle disorders. Nowadays ankle arthroscopy provides good to excellent results (up to 90%) in the treatment of certain intra-articular disorders. Due to the superficial location of ankle joint and the abundance of overlying neurovascular structures, complications reported in ankle arthroscopy are greater than those reported in other joints. We present the first reported case of a complete division of the posterior tibial nerve during an anterior ankle arthroscopy combined with an additional posterolateral portal. This was due to a poorly controlled use of the arthroscopic instruments. PMID:27197613

  20. Iatrogenic posterior tibial nerve division during a combined anterior ankle arthroscopy with an additional posterolateral portal

    PubMed Central

    Abdul-Jabar, Hani B; Bhamra, Jagmeet; Quick, Tom J; Fox, Michael

    2016-01-01

    Ankle arthroscopy is an important diagnostic and therapeutic technique in the management of ankle disorders. Nowadays ankle arthroscopy provides good to excellent results (up to 90%) in the treatment of certain intra-articular disorders. Due to the superficial location of ankle joint and the abundance of overlying neurovascular structures, complications reported in ankle arthroscopy are greater than those reported in other joints. We present the first reported case of a complete division of the posterior tibial nerve during an anterior ankle arthroscopy combined with an additional posterolateral portal. This was due to a poorly controlled use of the arthroscopic instruments. PMID:27197613

  1. Ball shear strength and fracture modes of lead-free solder joints prepared using nickel nanoparticle doped flux

    NASA Astrophysics Data System (ADS)

    Sujan, G. K.; Haseeb, A. S. M. A.; Amalina, M. A.; Nishikawa, Hiroshi

    2015-05-01

    Miniaturization and the need for the replacement of lead (Pb) based solders in microelectronic devices raise concerns over their reliability in the recent years. Particularly, the rapid growth of interfacial intermetallic compound (IMC) layers in Pb free solders can lead to brittle fracture. A novel nanoparticle doped fluxing method was used to prepare ball grid array solder joints between Sn-3.0Ag-0.5Cu solder balls and Cu pads. In this method, nickel nanoparticles were mixed with a water soluble flux prior to its use. The shear strength and fracture modes of the resulting solder joints were investigated as a function of aging time. Results showed that IMC layer growth was suppressed in solder joints prepared with 0.1 wt.% Ni doped flux. The average shear strength was marginally higher for solder joints prepared using 0.1 wt. % Ni doped flux compared with the joints prepared with undoped flux. Samples prepared using Ni doped flux showed a better resistant against brittle fracture for up to 30 days of aging.[Figure not available: see fulltext.

  2. Establishment of a model predicting tensile shear strength and fracture portion of laser-welded lap joints

    NASA Astrophysics Data System (ADS)

    Furusako, Seiji; Miyazaki, Yasunobu; Hashimoto, Koji; Kobayashi, Junichi

    2003-03-01

    This study was aimed at establishment of a model that can predict tensile shear strength and fracture portion laser-welded lap joints in the tensile test. To clear influence of the bead length and width on them, the joints employed steel sheets with a thickness in the range of 0.8 mm to 1.2 mm were evaluated. It was found that the tensile shear strength increased with the bead size, and the fracture occurred at base metal (BM), weld metal (WM) or portion between them with a curvature (referred to as portion R). Also to clarify rotational deformation process around WM during the tensile test, joint cross-sections were observed at some applied load levels in the test. This observation derived the relationship between the radius, Ri, at the inner plane of portion R and the rotational angle, θ, of the center of sheet thickness, and the relationship between Ri and applied load. A plastic analysis based on these functions and assumptions that the joint consists of BM, WM and R, which are under simplified stress mode respectively, could estimate the tensile shear strength and the fracture portion of the joints. This estimation made good accord with experimental results.

  3. Effect of Interfacial Microstructure Evolution on Mechanical Properties and Fracture Behavior of Friction Stir-Welded Al-Cu Joints

    NASA Astrophysics Data System (ADS)

    Xue, P.; Xiao, B. L.; Ma, Z. Y.

    2015-07-01

    The interfacial microstructure evolution of Al-Cu joints during friction stir welding and post-welding annealing and its influence on the tensile strength and the fracture behavior were investigated in detail. An obvious interface including three sub-layers of α-Al, Al2Cu, and Al4Cu9 intermetallic compound (IMC) layers is generated in the as-FSW joint. With the development of annealing process, the α-Al layer disappeared and a new IMC layer of AlCu formed between initial two IMC layers of Al2Cu and Al4Cu9. The growth rate of IMC layers was diffusion controlled before the formation of Kirkendall voids, with activation energy of 117 kJ/mol. When the total thickness of IMC layers was less than the critical value of 2.5 μm, the FSW joints fractured at the heat-affected zone of Al side with a high ultimate tensile strength (UTS) of ~100 MPa. When the thickness of IMC layers exceeded 2.5 μm, the joints fractured at the interface. For relatively thin IMC layer, the joints exhibited a slightly decreased UTS of ~90 MPa and an inter-granular fracture mode with crack propagating mainly between the Al2Cu and AlCu IMC layers. However, when the IMC layer was very thick, crack propagated in the whole IMC layers and the fracture exhibited trans-granular mode with a greatly decreased UTS of 50-60 MPa.

  4. Range of Motion of the Ankle According to Pushing Force, Gender and Knee Position

    PubMed Central

    Cho, Kang Hee; Lee, Hyunkeun

    2016-01-01

    Objective To investigate the difference of range of motion (ROM) of ankle according to pushing force, gender and knee position. Methods One hundred and twenty-eight healthy adults (55 men, 73 women) between the ages of 20 and 51, were included in the study. One examiner measured the passive range of motion (PROM) of ankle by Dualer IQ Inclinometers and Commander Muscle Testing. ROM of ankle dorsiflexion (DF) and plantarflexion (PF) according to change of pushing force and knee position were measured at prone position. Results There was significant correlation between ROM and pushing force, the more pushing force leads the more ROM at ankle DF and ankle PF. Knee flexion of 90° position showed low PF angle and high ankle DF angle, as compared to the at neutral position of knee joint. ROM of ankle DF for female was greater than for male, with no significant difference. ROM of ankle PF for female was greater than male regardless of the pushing force. Conclusion To our knowledge, this is the first study to assess the relationship between pushing force and ROM of ankle joint. There was significant correlation between ROM of ankle and pushing force. ROM of ankle PF for female estimated greater than male regardless of the pushing force and the number of measurement. The ROM of the ankle is measured differently according to the knee joint position. Pushing force, gender and knee joint position are required to be considered when measuring the ROM of ankle joint. PMID:27152277

  5. Posterior Ankle Structure Injury During Total Ankle Replacement.

    PubMed

    Reb, Christopher W; McAlister, Jeffrey E; Hyer, Christopher F; Berlet, Gregory C

    2016-01-01

    Total ankle replacement studies have focused on reporting complications that are directly observed clinically or radiographically, including wound problems, technical errors, implant loosening, subsidence, infection, bone fractures, and heterotopic ossification. However, patients can still experience unresolved pain even when these problems have been ruled out. We initiated a study to more clearly define the relative risk of injury to the anatomic structures in the posterior ankle during total ankle replacement using a third-generation implant system. Ten fresh-frozen adult cadaveric below-the-knee specimens were positioned in the intraoperative positioning frame of an approved total ankle replacement system and adjusted to achieve proper foot alignment using fluoroscopic imaging. The relationship between the tibial cutting guide pins and the posterior neurovascular and tendon structures was measured using digital calipers. High rates of posterior structural injury were found. Nearly all proximal-medial pins encountered a posteromedial neurovascular structure, most commonly the tibial nerve. The distal-medial pins mainly encountered posteromedial tendinous structures, in particular, the flexor digitorum longus tendon. The proximal lateral pins were highly likely to encounter the Achilles tendon and the sural nerve. Our results support our hypothesis that the tibial neurovascular structures are at the greatest risk when preparing for and completing the bony resection, particularly with the medial and proximal cuts. Posterior ankle soft tissue structure injuries can occur during implantation but currently with unknown frequency and undetermined significance. Further study of posterior structural injuries could result in a more informed approach to post-total ankle replacement complications and management. PMID:27291681

  6. Effects of Microstructure and Loading on Fracture of Sn-3.8Ag-0.7Cu Joints on Cu Substrates with ENIG Surface Finish

    NASA Astrophysics Data System (ADS)

    Huang, Z.; Kumar, P.; Dutta, I.; Sidhu, R.; Renavikar, M.; Mahajan, R.

    2014-12-01

    When dropped, electronic packages often undergo failure by propagation of an interfacial crack in solder joints under a combination of tensile and shear loading. Hence, it is crucial to understand and predict the fracture behavior of solder joints under mixed-mode high-rate loading conditions. In this work, the effects of the loading conditions (strain rate and loading angle) and microstructure [interfacial intermetallic compound (IMC) morphology and solder yield strength] on the mixed-mode fracture toughness of Sn-3.8 wt.%Ag-0.7 wt.%Cu solder joints sandwiched between two Cu substrates with electroless nickel immersion gold (ENIG) metallization have been studied, and compared with the fracture behavior of joints attached to bare Cu. Irrespective of the surface finish, the fracture toughness of the solder joints decreased monotonically with strain rate and mode-mixity, both resulting in increased fracture proportion through the interfacial IMC layer. Furthermore, the proportion of crack propagation through the interfacial IMC layer increased with increase in the thickness and the roughness of the interfacial IMC layer and the yield strength of the solder, resulting in a decrease in the fracture toughness of the joint. However, under most conditions, solder joints with ENIG finish showed higher resistance to fracture than joints attached directly to Cu substrates without ENIG metallization. Based on the experimental observations, a fracture mechanism map is constructed correlating the yield strength of the solder, the morphology and thickness of the interfacial IMC, and the fracture mechanisms as well as the fracture toughness values for different solder joints under mode I loading.

  7. Dislocation of the distal radioulnar joint associated with a transstyloid radiocarpal fracture dislocation. A case report and review of the literature.

    PubMed

    Stoffelen, D; Fortems, Y; De Smet, L; Broos, P

    1996-03-01

    Dislocations of the distal radio-ulnar joint (DRUJ) can be isolated or combined with fractures. Cases of DRUJ dislocations have been described with Galleazi fractures, open radius and ulna fractures and intraarticular fractures of the distal radius. We report a case of a volar DRUJ dislocation combined with a transstyloid radio-carpal dislocation. Because of severe instability of the wrist, open reduction of the radial styloid combined with an open reduction of the dislocated DRUJ is advised. PMID:8669257

  8. Diagnosis and treatment of chronic ankle pain.

    PubMed

    Wukich, Dane K; Tuason, Dominick A

    2011-01-01

    The differential diagnosis for chronic ankle pain is quite broad. Ankle pain can be caused by intra-articular or extra-articular pathology and may be a result of a traumatic or nontraumatic event. A detailed patient history and physical examination, coupled with judicious selection of the appropriate imaging modalities, are vital in making an accurate diagnosis and providing effective treatment. Chronic ankle pain can affect all age groups, ranging from young athletes to elderly patients with degenerative joint and soft-tissue disorders. It has been estimated that 23,000 ankle sprains occur each day in the United States, representing approximately 1 sprain per 10,000 people per day. Because nearly one in five ankle injuries result in chronic symptoms, orthopaedic surgeons are likely to see patients with chronic ankle pain. Many patients with chronic ankle pain do not recall any history of trauma. Reviewing the management of the various disorders that can cause chronic ankle pain will help orthopaedic surgeons provide the best treatment for their patients. PMID:21553785

  9. Do joints initiate as sharp mode I fractures or finite thickness dilatancy bands? Insights from laboratory experiments and field data

    NASA Astrophysics Data System (ADS)

    Petit, J.; Chemenda, A. I.; Jorand, C.

    2011-12-01

    Terminology on fracture and discontinuities in geological objects mainly relies on distinguishing between tabular and sharp forms of deformation localization/failure structures (Aydin et al, JSG 2006; Shultz and Fossen, AAPG, 2009). On this basis joints (considered as mode I fractures) and dilation bands (very rarely observed) are distinguished among extension discontinuities. The former propagate with the separation of the fracture walls due to strong stress concentration at the fracture tips. The plumose features or hackles typical of joints (these terms cover a wide variety of diverging fractographic features) are believed to result from the fracture front breakdown due to the loading mode change (the origin of this change remains unclear). This view is called into question by recent experimental results of extension tests conducted on a synthetic physical rock analogue (granular, frictional, cohesive and dilatant) material (GRAM1) and by field observations of embryonic (not yet open) joints in highly jointed dolomicrite Chemenda et al., JGR, 2011). The initial porosity and grain size of both materials are very different, but at SEM scale, both experimental and natural unopened discontinuities reveal a comparable dilatancy (dilation) band structure with a porosity increase over a width of several grains. This suggests that the distinction between tabular and sharp is a matter of observation scale. Both axisymetric and poly-axial extension tests show that dilatancy bands form at elevated mean stress and have plumose morphology. Mode I cracking occurs only at very low mean stres and the forming fractures do not bear plumose features. Thus the absence of plumose structures can be considered as the signature of mode I fracturing. Consequently, we propose that non- plumose bearing natural joints (provided their fractography is not eroded) could originate as mode I fractures and call them "mode I joints". We call the joints formed as closed dilatancy bands propagating

  10. A multimodal approach to ankle instability: Interrelations between subjective and objective assessments of ankle status in athletes.

    PubMed

    Golditz, Tobias; Welsch, Goetz H; Pachowsky, Milena; Hennig, Friedrich F; Pfeifer, Klaus; Steib, Simon

    2016-03-01

    The aim of this retrospective cohort study is to investigate the association between different subjective and objective assessments of ankle function in a population of athletes with or without functional ankle instability (FAI). 29 athletes with a history of ankle spraining were divided into two groups according to their ankle status: 16 with FAI (initial ankle sprain with residual functional instability) (age 24.6 ± 3.1 years), and 13 COPERS (initial ankle sprain without residual instability) (age 25.3 ± 4.4 years). The assessment of each individual's ankle function was based on three approaches: The "functional-ankle-ability-measure" (FAAM) assessing subjective ankle functionality, measures of sensorimotor control as objective functional measurements and MRI-based T2-mapping as a quantitative marker of compositional joint status. Pearson's product-moment-correlation coefficient, student's t-test and analysis-of-variance were used for statistical analysis. Significant group differences existed for subjective ankle function (FAAM, p = 0.04) and MRI-data mainly in the medial compartment of the ankle joint (p ≤ 0.05). We found unique associations between T2-mapping results and sensorimotor scores in the COPER (r = -0.756-0.849), and "FAI"-group (r = 0.630-0.657). The location and magnitude differed between groups. No correlations existed between these measures and the FAAM. This exploratory study provides preliminary evidence for potential interrelations between various diagnostic measures of ankle function and structure in individuals with and without FAI. We found associations between MRI-results and selected measures of sensorimotor control, indicating a potential link between loss of ankle function and early joint degeneration. Despite these interrelations, each of the different assessment options appears to contain unique information on ankle functionality important in a clinical assessment. PMID:26309042

  11. Foot and Ankle Injuries in Runners.

    PubMed

    Tenforde, Adam S; Yin, Amy; Hunt, Kenneth J

    2016-02-01

    Foot and ankle injuries account for nearly one-third of running injuries. Achilles tendinopathy, plantar fasciopathy, and ankle sprains are 3 of the most common types of injuries sustained during training. Other common injuries include other tendinopathies of the foot and ankle, bone stress injuries, nerve conditions including neuromas, and joint disease including osteoarthritis. This review provides an evidence-based framework for the evaluation and optimal management of these conditions to ensure safe return to running participation and reduce risk for future injury. PMID:26616180

  12. Multiscale organization of joints and faults in a fractured reservoir revealed by geostatistical, multifractal and wavelet techniques

    SciTech Connect

    Castaing, C.; Genter, A.; Ouillon, G.

    1995-08-01

    Datasets of the geometry of fracture systems were analysed at various scales in the western Arabian sedimentary platform by means of geostatistical, multifractal, and anisotropic-wavelet techniques. The investigations covered a wide range of scales, from regional to outcrops in a well-exposed area, and were based on field mapping of fractures, and the interpretation and digitizing of fracture patterns on aerial photographs and satellite images. As a first step, fracture data sets were used to examine the direction, size, spacing and density systematics, and the variability in these quantities with space and scale. Secondly, a multifractal analysis was carried out, which consists in estimating the moments of the spatial distribution of fractures at different resolutions. This global multifractal method was complemented by a local wavelet analysis, using a new anisotropic technique tailored to linear structures. For a map with a given scale of detail, this procedure permits to define integrated fracture patterns and their associated directions at a more regional scale. The main result of this combined approach is that fracturing is not a self-similar process from the centimeter scale up to the one-million-kilometer scale. Spatial distribution of faults appears as being highly controlled by the thickness of the different rheological layers that constitute the crust. A proceeding for upscaling fracture systems in sedimentary reservoirs can be proposed, based on (i) a power law for joint-length distribution, (ii) characteristic joint spacing depending on the critical sedimentary units, and (iii) fractal fault geometry for faults larger than the whole thickness of the sedimentary basin.

  13. Examination and repair of the AITFL in transmalleolar fractures.

    PubMed

    Nelson, Owen A

    2006-10-01

    The surgical repair of transmalleolar fractures commonly involves reduction and internal fixation of the boney injuries. In the absence of extreme syndesmotic disruptions, little attention has been given in the recent literature to the role of the syndesmosis in general or to the anterior inferior tibiofibular ligament (AITFL) in particular in preserving the stability of the ankle mortise. In this paper, the author describes a surgical approach to evaluate and repair AITFL ligament injuries in transmalleolar ankle fractures. A significant portion of these injuries are associated with an avulsion of the tibial or fibular insertion resulting in an intra-articular fracture in the distal tibiofibular joint which may not be apparent on plain x-rays. Direct visualization of the injury allows accurate assessment of the injury pattern and obviates the need for more costly imaging studies such as computed tomography and magnetic resonance imaging scans. Anatomic repair of the AITFL injury restores the stability of the ankle mortise and improves the stability of the bone repair, allowing for early return to functional exercises and activities. Syndesmotic screw fixation of transmalleolar ankle fractures was not necessary when the AITFL was repaired directly by the techniques described. PMID:17088669

  14. Temporomandibular joint ankylosis caused by condylar fractures: a retrospective analysis of cases at an urban teaching hospital in Nigeria.

    PubMed

    Anyanechi, C E

    2015-08-01

    Mandibular condylar fractures are common presentations to hospitals across the globe and remain the most important cause of temporomandibular joint (TMJ) ankylosis. This study aimed to analyze cases of mandibular condylar fracture complicated by TMJ ankylosis after treatment. A 16-year retrospective analysis was performed at the dental and maxillofacial surgery clinic of the study institution; patient data were collected from the hospital records and entered into a pro-forma questionnaire. It was found that 56/3596 (1.6%) fractures resulted in TMJ ankylosis. The age of patients with ankylosis ranged from 12 to 47 years. The age (P=0.03) and gender (P=0.01) distributions were significant, with most cases of ankylosis occurring in those aged 11-30 years (n=43/56, 76.8%). Fractures complicated by ankylosis were intracapsular (n=22/56, 39.3%) and extracapsular (n=34/56, 60.7%). Ankylosis increased significantly with the increase in time lag between injury and fracture treatment (P=0.001). Ankylosis was associated with concomitant mandibular (85.7%) and middle third (66.1%) fractures. Treatment methods were not significantly related to ankylosis (P=0.32). All cases of ankylosis were unilateral, and complete (n=36, 64.3%) and incomplete ankylosis (n=20, 35.7%) were diagnosed clinically. The incorporation of computed tomography scans and rigid internal fixation in the management of condylar fractures will reduce ankylosis. PMID:26008733

  15. Assessment of the Injured Ankle in the Athlete

    PubMed Central

    Lynch, Scott A.

    2002-01-01

    Objective: To present appropriate tools to assist in the assessment and evaluation of ankle injuries in athletes. Data Sources: A MEDLINE search was performed for the years 1980–2001 using the terms ankle injuries and ankle sprains. Data Synthesis: Ankle sprains are the most common injuries sustained by athletes. In order to render appropriate treatment, a proper evaluation must be made. Assessment of ankle injuries includes obtaining a good history of the mechanism of injury, a thorough physical examination, and judicious use of radiographic evaluation and special tests. I will outline techniques for diagnosing the most common ankle injuries among athletes. Conclusions/Recommendations: In order to provide appropriate treatment, the examiner must differentiate among injuries to the lateral ankle-ligament complex, subtalar joint, deltoid ligament, and syndesmosis. It is important to realize that injury can occur to any or all of these structures simultaneously. PMID:12937562

  16. Neuromuscular control and rehabilitation of the unstable ankle

    PubMed Central

    Hung, You-jou

    2015-01-01

    Lateral ankle sprain is a common orthopedic injury with a very high recurrence rate in athletes. After decades of research, it is still unclear what contributes to the high recurrence rate of ankle sprain, and what is the most effective intervention to reduce the incident of initial and recurrent injuries. In addition, clinicians often implement balance training as part of the rehabilitation protocol in hopes of enhancing the neuromuscular control and proprioception of the ankle joint. However, there is no consensus on whether the neuromuscular control and proprioception are compromised in unstable ankles. To reduce the prevalence of ankle sprains, the effectiveness of engaging balance training to enhance the neuromuscular control and proprioception of the ankle joint is also questionable. PMID:26085985

  17. Ankle moment generation and maximum-effort curved sprinting performance.

    PubMed

    Luo, Geng; Stefanyshyn, Darren

    2012-11-15

    Turning at high speed along acute curves is crucial for athletic performance. One determinant of curved sprinting speed is the ground reaction force that can be created by the supporting limb; the moment generated at the ankle joint may influence such force generation. Body lean associated with curved sprints positions the ankle joints in extreme in-/eversion, and may hinder the ankle moment generation. To examine the influence of ankle moment generation on curved sprinting performance, 17 male subjects performed maximum-effort curved sprints in footwear with and without a wedge. The wedged footwear was constructed with the intention to align the ankle joints closer to their neutral frontal-plane configuration during counter-clockwise curved sprints so greater joint moments might be generated. We found, with the wedged footwear, the average eversion angle of the inside leg ankle was reduced, and the plantarflexion moment generation increased significantly. Meanwhile, the knee extension moment remained unchanged. With the wedged footwear, stance-average centripetal ground reaction force increased significantly while no difference in the vertical ground reaction force was detected. The subjects created a greater centripetal ground reaction impulse in the wedged footwear despite a shortened stance phase when compared to the control. Stance-average curved sprinting speed improved by 4.3% with the wedged footwear. The changes in ankle moment and curved sprinting speed observed in the current study supports the notion that the moment generation at the ankle joint may be a performance constraint for curved sprinting. PMID:23022207

  18. Rehabilitation of Ankle and Foot Injuries in Athletes

    PubMed Central

    Chinn, Lisa; Hertel, Jay

    2009-01-01

    Foot and ankle injuries are extremely common among athletes and other physically active individuals. Rehabilitation programs that emphasize the use of therapeutic exercise to restore joint range of motion, muscle strength, neuromuscular coordination, and gait mechanics have been shown to have clinical success for patients suffering various foot and ankle pathologies. Rehabilitation programs are discussed for ankle sprains, plantar fasciitis, Achilles tendonitis, and turf toe. PMID:19945591

  19. [Malunited juvenile fractures in the foot region].

    PubMed

    Zwipp, H; Ranft, T

    1991-11-01

    Between 1971 and 1990 we treated 121 juvenile patients up to 14 years of age with fractures of the ankle joint and foot in the department of trauma surgery at Hannover Medical School. A total of 128 fractures were treated in these patients, excluding toe fractures. The distribution of fractures as referred to the anatomical-functional planes was as follows: Tibia-talar joint 69; talus 8; calcaneus 6; Chopart joint 5; Lisfranc joint 4 and metatarsal area 36. Clinical and radiological follow-up investigations were possible a mean of 8.7 years post trauma for all talar and calcaneal fractures, for 7 out of 9 Chopart/Lisfranc injuries and for 7 out of 35 of metatarsal fractures. In the case of talus fractures our results suggest that it is to restore the original length of the talus bone (medial column); this is important to prevent collapse of the longitudinal arch with subsequent early arthritis. The rare cases of sustained intraarticular damage to calcaneal fractures should be treated as in adults, i.e. by open, anatomical reconstruction. In children, Chopart/Lisfranc 2 fracture dislocations only occur if high-energy trauma is present (runover trauma in 4 out of 9 cases). Optimal treatment again is comparable to that in adults: open, anatomical reduction with Kirschner-wires followed by temporary, tibio-tarsal transfixation; this is important since no compensatory mechanisms develop if a subluxation is present after reduction. Metatarsal fractures often occur along the first and fifth rays and have a good prognosis. Conservative treatment is justified, since, according to our results, even in intraarticular fractures of the metatarsal head good remodeling to fragments occurs. PMID:1684652

  20. Proprioception and ankle injuries in soccer.

    PubMed

    Ergen, Emin; Ulkar, Bülent

    2008-01-01

    Because soccer attracts many participants and leads to a substantial number of injuries, especially of the lower extremities, it is important to study possibilities for injury prevention and proper rehabilitation to return safely to activities. Ankle sprains can be prevented by external ankle supports and proprioceptive-coordination training, especially in athletes with previous ankle sprains. Proprioception is a broad concept that includes balance and postural control with visual and vestibular contributions, joint kinesthesia, position sense, and muscle reaction time. Proprioceptive feedback is crucial in the conscious and unconscious awareness of a joint or limb in motion. Enhancement of functional joint stability by proprioceptive (or neuromuscular) training is important both in prevention and rehabilitation of athletic injuries. PMID:18206575

  1. Unsupported standing with minimized ankle muscle fatigue.

    PubMed

    Mihelj, Matjaz; Munih, Marko

    2004-08-01

    In the past, limited unsupported standing has been restored in patients with thoracic spinal cord injury through open-loop functional electrical stimulation of paralyzed knee extensor muscles and the support of intact arm musculature. Here an optimal control system for paralyzed ankle muscles was designed that enables the subject to stand without hand support in a sagittal plane. The paraplegic subject was conceptualized as an underactuated double inverted pendulum structure with an active degree of freedom in the upper trunk and a passive degree of freedom in the paralyzed ankle joints. Control system design is based on the minimization of a cost function that estimates the effort of ankle joint muscles via observation of the ground reaction force position, relative to ankle joint axis. Furthermore, such a control system integrates voluntary upper trunk activity and artificial control of ankle joint muscles, resulting in a robust standing posture. Figures are shown for the initial simulation study, followed by disturbance tests on an intact volunteer and several laboratory trials with a paraplegic person. Benefits of the presented methodology are prolonged standing sessions and in the fact that the subject is able to maintain voluntary control over upper body orientation in space, enabling simple functional standing. PMID:15311817

  2. Determining the shear fracture properties of HIP joints of reduced-activation ferritic/martensitic steel by a torsion test

    NASA Astrophysics Data System (ADS)

    Nozawa, Takashi; Noh, Sanghoon; Tanigawa, Hiroyasu

    2012-08-01

    Hot isostatic pressing (HIP) is a key technology used to fabricate a first wall with cooling channels for the fusion blanket system utilizing a reduced-activation ferritic/martensitic steel. To qualify the HIPped components, small specimen test techniques are beneficial not only to evaluate the thin-wall cooling channels containing the HIP joint but also to use in neutron irradiation studies. This study aims to develop the torsion test method with special emphasis on providing a reasonable and comprehensive method to determine interfacial shear properties of HIP joints during the torsional fracture process. Torsion test results identified that the torsion process shows yield of the base metal followed by non-elastic deformation due to work hardening of the base metal. By considering this work hardening issue, we propose a reasonable and realistic solution to determine the torsional yield shear stress and the ultimate torsional shear strength of the HIPped interface. Finally, a representative torsion fracture process was identified.

  3. Total ankle replacement. The results in 200 ankles.

    PubMed

    Wood, P L R; Deakin, S

    2003-04-01

    Between 1993 and 2000 we implanted 200 cementless, mobile-bearing STAR total ankle replacements. None was lost to follow-up for reasons other than the death of a patient. The mean follow-up was for 46 months (24 to 101). A complication requiring further surgery developed in eight ankles and 14 were revised or fused. The cumulative survival rate at five years was 92.7% (95% CI 86.6 to 98.8) with time to decision to revision or fusion as an endpoint. The most frequent complications were delayed wound healing and fracture of a malleolus. These became less common with experience of the operation. The radiological appearance of the interface of the tibial implant was significantly related to its operative fit and to the type of bioactive coating. PMID:12729104

  4. Rehabilitation of the Ankle After Acute Sprain or Chronic Instability

    PubMed Central

    Mattacola, Carl G.; Dwyer, Maureen K.

    2002-01-01

    Objective: To outline rehabilitation concepts that are applicable to acute and chronic injury of the ankle, to provide evidence for current techniques used in the rehabilitation of the ankle, and to describe a functional rehabilitation program that progresses from basic to advanced, while taking into consideration empirical data from the literature and clinical practice. Background: Important considerations in the rehabilitation of ankle injuries include controlling the acute inflammatory process, regaining full ankle range of motion, increasing muscle strength and power, and improving proprioceptive abilities. These goals can be achieved through various modalities, flexibility exercises, and progressive strength- and balance-training exercises. In this article, we discuss the deleterious effects of ankle injury on ankle-joint proprioception and muscular strength and how these variables can be quantifiably measured to follow progress through a rehabilitation program. Evidence to support the effectiveness of applying orthotics and ankle braces during the acute and subacute phases of ankle rehabilitation is provided, along with recommendations for functional rehabilitation of ankle injuries, including a structured progression of exercises. Recommendations: Early functional rehabilitation of the ankle should include range-of-motion exercises and isometric and isotonic strength-training exercises. In the intermediate stage of rehabilitation, a progression of proprioception-training exercises should be incorporated. Advanced rehabilitation should focus on sport-specific activities to prepare the athlete for return to competition. Although it is important to individualize each rehabilitation program, this well-structured template for ankle rehabilitation can be adapted as needed. PMID:12937563

  5. Ultrasonography in the Assessment of Lateral Ankle Ligament Injury, Instability, and Anterior Ankle Impingement: A Diagnostic Case Report

    PubMed Central

    Battaglia, Patrick J.; Craig, Kate; Kettner, Norman W.

    2015-01-01

    Objective The purpose of this case report is to describe the diagnostic value of ultrasonography (US) in a patient with injury to the lateral ligaments of the ankle with concomitant ankle joint osteoarthritis and anterior impingement. Clinical Features A 28-year-old male had a history of an inversion injury of the left ankle. Diagnostic US of the left ankle using an 8- to 15-MHz linear array transducer demonstrated a full thickness tear of the anterior talofibular ligament, partial thickness tearing of the calcaneofibular ligament, and laxity of the ankle with varus stress testing. In addition, US was able to demonstrate degeneration of the ankle and talonavicular joints and anterior impingement with dorsiflexion. Osteoarthritic changes were confirmed with radiography. Other US findings included remote deltoid ligamentous complex injury, multiple sites of tenosynovitis, and a large ankle joint effusion with synovial hypertrophy and synovitis. Intervention and Outcome Using US, an accurate diagnosis was established with respect to the pathology and functional impairments of the patient’s ankle. Conclusion This case report exemplifies the value and utility of US in diagnosing derangement in ligamentous, tendinous, articular, and osseous injuries of the ankle. PMID:26793038

  6. A novel dynamic ankle-supinating device.

    PubMed

    Gutierrez, Gregory M; Kaminski, Thomas

    2010-02-01

    Lateral ankle sprains (LAS) are among the most common joint injuries, and although most are resolved with conservative treatment, others develop chronic ankle instability (AI). Considerable attention has been directed toward understanding the underlying causes of this pathology; however, little is known concerning the neuromuscular mechanisms behind AI. A biomechanical analysis of the landing phase of a drop jump onto a device that simulates the mechanism of a LAS may give insight into the dynamic restraint mechanisms of the ankle by individuals with AI. Furthermore, work evaluating subjects who have a history of at least one lateral ankle sprain, yet did not develop AI, may help elucidate compensatory mechanisms following a LAS event. Identifying proper neuromuscular control strategies is crucial in reducing the incidence of AI. PMID:20147765

  7. Assessment of Effective Ankle Joint Positioning in Strength Training for Intrinsic Foot Flexor Muscles: A Comparison of Intrinsic Foot Flexor Muscle Activity in a Position Intermediate to Plantar and Dorsiflexion with that in Maximum Plantar Flexion Using Needle Electromyography

    PubMed Central

    Hashimoto, Takayuki; Sakuraba, Keishoku

    2014-01-01

    [Purpose] The effectiveness of intrinsic foot flexor strength training performed in the plantar flexion position was examined using needle electromyography. [Subjects] The subjects of this study were 18 healthy men. [Methods] We used needle electromyography to measure the muscle activities of the flexor hallucis brevis (FHB), and the flexor digitorum brevis (FDB) in maximum plantar and an intermediate position. [Results] Significant increases in muscle activities were observed for both FHB and FDB, and the rates of increase from the intermediate position to the plantar flexion position were 43% for FHB and 46% for FDB. [Conclusion] This study demonstrated that it is possible to evaluate intrinsic foot flexors, in addition to the numerous reports on treatment methods focusing on extrinsic foot flexors. Furthermore, the results suggest that toe flexion exercises performed during plantar flexion of the ankle joint are an effective method for intrinsic foot flexor strength training. PMID:24707106

  8. Clinical experiences with three different designs of ankle prostheses.

    PubMed

    Rippstein, Pascal F

    2002-12-01

    Until 1995, fusion was in our institution the only rational surgical option for a severe ankle arthrosis. Consistent reports about good mid- and long-term results with ankle replacement allowed us to change our minds. Ankle replacement became the gold standard and fusion was then almost totally banished. Because ankle arthrosis can be morphologically different from one patient to another, we soon believed that one single type of ankle prosthesis would not be the universal optimal solution for all patients. We therefore divided the ankle arthrosis into three groups. Each group shows the best solution from each of the ankle prostheses with which we had gained experience (Agility, STAR, and BP). The Agility prosthesis, which was indicated for ankles with extremely damaged geometry, did not restore sufficiently the ankle motion. Preoperatively stiff ankles remained stiff postoperatively. Additionally, significant residual pain was more likely to occur in those patients. These cases did not show significant advantages compared with ankle fusion, especially from a functional point of view. Fusion for these stiff ankles is therefore today our first treatment of choice. In our experience, the malleolar joints do not have to be replaced. Even a severe arthrosis at this level does not produce significant pain, provided that osteophytes have been removed and joint height has been restored by the implanted prosthesis. It is our strong belief that these malleolar joints are also less sensitive to pain, similar to the femoropatellar joint. For these reasons, a replacement of the malleolar joints and the resurfacing of the talar sides is not necessary. Leaving the talar sides untouched requires less bone resection and makes the implantation of the talar component easier. Although we obtained good results with the STAR prosthesis, we progressively abandoned it because of these reasons, and we preferred the BP prosthesis. The BP prosthesis works on the same biomechanic principle as

  9. [Ankle sprain during a volleyball game].

    PubMed

    Boersma, Anton R; Munzebrock, Arvid V E

    2015-01-01

    A 27-year old woman was admitted to the emergency room after her left ankle rolled inward during a volleyball game. On physical examination a bony prominence on the lateral side of the left foot was noticeable, without neurovascular injury. An X-ray (anterior-posterior view) showed a subtalar dislocation without associated fractures. PMID:26420145

  10. Effect of Yttrium on the Fracture Strength of the Sn-1.0Ag-0.5Cu Solder Joints

    NASA Astrophysics Data System (ADS)

    Choi, Hyelim; Kaplan, Wayne D.; Choe, Heeman

    2016-04-01

    This is a preliminary investigation on the mechanical properties of Pb-free Sn-1.0Ag-0.5Cu solder joints containing 0.02 wt.% to 0.1 wt.% Y under a range of thermal aging and reflow conditions. Despite the significantly thicker intermetallic compound (IMC) formed at the solder joint, the 0.1 wt.% Y-doped joint exhibited a higher fracture strength than its baseline Sn-1.0Ag-0.5Cu counterpart under most aging and reflow conditions. This may be associated with the formation of Y-Cu IMCs formed at the interface between the solder and the Cu substrate, because the Y-Cu IMCs have recently been referred to as relatively `ductile' IMCs.

  11. Effect of Yttrium on the Fracture Strength of the Sn-1.0Ag-0.5Cu Solder Joints

    NASA Astrophysics Data System (ADS)

    Choi, Hyelim; Kaplan, Wayne D.; Choe, Heeman

    2016-07-01

    This is a preliminary investigation on the mechanical properties of Pb-free Sn-1.0Ag-0.5Cu solder joints containing 0.02 wt.% to 0.1 wt.% Y under a range of thermal aging and reflow conditions. Despite the significantly thicker intermetallic compound (IMC) formed at the solder joint, the 0.1 wt.% Y-doped joint exhibited a higher fracture strength than its baseline Sn-1.0Ag-0.5Cu counterpart under most aging and reflow conditions. This may be associated with the formation of Y-Cu IMCs formed at the interface between the solder and the Cu substrate, because the Y-Cu IMCs have recently been referred to as relatively `ductile' IMCs.

  12. Evaluation of J-initiation fracture toughness of ultra high molecular weight polyethylene used in total joint replacements

    PubMed Central

    Varadarajan, R.; Rimnac, C.M.

    2010-01-01

    Fracture of ultra high molecular weight polyethylene (UHMWPE) total joint replacement components is a clinical concern. Thus, it is important to characterize the fracture resistance of UHMWPE. To determine J-initiation fracture toughness (JQ) for metals and metallic alloys, ASTM E1820 recommends a procedure based on an empirical crack blunting line. This approach has been found to overestimate the initiation toughness of tough polymers like UHMWPE. Therefore, in this study, a novel experimental approach based on crack tip opening displacement (CTOD) was utilized to evaluate JQ of UHMWPE materials. J-initiation fracture toughness was experimentally measured in ambient air and a physiologically-relevant 37°C PBS environment for three different formulations of UHMWPE and compared to the blunting line approach. The CTOD method was found to provide JQ values comparable to the blunting line approach for the UHMWPE materials and environments examined in this study. The CTOD method used in this study is based on experimental observation and, thus, does not rely on an empirical relationship or fracture surface measurements. Therefore, determining JQ using the experimentally based CTOD method proposed in this study may be a more reliable approach for UHMWPE and other tough polymers than the blunting line approach. PMID:20671815

  13. Evaluation of J-initiation fracture toughness of ultra high molecular weight polyethylene used in total joint replacements.

    PubMed

    Varadarajan, R; Rimnac, C M

    2008-08-01

    Fracture of ultra high molecular weight polyethylene (UHMWPE) total joint replacement components is a clinical concern. Thus, it is important to characterize the fracture resistance of UHMWPE. To determine J-initiation fracture toughness (J(Q)) for metals and metallic alloys, ASTM E1820 recommends a procedure based on an empirical crack blunting line. This approach has been found to overestimate the initiation toughness of tough polymers like UHMWPE. Therefore, in this study, a novel experimental approach based on crack tip opening displacement (CTOD) was utilized to evaluate J(Q) of UHMWPE materials. J-initiation fracture toughness was experimentally measured in ambient air and a physiologically-relevant 37°C PBS environment for three different formulations of UHMWPE and compared to the blunting line approach. The CTOD method was found to provide J(Q) values comparable to the blunting line approach for the UHMWPE materials and environments examined in this study. The CTOD method used in this study is based on experimental observation and, thus, does not rely on an empirical relationship or fracture surface measurements. Therefore, determining J(Q) using the experimentally based CTOD method proposed in this study may be a more reliable approach for UHMWPE and other tough polymers than the blunting line approach. PMID:20671815

  14. Assessment of Ankle Injuries

    ERIC Educational Resources Information Center

    Mai, Nicholas; Cooper, Leslie

    2009-01-01

    School nurses are faced with the challenge of identifying and treating ankle injuries in the school setting. There is little information guiding the assessment and treatment of these children when an injury occurs. It is essential for school nurses to understand ankle anatomy, pathophysiology of the acute ankle injury, general and orthopedic…

  15. On the nature of static and cyclic fracture resistance of ultra high molecular weight polyethylenes used in total joint replacements

    NASA Astrophysics Data System (ADS)

    Varadarajan, Ravikumar

    In 2005, about 629,000 total joint replacement (TJR) surgeries were performed in the United States alone and the number is expected to increase by 343% by 2030. In addition, the average age of the patient receiving TJR is decreasing. Therefore, there is an immediate need to enhance the material properties of the implants. Fracture of ultra high molecular weight polyethylene (UHMWPE) components used in total joint replacements is a clinical concern. In this work, static and cyclic fracture resistance of conventional and highly crosslinked and post-processed UHMWPE materials were evaluated in ambient air and physiologically relevant environmental conditions. Applicability of a compliance based automated system for crack length measurement during fatigue crack propagation (FCP) tests was demonstrated for UHMWPE materials. The Standard compliance calibration coefficients were found to accurately predict the fatigue crack growth only in the low da/dN regime (da/dN < 10-4 mm/cycle). New compliance calibration coefficients that can accurately predict the fatigue crack growth were computed for different UHMWPE materials. FCP studies were conducted in ambient air and in 37°C PBS environments to evaluate the cyclic fracture resistance of UHMWPE materials. In a 37°C PBS environment, the resistance to fatigue crack inception and propagation of sterilized and highly crosslinked UHMWPE materials were found to be reduced compared to ambient air. This findings suggests that under in-vivo conditions UHMWPE implants are more likely to be susceptible to fatigue fracture than might be expected from tests conducted in ambient air. The presence of crack closure overestimates the FCP resistance in the near threshold regime. Crack closure was not observed for any of the UHMWPE materials under the testing conditions selected for this study. Under in-vivo conditions, UHMWPE components may be subjected to overloads. On application of an overload, some test specimens exhibited crack

  16. Treatment of acute lateral ankle ligament rupture in the athlete. Conservative versus surgical treatment.

    PubMed

    Lynch, S A; Renström, P A

    1999-01-01

    Acute lateral ankle ligament sprains are common in young athletes (15 to 35 years of age). Diagnostic and treatment protocols vary. Therapies range from cast immobilisation or acute surgical repair to functional rehabilitation. The lateral ligament complex includes 3 capsular ligaments: the anterior tibiofibular (ATFL), calcaneofibular (CFL) and posterior talofibular (PTFL) ligaments. Injuries typically occur during plantar flexion and inversion; the ATFL is most commonly torn. The CFL and the PTFL can also be injured and, after severe inversion, subtalar joint ligaments are also affected. Commonly, an athlete with a lateral ankle ligament sprain reports having 'rolled over' the outside of their ankle. The entire ankle and foot must be examined to ensure there are no other injuries. Clinical stability tests for ligamentous disruption include the anterior drawer test of ATFL function and inversion tilt test of both ATFL and CFL function. Radiographs may rule out treatable fractures in severe injuries or when pain or tenderness are not associated with lateral ligaments. Stress radiographs do not affect treatment. Ankle sprains are classified from grades I to III (mild, moderate or severe). Grade I and II injuries recover quickly with nonoperative management. A non-operative 'functional treatment' programme includes immediate use of RICE (rest, ice, compression, elevation), a short period of immobilisation and protection with a tape or bandage, and early range of motion, weight-bearing and neuromuscular training exercises. Proprioceptive training on a tilt board after 3 to 4 weeks helps improve balance and neuromuscular control of the ankle. Treatment for grade III injuries is more controversial. A comprehensive literature evaluation and meta-analysis showed that early functional treatment provided the fastest recovery of ankle mobility and earliest return to work and physical activity without affecting late mechanical stability. Functional treatment was complication

  17. Total ankle replacement for posttraumatic arthritis

    PubMed Central

    Weme, Rebecca A Nieuwe; van Solinge, Guido; N Doornberg, Job; Sierevelt, Inger; Haverkamp, Daniël; Doets, H Cornelis

    2015-01-01

    Background and purpose Most studies on total ankle replacement (TAR) have used a case mix of patients. We evaluated the outcome of TAR performed for end-stage arthritis either because of fracture or ligamentous injury. Patients and methods We prospectively followed 88 consecutive patients (50 postfracture ankles and 40 ankles with instability arthritis (2 bilateral)) who underwent TAR between 2001 and 2009. Mean follow-up for both groups was 5 years. Results Preoperative varus deformity of 10° or more was present in 23 ankles in the instability group. At 6 years, survival with revision or salvage fusion as an endpoint was 87% (95% CI: 74–99) in the postfracture group and 79% (95% CI: 63–94) in the instability group. Progressive periprosthetic osteolysis was seen in 23 ankles, and required salvage fusion in 6. The number of reoperations was similar in both groups. Clinical outcome, as assessed with 2 ankle scores and 2 questionnaires, showed good results and was similar at the latest follow-up. Interpretation The outcome was similar in the postfracture and instability groups and also similar to that reported in series including a case mix of patients. In contrast to earlier reports, preoperative frontal plane deformity in this series was not identified as a risk factor for failure. PMID:25772269

  18. ANALYSIS OF CLINICAL AND FUNCTIONAL OUTCOME AND COMPLICATIONS OF TALAR NECK FRACTURES

    PubMed Central

    Bastos, Leonardo Ribeiro; Ferreira, Ricardo Cardenuto; Mercadante, Marcelo Tomanik

    2015-01-01

    Objective: To evaluate the clinical, functional and radiographic results from talar neck fractures in patients treated at the Foot and Ankle Surgery Group of Santa Casa de Sao Paulo. Method: We evaluated 20 patients. The mean follow-up time was 71 months. One fracture was classified as Hawkins Type I, 12 as Hawkins type II, five as Hawkins type III, two as Hawkins type IV and four fractures were open. Results: One patient was treated conservatively, 16 were treated with open reduction and internal fixation (three with primary subtalar arthrodesis), one was treated with talectomy and two with tibiotalocalcaneal arthrodesis. The reduction obtained was anatomical in seven feet, acceptable in six feet and poor in four. Seven patients had early complications. There was one case of delayed consolidation and four of talar body osteonecrosis. Four patients required secondary reconstruction procedures. No significant radiographic impairment of the ankle joint was found in 62% of the patients and of the subtalar joint in 25%. Of the patients who did not undergo secondary procedures, 81% complained about the treated foot, 37.5% showed some deformity, 44% presented diminished sensitivity and 50% had to retire from work. The mean loss of motion in the ankle was 49%, and in the subtalar joint, 80%. The average AOFAS score was 73 points. Conclusion: Talar neck fractures are associated with high rates of clinical, functional and radiographic complications. PMID:27022565

  19. Osteochondral defects in the ankle: why painful?

    PubMed Central

    Reilingh, Mikel L.; Zengerink, Maartje; van Bergen, Christiaan J. A.

    2010-01-01

    Osteochondral defects of the ankle can either heal and remain asymptomatic or progress to deep ankle pain on weight bearing and formation of subchondral bone cysts. The development of a symptomatic OD depends on various factors, including the damage and insufficient repair of the subchondral bone plate. The ankle joint has a high congruency. During loading, compressed cartilage forces its water into the microfractured subchondral bone, leading to a localized high increased flow and pressure of fluid in the subchondral bone. This will result in local osteolysis and can explain the slow development of a subchondral cyst. The pain does not arise from the cartilage lesion, but is most probably caused by repetitive high fluid pressure during walking, which results in stimulation of the highly innervated subchondral bone underneath the cartilage defect. Understanding the natural history of osteochondral defects could lead to the development of strategies for preventing progressive joint damage. PMID:20151110

  20. A Posteriorly Displaced Distal Metaphyseal Clavicular Fracture (Type IV AC Joint Dislocation-Like) in Children: A Case Report and Literature Review Study.

    PubMed

    Kotb, Ahmed; Yong, Taylor; Abdelgawad, Amr

    2016-01-01

    Fractures of the lateral end of the clavicle are common in pediatric patients; most of these fractures occur at the physeal level representing Salter Harris injuries. The vast majority of fractures of the lateral end of the clavicle are managed nonoperatively. In this report, we describe a unique type of fracture of the distal end of the clavicle in the pediatric patients in which the fracture occurs in the metaphyseal lateral clavicle with the proximal edge of the fracture displaced posteriorly through the trapezius muscle causing obvious deformity. It is similar in pathology to type IV AC joint dislocation. In this study we report this injury in eleven-year-old boy. Literature review showed that similar injuries were described before three times (two of them in pediatric patients). Due to the significant clinical deformity of this category with entrapment of the bone through the trapezius muscle, reduction (open or closed) of the fracture is the recommended treatment. PMID:26904336

  1. A Posteriorly Displaced Distal Metaphyseal Clavicular Fracture (Type IV AC Joint Dislocation-Like) in Children: A Case Report and Literature Review Study

    PubMed Central

    Kotb, Ahmed; Yong, Taylor; Abdelgawad, Amr

    2016-01-01

    Fractures of the lateral end of the clavicle are common in pediatric patients; most of these fractures occur at the physeal level representing Salter Harris injuries. The vast majority of fractures of the lateral end of the clavicle are managed nonoperatively. In this report, we describe a unique type of fracture of the distal end of the clavicle in the pediatric patients in which the fracture occurs in the metaphyseal lateral clavicle with the proximal edge of the fracture displaced posteriorly through the trapezius muscle causing obvious deformity. It is similar in pathology to type IV AC joint dislocation. In this study we report this injury in eleven-year-old boy. Literature review showed that similar injuries were described before three times (two of them in pediatric patients). Due to the significant clinical deformity of this category with entrapment of the bone through the trapezius muscle, reduction (open or closed) of the fracture is the recommended treatment. PMID:26904336

  2. Supramalleolar Osteotomies for the Treatment of Ankle Arthritis.

    PubMed

    Hintermann, Beat; Knupp, Markus; Barg, Alexej

    2016-07-01

    Supramalleolar osteotomy is a joint-preserving surgical treatment for patients with asymmetric valgus or varus ankle arthritis. The primary goal of the procedure is to realign the spatial relationship between the talus and tibia and thereby normalize joint loading within the ankle. Procedures to balance the soft tissues, as well as hindfoot osteotomy and arthrodesis, may also be necessary. Clinical studies of supramalleolar osteotomy demonstrate that correction of the altered biomechanics associated with asymmetric arthritis improves functional outcomes. PMID:27195382

  3. Biomechanics of foot/ankle trauma with variable energy impacts

    PubMed Central

    Gallenberger, Kathryn; Yoganandan, Narayan; Pintar, Frank

    2013-01-01

    A total of 60 pendulum impacts to the plantar surface of 15 lower limb PMHS specimens were conducted. Impact conditions were chosen to obtain data from high velocity tests without injury. For 19 impacts the specimen was initially positioned in 20-deg of dorsiflexion. The remaining impacts used neutral positioning. The foot-ankle response was investigated based on impact energy and velocity. Response was characterized by heel pad and joint stiffness. For neutral tests, axial force vs compression corridors were developed for 2–3 m/s, 4–6 m/s, and 7–63 J impacts. For dorsiflexion tests corridors of 1–3 m/s, 6–8 m/s, 7–20 J, and 80–100 J were developed. These results indicate foot/ankle response is not more sensitive to impact energy than velocity. Injury risk curves were developed for both neutral and dorsiflexion positioning using logistic regression. Strain gage data were used to obtain uncensored force values for injury analysis. In neutral, 50% probability of injury occurred at 6800 N. In dorsiflexion, 50% probability occurred at 7900 N, but the regression was not statistically significant. These preliminary results indicate dorsiflexed specimens fracture at a higher force than neutral specimens. PMID:24406952

  4. Isolated posterior malleolus fracture: a rare injury mechanism

    PubMed Central

    Serbest, Sancar; Tiftikçi, Uğur; Tosun, Haci Bayram; Kesgin, Engin; Karataş, Metin

    2015-01-01

    Sprain of the ankle is undoubtedly a common injury during athletic activity, and the sprain can be also associated with fracture of the ankle. Isolated posterior malleolus fracture is a very rare condition, which is usually missed. Here, we are presenting a 37 years old female patient, who suffered injury secondary pressing on brake pedal during collision in a traffic accident. Clinical evaluation is based on Ottawa Ankle Rules and a fracture is diagnosed; patient is started on daily activities at postoperative Week 8. This study aims to emphasize that Ottawa Ankle Rules are usually efficient for evaluating fractures of ankle, but clinicians should always make a detailed physical examination. PMID:26097627

  5. Isolated posterior malleolus fracture: a rare injury mechanism.

    PubMed

    Serbest, Sancar; Tiftikçi, Uğur; Tosun, Haci Bayram; Kesgin, Engin; Karataş, Metin

    2015-01-01

    Sprain of the ankle is undoubtedly a common injury during athletic activity, and the sprain can be also associated with fracture of the ankle. Isolated posterior malleolus fracture is a very rare condition, which is usually missed. Here, we are presenting a 37 years old female patient, who suffered injury secondary pressing on brake pedal during collision in a traffic accident. Clinical evaluation is based on Ottawa Ankle Rules and a fracture is diagnosed; patient is started on daily activities at postoperative Week 8. This study aims to emphasize that Ottawa Ankle Rules are usually efficient for evaluating fractures of ankle, but clinicians should always make a detailed physical examination. PMID:26097627

  6. Fractures

    PubMed Central

    Hall, Michael C.

    1963-01-01

    Recent studies on the epidemiology and repair of fractures are reviewed. The type and severity of the fracture bears a relation to the age, sex and occupation of the patient. Bone tissue after fracture shows a process of inflammation and repair common to all members of the connective tissue family, but it repairs with specific tissue. Cartilage forms when the oxygen supply is outgrown. After a fracture, the vascular bed enlarges. The major blood supply to healing tissue is from medullary vessels and destruction of them will cause necrosis of the inner two-thirds of the cortex. Callus rapidly mineralizes, but full mineralization is achieved slowly; increased mineral metabolism lasts several years after fracture. PMID:13952119

  7. Extra-articular ankle stabilization: a case series.

    PubMed

    Roukis, Thomas S

    2010-06-01

    Maintenance of the foot at 90 degrees to the lower leg following posterior calf lengthening or to prevent an equinus contracture in situations in which splint, cast, or external fixation is deemed inappropriate is a challenge. The author presents an observational case series involving 9 extra-articular ankle stabilizations performed in 9 consecutive patients. Each patient underwent his or her index surgery followed by percutaneous placement of 2 smooth 2.8-mm or larger diameter Steinmann pins extra-articular to the ankle joint. There were 6 men and 3 women with a mean age of 56.1 years (range, 31-73 years). Five patients had diabetes with peripheral neuropathy, 2 had critical limb ischemia, 1 had alcohol-induced neuropathy, 1 had lupus, and 1 was an active smoker. Eight patients had posterior calf lengthening, and 1 had open metatarsal fractures with severe soft-tissue disruption with an inability to use splint immobilization. Three patients had a transmetatarsal amputation, 2 patients had Chopart amputations, 2 patients had forefoot plastic surgery reconstructive procedures, 1 had a complex Charcot reconstruction, and 1 had a splittibialis anterior tendon transfer. Extra-articular ankle stabilization fixation was retained for a mean of 5.5 weeks (range, 2-10 weeks). Mean follow-up was 12 months (range, 1-17 months). All extra-articular stabilization procedures were deemed successful. When properly performed, extra-articular stabilization to maintain the foot at 90 degrees to the lower leg represents a safe, simple, reliable, and minimally invasive technique useful in situations in which traditional splint or cast immobilization is not possible and when external fixation is deemed inappropriate. PMID:20508012

  8. Modified Labial Button Technique for Maintaining Occlusion After Caudal Mandibular Fracture/Temporomandibular Joint Luxation in the Cat.

    PubMed

    Goodman, Alice E; Carmichael, Daniel T

    2016-03-01

    Maxillofacial trauma in cats often results in mandibular symphyseal separation in addition to injuries of the caudal mandible and/or temporomandibular joint (TMJ). Caudal mandibular and TMJ injuries are difficult to access and stabilize using direct fixation techniques, thus indirect fixation is commonly employed. The immediate goals of fixation include stabilization for return to normal occlusion and function with the long-term objective of bony union. Indirect fixation techniques commonly used for stabilization of caudal mandibular and temporomandibular joint fracture/luxation include maxillomandibular fixation (MMF) with acrylic composite, interarcade wiring, tape muzzles, and the bignathic encircling and retaining device (BEARD) technique. This article introduces a modification of the previously described "labial reverse suture through buttons" technique used by Koestlin et al and the "labial locking with buttons" technique by Rocha et al. In cases with minimally displaced subcondylar and pericondylar fractures without joint involvement, the labial button technique can provide sufficient stabilization for healing. Advantages of the modified labial button technique include ease of application, noninvasive nature, and use of readily available materials. The construct can remain in place for a variable of amount of time, depending on its intended purpose. It serves as an alternative to the tape muzzle, which is rarely tolerated by cats. This technique can be easily used in conjunction with other maxillomandibular repairs, such as cerclage wire fixation of mandibular symphyseal separation. The purpose of this article is to demonstrate a modified labial button technique for maintaining occlusion of feline caudal mandibular fractures/TMJ luxations in a step-by-step fashion. PMID:27487655

  9. The sprained ankle.

    PubMed

    Puffer, J C

    2001-01-01

    The sprained ankle is the most common musculoskeletal injury seen by physicians caring for active youngsters and adults. It accounts for approximately one fourth of all sports-related injuries and is commonly seen in athletes participating in basketball, soccer, or football. It has been shown that one third of West Point cadets suffer an ankle sprain during their 4 years at the military academy. While diagnosis and management of the sprained ankle is usually straightforward, several serious injuries can masquerade as an ankle sprain, and it is important for the clinician to recognize these to prevent long-term morbidity. In this article the basic anatomy of the ankle, mechanisms by which the ankle is injured, and the differential diagnosis of the acutely injured ankle are reviewed. Appropriate evaluation of the injured ankle and the criteria that should be utilized for determining the necessity of radiographs are discussed as well as management of the acutely sprained ankle and the role of prevention in reducing the risk of ankle injury. PMID:11464730

  10. Stress fracture of the second metatarsal and sprain of lisfranc joint in a pre-professional ballet dancer.

    PubMed

    Kriz, Peter; Rafferty, Jason; Evangelista, Peter; Van Valkenburg, Scott; DiGiovanni, Christopher

    2015-06-01

    We present the case of a 14-year-old pre-professional ballerina that demonstrates common features of two conditions affecting the midfoot that are often missed or subject to delay in diagnosis in such young athletes: 1. stress fractures at the base of the second metatarsal, and 2. sprain of the Lisfranc joint complex. While these represent potentially career-altering injuries in the professional dancer, this case demonstrates that a high index of clinical suspicion, careful physical exam, appropriate radiographic assessment, and prompt treatment are essential to achieving the best possible outcome. PMID:26045400

  11. Rehabilitation of Syndesmotic (High) Ankle Sprains

    PubMed Central

    Williams, Glenn N.; Allen, Eric J.

    2010-01-01

    Context: High ankle sprains are common in athletes who play contact sports. Most high ankle sprains are treated nonsurgically with a rehabilitation program. Evidence Acquisition: All years of PUBMED, Cochrane Database of Systematic Reviews, CINAHL PLUS, SPORTDiscuss, Google Scholar, and Web of Science were searched to August 2010, cross-referencing existing publications. Keywords included syndesmosis ankle sprain or high ankle sprain and the following terms: rehabilitation, treatment, cryotherapy, braces, orthosis, therapeutic modalities, joint mobilization, massage, pain, pain medications, TENS (ie, transcutaneous electric nerve stimulation), acupuncture, aquatic therapy, strength, neuromuscular training, perturbation training, and outcomes. Results: Level of evidence, 5. A 3-phase rehabilitation program is described. The acute phase is directed at protecting the joint while minimizing pain, inflammation, muscle weakness, and loss of motion. Most patients are treated with some form of immobilization and have weightbearing restrictions. A range of therapeutic modalities are used to minimize pain and inflammation. Gentle mobilization and resistance exercises are used to gain mobility and maintain muscle size and strength. The subacute phase is directed at normalizing range of motion, strength, and function in activities of daily living. Progressive mobilization and strengthening are hallmarks of this phase. Neuromuscular training is begun and becomes the central component of rehabilitation. The advanced training phase focuses on preparing the patient for return to sports participation. Perturbation of support surfaces, agility drills, plyometrics, and sport-specific training are central components of this phase. Conclusion: The rehabilitation guidelines discussed may assist clinicians in managing syndesmotic ankle sprains. PMID:23015976

  12. Invariant ankle moment patterns when walking with and without a robotic ankle exoskeleton

    PubMed Central

    Kao, Pei-Chun; Lewis, Cara L.; Ferris, Daniel P.

    2009-01-01

    To guide development of robotic lower limb exoskeletons, it is necessary to understand how humans adapt to powered assistance. The purposes of this study were to quantify joint moments while healthy subjects adapted to a robotic ankle exoskeleton and to determine if the period of motor adaptation is dependent on the magnitude of robotic assistance. The pneumatically-powered ankle exoskeleton provided plantar flexor torque controlled by the wearer’s soleus electromyography (EMG). Eleven naïve individuals completed two 30-min sessions walking on a split-belt instrumented treadmill at 1.25 m/s while wearing the ankle exoskeleton. After two sessions of practice, subjects reduced their soleus EMG activation by ~36% and walked with total ankle moment patterns similar to their unassisted gait (r2 = 0.98±0.02, THSD, p>0.05). They had substantially different ankle kinematic patterns compared to their unassisted gait (r2 = 0.79±0.12, THSD, p<0.05). Not all of the subjects reached a steady state gait pattern within the two sessions, in contrast to a previous study using a weaker robotic ankle exoskeleton (Gordon and Ferris 2007). Our results strongly suggest that humans aim for similar joint moment patterns when walking with robotic assistance rather than similar kinematic patterns. In addition, greater robotic assistance provided during initial use results in a longer adaptation process than lesser robotic assistance. PMID:19878952

  13. Invariant ankle moment patterns when walking with and without a robotic ankle exoskeleton.

    PubMed

    Kao, Pei-Chun; Lewis, Cara L; Ferris, Daniel P

    2010-01-19

    To guide development of robotic lower limb exoskeletons, it is necessary to understand how humans adapt to powered assistance. The purposes of this study were to quantify joint moments while healthy subjects adapted to a robotic ankle exoskeleton and to determine if the period of motor adaptation is dependent on the magnitude of robotic assistance. The pneumatically powered ankle exoskeleton provided plantar flexor torque controlled by the wearer's soleus electromyography (EMG). Eleven naïve individuals completed two 30-min sessions walking on a split-belt instrumented treadmill at 1.25m/s while wearing the ankle exoskeleton. After two sessions of practice, subjects reduced their soleus EMG activation by approximately 36% and walked with total ankle moment patterns similar to their unassisted gait (r(2)=0.98+/-0.02, THSD, p>0.05). They had substantially different ankle kinematic patterns compared to their unassisted gait (r(2)=0.79+/-0.12, THSD, p<0.05). Not all of the subjects reached a steady-state gait pattern within the two sessions, in contrast to a previous study using a weaker robotic ankle exoskeleton (Gordon and Ferris, 2007). Our results strongly suggest that humans aim for similar joint moment patterns when walking with robotic assistance rather than similar kinematic patterns. In addition, greater robotic assistance provided during initial use results in a longer adaptation process than lesser robotic assistance. PMID:19878952

  14. Sequential approach to joint flow-seismic inversion for improved characterization of fractured media

    NASA Astrophysics Data System (ADS)

    Kang, Peter K.; Zheng, Yingcai; Fang, Xinding; Wojcik, Rafal; McLaughlin, Dennis; Brown, Stephen; Fehler, Michael C.; Burns, Daniel R.; Juanes, Ruben

    2016-02-01

    Seismic interpretation of subsurface structures is traditionally performed without any account of flow behavior. Here we present a methodology for characterizing fractured geologic reservoirs by integrating flow and seismic data. The key element of the proposed approach is the identification—within the inversion—of the intimate relation between fracture compliance and fracture transmissivity, which determine the acoustic and flow responses of a fractured reservoir, respectively. Owing to the strong (but highly uncertain) dependence of fracture transmissivity on fracture compliance, the modeled flow response in a fractured reservoir is highly sensitive to the geophysical interpretation. By means of synthetic models, we show that by incorporating flow data (well pressures and tracer breakthrough curves) into the inversion workflow, we can simultaneously reduce the error in the seismic interpretation and improve predictions of the reservoir flow dynamics. While the inversion results are robust with respect to noise in the data for this synthetic example, the applicability of the methodology remains to be tested for more complex synthetic models and field cases.

  15. Understanding acute ankle ligamentous sprain injury in sports

    PubMed Central

    Fong, Daniel TP; Chan, Yue-Yan; Mok, Kam-Ming; Yung, Patrick SH; Chan, Kai-Ming

    2009-01-01

    This paper summarizes the current understanding on acute ankle sprain injury, which is the most common acute sport trauma, accounting for about 14% of all sport-related injuries. Among, 80% are ligamentous sprains caused by explosive inversion or supination. The injury motion often happens at the subtalar joint and tears the anterior talofibular ligament (ATFL) which possesses the lowest ultimate load among the lateral ligaments at the ankle. For extrinsic risk factors to ankle sprain injury, prescribing orthosis decreases the risk while increased exercise intensity in soccer raises the risk. For intrinsic factors, a foot size with increased width, an increased ankle eversion to inversion strength, plantarflexion strength and ratio between dorsiflexion and plantarflexion strength, and limb dominance could increase the ankle sprain injury risk. Players with a previous sprain history, players wearing shoes with air cells, players who do not stretch before exercising, players with inferior single leg balance, and overweight players are 4.9, 4.3, 2.6, 2.4 and 3.9 times more likely to sustain an ankle sprain injury. The aetiology of most ankle sprain injuries is incorrect foot positioning at landing – a medially-deviated vertical ground reaction force causes an explosive supination or inversion moment at the subtalar joint in a short time (about 50 ms). Another aetiology is the delayed reaction time of the peroneal muscles at the lateral aspect of the ankle (60–90 ms). The failure supination or inversion torque is about 41–45 Nm to cause ligamentous rupture in simulated spraining tests on cadaver. A previous case report revealed that the ankle joint reached 48 degrees inversion and 10 degrees internal rotation during an accidental grade I ankle ligamentous sprain injury during a dynamic cutting trial in laboratory. Diagnosis techniques and grading systems vary, but the management of ankle ligamentous sprain injury is mainly conservative. Immobilization should not

  16. Dysplasia epiphysealis hemimelica (Trevor disease) in the ankle

    PubMed Central

    Ozan, Fırat; Doğar, Fatih; Gürbüz, Kaan; Ekinci, Yakup; Bilal, Ökkeş; Öncel, Eyyüp Sabri

    2016-01-01

    Dysplasia epiphysealis hemimelica, also termed Trevor disease, is a rare disorder that, although benign in nature, can be locally aggressive, particularly when affecting the ankle joint, which is the joint most frequently affected, followed by the knee. The female:male ratio is 1:3, and it is generally diagnosed between 2 and 14 years of age. Surgical treatment with complete resection is recommended before irreversible joint damage and deformity occurs. We presented a case in which dysplasia epiphysealis hemimelica was diagnosed on the medial aspect of a right ankle joint. PMID:27103813

  17. Fractures

    MedlinePlus

    ... commonly happen because of car accidents, falls, or sports injuries. Other causes are low bone density and osteoporosis, which cause weakening of the bones. Overuse can cause stress fractures, which are very small cracks in the ...

  18. Fractures

    MedlinePlus

    A fracture is a break, usually in a bone. If the broken bone punctures the skin, it is called an open ... falls, or sports injuries. Other causes are low bone density and osteoporosis, which cause weakening of the ...

  19. Congenital Pseudoarthrosis of Medial Malleolus in A Young Soccer Player - Diagnosis in Clinical setting of Ankle Sprain

    PubMed Central

    Cerulli, Giuliano; Fabiano, Fantasia; Gabriele, Potalivo; Giacomo, Placella; Enrico, Sebastiani

    2014-01-01

    Introduction: We report a case of a young female soccer player affected by congenital medial bilateral malleolus pseudoarthrosis and os subfibulare. Congenital pseudoarthrosis is the failure of the bones to fuse prior or at birth. The etiology is still unknown, although frequency is high in subjects affected by neurofibromatosis or correlated syndromes, so it has been suggested that these congenital disorders may be the cause of congenital pseudoarthrosis. Case Report: Our patient, a 16-year-old female, high level soccer player, was referred to us following a right ankle sprain during a match. She reported no medical history of tibia-tarsus joint injuries or disease. Pain, swelling and functional impairment were noted immediately after the accident. Standard radiographs in the emergency department revealed a displaced fracture of the medial malleolus and the presence of os subfibularis. The patient was transferred to our Traumatology and Orthopaedic Department to undergo malleolus ostheosynthesis. Before surgery swelling, functional impairment and intense pain at the medial malleolus level were confirmed. However, there was no radiological opening of ankle, instability or pronation pain; furthermore the flexion-extension was preserved with slight pain. Twenty-four hours later a considerable remission of symptoms was evident with increased range of motion and reduction in the swelling and post-traumatic edema. A radiograph on the left ankle to compare with that of the right ankle was necessary to overcome the discrepancy between the radiological diagnosis and the clinical examination. The radiographic results of both medial malleoli were comparable although on the left the os subfibularis was absent. Since the diagnosis of fracture by the association between the radiographs and the symptomatology was doubtful, a bilateral CT was performed. The scan revealed a medial bilateral malleolus pseudoarthrosis and an accessory right subfibularis nucleus. The patient was

  20. Force-controlled dynamic wear testing of total ankle replacements.

    PubMed

    Reinders, Jörn; von Stillfried, Falko; Altan, Emel; Sonntag, Robert; Heitzmann, Daniel W W; Kretzer, Jan Philippe

    2015-01-01

    Currently, our knowledge of wear performance in total ankle replacements is limited. The aim of this study is to develop a scenario for force-controlled testing and wear testing of total ankle replacements. A force-controlled wear test was developed: based on cadaver measurements, the passive stabilization (ligaments and soft tissue) of the ankle joint was characterized and a restraint model for ankle stabilization was developed. Kinematics and kinetics acting at the replaced ankle joint were defined based on literature data and gait analysis. Afterwards, force-controlled wear testing was carried out on a mobile, three-component, total ankle replacement design. Wear was assessed gravimetrically and wear particles were analyzed. Wear testing resulted in a mean wear rate of 18.2±1.4mm(3)/10(6) cycles. Wear particles showed a mean size of 0.23μm with an aspect ratio of 1.61±0.96 and a roundness of 0.62±0.14. Wear testing of total ankle replacement shows that a relevant wear mass is generated with wear particles in a biologically relevant size range. The developed wear test provides a basis for future wear testing of total ankle replacements. PMID:25448342

  1. Ankle Sprains. A Round Table.

    ERIC Educational Resources Information Center

    Physician and Sportsmedicine, 1986

    1986-01-01

    Types of ankle sprains, surgical versus nonsurgical treatment, tape versus brace for support, rehabilitation, exercise, and prevention of ankle sprains are discussed by a panel of experts. An acute ankle taping technique is illustrated. (MT)

  2. Foot, leg, and ankle swelling

    MedlinePlus

    Swelling of the ankles - feet - legs; Ankle swelling; Foot swelling; Leg swelling; Edema - peripheral; Peripheral edema ... Foot, leg, and ankle swelling is common when the person also: Is overweight Has a blood clot in the leg Is older Has ...

  3. Fracture Analysis of Competing Failure Modes of Aluminum-CFRP Joints Using Three-Layer Titanium Laminates as Transition

    NASA Astrophysics Data System (ADS)

    Woizeschke, P.; Vollertsen, F.

    2015-09-01

    The structural properties of lightweight constructions can be adapted to specific local requirements using multi-material designs. Aluminum alloys and carbon fiber-reinforced plastics (CFRP) are materials of great interest requiring suitable joining techniques in order to transfer the advantages of combining the materials to structural benefits. Thus, the research group "Schwarz-Silber" investigates novel concepts to enable frontal aluminum-CFRP joints using transition structures. In the foil concept titanium foils are used as transition elements. Specimens have been produced using three-layer titanium laminates. In tensile tests, three failure locations have been observed: (1) Al-Ti seam, (2) Ti-CFRP hybrid laminate, and (3) CFRP laminate. In this paper, the fracture mechanisms of these failure modes are investigated by analyzing metallographic micrographs and fracture surfaces as well as by correlating load-displacement curves to video imaging of tensile tests. The results show that the cracking of the CFRP layers can be traced back to an assembly error. The laminate character of the titanium part tends to reduce the Al-Ti seam strength. However, two sub-joint tests demonstrate that the Al-Ti seam can endure loads up to 9.5 kN. The ductile failure behavior of the Ti-CFRP hybrid laminates is caused by plastic deformations of the titanium laminate liners.

  4. How to Care for a Sprained Ankle

    MedlinePlus

    ... Sprained Ankle How to Care for a Sprained Ankle Page Content Ankle sprains are very common injuries. ... Grade I, II or III. Treating your Sprained Ankle Treating your sprained ankle properly may prevent chronic ...

  5. Mechanics and energetics of level walking with powered ankle exoskeletons.

    PubMed

    Sawicki, Gregory S; Ferris, Daniel P

    2008-05-01

    Robotic lower limb exoskeletons that can alter joint mechanical power output are novel tools for studying the relationship between the mechanics and energetics of human locomotion. We built pneumatically powered ankle exoskeletons controlled by the user's own soleus electromyography (i.e. proportional myoelectric control) to determine whether mechanical assistance at the ankle joint could reduce the metabolic cost of level, steady-speed human walking. We hypothesized that subjects would reduce their net metabolic power in proportion to the average positive mechanical power delivered by the bilateral ankle exoskeletons. Nine healthy individuals completed three 30 min sessions walking at 1.25 m s(-1) while wearing the exoskeletons. Over the three sessions, subjects' net metabolic energy expenditure during powered walking progressed from +7% to -10% of that during unpowered walking. With practice, subjects significantly reduced soleus muscle activity (by approximately 28% root mean square EMG, P<0.0001) and negative exoskeleton mechanical power (-0.09 W kg(-1) at the beginning of session 1 and -0.03 W kg(-1) at the end of session 3; P=0.005). Ankle joint kinematics returned to similar patterns to those observed during unpowered walking. At the end of the third session, the powered exoskeletons delivered approximately 63% of the average ankle joint positive mechanical power and approximately 22% of the total positive mechanical power generated by all of the joints summed (ankle, knee and hip) during unpowered walking. Decreases in total joint positive mechanical power due to powered ankle assistance ( approximately 22%) were not proportional to reductions in net metabolic power ( approximately 10%). The ;apparent efficiency' of the ankle joint muscle-tendon system during human walking ( approximately 0.61) was much greater than reported values of the ;muscular efficiency' of positive mechanical work for human muscle ( approximately 0.10-0.34). High ankle joint

  6. A non-invasive, 3D, dynamic MRI method for measuring muscle moment arms in vivo: demonstration in the human ankle joint and Achilles tendon.

    PubMed

    Clarke, E C; Martin, J H; d'Entremont, A G; Pandy, M G; Wilson, D R; Herbert, R D

    2015-01-01

    Muscle moment arms are used widely in biomechanical analyses. Often they are measured in 2D or at a series of static joint positions. In the present study we demonstrate a simple MRI method for measuring muscle moment arms dynamically in 3D from a single range-of-motion cycle. We demonstrate this method in the Achilles tendon for comparison with other methods, and validate the method using a custom apparatus. The method involves registration of high-resolution joint geometry from MRI scans of the stationary joint with low-resolution geometries from ultrafast MRI scans of the slowly moving joint. Tibio-talar helical axes and 3D Achilles tendon moment arms were calculated throughout passive rotation for 10 adult subjects, and compared with recently published data. A simple validation was conducted by comparing MRI measurements with direct physical measurements made on a phantom. The moment arms measured using our method and those of others were similar and there was good agreement between physical measurements (mean 41.0mm) and MRI measurements (mean 39.5mm) made on the phantom. This new method can accurately measure muscle moment arms from a single range-of-motion cycle without the need to control rotation rate or gate the scanning. Supplementary data includes custom software to assist implementation. PMID:25466777

  7. Total elbow joint replacement for the treatment of distal humerus fracture of type c in eight elderly patients

    PubMed Central

    Tian, Wei; He, Chao; Jia, Jian

    2015-01-01

    Objective: To analyze the outcomes of total elbow arthroplasty in the treatment of elderly type C distal humeral fractures and discuss the clinic efficacy. Methods: 8 cases of elderly type C distal humeral fractures, Male was in one case, female in seven cases, and the average age was 66.5 years (60-81). All cases were closed fractures because of falling and none had associated injuries. According to AO classification, type C1 were in one cases, C2 in four cases and C3 in three cases. The average time from injury to operation was 5.5 days (3-9), and the type of prosthesis which all cases replaced was Coonrad-Marrey. The postoperative follow-up was obtained regularly which the contents included Mayo elbow score, pain evaluation, the motion range and the stability of the elbow, muscle strength, examination of related complications such as heterotopic ossification, prosthesis loosening and nerve damage. Results: The incision infection was in one case, ulnar nerve symptom in two cases, weakness of musculus triceps brachii in one case and mild pain of elbow in two cases. The average motion rage of elbow was 103.5±3.2 degree (78-118) in flexion-extension and 126.4±4.1 degree (94-148) in rotation. All elbow joints were stable postoperatively, no prosthesis loosening and apparent wear was found. The heterotopic ossification was found in 1 case. The average Mayo elbow score was 85.2±3.4 (75-95), four cases of excellent and four cases of good. Conclusion: The total elbow arthroplasty was recommended in clinic to treat elderly type C distal humeral fractures because the clinic outcomes are satisfied. PMID:26309701

  8. Locking Plate in Proximal Tibial Fracture: A Correlation between the Coronal Alignment of Tibia and Joint Screw Angle

    PubMed Central

    Oh, Jong-Keon; Varte, Lalrinliana; Ko, Jae-Han; Oh, Chang-Wug; Jung, Duk-Young; An, Hyonggin; Cho, Jae-Woo

    2013-01-01

    Purpose The purpose of this study is to evaluate the relationship between the angle formed between the proximal most screw through the locking compression plate-proximal lateral tibia (LCP PLT) and the joint line, and to evaluate if this angle can be used intraoperatively as an assessment tool to determine normal alignment of the tibia in the coronal plane. Materials and Methods There are two parts to this study: in the first part, LCP PLT was applied to 30 cadaveric adult tibia. The angle between the joint line and the proximal most screw was measured and termed as the 'joint screw angle' (JSA). In the second part, 56 proximal tibial fractures treated with LCP PLT were retrospectively studied. Two angles were measured on the radiographs, the medial proximal tibial angle (MPTA) and the JSA. Their relationship was analyzed statistically. Results The average JSA was 1.16 degrees in the anatomical study. Statistical analysis of the clinical study showed that the normal MPTA had a direct correlation with an acceptable JSA. Conclusion We therefore conclude that the JSA can be used intraoperatively to assess the achievement of a normal coronal axis. PMID:23549821

  9. Finite element analysis of a composite artificial ankle

    NASA Technical Reports Server (NTRS)

    Perkins, Leigh Ann; Johnston, Lawrence; Denniston, Charles; Czekalski, Blaise E.

    1993-01-01

    Ultra-light carbon fiber composite materials are being utilized in artificial limbs with increasing frequency in recent years. Dr. Arthur Copes, an orthotist from Baton Rouge, Louisiana, has developed a graphite expoxy composite material artificial ankle (Copes/Bionic Ankle) that is intended to be used by amputees who require the most advanced above-and-below-the-knee prosthetic devices. The Copes/Bionic Ankle is designed to reproduce the function of the natural ankle joint by allowing the composite material to act as a spring mechanism without the use of metal mechanical parts. NASA Marshall Space Flight Center has agreed to participate in the design effort by providing the structural analysis of the artificial ankle design.

  10. Functional Design in Rehabilitation: Modular Mechanisms for Ankle Complex

    PubMed Central

    2016-01-01

    This paper is aimed at presenting an innovative ankle rehabilitation device based on a parallel mechanism. A functional analysis and design are described to obtain a device able to guarantee ankle movement while patient's body remains stationary. Human ankle is a challenging context where a series of joints are highly integrated. The proposed rehabilitation device permits a patient with walking defects to improve his or her gait. The research focuses on plantar-flexion-dorsiflexion movement. The robust design starts from an accurate modelling of ankle movements during walking, assessing motion data from healthy individuals and patients. The kinematics analysis and functional evaluations lead the study and development of the articulated system. In particular, results of simulations support the effectiveness of the current design. A 3D prototype is presented highlighting that the ankle motion is successfully demonstrated. PMID:27524881

  11. The effects of a strategic strength resistance exercise program on the isokinetic muscular function of the ankle

    PubMed Central

    Jeon, Kyoung-Kyu; Kim, Tae-Young; Lee, Sang-Ho

    2015-01-01

    [Purpose] The purpose of this study was to investigate the effects of a strategic strength resistance exercise program on the isokinetic muscular function of the ankle joint. [Subjects] This study included 22 males in their twenties who were diagnosed with functional injury of the ankle joint. [Methods] To strengthen plantar flexion and dorsiflexion of the ankle joint, 8 weeks of weight, resistance band, and plyometric training, and training using props were performed. [Results] A medical examination by interview indicated that pain, swelling, instability, running, and support capacity of the ankle joint significantly improved with the strategic strength resistance exercise program. For the isokinetic peak torque of the ankles, significant differences were observed in right plantar flexion and bilateral dorsiflexion. [Conclusion] The strategic strength resistance exercise program is highly recommended for the functional stability of the ankle joint. Efficient exercise therapy is useful for muscle damage prevention, muscle strengthening, and functional interventions. PMID:26644696

  12. Systematic review of chronic ankle instability in children

    PubMed Central

    2014-01-01

    Background Chronic ankle instability (CAI) is a disabling condition often encountered after ankle injury. Three main components of CAI exist; perceived instability; mechanical instability (increased ankle ligament laxity); and recurrent sprain. Literature evaluating CAI has been heavily focused on adults, with little attention to CAI in children. Hence, the objective of this study was to systematically review the prevalence of CAI in children. Methods Studies were retrieved from major databases from earliest records to March 2013. References from identified articles were also examined. Studies involving participants with CAI, classified by authors as children, were considered for inclusion. Papers investigating traumatic instability or instability arising from fractures were excluded. Two independent examiners undertook all stages of screening, data extraction and methodological quality assessments. Screening discrepancies were resolved by reaching consensus. Results Following the removal of duplicates, 14,263 papers were screened for eligibility against inclusion and exclusion criteria. Nine full papers were included in the review. Symptoms of CAI evaluated included perceived and mechanical ankle instability along with recurrent ankle sprain. In children with a history of ankle sprain, perceived instability was reported in 23-71% whilst mechanical instability was found in 18-47% of children. A history of recurrent ankle sprain was found in 22% of children. Conclusion Due to the long-lasting impacts of CAI, future research into the measurement and incidence of ankle instability in children is recommended. PMID:24641786

  13. Severe injury of bilateral elbow joints with unilateral terrible triad of the elbow and unilateral suspected terrible triad of the elbow complicated with olecranon fracture: one case report

    PubMed Central

    Zha, Guoqing; Niu, Xiaofeng; Yu, Weiguang; Xiao, Liangbao

    2015-01-01

    Terrible triad of the elbow is characterized as posterior dislocation of the elbow joint accompanied by the fractures of the radial head and coronoid process of the ulna, which is rarely seen in clinical practice, especially because the mild fracture is barely detected by imaging method In this study, we reported one case of serious complex bilateral elbow injury, presenting with unilateral typical terrible triad of the elbow and suspected terrible triad of the elbow complicated with olecranon fracture on the other side. Clinical experience was obtained during the diagnosis and treatment procedures. PMID:26550399

  14. Closed antegrade intramedullary pinning for reduction and fixation of metatarsal fractures.

    PubMed

    Kim, Hyong-Nyun; Park, Yoo-Jung; Kim, Gab-Lae; Park, Yong-Wook

    2012-01-01

    The purpose of this study was to present the results of the metatarsal fractures treated with a closed antegrade intramedullary pinning technique. The records of 35 consecutive patients with metatarsal fractures operated on from August 2005 to June 2010 by the authors were retrospectively reviewed. Four patients were not contactable and 1 patient refused to participate. Accordingly, the study cohort was composed of 30 patients (24 male, 6 female) with 46 metatarsal head, neck, or shaft fractures. Inclusion criteria were metatarsal head, neck, or shaft fractures with a displacement of more than 3 to 4 mm or an angulation of more than 10° in the sagittal plane. Fractures combined with Lisfranc injury or metatarsal base fractures were excluded, as were bicortical comminuted fractures or long oblique fractures. Times to bone union, limitations of motion at affected metatarsophalangeal joints, and residual pain were evaluated at 6 weeks after surgery and at final follow-up. American Orthropedic Foot and Ankle Society scale was evaluated at final follow-up. Fracture union was obtained at an average of 7.1 (range 6 to 10) weeks. Two patients had moderate limitation of metatarsophalangeal joint at 6 weeks but recovered to full range at final follow-up. Average American Orthropedic Foot and Ankle Society score at final follow-up was 96.7 (range 83 to 100) points. Closed antegrade intramedullary pinning was found to be a useful method for treating displaced metatarsal fractures and to allow immediate joint motion and partial weightbearing in a stiff-soled shoe. PMID:22608998

  15. Association of the type of trauma, occurrence of bone bruise, fracture and joint effusion with the injury to the menisci and ligaments in MRI of knee trauma

    PubMed Central

    Pezeshki, Sina; Vogl, Thomas J.; Pezeshki, Mohammad Zakaria; Daghighi, Mohammad Hossein; Pourisa, Masoud

    2016-01-01

    Summary Background magnetic resonance imaging (MRI) as a noninvasive diagnostic tool may help clinicians in the evaluation of injuries to menisci and ligaments. Purpose this study assessed the associations between type of trauma to knee joint, bone bruise, fracture and pathological joint effusion with injuries to menisci and ligaments of knee joint. Methods we reviewed knee joint MRI of 175 patients aged less than 45 years old who were referred to MRI center of our University. Results statistical analysis showed that tearing of medial meniscus (MM) is significantly more common in sport related trauma (p= 0.045) but tearing of medial collateral ligament (MCL) is significantly more common in non-sport related trauma (p= 0.005). Existence of bone bruise in knee MRI is negatively associated with tearing of medial meniscus (MM) (p=0.004) and positively associated with tearing of anterior cruciate ligament (ACL) (p=0.00047) and medial collateral ligament (MCL) (p = 0.0001). Existence of fracture is associated with decreased risk of the tearing of ACL and MM (p=0.04, p=0.001 respectively). Pathologic joint effusion is significantly more common in ACL and MCL tearing (p=0.0001, p=0.004 respectively). Conclusions as diagnostic clues, bone bruise, fracture and joint effusion may help radiologists for better assessment of injury to menisci and ligaments in MRI of patients with knee trauma. PMID:27331046

  16. Investigation of Fatigue Crack Propagation in Spot-Welded Joints Based on Fracture Mechanics Approach

    NASA Astrophysics Data System (ADS)

    Hassanifard, S.; Bonab, M. A. Mohtadi; Jabbari, Gh.

    2013-01-01

    In this paper, fatigue crack propagation life of resistance spot welds in tensile-shear specimens is investigated based on the calculation of stress intensity factors and J-integral using three-dimensional finite element method. For comparison, experimental works on 5083-O aluminum alloy spot-welded joints have been carried out to verify the numerical predictions of fatigue crack propagation of welded joints. A lot of analyses have been performed to obtain stress intensity factors and J-integral in tensile-shear specimens of spot-welded joints by using commercial software ANSYS. These gathered data have been formulated by using statistical software SPSS. The results of fatigue propagation life and predicted fatigue crack path revealed very good agreement with the experimental fatigue test data and photograph of cross-section of the fatigued spot-weld specimens.

  17. Forces predicted at the ankle during running.

    PubMed

    Burdett, R G

    1982-01-01

    A biomechanical model of the ankle joint was developed and was used to predict the forces at the ankle during the stance phase of running. Measurements from five cadavers were averaged to obtain insertion points and directions of pull of equivalent tendons with respect to the assumed center of the ankle joint. A minimum joint force solution was obtained by assuming that only two equivalent muscle groups could exert force at one time. Three subjects ran at 4.47 m/s across a force platform that recorded the external forces and moments acting on the foot. Cinematography was used to measure the foot and leg positions during stance. Peak resultant joint forces ranging from 9.0 to 13.3 times body weight and peak Achilles tendon forces ranging from 5.3 to 10.0 times body weight were predicted. Small variations in some cases resulted in large differences in predicted forces. The highest tendon forces predicted exceeded those reported to cause damage to cadaver tendons in other studies. PMID:7132650

  18. The Anatomy and Mechanisms of Syndesmotic Ankle Sprains

    PubMed Central

    Floyd, R. T.

    2001-01-01

    Objective: To present a comprehensive review of the anatomy, biomechanics, and mechanisms of tibiofibular syndesmosis ankle sprains. Data Sources: MEDLINE (1966–1998) and CINAHL (1982–1998) searches using the key words syndesmosis, tibiofibular, ankle injuries, and ankle injuries–etiology. Data Synthesis: Stability of the distal tibiofibular syndesmosis is necessary for proper functioning of the ankle and lower extremity. Much of the ankle's stability is provided by the mortise formed around the talus by the tibia and fibula. The anterior and posterior inferior tibiofibular ligaments, the interosseous ligament, and the interosseous membrane act to statically stabilize the joint. During dorsiflexion, the wider portion anteriorly more completely fills the mortise, and contact between the articular surfaces is maximal. The distal structures of the lower leg primarily prevent lateral displacement of the fibula and talus and maintain a stable mortise. A variety of mechanisms individually or combined can cause syndesmosis injury. The most common mechanisms, individually and particularly in combination, are external rotation and hyperdorsiflexion. Both cause a widening of the mortise, resulting in disruption of the syndesmosis and talar instability. Conclusions and Recommendation: Syndesmosis ankle injuries are less common than lateral ankle injuries, are difficult to evaluate, have a long recovery period, and may disrupt normal joint functioning. To effectively evaluate and treat this injury, clinicians should have a full understanding of the involved structures, functional anatomy, and etiologic factors. PMID:16404437

  19. Fracture toughness testing of bi-material joints with high strength mis-match

    SciTech Connect

    Kocak, M.; Hornet, P.; Cornec, A.; Schwalbe, K.H.

    1995-12-31

    This paper deals with the influence of strength mis-match on CTOD ({delta}{sub 5}) R-curves obtained from homogeneous and electron beam (EB) welded bimaterial CT and SENB specimens of two aluminum alloys. The R-curves of metal-metal bimaterial specimens are compared with the R-curves of each alloy to determine the effect of strength mismatch on the locally measured CTOD ({delta}{sub 5}) fracture toughness properties. The homogeneous specimens of two different aluminum alloys, namely 2024-FC and 2024-T351 with yield strengths of 80 and 360 MPa respectively, as well as EB welded bi-material 5 mm thick CT and SENB specimens (a/W = 0.15 and 0.5) have been tested at room temperature. The local CTOD ({delta}{sub 5}) fracture toughness measurements on such composite specimen configurations produced generally strength mis-match and geometry independent R-curves.

  20. Review on design and control aspects of ankle rehabilitation robots.

    PubMed

    Jamwal, Prashant K; Hussain, Shahid; Xie, Sheng Q

    2015-03-01

    Ankle rehabilitation robots can play an important role in improving outcomes of the rehabilitation treatment by assisting therapists and patients in number of ways. Consequently, few robot designs have been proposed by researchers which fall under either of the two categories, namely, wearable robots or platform-based robots. This paper presents a review of both kinds of ankle robots along with a brief analysis of their design, actuation and control approaches. While reviewing these designs it was observed that most of them are undesirably inspired by industrial robot designs. Taking note of the design concerns of current ankle robots, few improvements in the ankle robot designs have also been suggested. Conventional position control or force control approaches, being used in the existing ankle robots, have been reviewed. Apparently, opportunities of improvement also exist in the actuation as well as control of ankle robots. Subsequently, a discussion on most recent research in the development of novel actuators and advanced controllers based on appropriate physical and cognitive human-robot interaction has also been included in this review. Implications for Rehabilitation Ankle joint functions are restricted/impaired as a consequence of stroke or injury during sports or otherwise. Robots can help in reinstating functions faster and can also work as tool for recording rehabilitation data useful for further analysis. Evolution of ankle robots with respect to their design and control aspects has been discussed in the present paper and a novel design with futuristic control approach has been proposed. PMID:24320195

  1. Ultrasound-guided interventions of the foot and ankle.

    PubMed

    Yablon, Corrie M

    2013-02-01

    Ultrasound (US) provides excellent delineation of tendons and ligaments in the foot and ankle and provides real-time visualization of a needle during interventions, yielding greater accuracy and efficacy than the traditional blind approach using anatomical landmarks. For this reason, US is rapidly gaining acceptance as the preferred modality for guiding interventions in the foot and ankle where the anatomy is complex, neurovascular structures should be identified, and precise technique is demanded. In the foot and ankle, US is especially useful to guide tendon sheath, bursal, and Achilles paratenon injections, Morton neuroma injections, plantar fascial injections, and joint aspirations and injections. PMID:23487336

  2. Talocrural Dislocation With Associated Weber Type C Fibular Fracture in a Collegiate Football Player: A Case Report

    PubMed Central

    Ricci, R Daniel; Cerullo, James; Blanc, Robert O; McMahon, Patrick J; Buoncritiani, Anthony M; Stone, David A; Fu, Freddie H

    2008-01-01

    Objective: To present the case of a talocrural dislocation with a Weber type C fibular fracture in a National Collegiate Athletic Association Division I football athlete. Background: The athlete, while attempting to make a tackle during a game, collided with an opponent, who in turn stepped on the lateral aspect of the athlete's ankle, resulting in forced ankle eversion and external rotation. On-field evaluation showed a laterally displaced talocrural dislocation. Immediate reduction was performed in the athletic training room to maintain skin integrity. Post-reduction radiographs revealed a Weber type C fibular fracture and increased medial joint clear space. A below-knee, fiberglass splint was applied to stabilize the ankle joint complex. Differential Diagnosis: Subtalar dislocation, Maisonneuve fracture, malleolar fracture, deltoid ligament rupture, syndesmosis disruption. Treatment: The sports medicine staff immediately splinted and transported the athlete to the athletic training room to reduce the dislocation. The athlete then underwent an open reduction and internal fixation procedure to stabilize the injury: 2 syndesmosis screws and a fibular plate were placed to keep the ankle joint in an anatomically reduced position. With the guidance of the athletic training staff, the athlete underwent an accelerated physical rehabilitation protocol in an effort to return to sport as quickly and safely as possible. Uniqueness: Most talocrural dislocations and associated Weber type C fibular fractures are due to motor vehicle accidents or falls. We are the first to describe this injury in a Division I football player and to present a general rehabilitation protocol for a high-level athlete. Conclusions: Sports medicine practitioners must recognize that this injury can occur in the athletic environment. Prompt reduction, early surgical intervention, sufficient resources, and an accelerated rehabilitation protocol all contributed to a successful outcome in the patient

  3. Corrosion fracture resistance of welded joints in 16GMYuCh steel

    SciTech Connect

    Steklov, O.I.; Efimenko, L.A.; Khakimov, A.M.; Paul', A.I.; Pushkina, O.A.

    1986-01-01

    This paper studies the effect of combined welding of thick-wall gas and oil chemical equipment consisting of welding the weld root by automatic submerged-arc welding and electrosag welding (ESW) with the control of thermal cycles (CWC) of the main joint, on the corrosion resistance of welded joints in low-alloy normalized 16GMYuCh steel 50 mm thick. The chemical composition of the steel, % 0.16 C; 1.05 Mn; 0.25 Si; 0.42 Mo; 0.14 Ni; 0.1 Cu; 0.11 Cr; 0.049 Al; 0.032 S; 0.019 P. The authors determined the effect of cooling rate in the temperature range of diffusion transformation of austenite on the corrosion resistance of the weld zone. Attention was then given to the corrosion resistance of the welded joints produced by conventional ESW welding and ESW with CWC. The investigations show that the corrosion resistance of the parent metal is lower than that of the welded joints.

  4. Effect of Segregation of Secondary Phase Particles and "S" Line on Tensile Fracture Behavior of Friction Stir-Welded 2024Al-T351 Joints

    NASA Astrophysics Data System (ADS)

    Zhang, Z.; Xiao, B. L.; Ma, Z. Y.

    2013-09-01

    A 5-mm-thick 2024Al-T351 plate was friction stir welded (FSWed) at welding speeds of 100, 200, and 400 mm min-1 with a constant rotation rate of 800 rpm, and the microstructure and tensile fracture behavior of the joints were investigated in detail. FSW resulted in the redistribution of secondary phase particles along the recrystallized grain boundaries at the nugget zone (NZ), forming linear segregation bands consisting of secondary phase particles. The segregation bands, mainly present in the shoulder-driven zone, were believed to result from periodic material flow, with the average band spacing on the longitudinal and horizontal cross sections equal to the tool advancement per revolution. At a low welding speed of 100 mm min-1, in spite of the highest density of segregation bands, the FSWed 2024Al-T351 joint fractured along the low hardness zone (LHZ) of the heat-affected zone because of large hardness gap between NZ and LHZ. Increasing the welding speed to 200 and 400 mm min-1 reduced both the hardness gap between NZ and LHZ and the density of segregation bands. In this case, the segregation bands played a role, resulting in unusual fracture of the joints along the segregation bands. The "S" line originated from the oxide film on the initial butting surfaces and did not affect the fracture behavior of the FSWed 2024Al-T351 joints.

  5. Repair of acute injuries of the lateral ligament complex of the ankle by suture anchors

    PubMed Central

    Liu, Xiang-Fei; Fang, Yang; Cao, Zhong-Hua; Li, Guang-Feng; Yang, Guo-Qing

    2015-01-01

    Objective: The objective of this study was to investigate the clinical curative effect of stage I repair of acute injuries of the lateral ligament complex of the ankle by the application of suture anchors. Methods: We retrospectively analyzed 18 cases of III degree acute injuries of the lateral ligament complex of the ankle. Results: There were statistically significant differences in preoperative and last follow-up VAS pain scores and AOFAS ankle hind-foot function scores. The X-ray talus displacement values in the anterior drawer test and pressure anteroposterior X-ray talar tilt in the ankle talar tilt test also showed statistically significant differences. Complications occurred in 2 patients, incision surface infection in one, and postoperative lateral dorsal skin numbness in one. All these cases were cured after symptomatic treatment. At the last follow-up all patients’ ankle joint activity recovered to their preinjury function levels. Conclusion: The application of suture anchors for small incision stage I repair of the lateral collateral ligament of ankle joint degree III injury, can effectively restored the stability of ankle joint, and prevent the occurrence of chronic ankle instability complications. It is effective and feasible for the treatment of ankle joint lateral collateral ligament injuries. PMID:26885144

  6. Effects of hip and head position on ankle range of motion, ankle passive torque, and passive gastrocnemius tension.

    PubMed

    Andrade, R J; Lacourpaille, L; Freitas, S R; McNair, P J; Nordez, A

    2016-01-01

    Ankle joint range of motion (ROM) is notably influenced by the position of the hip joint. However, this result remains unexplained. Thus, the aim of this study was to test if the ankle passive torque and gastrocnemius muscle tension are affected by the hip and the head positions. The torque and the muscle shear elastic modulus (measured by elastography to estimate muscle tension) were collected in nine participants during passive ankle dorsiflexions performed in four conditions (by combining hip flexion at 90 or 150°, and head flexed or neutral). Ankle maximum dorsiflexion angle significantly decreased by flexing the hip from 150 to 90° (P < 0.001; mean difference 17.7 ± 2.5°), but no effect of the head position was observed (P > 0.05). Maximal passive torque and shear elastic modulus were higher with the hip flexed at 90° (P < 0.001). During submaximal ROM, no effects of the head and hip positioning (P > 0.05) were found for both torque and shear elastic modulus at a given common ankle angle among conditions. Shifts in maximal ankle angle due to hip angle manipulation are not related neither to changes in passive torque nor tension of the gastrocnemius. Further studies should be addressed to better understand the functional role of peripheral nerves and fasciae in the ankle ROM limits. PMID:25676048

  7. Therapeutic Interventions for Increasing Ankle Dorsiflexion After Ankle Sprain: A Systematic Review

    PubMed Central

    Terada, Masafumi; Pietrosimone, Brian G.; Gribble, Phillip A.

    2013-01-01

    Context: Clinicians perform therapeutic interventions, such as stretching, manual therapy, electrotherapy, ultrasound, and exercises, to increase ankle dorsiflexion. However, authors of previous studies have not determined which intervention or combination of interventions is most effective. Objective: To determine the magnitude of therapeutic intervention effects on and the most effective therapeutic interventions for restoring normal ankle dorsiflexion after ankle sprain. Data Sources: We performed a comprehensive literature search in Web of Science and EBSCO HOST from 1965 to May 29, 2011, with 19 search terms related to ankle sprain, dorsiflexion, and intervention and by cross-referencing pertinent articles. Study Selection: Eligible studies had to be written in English and include the means and standard deviations of both pretreatment and posttreatment in patients with acute, subacute, or chronic ankle sprains. Outcomes of interest included various joint mobilizations, stretching, local vibration, hyperbaric oxygen therapy, electrical stimulation, and mental-relaxation interventions. Data Extraction: We extracted data on dorsiflexion improvements among various therapeutic applications by calculating Cohen d effect sizes with associated 95% confidence intervals (CIs) and evaluated the methodologic quality using the Physiotherapy Evidence Database (PEDro) scale. Data Synthesis: In total, 9 studies (PEDro score = 5.22 ± 1.92) met the inclusion criteria. Static-stretching interventions with a home exercise program had the strongest effects on increasing dorsiflexion in patients 2 weeks after acute ankle sprains (Cohen d = 1.06; 95% CI = 0.12, 2.42). The range of effect sizes for movement with mobilization on ankle dorsiflexion among individuals with recurrent ankle sprains was small (Cohen d range = 0.14 to 0.39). Conclusions: Static-stretching intervention as a part of standardized care yielded the strongest effects on dorsiflexion after acute ankle sprains. The

  8. Lateral and syndesmotic ankle sprain injuries: a narrative literature review

    PubMed Central

    Dubin, Joshua C.; Comeau, Doug; McClelland, Rebecca I.; Dubin, Rachel A.; Ferrel, Ernest

    2011-01-01

    Objective The purpose of this article is to review the literature that discusses normal anatomy and biomechanics of the foot and ankle, mechanisms that may result in a lateral ankle sprain or syndesmotic sprain, and assessment and diagnostic procedures, and to present a treatment algorithm based on normal ligament healing principles. Methods Literature was searched for years 2000 to 2010 in PubMed and CINAHL. Key search terms were ankle sprain$, ankle injury and ankle injuries, inversion injury, proprioception, rehabilitation, physical therapy, anterior talofibular ligament, syndesmosis, syndesmotic injury, and ligament healing. Discussion Most ankle sprains respond favorably to nonsurgical treatment, such as those offered by physical therapists, doctors of chiropractic, and rehabilitation specialists. A comprehensive history and examination aid in diagnosing the severity and type of ankle sprain. Based on the diagnosis and an understanding of ligament healing properties, a progressive treatment regimen can be developed. During the acute inflammatory phase, the goal of care is to reduce inflammation and pain and to protect the ligament from further injury. During the reparative and remodeling phase, the goal is to progress the rehabilitation appropriately to facilitate healing and restore the mechanical strength and proprioception. Radiographic imaging techniques may need to be used to rule out fractures, complete ligament tears, or instability of the ankle mortise. A period of immobilization and ambulating with crutches in a nonweightbearing gait may be necessary to allow for proper ligament healing before commencing a more active treatment approach. Surgery should be considered in the case of grade 3 syndesmotic sprain injuries or those ankle sprains that are recalcitrant to conservative care. Conclusion An accurate diagnosis and prompt treatment can minimize an athlete's time lost from sport and prevent future reinjury. Most ankle sprains can be successfully

  9. Imaging in Foot and Ankle Arthritis.

    PubMed

    Wilkinson, Victoria H; Rowbotham, Emma L; Grainger, Andrew J

    2016-04-01

    The foot and ankle are commonly involved in a range of arthritides that affect the joints, bones, and soft tissues. Accurate plain film interpretation can often aid the diagnosis and monitor disease progression and treatment response. Ultrasound and MRI afford superior depiction of the soft tissues, and advances over recent years have centered on early detection of synovitis, enabling earlier diagnosis and treatment. Advantages and disadvantages of the imaging techniques of radiography, multidetector computed tomography, ultrasound, and MRI are discussed, as is optimization of these modalities for the assessment of the anatomically complex joints of the foot and ankle. Diagnostic features enabling differentiation between rheumatoid arthritis, seronegative spondyloarthropathies, osteoarthritis, gout, crystal deposition disease, pigmented villonodular synovitis, Charcot arthropathy, septic arthritis, synovial osteochondromatosis, hemophilia, and reflex sympathetic dystrophy are also reviewed. PMID:27336451

  10. Design of a quasi-passive 3 DOFs ankle-foot wearable rehabilitation orthosis.

    PubMed

    Zhang, Chao; Zhu, Yanhe; Fan, Jizhuang; Zhao, Jie; Yu, Hongying

    2015-01-01

    Muscular rigidity and atrophy caused by long-term underactivity usually lead to foot drop, strephenopodia, foot extorsion or some other complications for the lower limb movement disorders or lower limb surgery sufferers. The ankle-foot orthosis can help patients conduct the right ankle motion mode training, inhibit spasm and prevent ankle complications. In this paper, a quasi-passive 3 DOFs ankle-foot wearable orthosis was designed on the basis of kinematics and dynamics analysis of the ankle joint. Ankle joint trajectory and dynamic characteristics similar to those of natural gait can be obtained by the combination of passive energy storage and additional power complement. In terms of function, the orthosis has shock absorption and low energy consumption. Given its excellent characteristics of comfortableness, lightweight, and anthropomorphic construction, the orthosis can be used in medical institutions for rehabilitation training or as a daily-walking auxiliary equipment for surgery sufferers. PMID:26406060

  11. Prediction of sub-seismic faults and fractures to ensure carbon traps - joint project PROTECT

    NASA Astrophysics Data System (ADS)

    Ziesch, Jennifer; Tanner, David C.; Beilecke, Thies; Krawczyk, Charlotte M.

    2015-04-01

    Deformation in the form of fractures and faults affects many reservoirs and their overburden. In a 3-D seismic data set we can identify faults on the large scale, while in well data we observe small-scale fractures. A large number of faults at the intermediate scale (sub-seismic space) also plays a very important role, but these are not detectable with conventional geophysical methods. Therefore, we use the retro-deformation approach within the context of long-term CO2 storage integrity to determine the characteristics of potential fluid migration pathways between reservoir and surface. This allows to produce strain maps, in order to analyse fault behaviour in the sub-seismic space. As part of the PROTECT (prediction of deformation to ensure carbon traps) project we focus on the sub-seismic faults of the CO2CRC Otway Project site in Australia. We interpreted a geological 3-D model of 8 km x 7 km x 4.5 km that comprises 8 stratigraphic horizons and 24 large-scale faults. This confirmed the site to contain a complex system of south-dipping normal faults and north-dipping antithetic normal faults. The most important aspect is that two different types of fault kinematics were simultaneously active: Dip-slip and a combination of dip-slip with dextral strike slip movement. After the retro-deformation of the 3-D model we calculated strain tensor maps to locate highly deformed or fractured zones and their orientation within the stratigraphic volume. The e1-strain magnitude shows heterogeneous distribution. The south of the study area is at least twice as much fractured on a sub-seismic scale. Four major faults act as "controlling faults" with smaller faults in between. The overburden is tilted northwards after retro-deformation. Thus, we believe that the area was affected by an even larger normal fault outside of the study area. In summary, this study reveals that good knowledge of the kinematics of the large-scale faults is essential to predict sub-seismic structures

  12. The Effect of Modified Brostrom-Gould Repair for Lateral Ankle Instability on In Vivo Tibiotalar Kinematics

    PubMed Central

    Wainright, William B; Spritzer, Charles E.; Lee, Jun Young; Easley, Mark E.; DeOrio, James K.; Nunley, James A.; DeFrate, Louis E.

    2012-01-01

    Background Lateral ankle instability leads to an increased risk of tibiotalar joint osteoarthritis. Previous studies have found abnormal tibiotalar joint motions with lateral ankle instability that may contribute to this increased incidence of osteoarthritis, including increased anterior translation and internal rotation of the talus under weight-bearing loading. Surgical repairs for lateral ankle instability have shown good clinical results, but the effects of repair on in vivo ankle motion are not well understood. Hypothesis The modified Broström-Gould lateral ligament reconstruction decreases anterior translation and internal rotation of the talus under in vivo weight-bearing loading conditions. Study Design Controlled laboratory study. Methods Seven patients underwent modified Brostöm-Gould repair for unilateral lateral ankle instability. Ankle joint kinematics as a function of increasing body weight were studied with magnetic resonance imaging and biplanar fluoroscopy. Tibiotalar kinematics were measured in unstable ankles preoperatively and postoperatively at a mean follow-up of 12 months, as well as in the uninjured contralateral ankles of the same individuals. Results Surgical repair resulted in statistically significant decreases in anterior translation of the talus (0.9±0.3mm, p=0.018) at 100% bodyweight and internal rotation of the talus at 75% (2.6±0.8°, p=0.019) and 100% (2.7±0.8°, p=0.013) bodyweight compared to ankle kinematics measured before repair. No statistically significant differences were detected between repaired ankles and contralateral normal ankles. Conclusion The modified Broström-Gould repair improved the abnormal joint motion observed in patients with lateral ankle instability, decreasing anterior translation and internal rotation of the talus. Clinical Relevance Altered kinematics may contribute to the tibiotalar joint degeneration that occurs with chronic lateral ankle instability. The findings of the current study support

  13. Proceedings of the Joint IAEA/CSNI Specialists` Meeting on Fracture Mechanics Verification by Large-Scale Testing held at Pollard Auditorium, Oak Ridge, Tennessee

    SciTech Connect

    Pugh, C.E.; Bass, B.R.; Keeney, J.A.

    1993-10-01

    This report contains 40 papers that were presented at the Joint IAEA/CSNI Specialists` Meeting Fracture Mechanics Verification by Large-Scale Testing held at the Pollard Auditorium, Oak Ridge, Tennessee, during the week of October 26--29, 1992. The papers are printed in the order of their presentation in each session and describe recent large-scale fracture (brittle and/or ductile) experiments, analyses of these experiments, and comparisons between predictions and experimental results. The goal of the meeting was to allow international experts to examine the fracture behavior of various materials and structures under conditions relevant to nuclear reactor components and operating environments. The emphasis was on the ability of various fracture models and analysis methods to predict the wide range of experimental data now available. The individual papers have been cataloged separately.

  14. Altered Knee and Ankle Kinematics During Squatting in Those With Limited Weight-Bearing–Lunge Ankle-Dorsiflexion Range of Motion

    PubMed Central

    Dill, Karli E.; Begalle, Rebecca L.; Frank, Barnett S.; Zinder, Steven M.; Padua, Darin A.

    2014-01-01

    Context: Ankle-dorsiflexion (DF) range of motion (ROM) may influence movement variables that are known to affect anterior cruciate ligament loading, such as knee valgus and knee flexion. To our knowledge, researchers have not studied individuals with limited or normal ankle DF-ROM to investigate the relationship between those factors and the lower extremity movement patterns associated with anterior cruciate ligament injury. Objective: To determine, using 2 different measurement techniques, whether knee- and ankle-joint kinematics differ between participants with limited and normal ankle DF-ROM. Design: Cross-sectional study. Setting: Sports medicine research laboratory. Patients or Other Participants: Forty physically active adults (20 with limited ankle DF-ROM, 20 with normal ankle DF-ROM). Main Outcome Measure(s): Ankle DF-ROM was assessed using 2 techniques: (1) nonweight-bearing ankle DF-ROM with the knee straight, and (2) weight-bearing lunge (WBL). Knee flexion, knee valgus-varus, knee internal-external rotation, and ankle DF displacements were assessed during the overhead-squat, single-legged squat, and jump-landing tasks. Separate 1-way analyses of variance were performed to determine whether differences in knee- and ankle-joint kinematics existed between the normal and limited groups for each assessment. Results: We observed no differences between the normal and limited groups when classifying groups based on nonweight-bearing passive-ankle DF-ROM. However, individuals with greater ankle DF-ROM during the WBL displayed greater knee-flexion and ankle-DF displacement and peak knee flexion during the overhead-squat and single-legged squat tasks. In addition, those individuals also demonstrated greater knee-varus displacement during the single-legged squat. Conclusions: Greater ankle DF-ROM assessed during the WBL was associated with greater knee-flexion and ankle-DF displacement during both squatting tasks as well as greater knee-varus displacement during

  15. Rheumatoid Arthritis of the Foot and Ankle.

    PubMed

    Abdo; Iorio

    1994-11-01

    Rheumatoid arthritis of the foot and ankle can be a debilitating problem, particularly for patients who have undergone successful hip or knee arthroplasty. Optimal medical management, use of orthotic devices, and surgical intervention are essential components of patient care. Forefoot involvement with hallux valgus and lesser metatarsophalangeal joint subluxation and dislocation are the most common findings. Reconstruction usually requires lesser metatarsophalangeal joint excisional arthroplasty and first metatarsophalangeal joint arthrodesis. Midfoot tarsometatarsal and intertarsal involvement is treated with orthotic devices and intertarsal fusion for advanced arthropathy. Hindfoot involvement frequently leads to pes planovalgus deformity, which may require isolated talonavicular arthrodesis if treated early or triple arthrodesis for advanced destruction. Ankle involvement is less frequent; when it is unresponsive to conservative measures, ankle symptoms may be improved by arthrodesis. Although great advances have been made in medical and surgical management of rheumatoid arthritis, the disease remains a serious problem. Through prudent use of medical management, orthotic devices, and other conservative measures as well as surgical intervention, long-term function can be enhanced greatly. PMID:10709025

  16. Open and Arthroscopic Surgical Anatomy of the Ankle

    PubMed Central

    Frank, Rachel M.; Hsu, Andrew R.; Gross, Christopher E.; Walton, David M.

    2013-01-01

    Ankle-related complaints are among the most commonly encountered problems for musculoskeletal clinicians. Ankle pathology is widely variable, including, but not limited to, fractures, deformity, infection, oncologic diseases, neuromuscular conditions, and arthritis. While nonoperative management with activity modification, bracing and/or shoe modifications, and medications is usually indicated as first line of treatment, surgical intervention may become necessary. A thorough understanding of the complex anatomy and biomechanics of the ankle, and in particular, the potential neurovascular structures that may be encountered, is important to reduce complications and obtain good surgical outcomes. The purpose of this review is to discuss the most common open and arthroscopic exposures to the ankle with a focus on surgically relevant anatomy for each approach. PMID:24288614

  17. Management of Syndesmotic Ankle Injuries in Children and Adolescents.

    PubMed

    Shore, Benjamin J; Kramer, Dennis E

    2016-06-01

    Pediatric ankle injuries are common, especially in athletes; however, the incidence of syndesmosis injuries in children has been scarcely reported. Injuries to the ankle syndesmosis, termed "high ankle sprains," can affect high-level and recreational athletes and have been related to delayed return to play, persistent pain, and adult injuries have been associated with long-term disability. Syndesmotic injuries do occur in children, especially those who participate in sports that involve cutting and pivoting (football, soccer) or sports with rigid immobilization of the ankle (skiing, hockey). Unstable pediatric syndesmosis injuries requiring surgical fixation are often associated with concomitant fibular fracture in skeletally mature children. Physician vigilance and careful clinical examination coupled with appropriate radiographs can determine the extent of the injury in the majority of circumstances. PMID:27100034

  18. The effect of osseous ankle configuration on chronic ankle instability

    PubMed Central

    Frigg, Arno; Magerkurth, Olaf; Valderrabano, Victor; Ledermann, Hans‐Peter; Hintermann, Beat

    2007-01-01

    Background Chronic ankle instability (CAI) is a common orthopaedic entity in sport. Although other risk factors have been studied extensively, little is known about how it is influenced by the osseous joint configuration. Aim To study the effect of osseous ankle configuration on CAI. Design Case–control study, level III. Setting Radiological examination with measurement of lateral x rays by an independent radiologist using a digital DICOM/PACS system. Patients A group of 52 patients who had had at least three recurrent sprains was compared with an age‐matched and sex‐matched control group of 52 healthy subjects. Main outcome measures The radius of the talar surface, the tibial coverage of the talus (tibiotalar sector) and the height of the talar body were measured. Results The talar radius was found to be larger in patients with CAI (21.2 (2.4) mm) than in controls (17.7 (1.9) mm; p<0.001, power >95%). The tibiotalar sector, representing the tibial coverage of the talus, was smaller in patients with CAI (80° (5.1°)) than in controls (88.4° (7.2°); p<0.001, power >95%). No significant difference was observed in the height of the talar body between patients with CAI (28.8 (2.6) mm) and controls (27.5 (4.0) mm; p = 0.055). Conclusion CAI is associated with an unstable osseous joint configuration characterised by a larger radius of the talus and a smaller tibiotalar sector. There is evidence that a higher talus might also play some part, particularly in women. PMID:17261556

  19. Multivariable Dynamic Ankle Mechanical Impedance With Active Muscles

    PubMed Central

    Lee, Hyunglae; Krebs, Hermano Igo; Hogan, Neville

    2015-01-01

    Multivariable dynamic ankle mechanical impedance in two coupled degrees-of-freedom (DOFs) was quantified when muscles were active. Measurements were performed at five different target activation levels of tibialis anterior and soleus, from 10% to 30% of maximum voluntary contraction (MVC) with increments of 5% MVC. Interestingly, several ankle behaviors characterized in our previous study of the relaxed ankle were observed with muscles active: ankle mechanical impedance in joint coordinates showed responses largely consistent with a second-order system consisting of inertia, viscosity, and stiffness; stiffness was greater in the sagittal plane than in the frontal plane at all activation conditions for all subjects; and the coupling between dorsiflexion–plantarflexion and inversion–eversion was small—the two DOF measurements were well explained by a strictly diagonal impedance matrix. In general, ankle stiffness increased linearly with muscle activation in all directions in the 2-D space formed by the sagittal and frontal planes, but more in the sagittal than in the frontal plane, resulting in an accentuated “peanut shape.” This characterization of young healthy subjects’ ankle mechanical impedance with active muscles will serve as a baseline to investigate pathophysiological ankle behaviors of biomechanically and/or neurologically impaired patients. PMID:25203497

  20. Which X-ray views are required in juvenile ankle trauma?

    PubMed

    Heim, M; Blankstein, A; Israeli, A; Horoszowski, H

    1990-01-01

    Although ankle sprains are probably the most common injury in adolescent sports people, epiphyseal injuries are missed on the presumption of a ligamentous tear. The risk of damaged ligaments has been overemphasized while the potentially dangerous epiphyseolysis has been understressed. An oblique X-ray of the ankle joint is indicated prior to "stress" pictures. PMID:2346717

  1. The gender issue: epidemiology of ankle injuries in athletes who participate in basketball.

    PubMed

    Hosea, T M; Carey, C C; Harrer, M F

    2000-03-01

    The increased participation of women in organized athletics has resulted in an interest in gender-related injury patterns. Previous reports have indicated an increased incidence in anterior cruciate knee injuries among female intercollegiate basketball players compared with their male counterparts. The current epidemiologic study prospectively evaluated the relative risk of ankle injuries in scholastic and collegiate basketball players during a 2-year period. Eleven thousand seven hundred eighty athletes participated in this study, 4940 females and 6840 males. There were 1052 ankle injuries. Overall, females had a 25% greater risk of sustaining a Grade I ankle sprain compared with their male counterparts. This increased risk was present in the interscholastic and intercollegiate players. There was no significant difference in the risk for Grades II and III ankle sprains, ankle fractures, or syndesmotic sprains. Male and female athletes doubled their risk for sustaining an ankle injury at the intercollegiate level compared with the interscholastic level. PMID:10738413

  2. Clinical anatomy and biomechanics of the ankle in dance.

    PubMed

    Russell, Jeffrey A; McEwan, Islay M; Koutedakis, Yiannis; Wyon, Matthew A

    2008-01-01

    The ankle is an important joint to understand in the context of dance because it is the connection between the leg and the foot that establishes lower extremity stability. Its function coordinates with the leg and foot and, thus, it is crucial to the dancer's ability to perform. Furthermore, the ankle is one of the most commonly injured body regions in dance. An understanding of ankle anatomy and biomechanics is not only important for healthcare providers working with dancers, but for dance scientists, dance instructors, and dancers themselves. The bony architecture, the soft tissue restraints, and the locomotive structures all integrate to allow the athletic artistry of dance. Yet, there is still much research to be carried out in order to more completely understand the ankle of the dancer. PMID:19618582

  3. Temporary bridging external fixation in distal tibial fracture.

    PubMed

    Lavini, F; Dall'Oca, C; Mezzari, S; Maluta, T; Luminari, E; Perusi, F; Vecchini, E; Magnan, B

    2014-12-01

    Fractures that involve the distal area of the tibia are associated with a high percentage of complications. Soft tissue oedema, swelling, blisters, skin abrasions and open wounds could compromise the outcome of these lesions. The waiting time before surgery with ORIF is mostly due to soft tissue conditions. Early application of a simple joint-spanning external fixator would achieve the initial goal of stability and the respect of soft tissue, thereby decreasing the time necessary for definitive treatment. A total of 40 consecutive patients (22 male and 18 female) with a mean age of 52 years (range 17-82 years) with distal tibial fracture treated between January 2010 and January 2013 were evaluated. Early temporary external fixation was the first treatment step. Twenty patients had pilon fractures, characterised by the intra-articular involvement of the distal tibia with metaphyseal extension, and 20 patients had malleolar fracture-dislocation. Patients were divided into two groups, A and B. Group A comprised 10 patients with ankle fracture-dislocation and bone fragmentation, who were treated with a temporary bridging external fixation that was maintained after ORIF to exploit ligamentotaxis during the first phases of bone healing. In Group B (30 patients), the external fixation was removed after ORIF. The results of the study are in line with the recent literature: temporary external fixation in high-energy trauma and fracture-dislocation of the ankle enables soft tissue to be restored, which facilitates postoperative assessment of bone fragments by CT scan. The complication rate in this study was 5% in patients with malleolar fractures and 20% in patients with pilon fractures. The maintenance of temporary external fixation after ORIF synthesis during the entire first stage of bone healing seems to be a good method of treatment that has a low rate of soft tissue complications. PMID:25457321

  4. Fracture characteristics of HAZ-double edge notched weld joints with mechanical undermatching

    SciTech Connect

    Zarzour, J.F.; Kleinosky, M.J.

    1995-12-31

    Both experimental and finite element investigations were carried out on double edge notched weld joints in tension to determine the influence of material gradients across the heat affected zone (HAZ) on cracks located at three interface regions: (1) base plate and fine grain HAZ, (2) coarse grain HAZ and fine grain HAZ, (3) weld metal and coarse grain HAZ. For HY-100 steel with a 20 percent weld undermatch, it was concluded that for case (a), the different mechanical properties of both fine grain HAZ (FGHAZ) and coarse grain HAZ (CGHAZ), obtained with a novel indentation technique, greatly affect the near tip stress fields and promote yielding into the base plate. For case (b), the stress triaxiality at the crack tip is the highest and the plastic deformation is confined to the HAZ zone. Finally for case (c), the stress triaxiality is lowered by the presence of a softer weld metal. However, there is a possibility of gross section yielding through the weld area. The overall conclusion indicates that, in order to evaluate crack initiation in the HAZ, one needs to verify the relevant microstructure and determine the mechanical properties of each constituent, mainly, the CGHAZ and FGHAZ. In addition, the assumption of homogeneous HAZ properties may lead to erroneous conclusions.

  5. Effect of processing, sterilization and crosslinking on UHMWPE fatigue fracture and fatigue wear mechanisms in joint arthroplasty.

    PubMed

    Ansari, Farzana; Ries, Michael D; Pruitt, Lisa

    2016-01-01

    Ultra high molecular weight polyethylene (UHMWPE) has been used as a bearing surface in total joint replacements (TJR) for nearly five decades. This semi-crystalline polymer has extraordinary energetic toughness owing to its high molecular weight and entanglement density. However, it is challenged by a need to offer a combined resistance to fatigue, wear and oxidation in vivo. The processing, sterilization treatment, and microstructural tailoring of UHMWPE has evolved considerably in the past 50 years but an optimized microstructure remains elusive. This review seeks to provide an overview of this processing history to address two primary questions: First, how does microstructure affect fatigue fracture and fatigue wear mechanisms in UHMWPE? And second, can microstructure be optimized to provide resistance to fatigue, oxidation and wear in vivo? Previous literature demonstrates that while crosslinking improves resistance to adhesive/abrasive wear, it also reduces resistance to fatigue crack propagation and fatigue wear by restricting molecular mobility and rendering the polymer more brittle. Crystallinity improves fatigue resistance but generally increases elastic modulus and concomitant contact stresses in vivo. The presence of fusion defects or oxidation reduces further fatigue resistance and enhances fatigue wear. Thus, UHMWPE microstructural evolution comes with trade-offs. Currently there is no singular formulation of UHMWPE that is ideal for all TJR applications. PMID:26386167

  6. Distraction-free ankle arthroscopy for anterolateral impingement.

    PubMed

    Rouvillain, Jean Louis; Daoud, Wael; Donica, Adrian; Garron, Emmanuel; Uzel, André Pierre

    2014-08-01

    The origin of chronic pain after external ankle sprain is better known with arthroscopy's contribution. Chronic hypertrophic synovitis of the anterolateral ankle region is seemingly the cause, resulting in "anterolateral ankle impingement." But is partial synovectomy with fibrosis resection under arthroscopy always possible without any distraction? Are results affected? This retrospective study concerned only patients with soft tissue ankle impingement. All cases with bone and joint diseases were excluded. The final sample of 24 patients had a mean age of 35 years (21-54 years) and presented anterolateral mechanical pain associated with oedema following external ankle sprain. Medical and rehabilitative treatment was undertaken for more than 6 months before arthroscopy. Average time between trauma and arthroscopy was 21 months (5-60 months). Clinical examination revealed no ankle instability or laxity. Debridement with joint lavage was systematically performed under arthroscopy without any distraction. Average patient follow-up was 22 months (12-92 months). All patients had a good Kitaoka score, with 22 patients registering excellent results. There were no septic complications or algodystrophy. Two transient hypoesthesias were observed in the dorsal surface and lateral border of the foot with full postoperative recovery at 6 months. Distraction was never used and simple dorsiflexion was sufficient to perform arthroscopic debridement. In this study, anterolateral ankle impingement diagnosis was primarily clinical. Arthroscopic treatment yielded significant benefits on pain, oedema and resumption of sport activities. Arthroscopic treatment of anterolateral ankle impingements is thus possible with simple dorsiflexion and no distraction, resulting in a possible decrease in complication rates. Level of evidence Retrospective cohort study, Level IV. PMID:24220747

  7. Multivariable Dynamic Ankle Mechanical Impedance With Relaxed Muscles

    PubMed Central

    Lee, Hyunglae; Krebs, Hermano Igo; Hogan, Neville

    2015-01-01

    Neurological or biomechanical disorders may distort ankle mechanical impedance and thereby impair locomotor function. This paper presents a quantitative characterization of multivariable ankle mechanical impedance of young healthy subjects when their muscles were relaxed, to serve as a baseline to compare with pathophysiological ankle properties of biomechanically and/or neurologically impaired patients. Measurements using a highly backdrivable wearable ankle robot combined with multi-input multi-output stochastic system identification methods enabled reliable characterization of ankle mechanical impedance in two degrees-of-freedom (DOFs) simultaneously, the sagittal and frontal planes. The characterization included important ankle properties unavailable from single DOF studies: coupling between DOFs and anisotropy as a function of frequency. Ankle impedance in joint coordinates showed responses largely consistent with a second-order system consisting of inertia, viscosity, and stiffness in both seated (knee flexed) and standing (knee straightened) postures. Stiffness in the sagittal plane was greater than in the frontal plane and furthermore, was greater when standing than when seated, most likely due to the stretch of bi-articular muscles (medial and lateral gastrocnemius). Very low off-diagonal partial coherences implied negligible coupling between dorsiflexion-plantarflexion and inversion-eversion. The directions of principal axes were tilted slightly counterclockwise from the original joint coordinates. The directional variation (anisotropy) of ankle impedance in the 2-D space formed by rotations in the sagittal and frontal planes exhibited a characteristic “peanut” shape, weak in inversion-eversion over a wide range of frequencies from the stiffness dominated region up to the inertia dominated region. Implications for the assessment of neurological and biomechanical impairments are discussed. PMID:24686292

  8. Mechanics and energetics of incline walking with robotic ankle exoskeletons.

    PubMed

    Sawicki, Gregory S; Ferris, Daniel P

    2009-01-01

    We examined healthy human subjects wearing robotic ankle exoskeletons to study the metabolic cost of ankle muscle-tendon work during uphill walking. The exoskeletons were powered by artificial pneumatic muscles and controlled by the user's soleus electromyography. We hypothesized that as the demand for net positive external mechanical work increased with surface gradient, the positive work delivered by ankle exoskeletons would produce greater reductions in users' metabolic cost. Nine human subjects walked at 1.25 m s(-1) on gradients of 0%, 5%, 10% and 15%. We compared rates of O(2) consumption and CO(2) production, exoskeleton mechanics, joint kinematics, and surface electromyography between unpowered and powered exoskeleton conditions. On steeper inclines, ankle exoskeletons delivered more average positive mechanical power (P<0.0001; +0.37+/-0.03 W kg(-1) at 15% grade and +0.23+/-0.02 W kg(-1) at 0% grade) and reduced subjects' net metabolic power by more (P<0.0001; -0.98+/-0.12 W kg(-1) at 15% grade and -0.45+/-0.07 W kg(-1) at 0% grade). Soleus muscle activity was reduced by 16-25% when wearing powered exoskeletons on all surface gradients (P<0.0008). The ;apparent efficiency' of ankle muscle-tendon mechanical work decreased from 0.53 on level ground to 0.38 on 15% grade. This suggests a decreased contribution from previously stored Achilles' tendon elastic energy and an increased contribution from actively shortening ankle plantar flexor muscle fibers to ankle muscle-tendon positive work during walking on steep uphill inclines. Although exoskeletons delivered 61% more mechanical work at the ankle up a 15% grade compared with level walking, relative reductions in net metabolic power were similar across surface gradients (10-13%). These results suggest a shift in the relative distribution of mechanical power output to more proximal (knee and hip) joints during inclined walking. PMID:19088208

  9. How to Tape an Ankle

    MedlinePlus

    ... Decide If You Need to See an Orthopaedic Foot and Ankle Specialist How to Care for a Sprained Ankle How to Be Non-weightbearing After Surgery Footwear All Site Content AOFAS / FootCareMD / How To... / Foot Injury / How to Tape an Ankle How to ...

  10. Effects of Knee and Ankle Movements on Foot Impact Forces in Human Walking

    NASA Astrophysics Data System (ADS)

    Tagawa, Yoshihiko; Shiba, Naoto; Miyazaki, Kenichiro; Matsuo, Shigeaki; Inoue, Akio; Yamashita, Tadashi

    Excessive repetitive impacts in human walking lead to lower extremity orthopaedic disorders such as degenerative joint disease and prosthetic loosening. In this study, two planar models, corresponding to free or fixed ankle joints, were used to examine movements of the knee and ankle joints that affect foot impact forces and their attenuation during level walking. A kinetic approach was used to describe the relationship between the landing style of the leg and the impact at heel contact. Human subjects with free and fixed ankle joints were studied to verify the models. Free and fixed ankle groups showed a significant difference with regard to acceleration (p<0.005). The attenuation capacity of acceleration for healthy subjects with a freed ankle joint was 59.9±12.1 (mean ±SD)%, while the capacity for the same subjects with a fixed joint was 27.4±28.9%. The movements of the knee and ankle joints at landing on the ground played important roles in attenuating impulsive force.

  11. Joint instability and osteoarthritis.

    PubMed

    Blalock, Darryl; Miller, Andrew; Tilley, Michael; Wang, Jinxi

    2015-01-01

    Joint instability creates a clinical and economic burden in the health care system. Injuries and disorders that directly damage the joint structure or lead to joint instability are highly associated with osteoarthritis (OA). Thus, understanding the physiology of joint stability and the mechanisms of joint instability-induced OA is of clinical significance. The first section of this review discusses the structure and function of major joint tissues, including periarticular muscles, which play a significant role in joint stability. Because the knee, ankle, and shoulder joints demonstrate a high incidence of ligament injury and joint instability, the second section summarizes the mechanisms of ligament injury-associated joint instability of these joints. The final section highlights the recent advances in the understanding of the mechanical and biological mechanisms of joint instability-induced OA. These advances may lead to new opportunities for clinical intervention in the prevention and early treatment of OA. PMID:25741184

  12. Joint Instability and Osteoarthritis

    PubMed Central

    Blalock, Darryl; Miller, Andrew; Tilley, Michael; Wang, Jinxi

    2015-01-01

    Joint instability creates a clinical and economic burden in the health care system. Injuries and disorders that directly damage the joint structure or lead to joint instability are highly associated with osteoarthritis (OA). Thus, understanding the physiology of joint stability and the mechanisms of joint instability-induced OA is of clinical significance. The first section of this review discusses the structure and function of major joint tissues, including periarticular muscles, which play a significant role in joint stability. Because the knee, ankle, and shoulder joints demonstrate a high incidence of ligament injury and joint instability, the second section summarizes the mechanisms of ligament injury-associated joint instability of these joints. The final section highlights the recent advances in the understanding of the mechanical and biological mechanisms of joint instability-induced OA. These advances may lead to new opportunities for clinical intervention in the prevention and early treatment of OA. PMID:25741184

  13. Long-term Results After Ankle Syndesmosis Injuries.

    PubMed

    van Vlijmen, Nicole; Denk, Katharina; van Kampen, Albert; Jaarsma, Ruurd L

    2015-11-01

    Syndesmotic disruption occurs in more than 10% of ankle fractures. Operative treatment with syndesmosis screw fixation has been successfully performed for decades and is considered the gold standard of treatment. Few studies have reported the long-term outcomes of syndesmosis injuries. This study investigated long-term patient-reported, radiographic, and functional outcomes of syndesmosis injuries treated with screw fixation and subsequent timed screw removal. A retrospective cohort study was carried out at a Level I trauma center. The study group included 43 patients who were treated for ankle fractures with associated syndesmotic disruptions between December 2001 and May 2011. The study included case file reviews, self-reported questionnaires, radiologic reviews, and clinical assessments. At 5.1 (±1.76) years after injury, 60% of participants had pain, 26% had degenerative changes, 51% had loss of tibiofibular overlap, and 33% showed medial clear space widening. Retained syndesmotic positions on radiographs were linked to better self-reported outcomes. There is an inversely proportional relation between age at the time of injury and satisfaction with the outcome of the ankle fracture as well as a directly proportional relation between age at the time of injury and pain compared with the preinjury state. Optimal restoration and preservation of the syndesmosis is crucial. Syndesmotic disruption is associated with poor long-term outcomes after ankle fracture. Greater age is a risk factor for chronic pain and dissatisfaction with the outcome of ankle fracture and syndesmosis injury. Therefore, patient education to facilitate realistic expectations about recovery is vital, especially in older patients. PMID:26558664

  14. Gait Biomechanics in Participants, Six Months after First-time Lateral Ankle Sprain.

    PubMed

    Doherty, C; Bleakley, C; Hertel, J; Caulfield, B; Ryan, J; Delahunt, E

    2016-06-01

    No research currently exists predicating a link between the injury-affiliated sensorimotor deficits of acute ankle sprain and those of chronic ankle instability during gait. This analysis evaluates participants with a 6-month history of ankle sprain injury to affirm this link. 69 participants with a 6-month history of acute first-time lateral ankle sprain were divided into subgroups ('chronic ankle instability' and 'coper') based on their self-reported disability and compared to 20 non-injured participants during a gait task. Lower extremity kinematic and kinetic data were collected from 200 ms pre- to 200 ms post-heel strike (period 1) and from 200 ms pre- to 200 ms post-toe off (period 2). The 'chronic ankle instability' subgroup (who reported greater disability) displayed increased knee flexion during period 1. During period 2, this subgroup exhibited greater total displacement at their ankle joint and greater extensor dominance at their knee. That many of these features are present, both in individuals with acute ankle sprain and those with chronic ankle instability may advocate a link between acute deficits and long-term outcome. Clinicians must be aware that the sensorimotor deficits of ankle sprain may persevere beyond the acute stage of injury and be cognizant of the capacity for impairments to pervade proximally. PMID:27136507

  15. [Tuberculosis of ankle].

    PubMed

    Rubio Barbón, S; Rodríguez Cocina, B; Suárez del Villar Acebal, R; Calvo Rodríguez, C E; Villar López, A; Escalada Rodríguez, P; Torreblanca Gil, A

    2004-09-01

    The authors present a case of tuberculous arthritis of ankle with sinovial fluid and sputum aspirate Lowenstein positive (M. tuberculosis) in a patient non inmunocomprometid and review the clinical, diagnosis and treatment aspects of this entity, and show the difficult diagnosis in cases of radiology normal or low suspect. PMID:15476422

  16. Ankle syndesmosis injuries.

    PubMed

    Peña, Fernando A; Coetzee, J Chris

    2006-03-01

    Physician awareness of ankle syndesmosis injuries is improving. The anatomy involved and the mechanism of injury are extremely relevant for the understanding and treatment of this type of injury. Examination under anesthesia may confirm the syndesmosis instability. Based on those findings, stabilization is the recommended approach. PMID:16564452

  17. Treatment of femoral neck fractures in elderly patients over 60 years of age - which is the ideal modality of primary joint replacement?

    PubMed Central

    2010-01-01

    Background Femoral neck fractures in the elderly are frequent, represent a great health care problem, and have a significant impact on health insurance costs. Reconstruction options using hip arthroplasty include unipolar or bipolar hemiarthroplasty (HA), and total hip arthroplasty (THA). The purpose of this review is to discuss the indications, limitations, and pitfalls of each of these techniques. Methods The Pubmed database was searched for all articles on femoral neck fracture and for the reconstruction options presented in this review using the search terms "femoral neck fracture", "unipolar hemiarthroplasty", "bipolar hemiarthroplasty", and "total hip arthroplasty". In addition, cross-referencing was used to cover articles eventually undetected by the respective search strategies. The resulting articles were then reviewed with regard to the different techniques, outcome and complications of the distinct reconstruction options. Results THA yields the best functional results in patients with displaced femoral neck fractures with complication rates comparable to HA. THA is beneficially implanted using an anterior approach exploiting the internervous plane between the tensor fasciae latae and the sartorius muscles allowing for immediate full weight-bearing. Based on our findings, bipolar hemiarthroplasty, similar to unipolar hemiarthroplasty, cannot restorate neither anatomical nor biomechanical features of the hip joint. Therefore, it can only be recommended as a second line of defense-procedure for patients with low functional demands and limited live expectancy. Conclusions THA is the treatment of choice for femoral neck fractures in patients older than 60 years. HA should only be implanted in patients with limited life expectancy. PMID:20961437

  18. Ankle syndesmosis injuries: anatomy, biomechanics, mechanism of injury, and clinical guidelines for diagnosis and intervention.

    PubMed

    Lin, Cheng-Feng; Gross, Michael L; Weinhold, Paul

    2006-06-01

    Syndesmosis injuries are rare, but very debilitating and frequently misdiagnosed. The purpose of this clinical commentary is to review the mechanisms of syndesmotic injuries, clinical examination methods, diagnosis, and management of the injuries. Cadaveric studies of the syndesmosis and deltoid ligaments are also reviewed for further understanding of stress transmission and the roles of different structures in stabilizing the distal syndesmosis. External rotation and excessive dorsiflexion of the foot on the leg have been reported as the most common mechanisms of injury. The injury is most often incurred by individuals who participate in skiing, football, soccer, and other sport activities played on turf. The external rotation and squeeze tests are reliable tests to detect this injury. The ability of imaging studies to assist in an accurate diagnosis may depend on the severity of the injury. The results of cadaveric studies indicate the importance of the deltoid ligament in maintaining stability of the distal tibiofibular syndesmosis and the congruency of the ankle mortise. Intervention programs with early rigid immobilization and pain relief strategies, followed by strengthening and balance training are recommended. Heel lift and posterior splint intervention can be used to avoid separation of the distal syndesmosis induced by excessive dorsiflexion of the ankle joint. Application of a rigid external device should be used with caution to prevent medial-lateral compression of the leg superior to the ankle mortise, thereby inducing separation of the distal syndesmosis articulation. Surgical intervention is an option when a complete tear of the syndesmotic ligaments is present or when fractures are observed. PMID:16776487

  19. Biomechanical and Neuromuscular Effects of Ankle Taping and Bracing

    PubMed Central

    Wilkerson, Gary B.

    2002-01-01

    Objective: An extensive review of clinically relevant research is provided to assist clinicians in understanding the underlying mechanisms by which various ankle-support systems may provide beneficial effects. Strategies for management of different types of ankle ligament conditions are also discussed. Background: Much of the literature pertaining to ankle instability and external support has focused on assessment of inward displacement of the hindfoot within the frontal plane. Some researchers have emphasized the importance of (1) pathologic rotary displacement of the talus within the transverse plane, (2) the frequent presence of subtalar joint ligament lesions, and (3) the interrelated effects of ankle support on deceleration of inversion velocity and facilitation of neuromuscular response. Description: The traditional method for application of adhesive tape to the ankle primarily restricts inward displacement of the hindfoot within the frontal plane. The biomechanical rationale for a method of ankle taping that restricts lower leg rotation and triplanar displacement of the foot associated with subtalar motion is presented. Clinical Advantages: The lateral subtalar-sling taping procedure may limit strain on the anterior talofibular ligament associated with subtalar inversion, restrain anterolateral rotary subluxation of the talus in the presence of ligament laxity, and protect the subtalar ligaments from excessive loading. The medial subtalar sling may reduce strain on the anterior-inferior tibiofibular syndesmosis and enhance hindfoot-to-forefoot force transfer during the push-off phase of the gait cycle. PMID:12937565

  20. Human hip-ankle coordination emerging from multisensory feedback control.

    PubMed

    Hettich, Georg; Assländer, Lorenz; Gollhofer, Albert; Mergner, Thomas

    2014-10-01

    Human sensorimotor control involves inter-segmental coordination to cope with the complexity of a multi-segment system. The combined activation of hip and ankle muscles during upright stance represents the hip-ankle coordination. This study postulates that the coordination emerges from interactions on the sensory levels in the feedback control. The hypothesis was tested in a model-based approach that compared human experimental data with model simulations. Seven subjects were standing with eyes closed on an anterior-posterior tilting motion platform. Postural responses in terms of angular excursions of trunk and legs with respect to vertical were measured and characterized using spectral analysis. The presented control model consists of separate feedback modules for the hip and ankle joints, which exchange sensory information with each other. The feedback modules utilize sensor-derived disturbance estimates rather than 'raw' sensory signals. The comparison of the human data with the simulation data revealed close correspondence, suggesting that the model captures important aspects of the human sensory feedback control. For verification, the model was re-embodied in a humanoid robot that was tested in the human laboratory. The findings show that the hip-ankle coordination can be explained by interactions between the feedback control modules of the hip and ankle joints. PMID:25150802

  1. Management of High-Energy Foot and Ankle Injuries in the Geriatric Population

    PubMed Central

    Herscovici, Dolfi; Scaduto, Julia M.

    2012-01-01

    By the year 2035 almost 20% of the US population of 389 million people will be 65 years and older. What this group has, compared with aged populations in the past, is better health, more mobility, and more active lifestyles. From January 1989 through December 2010, a total of 494 elderly patients with 536 foot and ankle injuries were identified. Within this group, 237 (48%) patients with 294 injuries were sustained as a result of a high-energy mechanism. These mechanisms consisted of 170 motor vehicle accidents, 30 as a result of high (not ground level) energy falls, 2 from industrial accidents, and 35 classified as other, which included sports, blunt trauma, bicycle, airplane or boating accidents, crush injuries, and injuries resulting from a lawn mower. The injuries produced were 17 metatarsal fractures, 9 Lisfranc injuries, 10 midfoot (navicular, cuneiform, or cuboid) fractures, 23 talus fractures, 63 calcaneal fractures, 73 unimalleolar, bimalleolar, or trimalleolar ankle fractures, 45 pilon fractures, and 3 pure dislocations of the foot or ankle. Overall, 243 (83%) of these injuries underwent surgical fixation and data have shown that when surgery is used to manage high-energy injuries of the foot and ankle in the elderly individuals, the complications and outcomes are similar to those seen in younger patients. Therefore, the decision for surgical intervention for high-energy injuries of the foot and ankle should be based primarily on the injury pattern and not solely on the age of the patient. PMID:23569695

  2. Quantitative analysis of human ankle characteristics at different gait phases and speeds for utilizing in ankle-foot prosthetic design

    PubMed Central

    2014-01-01

    Background Ankle characteristics vary in terms of gait phase and speed change. This study aimed to quantify the components of ankle characteristics, including quasi-stiffness and work in different gait phases and at various speeds. Methods The kinetic and kinematic data of 20 healthy participants were collected during normal gait at four speeds. Stance moment-angle curves were divided into three sub-phases including controlled plantarflexion, controlled dorsiflexion and powered plantarflexion. The slope of the moment-angle curves was quantified as quasi-stiffness. The area under the curves was defined as work. Results The lowest quasi-stiffness was observed in the controlled plantarflexion. The fitted line to moment-angle curves showed R2 > 0.8 at controlled dorsiflexion and powered plantarflexion. Quasi-stiffness was significantly different at different speeds (P = 0.00). In the controlled dorsiflexion, the ankle absorbed energy; by comparison, energy was generated in the powered plantarflexion. A negative work value was recorded at slower speeds and a positive value was observed at faster speeds. Ankle peak powers were increased with walking speed (P = 0.00). Conclusions Our findings suggested that the quasi-stiffness and work of the ankle joint can be regulated at different phases and speeds. These findings may be clinically applicable in the design and development of ankle prosthetic devices that can naturally replicate human walking at various gait speeds. PMID:24568175

  3. A Walking Controller for a Powered Ankle Prosthesis

    PubMed Central

    Shultz, Amanda H.; Mitchell, Jason E.; Truex, Don; Lawson, Brian E.; Ledoux, Elissa; Goldfarb, Michael

    2015-01-01

    This paper describes a walking controller implemented on a powered ankle prosthesis prototype and assessed by a below-knee amputee subject on a treadmill at three speeds. The walking controller is a finite state machine which emulates a series of passive impedance functions at the joint in order to reproduce the behavior of a healthy joint. The assessments performed demonstrate the ability of the powered prosthesis prototype and walking controller to reproduce essential biomechanical aspects (i.e. joint angle, torque, and power profiles) of the healthy joint, especially relative to a passive prosthesis. PMID:25571414

  4. Ankle manual therapy for individuals with post-acute ankle sprains: description of a randomized, placebo-controlled clinical trial

    PubMed Central

    2010-01-01

    Background Ankle sprains are common within the general population and can result in prolonged disablement. Limited talocrural dorsiflexion range of motion (DF ROM) is a common consequence of ankle sprain. Limited talocrural DF ROM may contribute to persistent symptoms, disability, and an elevated risk for re-injury. As a result, many health care practitioners use hands-on passive procedures with the intention of improving talocrural joint DF ROM in individuals following ankle sprains. Dosage of passive hands-on procedures involves a continuum of treatment speeds. Recent evidence suggests both slow- and fast-speed treatments may be effective to address disablement following ankle sprains. However, these interventions have yet to be longitudinally compared against a placebo study condition. Methods/Design We developed a randomized, placebo-controlled clinical trial designed to test the hypotheses that hands-on treatment procedures administered to individuals following ankle sprains during the post-acute injury period can improve short-, intermediate-, and long-term disablement, as well as reduce the risk for re-injury. Discussion This study is designed to measure the clinical effects of hands-on passive stretching treatment procedures directed to the talocrural joint that vary in treatment speed during the post-acute injury period, compared to hands-on placebo control intervention. Trial Registration http://www.clinicaltrials.gov identifier NCT00888498. PMID:20958995

  5. Functional properties of adhesive ankle taping: neuromuscular and mechanical effects before and after exercise.

    PubMed

    Alt, W; Lohrer, H; Gollhofer, A

    1999-04-01

    The purpose of the study was to investigate effects of adhesive ankle taping. Using electromyographic, goniometric, and thermologic methods, different ankle tapes were tested before and after athletic exercise in simulated inversion trauma. Twelve subjects with stable ankle joints performed five trials: with two different materials, with two taping techniques, and one trial without tape as control. After the simulated inversion trauma, approximately 35% of the initial maximum inversion amplitude was decreased by ankle taping. Depending on the technique, there was a loss of tape stability < or =14% after 30 min of athletic exercise. Thermologic analysis revealed a postexercise 6 degrees C temperature increase in the foot, especially under the tape. Initially, interpreted as the primary effect, the improved joint stabilization is based on mechanical stiffness caused by the adhesive tape. Joint stability was influenced positively by neuromuscular proprioceptive and physiological processes, characterized by relatively increased electromyographic activation. PMID:10229280

  6. [Ankle braces prevent ligament injuries].

    PubMed

    Karlsson, Jon

    2002-09-01

    The Cochrane collaboration has performed a meta-analysis of all studies found on the prevention of ankle ligament injuries, frequent in sports like soccer, European handball and basketball. Interventions include the use of modified footwear and associated supports, training programmes and health education. Five randomized trials totalling 3,954 participants were included. With the exception of ankle disc training, all prophylactic interventions entailed the application of an external ankle support in the form of a semi-rigid orthosis, air-cast or high top shoes. The studies showed a significant reduction in the number of ankle sprains in individuals allocated to external ankle support. This reduction was greater for those with a previous history of ankle sprains. PMID:12362747

  7. Dynamic postural control but not mechanical stability differs among those with and without chronic ankle instability.

    PubMed

    Wikstrom, E A; Tillman, M D; Chmielewski, T L; Cauraugh, J H; Naugle, K E; Borsa, P A

    2010-02-01

    The purpose of this investigation was to compare dynamic postural control and mechanical ankle stability among patients with and without chronic ankle instability (CAI) and controls. Seventy-two subjects were divided equally into three groups: uninjured controls, people with previous ankle injury but without CAI, and people with CAI. Subjects completed a single-leg hop-stabilization task, and then had an anterior drawer test and lateral ankle radiograph performed bilaterally. The dynamic postural stability index was calculated from the ground reaction forces of the single-leg hop-stabilization task. Ankle joint stiffness (N/m) was measured with an instrumented arthrometer during the anterior drawer test, and fibula position was assessed from the radiographic image. Patients with previous ankle injuries but without CAI demonstrated higher frontal plane dynamic postural stability scores than both the uninjured control and CAI groups (P<0.01). Patients with and without CAI had significantly higher sagittal plane dynamic postural stability scores (P<0.01) and increased ankle joint stiffness (P=0.045) relative to the control group. The increased frontal plane dynamic postural control may represent a component of a coping mechanism that limits recurrent sprains and the development of CAI. Mechanical stability alterations are speculated to result from the initial ankle trauma. PMID:19422654

  8. A Pediatric Comminuted Talar Fracture Treated by Minimal K-Wire Fixation Without Using a Tourniquet

    PubMed Central

    Inal, Sermet; Inal, Canan

    2014-01-01

    Background Pediatric comminuted talar fractures are reported to be rare, and treatment options such as minimal internal K-wire fixation without using a tourniquet to prevent avascular necrosis have not previously been investigated. Case Description We report a case of a comminuted talar body and a non-displaced neck fracture with dislocation of the tibiotalar, talonavicular and subtalar joints with bimalleolar epiphyseal fractures in an 11-year-old boy due to a fall from height. We present radiological findings, the surgical procedure and clinical outcomes of minimal internal K-wire fixation without using a tourniquet. Literature Review Avascular necrosis rates are reported to be between 0 % and 66 % after fractures of the neck of the talus and the talar body in children. The likelihood of developing avascular necrosis increases with the severity of the fracture. Clinical Relevance To avoid avascular necrosis in a comminuted talar fracture accompanied by tibiotalar, talonavicular, subtalar dislocations and bimalleolar epiphyseal fractures, a minimal internal K-wire fixation without the use of a tourniquet was performed. The outcome was evaluated by the American Orthopedic Foot and Ankle Society score (AOFAS). A score of 90 (excellent) was found at the end of the second year of follow up. Radiology revealed preservation of the joint with no evidence of avascular necrosis, and clinical findings revealed a favorable functional outcome after two years. Level of Evidence 4 PMID:25328479

  9. What Is a Foot and Ankle Surgeon?

    MedlinePlus

    ... Text Size Print Bookmark What is a Foot & Ankle Surgeon? Foot and ankle surgeons are the surgical specialists of the podiatric ... every age. What education has a foot and ankle surgeon received? After completing undergraduate education, the foot ...

  10. Identification of intrinsic and reflex ankle stiffness components in stroke patients.

    PubMed

    Galiana, Laura; Fung, Joyce; Kearney, Robert

    2005-09-01

    Reflex and intrinsic contributions to ankle stiffness were examined in 11 stroke patients with clinical evidence of ankle spasticity and nine gender-matched and age-matched controls. Subjects lay supine with one foot placed in a custom-fitted boot attached to an electro-hydraulic actuator. They were instructed to relax while pseudo-random binary sequence perturbations were applied to their ankle joint. The ankle position and torque, as well as EMG from the ankle dorsiflexors and plantarflexors were recorded. These were used to identify reflex and intrinsic components of ankle stiffness, using a non-linear, parallel-cascade, system identification method. Results demonstrated that the majority of stroke patients (7/11) had ankle stiffness similar to that of control subjects. In contrast, a minority of stroke patients (4/11) had an abnormal increase in ankle stiffness, most of which could be attributed to an increased reflex gain. Reflex stiffness increased as the ankle was dorsiflexed in all subjects. These results differ from a previous study showing that reflex gain and intrinsic stiffness were increased in all patients with spinal cord injury. This difference may reflect the different topography of the lesions in the two neurological conditions. PMID:15991034

  11. Short-term motor compensations to denervation of feline soleus and lateral gastrocnemius result in preservation of ankle mechanical output during locomotion.

    PubMed

    Prilutsky, Boris I; Maas, Huub; Bulgakova, Margarita; Hodson-Tole, Emma F; Gregor, Robert J

    2011-01-01

    Denervation of selected ankle extensors in animals results in locomotor changes. These changes have been suggested to permit preservation of global kinematic characteristics of the hindlimb during stance. The peak ankle joint moment is also preserved immediately after denervation of several ankle extensors in the cat, suggesting that the animal's response to peripheral nerve injury may also be aimed at preserving ankle mechanical output. We tested this hypothesis by comparing joint moments and power patterns during walking before and after denervation of soleus and lateral gastrocnemius muscles. Hindlimb kinematics, ground reaction forces and electromyographic activity of selected muscles were recorded during level, downslope (-50%) and upslope (50%) walking before and 1-3 weeks after nerve denervation. Denervation resulted in increased activity of the intact medial gastrocnemius and plantaris muscles, greater ankle dorsiflexion, smaller knee flexion, and the preservation of the peak ankle moment during stance. Surprisingly, ankle positive power generated in the propulsion phase of stance was increased (up to 50%) after denervation in all walking conditions (p < 0.05). The obtained results suggest that the short-term motor compensation to denervation of lateral gastrocnemius and soleus muscles may allow for preservation of mechanical output at the ankle. The additional mechanical energy generated at the ankle during propulsion can result, in part, from increased activity of intact synergists, the use of passive tissues around the ankle and by the tendon action of ankle two-joint muscles and crural fascia. PMID:21411965

  12. Short-Term Motor Compensations to Denervation of Feline Soleus and Lateral Gastrocnemius Result in Preservation of Ankle Mechanical Output during Locomotion

    PubMed Central

    Prilutsky, Boris I.; Maas, Huub; Bulgakova, Margarita; Hodson-Tole, Emma F.; Gregor, Robert J.

    2011-01-01

    Denervation of selected ankle extensors in animals results in locomotor changes. These changes have been suggested to permit preservation of global kinematic characteristics of the hindlimb during stance. The peak ankle joint moment is also preserved immediately after denervation of several ankle extensors in the cat, suggesting that the animal's response to peripheral nerve injury may also be aimed at preserving ankle mechanical output. We tested this hypothesis by comparing joint moments and power patterns during walking before and after denervation of soleus and lateral gastrocnemius muscles. Hindlimb kinematics, ground reaction forces and electromyographic activity of selected muscles were recorded during level, downslope (−50%) and upslope (50%) walking before and 1–3 weeks after nerve denervation. Denervation resulted in increased activity of the intact medial gastrocnemius and plantaris muscles, greater ankle dorsiflexion, smaller knee flexion, and the preservation of the peak ankle moment during stance. Surprisingly, ankle positive power generated in the propulsion phase of stance was increased (up to 50%) after denervation in all walking conditions (p < 0.05). The obtained results suggest that the short-term motor compensation to denervation of lateral gastrocnemius and soleus muscles may allow for preservation of mechanical output at the ankle. The additional mechanical energy generated at the ankle during propulsion can result, in part, from increased activity of intact synergists, the use of passive tissues around the ankle and by the tendon action of ankle two-joint muscles and crural fascia. PMID:21411965

  13. [Unexplained pain in the ankle and foot. Consider transient osteoporosis].

    PubMed

    Snijders, G F; van Bokhoven, S C; van Zadelhoff, J T H; Swierstra, B A; Poelkens, F; Martens, H A

    2016-01-01

    Transient osteoporosis is an increasingly recognized condition that causes severe pain in weight-bearing joints and is characterized by otherwise unexplained bone-marrow oedema on MRI. We present two patients, a 40-year-old man and a 60-year-old woman, with longstanding severe pain in the foot and ankle. Both had invalidating pain with only mild swelling of the foot or ankle. Laboratory investigation was unremarkable, and conventional X-ray showed osteopenia of the bones involved. In both cases, consecutive MRIs showed migrating bone marrow oedema. The patients were treated with analgesics, immobilization of the body parts concerned and an intravenous bisphosphonate. PMID:27165454

  14. Tibiofemoral angle and its relation to ankle sprain occurrence.

    PubMed

    Pefanis, Nikolaos; Karagounis, Panagiotis; Tsiganos, Georgios; Armenis, Elias; Baltopoulos, Panagiotis

    2009-12-01

    The lack of a normal joint orientation generates translational or shear forces across the joint. These forces can put abnormally high strain on the cartilage and the surrounding capsuloligamentous tissues. Ankle joint structure can affect or be affected by bony malformations of the surrounding areas, including the knee and hip. The aim of the current study is to examine the possible relationship between the tibiofemoral (TFA) angle and other factors (anthropometric characteristics, medical history, and age) on the occurrence of ankle sprains because its value provides useful information for the anatomical alignment of the lower extremity. The study sample consisted of 45 high-level athletes, evenly distributed among 3 sports (basketball, soccer, and volleyball). TFA measurements were made on radiographs. The study lasted 2 years. A logistic regression was used to determine the importance of each factor on the probability in question. A significance level of P = .1 was used. The factors contributing more to an ankle sprain were a previous injury of the same type followed by body mass index (BMI) and age. On the contrary, TFA was proven to be statistically nonsignificant. When the BMI variable was substituted with body inertia propensity, a derived variable, the TFA remained statistically nonsignificant. TFA magnitude does not seem to be a determinant factor that could increase the probability of spraining an ankle. PMID:20400424

  15. The Anatomic Pattern of Injuries in Acute Inversion Ankle Sprains

    PubMed Central

    Khor, Yuet Peng; Tan, Ken Jin

    2013-01-01

    Background: There are little data on the incidence and patterns of injuries seen on magnetic resonance imaging (MRI) in acute inversion ankle sprains. This study may help in the understanding of the pathomechanics, natural history, and outcomes of this common injury. Study Design: Case series; Level of evidence, 4. Methods: From June 2011 to June 2013, a total of 64 consecutive patients had MRI of the ankle performed for acute inversion injury to the ankle. All injuries/pathologies reported were recorded. Results: Only 22% of patients had isolated lateral ligament complex injuries. Twenty-two percent of patients had other pathologies but no lateral ligament injury, and 53% had lateral ligament injuries in combination with other pathologies or injuries. The most common associated finding with lateral ligament injuries was bone bruising (76%) followed by deltoid ligament injury (50%). The overall incidence of bone bruising was 50%. Thirty percent of ankles had tendon pathology, 27% had deltoid ligament injury, and 22% had occult fractures. Conclusion: Isolated lateral ligament ankle injury is not as common as is believed. The pattern of injury seems complex, and most patients appear to have more injuries than expected. MRI reveals additional information that may have significance in terms of diagnosis, treatment, and prognosis in this common injury. PMID:26535261

  16. Control of fracture reduction robot using force/torque measurement.

    PubMed

    Douke, T; Nakajima, Y; Mori, Y; Onogi, S; Sugita, N; Mitsuishi, M; Bessho, M; Ohhashi, S; Tobita, K; Ohnishi, I; Sakuma, I; Dohi, T; Maeda, Y; Koyama, T; Sugano, N; Yonenobu, K; Matsumoto, Y; Nakamura, K

    2008-01-01

    We have developed a surgical robotic system for femoral fracture reduction employing indirect traction. Indirect traction in fracture reduction is a generally used surgical method for preventing complications such as bone splits caused by high stress on bones. For traction, a patient's foot is gripped by a jig and pulled to the distal side. Indirect traction has the advantage of distributing bone stress by utilizing a strong traction force; however, this procedure does not accurately control the proper positioning of fractured fragments when a surgical robot is used. The human leg has knee and an ankle joints, and thus robotic motion presents problems in not being able to directly propagate reduction motion to a fractured femoral fragment, rendering control of bone position difficult. We propose a control method for fracture reduction robots using external force/torque measurements of the human leg to achieve precise fracture reduction. Results showed that the proposed method reduced repositioning error from 6.8 mm and 15.9 degrees to 0.7 mm and 5.3 degrees, respectively. PMID:19163404

  17. Ankle sprain: pathophysiology, predisposing factors, and management strategies

    PubMed Central

    Hubbard, Tricia J; Wikstrom, Erik A

    2010-01-01

    With the high percentage (up to 75%) of initial lateral ankle sprains (LAS) leading to repetitive sprains and chronic symptoms, it is imperative to better understand how best to treat and rehabilitate LAS events. The purpose of this paper is to review LAS pathophysiology, predisposing factors, and the current evidence regarding therapeutic modalities and exercises used in the treatment of LAS. Functional rehabilitation, early mobilization with support, is the current standard of care for LAS. However, the high percentage of reinjury occurrence and development of chronic symptoms (up to 75%) after a LAS, suggests the current standard of care may not be effective. Recent evidence has shown the need for more stringent immobilization to facilitate ligament healing and restoration of joint stability and function after a LAS. Additionally, the importance of adding adjunctive therapies, specifically joint mobilizations and balance training have been shown to improve function and decrease the incidence of reinjury after a LAS. Modifying current rehabilitation protocols to include protecting the ankle joint with stringent immobilization, and including joint mobilizations and balance training may be the first step to decreasing the incidence of short and long term ankle joint dysfunction. PMID:24198549

  18. Ankle sprain: pathophysiology, predisposing factors, and management strategies.

    PubMed

    Hubbard, Tricia J; Wikstrom, Erik A

    2010-01-01

    With the high percentage (up to 75%) of initial lateral ankle sprains (LAS) leading to repetitive sprains and chronic symptoms, it is imperative to better understand how best to treat and rehabilitate LAS events. The purpose of this paper is to review LAS pathophysiology, predisposing factors, and the current evidence regarding therapeutic modalities and exercises used in the treatment of LAS. Functional rehabilitation, early mobilization with support, is the current standard of care for LAS. However, the high percentage of reinjury occurrence and development of chronic symptoms (up to 75%) after a LAS, suggests the current standard of care may not be effective. Recent evidence has shown the need for more stringent immobilization to facilitate ligament healing and restoration of joint stability and function after a LAS. Additionally, the importance of adding adjunctive therapies, specifically joint mobilizations and balance training have been shown to improve function and decrease the incidence of reinjury after a LAS. Modifying current rehabilitation protocols to include protecting the ankle joint with stringent immobilization, and including joint mobilizations and balance training may be the first step to decreasing the incidence of short and long term ankle joint dysfunction. PMID:24198549

  19. [Demonstration of the impossibility of simultaneous Dupuytren and Destot fractures in the result of the car-pedestrian collision].

    PubMed

    Gusarov, A A; Fetisov, V A; Kucheryavets, Yu O

    2016-01-01

    This article reports the results of the commission forensic medical expertise undertaken to evaluate the possibility of severe injury to the ankle joint resulting from the road traffic accident as exemplified by the collision of a VAS 21043 car moving backward with a pedestrian. It was shown that the injury to the victim's right lower leg included the tear of the right crural deltoid ligament, the open communicated fracture of the lower third of fibular diaphysis with the displacement of the distal fragment, the lacerated wound in the lower third of the right leg, the rupture of distal tibiofibular synedesmosis, the closed communicated fracture of the posterior edge of the tibia without displacement, and outward subluxation of the right foot. According to the classification accepted in orthopedics , this variant of the injury to the ankle joint is a combination of the classical «complete» Dupuytren fracture and the Destot-type fracture. The analysis of the mechanism underlying formation of such injury has shown that it was a consequence of the indirect injurious action in the absence of the primary impact without the car running over the victim's leg. PMID:27500486

  20. Ankle Deformity Secondary to Acquired Fibular Segmental Defect in Children

    PubMed Central

    Kang, Soo Hwan; Song, Seok Whan; Chung, Jin Wha; Kim, Yoon Chung; Suhl, Kyung Hwan

    2010-01-01

    Background The authors report the long-term effect of acquired pseudoarthrosis of the fibula on ankle development in children during skeletal growth, and the results of a long-term follow-up of Langenskiold's supramalleolar synostosis to correct an ankle deformity induced by an acquired fibular segmental defect in children. Methods Since 1980, 19 children with acquired pseudoarthrosis of the fibula were treated and followed up for an average of 11 years. Pseudoarthrosis was the result of a fibulectomy for tumor surgery, osteomyelitis of the fibula and traumatic segmental loss of the fibula in 10, 6, and 3 cases, respectively. Initially, a Langenskiold's operation (in 4 cases) and fusion of the lateral malleolus to the distal tibial epiphysis (in 1 case) were performed, whereas only skeletal growth was monitored in the other 14 cases. After a mean follow-up of 11 years, the valgus deformity and external tibial torsion of the ankle joint associated with proximal migration of the lateral malleolus needed to be treated with a supramallolar osteotomy in 12 cases (63%). These ankle deformities were evaluated using the serial radiographs and limb length scintigraphs. Results In all cases, early closure of the lateral part of the distal tibial physis, upward migration of the lateral malleolus, unstable valgus deformity and external tibial torsion of the ankle joint developed during a mean follow-up of 11 years (range, 5 to 21 years). The mean valgus deformity and external tibial torsion of the ankle at the final follow-up were 15.2° (range, 5° to 35°) and 10° (range, 5° to 12°), respectively. In 12 cases (12/19, 63%), a supramalleolar corrective osteotomy was performed but three children had a recurrence requiring an additional supramalleolar corrective osteotomy 2-4 times. Conclusions A valgus deformity and external tibial torsion are inevitable after acquired pseudoarthrosis of the fibula in children. Both Langenskiöld supramalleolar synostosis to prevent these

  1. A mechanical supination sprain simulator for studying ankle supination sprain kinematics.

    PubMed

    Chan, Yue-Yan; Fong, Daniel Tik-Pui; Yung, Patrick Shu-Hang; Fung, Kwai-Yau; Chan, Kai-Ming

    2008-08-01

    This study presents a free-fall mechanical supination sprain simulator for evaluating the ankle joint kinematics during a simulated ankle supination sprain injury. The device allows the foot to be in an anatomical position before the sudden motion, and also allows different degrees of supination, or a combination of inversion and plantarflexion. Five subjects performed simulated supination sprain trials in five different supination angles. Ankle motion was captured by a motion analysis system, and the ankle kinematics were reported in plantarflexion/dorsiflexion, inversion/eversion and internal/external rotation planes. Results showed that all sprain motions were not pure single-plane motions but were accompanied by motion in other two planes, therefore, different degrees of supination were achieved. The presented sprain simulator allows a more comprehensive study of the kinematics of ankle sprain when compared with some previous laboratory research designs. PMID:18617179

  2. Sinus tarsi approach with trans-articular fixation for displaced intra-articular fractures of the calcaneus.

    PubMed

    Ebraheim, N A; Elgafy, H; Sabry, F F; Freih, M; Abou-Chakra, I S

    2000-02-01

    The charts and radiographs of 99 patients with 106 intraarticular fractures of the calcaneus were retrospectively reviewed. There were 75 men and 24 women. The average age was forty-two (range, 17 to 81). Fifty-seven of the fractures were left and 49 were right. The mechanism of injury was a fall from a height in 69 patients and motor vehicle accident in 30 patients. According to Sanders classification, seventy-one cases (67%) had type II fractures, 25 cases (23.6%) had type III, and ten cases (9.4%) had type IV. All the patients had operative management through a limited sinus tarsi approach with minimal fixation of the fracture with one or several pins. One of the pins was usually applied from the talus to the calcaneus through the fracture after reduction of the posterior facet. Nine cases (8.5%) developed postoperative infection, four cases (3.8%) had superficial wound infection, four cases (3.8%) had pin tract infection and one case (0.9%) had osteomylitis. Our follow-up at an average of 29 months (range, 12 to 84 months) showed that the American Orthopedic Foot and Ankle Society, Ankle-Hindfoot Score for the all group was 77.6 (range, 31-91). Forty-one fractures (38.8%) were graded excellent, 39 fractures (36.7%) good, 14 fractures (13.2%) fair, and 12 fractures (11.3%) were failures. Although radiological degenerative changes in the subtalar joint were seen in 41 cases (38.7%), only six cases (5.6%) required subsequent subtalar fusion. The authors conclude that the operative method used in the current study which followed the principle of minimal soft tissue damage and minimal internal fixation may be a good option for management of calcaneus fractures. PMID:10694021

  3. The effects of ankle restriction on the multijoint coordination of vertical jumping.

    PubMed

    Arakawa, Hiroshi; Nagano, Akinori; Hay, Dean C; Kanehisa, Hiroaki

    2013-08-01

    The current study aimed to investigate the effect of ankle restriction on the coordination of vertical jumping and discuss the influence of energy transfer through m. gastrocnemius on the multijoint movement. Eight participants performed two types of vertical jumps: a normal squat jump, and a squat jump with restricted ankle joint movement. Mechanical outputs were calculated using an inverse dynamics analysis. Custom-made shoes were used to restrict plantar flexion, resulting in significantly (P < .001) reduced maximum power and work at the ankle joint to below 2% and 3%, while maintaining natural range of motion at the hip and knee. Based on the comparison between the two types of jumps, we determined that the ankle restriction increased (P < .001) the power (827 ± 346 W vs. 1276 ± 326 W) and work (92 ± 34 J vs. 144 ± 36 J) at the knee joint. A large part of the enhanced output at the knee is assumed to be due to ankle restriction, which results in the nullification of energy transport via m. gastrocnemius; that is, reduced contribution of the energy transfer with ankle restriction appeared as augmentation at the knee joint. PMID:23182763

  4. Lyme arthritis of the pediatric ankle.

    PubMed

    Aiyer, Amiethab; Walrath, Jessica; Hennrikus, William

    2014-10-01

    Lyme arthritis results from acute inflammation caused by the spirochete Borrelia burgdorferi. The number of cases per year has been rising since 2006, with a majority of patients being affected in the northeastern United States. Development of Lyme arthritis is of particular importance to the orthopedic surgeon because Lyme arthritis often presents as an acute episode of joint swelling and tenderness and may be confused with bacterial septic arthritis. Considering the vast difference in treatment management between these 2 pathologies, differentiating between them is of critical importance. Septic arthritis often needs to be addressed surgically, whereas Lyme arthritis can be treated with oral antibiotics alone. Laboratory testing for Lyme disease often results in a delay in diagnosis because many laboratories batch-test Lyme specimens only a few times per week because of increased expense. The authors present a case of Lyme arthritis in the pediatric ankle in an endemic region. No clear algorithm exists to delineate between septic arthritis and Lyme arthritis of the joint. Improved clinical guidelines for the identification and diagnosis of Lyme arthritis of the ankle are important so that appropriate antibiotics can be used and surgery can be avoided. PMID:25275987

  5. Diagnosing, planning and evaluating osteochondral ankle defects with imaging modalities.

    PubMed

    van Bergen, Christiaan Ja; Gerards, Rogier M; Opdam, Kim Tm; Terra, Maaike P; Kerkhoffs, Gino Mmj

    2015-12-18

    This current concepts review outlines the role of different imaging modalities in the diagnosis, preoperative planning, and follow-up of osteochondral ankle defects. An osteochondral ankle defect involves the articular cartilage and subchondral bone (usually of the talus) and is mostly caused by an ankle supination trauma. Conventional radiographs are useful as an initial imaging tool in the diagnostic process, but have only moderate sensitivity for the detection of osteochondral defects. Computed tomography (CT) and magnetic resonance imaging (MRI) are more accurate imaging modalities. Recently, ultrasonography and single photon emission CT have been described for the evaluation of osteochondral talar defects. CT is the most valuable modality for assessing the exact location and size of bony lesions. Cartilage and subchondral bone damage can be visualized using MRI, but the defect size tends to be overestimated due to bone edema. CT with the ankle in full plantar flexion has been shown a reliable tool for preoperative planning of the surgical approach. Postoperative imaging is useful for objective assessment of repair tissue or degenerative changes of the ankle joint. Plain radiography, CT and MRI have been used in outcome studies, and different scoring systems are available. PMID:26716090

  6. Diagnosing, planning and evaluating osteochondral ankle defects with imaging modalities

    PubMed Central

    van Bergen, Christiaan JA; Gerards, Rogier M; Opdam, Kim TM; Terra, Maaike P; Kerkhoffs, Gino MMJ

    2015-01-01

    This current concepts review outlines the role of different imaging modalities in the diagnosis, preoperative planning, and follow-up of osteochondral ankle defects. An osteochondral ankle defect involves the articular cartilage and subchondral bone (usually of the talus) and is mostly caused by an ankle supination trauma. Conventional radiographs are useful as an initial imaging tool in the diagnostic process, but have only moderate sensitivity for the detection of osteochondral defects. Computed tomography (CT) and magnetic resonance imaging (MRI) are more accurate imaging modalities. Recently, ultrasonography and single photon emission CT have been described for the evaluation of osteochondral talar defects. CT is the most valuable modality for assessing the exact location and size of bony lesions. Cartilage and subchondral bone damage can be visualized using MRI, but the defect size tends to be overestimated due to bone edema. CT with the ankle in full plantar flexion has been shown a reliable tool for preoperative planning of the surgical approach. Postoperative imaging is useful for objective assessment of repair tissue or degenerative changes of the ankle joint. Plain radiography, CT and MRI have been used in outcome studies, and different scoring systems are available. PMID:26716090

  7. [PARTICULAR QUALITIES OF DIAGNOSTIC ACUTE LATERAL ANKLE LIGAMENT INJURIES].

    PubMed

    Krasnoperov, S N; Shishka, I V; Golovaha, M L

    2015-01-01

    Delayed diagnosis of acute lateral ankle ligaments injury and subsequent inadequate treatment leads to the development of chronic instability and rapid progression of degenerative processes in the joint. The aim of our work was to improve treatment results by developing an diagnostic algorithm and treatment strategy of acute lateral ankle ligament injuries. The study included 48 patients with history of acute inversion ankle injury mechanism. Diagnostic protocol included clinical and radiological examination during 48 hours and after 7-10 days after injury. According to the high rate of inaccurate clinical diagnosis in the first 48 hours of the injury a short course of conservative treatment for 7-10 days is needed with follow-up and controlling clinical and radiographic instability tests. Clinical symptoms of ankle inversion injury showed that the combination of local tenderness in the projection of damaged ligaments, the presence of severe periarticular hematoma in the lateral department and positive anterior drawer and talar tilt tests in 7-10 days after the injury in 87% of cases shows the presence of ligament rupture. An algorithm for diagnosis of acute lateral ankle ligament injury was developed, which allowed us to determine differential indications for surgical repair of the ligaments and conservative treatment of these patients. PMID:27089717

  8. Optimal management of ankle syndesmosis injuries

    PubMed Central

    Porter, David A; Jaggers, Ryan R; Barnes, Adam Fitzgerald; Rund, Angela M

    2014-01-01

    Syndesmosis injuries occur when there is a disruption of the distal attachment of the tibia and fibula. These injuries occur commonly (up to 18% of ankle sprains), and the incidence increases in the setting of athletic activity. Recognition of these injuries is key to preventing long-term morbidity. Diagnosis and treatment of these injuries requires a thorough understanding of the normal anatomy and the role it plays in the stability of the ankle. A complete history and physical examination is of paramount importance. Patients usually experience an external rotation mechanism of injury. Key physical exam features include detailed documentation about areas of focal tenderness (syndesmosis and deltoid) and provocative maneuvers such as the external rotation stress test. Imaging workup in all cases should consist of radiographs with the physiologic stress of weight bearing. If these images are inconclusive, then further imaging with external rotation stress testing or magnetic resonance imaging are warranted. Nonoperative treatment is appropriate for stable injuries. Unstable injuries should be treated operatively. This consists of stabilizing the syndesmosis with either trans-syndesmotic screw or tightrope fixation. In the setting of a concomitant Weber B or C fracture, the fibula is anatomically reduced and stabilized with a standard plate and screw construct. Proximal fibular fractures, as seen in the Maisonneuve fracture pattern, are not repaired operatively. Recent interest is moving toward repair of the deltoid ligament, which may provide increased stability, especially in rehabilitation protocols that involve early weight bearing. Rehabilitation is focused on allowing patients to return to their pre-injury activities as quickly and safely as possible. Protocols initially focus on controlling swelling and recovery from surgery. The protocols then progress to restoration of motion, early protected weight bearing, restoration of strength, and eventually a

  9. Validation of the Ottawa Ankle Rules in Indian Scenario

    PubMed Central

    Meena, Sanjay; Gangary, Shreesh Kumar

    2015-01-01

    Background: Ankle injuries are one of the most common presentations in emergency department. Ottawa Ankle Rules (OARs) have been used to predict the requirement of radiographs. Objectives: This study aimed to validate the OARs protocol for predicting ankle and midfoot fractures in Indian population. Patients and Methods: A prospective study was conducted in a teaching hospital in north India, during a period of nine months, including all patients who presented with complaints in the ankle region and evolution of less than 48 hours. The study excluded patients with multiple trauma and Glasgow coma scale of less than 15. All patients underwent clinical evaluation, followed by radiographs depending upon the location of the complaints. Radiographic study results were evaluated by orthopedic surgeons who had not seen the patient. Results: We evaluated 140 patients (84 males and 60 females) with the mean age of 35.2 (range, 8 - 76 years). Of the 140 evaluable patients, 71 had positive criteria for radiological evaluation of which 43 presented with fracture, 69 had negative criteria for radiography with no fracture. The sensitivity of OARs to detect fractures was 100%. The implementation of the OARs appears to have the potential to reduce the number of radiographs for the assessment of these patients by about 51%. Conclusions: The implementations of OARs have the potential to reduce the number of X-ray graphics needed to assess these patients by about 51%. The results of this study demonstrate no false negatives and are in agreement with results from other similar studies. It encourages us to implement these criteria in our services urgently, with all the resulting socio-economic implications. PMID:26101760

  10. Soft Tissue Impingement of the Ankle: Pathophysiology, Evaluation, and Arthroscopic Treatment.

    PubMed

    Shane, Amber M; Reeves, Christopher L; Vazales, Ryan; Farley, Zachary

    2016-10-01

    Soft tissue impingement (STI) syndrome is one of 3 causes of a larger all-encompassing joint impingement pathologic condition, which also includes bone and neuropathic entrapment. Altered joint biomechanics and friction of joint tissues combine to cause chronic pain and often functional instability. Although the most common form of STI to the ankle is anterolateral in location, posterior and anteromedial impingement is also discussed in this article. Furthermore, a discussion of biomechanical deficiencies and how they may effect location and cause of STI of the ankle is explored along with pathophysiology, clinical and diagnostic evaluation, current treatments, and long-term outcomes. PMID:27599436

  11. Propulsion System with Pneumatic Artificial Muscles for Powering Ankle-Foot Orthosis

    NASA Astrophysics Data System (ADS)

    Veneva, Ivanka; Vanderborght, Bram; Lefeber, Dirk; Cherelle, Pierre

    2013-12-01

    The aim of this paper is to present the design of device for control of new propulsion system with pneumatic artificial muscles. The propulsion system can be used for ankle joint articulation, for assisting and rehabilitation in cases of injured ankle-foot complex, stroke patients or elderly with functional weakness. Proposed device for control is composed by microcontroller, generator for muscles contractions and sensor system. The microcontroller receives the control signals from sensors and modulates ankle joint flex- ion and extension during human motion. The local joint control with a PID (Proportional-Integral Derivative) position feedback directly calculates desired pressure levels and dictates the necessary contractions. The main goal is to achieve an adaptation of the system and provide the necessary joint torque using position control with feedback.

  12. Proximal tibiofibular joint: Rendezvous with a forgotten articulation.

    PubMed

    Sarma, Amitav; Borgohain, Bhaskar; Saikia, Bishwajeet

    2015-01-01

    The proximal tibiofibular joint (PTFJ) is a plane type synovial joint. The primary function of the PTFJ is dissipation of torsional stresses applied at the ankle and the lateral tibial bending moments besides a very significant tensile, rather than compressive weight bearing. Though rare, early diagnosis and treatment of the PTFJ dislocation are essential to prevent chronic joint instability and extensive surgical intervention to restore normal PTFJ biomechanics, ankle and knee function, especially in athletes prone to such injuries. PTFJ dislocations often remain undiagnosed in polytrauma scenario with ipsilateral tibial fracture due to the absence of specific signs and symptoms of PTFJ injury. Standard orthopedic textbooks generally describe no specific tests or radiological signs for assessment of the integrity of this joint. The aim of this paper was to review the relevant clinical anatomy, biomechanics and traumatic pathology of PTFJ with its effect on the knee emphasizing the importance of early diagnosis through a high index of suspicion. Dislocation of the joint may have serious implications for the knee joint stability since fibular collateral ligament and posterolateral ligament complex is attached to the upper end of the fibula. Any high energy knee injury with peroneal nerve palsy should immediately raise the suspicion of PTFJ dislocation especially if the mechanism of injury involved knee twisting in flexion beyond 80° and in such cases a comparative radiograph of the contralateral side should be performed. Wider clinical awareness can avoid both embarrassingly extensive surgeries due to diagnostic delays or unnecessary overtreatment due to misinformation on the part of the treating surgeon. PMID:26538753

  13. Proximal tibiofibular joint: Rendezvous with a forgotten articulation

    PubMed Central

    Sarma, Amitav; Borgohain, Bhaskar; Saikia, Bishwajeet

    2015-01-01

    The proximal tibiofibular joint (PTFJ) is a plane type synovial joint. The primary function of the PTFJ is dissipation of torsional stresses applied at the ankle and the lateral tibial bending moments besides a very significant tensile, rather than compressive weight bearing. Though rare, early diagnosis and treatment of the PTFJ dislocation are essential to prevent chronic joint instability and extensive surgical intervention to restore normal PTFJ biomechanics, ankle and knee function, especially in athletes prone to such injuries. PTFJ dislocations often remain undiagnosed in polytrauma scenario with ipsilateral tibial fracture due to the absence of specific signs and symptoms of PTFJ injury. Standard orthopedic textbooks generally describe no specific tests or radiological signs for assessment of the integrity of this joint. The aim of this paper was to review the relevant clinical anatomy, biomechanics and traumatic pathology of PTFJ with its effect on the knee emphasizing the importance of early diagnosis through a high index of suspicion. Dislocation of the joint may have serious implications for the knee joint stability since fibular collateral ligament and posterolateral ligament complex is attached to the upper end of the fibula. Any high energy knee injury with peroneal nerve palsy should immediately raise the suspicion of PTFJ dislocation especially if the mechanism of injury involved knee twisting in flexion beyond 80° and in such cases a comparative radiograph of the contralateral side should be performed. Wider clinical awareness can avoid both embarrassingly extensive surgeries due to diagnostic delays or unnecessary overtreatment due to misinformation on the part of the treating surgeon. PMID:26538753

  14. Rotational stiffness of American football shoes affects ankle biomechanics and injury severity.

    PubMed

    Button, Keith D; Braman, Jerrod E; Davison, Mark A; Wei, Feng; Schaeffer, Maureen C; Haut, Roger C

    2015-06-01

    While previous studies have investigated the effect of shoe-surface interaction on injury risk, few studies have examined the effect of rotational stiffness of the shoe. The hypothesis of the current study was that ankles externally rotated to failure in shoes with low rotational stiffness would allow more talus eversion than those in shoes with a higher rotational stiffness, resulting in less severe injury. Twelve (six pairs) cadaver lower extremities were externally rotated to gross failure while positioned in 20 deg of pre-eversion and 20 deg of predorsiflexion by fixing the distal end of the foot, axially loading the proximal tibia, and internally rotating the tibia. One ankle in each pair was constrained by an American football shoe with a stiff upper, while the other was constrained by an American football shoe with a flexible upper. Experimental bone motions were input into specimen-specific computational models to examine levels of ligament elongation to help understand mechanisms of ankle joint failure. Ankles in flexible shoes allowed 6.7±2.4 deg of talus eversion during rotation, significantly greater than the 1.7±1.0 deg for ankles in stiff shoes (p = 0.01). The significantly greater eversion in flexible shoes was potentially due to a more natural response of the ankle during rotation, possibly affecting the injuries that were produced. All ankles failed by either medial ankle injury or syndesmotic injury, or a combination of both. Complex (more than one ligament or bone) injuries were noted in 4 of 6 ankles in stiff shoes and 1 of 6 ankles in flexible shoes. Ligament elongations from the computational model validated the experimental injury data. The current study suggested flexibility (or rotational stiffness) of the shoe may play an important role in both the severity of ankle injuries for athletes. PMID:25751589

  15. The effect of Q angle on ankle sprain occurrence.

    PubMed

    Pefanis, Nikolaos; Papaharalampous, Xenofon; Tsiganos, Georgios; Papadakou, Eugenia; Baltopoulos, Panagiotis

    2009-02-01

    The intersegmental joint forces and the structures that must resist them (articular surfaces, ligaments, and musculature) are related through anatomical alignment of the joints and skeletal system. Ankle joint structure can affect or be affected by bony malformations of the surrounding areas, including the knee and hip. The aim of the current study is to examine the possible relationship between the quadriceps (Q) angle and other factors (anthropometric characteristics, medical history, and age) on the occurrence of ankle sprains, because its value, when assessed correctly, provides useful information for the anatomical alignment of the lower extremity. The study sample consisted of 45 high-level athletes, evenly distributed among 3 sports (basketball, soccer, and volleyball). Q angle measurements were made on radiographs. The study lasted for 2 years. A logistic regression was used to determine the importance of each factor on the probability in question. A significance level of P = .1 was used. The factors contributing more to an ankle sprain were a previous injury of the same type ( P < .01) followed by body mass index (BMI; P < .10) and age (P < .10). On the contrary, Q angle was proven to be statistically nonsignificant (P > .10). The results were valid even when the BMI variable was substituted by body inertia propensity, a derived variable. The Q angle remained statistically nonsignificant ( P > .10). The Q angle magnitude does not seem to be a decisive factor that could increase the probability of spraining an ankle. The most important factors that could affect the probability of sustaining an ankle sprain are the athlete's age, anthropometric characteristics, and prior injuries. PMID:19825746

  16. Dynamic high-resolution US of ankle and midfoot ligaments: normal anatomic structure and imaging technique.

    PubMed

    Sconfienza, Luca Maria; Orlandi, Davide; Lacelli, Francesca; Serafini, Giovanni; Silvestri, Enzo

    2015-01-01

    The ankle is the most frequently injured major joint in the body, and ankle sprains are frequently encountered in individuals playing football, basketball, and other team sports, in addition to occurring in the general population. Imaging plays a crucial role in the evaluation of ankle ligaments. Magnetic resonance imaging has been proven to provide excellent evaluation of ligaments around the ankle, with the ability to show associated intraarticular abnormalities, joint effusion, and bone marrow edema. Ultrasonography (US) performed with high-resolution broadband linear-array probes has become increasingly important in the assessment of ligaments around the ankle because it is low cost, fast, readily available, and free of ionizing radiation. US can provide a detailed depiction of normal anatomic structures and is effective for evaluating ligament integrity. In addition, US allows the performance of dynamic maneuvers, which may contribute to increased visibility of normal ligaments and improved detection of tears. In this article, the authors describe the US techniques for evaluation of the ankle and midfoot ligaments and include a brief review of the literature related to their basic anatomic structures and US of these structures. Short video clips showing dynamic maneuvers and dynamic real-time US of ankle and midfoot structures and their principal pathologic patterns are included as supplemental material. Use of a standardized imaging technique may help reduce the intrinsic operator dependence of US. Online supplemental material is available for this article. PMID:25590396

  17. Ankle trauma significantly impairs posture control--a study in basketball players and controls.

    PubMed

    Perrin, P P; Béné, M C; Perrin, C A; Durupt, D

    1997-07-01

    Both ankle and hip movements are used to maintain balance in strategies defined as bottom up and top down models. This suggests that pathological impairment of either of these articulations could modify the parameters of balance control. In order to appreciate the bearing of ankle damage on the proper control of equilibrium, posturographic recordings were compared, in a static and two dynamic tests, between 15 professional national basketball players, with histories of 10 to 15 ankle sprains, and 50 controls. In statokinesigrams obtained with eyes open or closed, center of foot pressure displacements were of similar length (way) between controls and players, while the area covered was increased for the latter and related to the history of ankle trauma. In a toes-up dynamic test (4 degrees, 50 degrees/s) coupled with electromyographic recordings, the short latency response (myotatic reflex in the triceps surae muscle) normalized to one meter body height, was shorter in players without relationship to histories of ankle damage. In a prolonged sinusoidal dynamic test, players with the largest number of ankle trauma showed greater difficulties in maintaining posture control. These data pinpoint the role of ankles in the control of both static and dynamic balance and demonstrate that the role of the hip joints becomes more important (top down strategy) in the case of damaged ankles. PMID:9298781

  18. Management and prevention of acute and chronic lateral ankle instability in athletic patient populations

    PubMed Central

    McCriskin, Brendan J; Cameron, Kenneth L; Orr, Justin D; Waterman, Brian R

    2015-01-01

    Acute and chronic lateral ankle instability are common in high-demand patient populations. If not managed appropriately, patients may experience recurrent instability, chronic pain, osteochondral lesions of the talus, premature osteoarthritis, and other significant long-term disability. Certain populations, including young athletes, military personnel and those involved in frequent running, jumping, and cutting motions, are at increased risk. Proposed risk factors include prior ankle sprain, elevated body weight or body mass index, female gender, neuromuscular deficits, postural imbalance, foot/ankle malalignment, and exposure to at-risk athletic activity. Prompt, accurate diagnosis is crucial, and evidence-based, functional rehabilitation regimens have a proven track record in returning active patients to work and sport. When patients fail to improve with physical therapy and external bracing, multiple surgical techniques have been described with reliable results, including both anatomic and non-anatomic reconstructive methods. Anatomic repair of the lateral ligamentous complex remains the gold standard for recurrent ankle instability, and it effectively restores native ankle anatomy and joint kinematics while preserving physiologic ankle and subtalar motion. Further preventative measures may minimize the risk of ankle instability in athletic cohorts, including prophylactic bracing and combined neuromuscular and proprioceptive training programs. These interventions have demonstrated benefit in patients at heightened risk for lateral ankle sprain and allow active cohorts to return to full activity without adversely affecting athletic performance. PMID:25793157

  19. Closed Reduction and Percutaneous Fixation of Calcaneal Fractures in Children.

    PubMed

    Feng, Yongzeng; Yu, Yang; Shui, Xiaolong; Ying, Xiaozhou; Cai, Leyi; Hong, Jianjun

    2016-07-01

    Open reduction and internal fixation has been widely used to treat displaced intra-articular calcaneus fractures in children. However, the complications of surgical trauma and the wound created through the extended lateral approach cannot be ignored. This study analyzed the outcomes of displaced intra-articular calcaneal fractures in children treated with closed reduction and percutaneous fixation. Medical records of pediatric patients who had displaced intra-articular calcaneus fractures and underwent closed reduction and percutaneous fixation at the study institution between January 2008 and January 2013 were reviewed. Preoperative radiographs and computed tomography scans were used to evaluate and classify the fractures. Clinical outcomes and radiographic findings were assessed at postoperative follow-up. The study included 14 displaced intra-articular calcaneal fractures in 11 patients (7 boys and 4 girls). Mean patient age was 11.18 years (range, 6-16 years), and average follow-up time was 42.8 months postoperatively (range, 12-72 months). There were 6 tongue-type fractures and 8 joint depression-type fractures, based on the Essex-Lopresti classification, and there were 11 type II and 3 type III fractures, based on the Sanders classification. Average Böhler angle was 8.00° (range, -5° to 18°) preoperatively and 30.79° (range, 26° to 40°) postoperatively (P<.001). Average subjective American Orthopaedic Foot and Ankle Society hindfoot score was 65.7 (range, 52-68). No patients had wound breakdown or infection. In the treatment of displaced intra-articular calcaneal fractures in pediatric patients, closed reduction and percutaneous fixation achieved good outcomes, with few complications. [Orthopedics. 2016; 39(4):e744-e748.]. PMID:27111072

  20. Multi-segment foot kinematics after total ankle replacement and ankle arthrodesis during relatively long-distance gait.

    PubMed

    Rouhani, H; Favre, J; Aminian, K; Crevoisier, X

    2012-07-01

    This study aimed to investigate the influence of ankle osteoarthritis (AOA) treatments, i.e., ankle arthrodesis (AA) and total ankle replacement (TAR), on the kinematics of multi-segment foot and ankle complex during relatively long-distance gait. Forty-five subjects in four groups (AOA, AA, TAR, and control) were equipped with a wearable system consisting of inertial sensors installed on the tibia, calcaneus, and medial metatarsals. The subjects walked 50-m twice while the system measured the kinematic parameters of their multi-segment foot: the range of motion of joints between tibia, calcaneus, and medial metatarsals in three anatomical planes, and the peaks of angular velocity of these segments in the sagittal plane. These parameters were then compared among the four groups. It was observed that the range of motion and peak of angular velocities generally improved after TAR and were similar to the control subjects. However, unlike AOA and TAR, AA imposed impairments in the range of motion in the coronal plane for both the tibia-calcaneus and tibia-metatarsals joints. In general, the kinematic parameters showed significant correlation with established clinical scales (FFI and AOFAS), which shows their convergent validity. Based on the kinematic parameters of multi-segment foot during 50-m gait, this study showed significant improvements in foot mobility after TAR, but several significant impairments remained after AA. PMID:22763319

  1. Arthrodesis versus ORIF for Lisfranc fractures.

    PubMed

    Sheibani-Rad, Shahin; Coetzee, J Christiaan; Giveans, M Russell; DiGiovanni, Christopher

    2012-06-01

    The Lisfranc joints make up the bony structural support of the transverse arch in the midfoot and account for approximately 0.2% of all fractures. Early recognition and treatment of this injury are paramount to preserving normal foot biomechanics and function. Controversy exists regarding the optimal treatment of patients with Lisfranc injuries, particularly when the instability is entirely ligamentous.The authors performed a qualitative, systematic review of the literature to compare the 2 most common procedures for Lisfranc fractures: primary arthrodesis and open reduction and internal fixation (ORIF). Six articles with a total of 193 patients met the inclusion criteria. At 1-year follow-up, the mean American Orthopaedic Foot and Ankle Society score of ORIF patients was 72.5 and of arthrodesis patients was 88.0. Fisher's exact test revealed no significant effect of treatment group on the percentage on patients who had an anatomic reduction (P=.319).This study highlights that both procedures yield satisfactory and equivalent results. A slight advantage may exist in performing a primary arthrodesis for Lisfranc joint injuries in terms of clinical outcomes. PMID:22691659

  2. Arthroscopic Repair of Ankle Instability.

    PubMed

    Sorensen, Matthew D; Baca, John; Arbuckle, Keith

    2016-10-01

    Arthroscopic lateral ankle stabilization procedures have been described for many years. New technological advances and a deeper understanding of the pathobiomechanics involved in chronic lateral ankle instability have allowed an expansion of arthroscopic approaches to this common pathology. As experience is gained and outcomes within the patient profile are understood, the authors feel that the arthroscopic approach to lateral ankle stabilization may prove superior to traditional methods secondary to the risk and traditional complications that are mitigated within minimally invasive arthroscopic approaches. Additionally, the arthroscopic approach may allow a quicker return to ballistic sport and decrease time for rehabilitation. PMID:27599440

  3. Multipurpose external fixator for intraarticular fracture of distal radius.

    PubMed

    Siripakarn, Yongyuth; Siripakarn, Zongyuti

    2010-12-01

    Fracture of distal radius is one of a complicated injury which can be difficult in reduction and maintaining its alignment and may result in malunion and shortening following a variety of fixation. Since Anderson's and O'neil described the use of sustain traction by extraskeletal device anchored to the radius and the first metacarpal of the hand. Vidal et al [1979] demonstrated that the ligamentotaxis could be used to reduce the fracture around the wrist, ankle, hip and knee. The external fixation frame can maintain radial length and inclination by the pullout force from the radial styloid. External fixation is useful for management of complex intraarticular fracture of distal radius. There are few types of commercially available fixator. It is important to use one that allow versatility and follow biomechanic principles of ligamentotaxis, which can be used to reduce the severe comminution and the most difficult fracture by distraction and stabilization effectively. The ideal characteristic of the external fixation are: Telescoping connecting frame fixed externally compose of two joints which can be easily adjust in any direction, two pins clamp connected to the external connecting rod. Our TU Multipurpose external fixator can be designed as a multiplana, can be used as a bridge or non bridge fixation, and can be adjusted to any direction which require for the treatment of distal radius fracture. It is differed to other commercially available devices. PMID:21294433

  4. Prevalence of chronic ankle instability and associated symptoms in university dance majors: an exploratory study.

    PubMed

    Simon, Janet; Hall, Emily; Docherty, Carrie

    2014-01-01

    Previous investigations have established that dancers suffer a large number of injuries to the lower leg, foot, and ankle, with a portion of these being significant time loss injuries or in some cases career ending. Lateral ankle sprain is a common injury in dancers and can often lead to recurrent instability and repetitive injuries. Research in other active populations has linked ankle sprains to the development of chronic ankle instability (CAI). Therefore, the purpose of this study was to identify the prevalence of CAI and related symptoms of ankle sprain in a student dance population. Individuals were included if they were currently a modern or ballet dance major at the investigators' university (exclusion criterion: a history of fracture or surgery in the lower extremities). A self-reported demographic questionnaire and the Identification of Functional Ankle Instability survey were used to identify the presence and characteristics of CAI. A total of 83 questionnaires were collected, and after exclusions, 77 participants remained: 43 modern dancers and 34 ballet dancers (10 males and 67 females, mean age 19.61 ± 2.53 years, mean dance experience 13.61 ± 3.16 years). Of all dancers surveyed, 41 (53.2%) had CAI, and of those 24 (58.5%) were modern dancers, and 17 (41.5%) were ballet dancers. When looking only at those dancers who had a previous lateral ankle sprain, 75.9% were identified as having CAI. Chronic Ankle Instability can create long-term problems for anyone but especially female dancers, who place extreme stress on their feet and ankles from being en pointe or demi-pointe. It is important to educate dancers, instructors, and medical staff of the importance of recognizing CAI and seeking medical care for ankle sprains and their residual symptoms. PMID:25474297

  5. Muscle Spindle Traffic in Functionally Unstable Ankles During Ligamentous Stress

    PubMed Central

    Needle, Alan R.; Charles B. (Buz), Swanik; Farquhar, William B.; Thomas, Stephen J.; Rose, William C.; Kaminski, Thomas W.

    2013-01-01

    Context: Ankle sprains are common in athletes, with functional ankle instability (FAI) developing in approximately half of cases. The relationship between laxity and FAI has been inconclusive, suggesting that instability may be caused by insufficient sensorimotor function and dynamic restraint. Research has suggested that deafferentation of peripheral mechanoreceptors potentially causes FAI; however, direct evidence confirming peripheral sensory deficits has been elusive because previous investigators relied upon subjective proprioceptive tests. Objective: To develop a method for simultaneously recording peripheral sensory traffic, joint forces, and laxity and to quantify differences between healthy ankles and those with reported instability. Design: Case-control study. Setting: University laboratory. Patients or Other Participants: A total of 29 participants (age = 20.9 ± 2.2 years, height = 173.1 ± 8.9 cm, mass = 74.5 ± 12.7 kg) stratified as having healthy (HA, n = 19) or unstable ankles (UA, n = 10). Intervention(s): Sensory traffic from muscle spindle afferents in the peroneal nerve was recorded with microneurography while anterior (AP) and inversion (IE) stress was applied to ligamentous structures using an ankle arthrometer under test and sham conditions. Main Outcome Measure(s): Laxity (millimeters or degrees) and amplitude of sensory traffic (percentage) were determined at 0, 30, 60, 90, and 125 N of AP force and at 0, 1, 2, 3, and 4 Nm of IE torque. Two-factor repeated-measures analyses of variance were used to determine differences between groups and conditions. Results: No differences in laxity were observed between groups (P > .05). Afferent traffic increased with increased force and torque in test trials (P < .001). The UA group displayed decreased afferent activity at 30 N of AP force compared with the HA group (HA: 30.2% ± 9.9%, UA: 17.1% ± 16.1%, P < .05). Conclusions: The amplitude of sensory traffic increased simultaneously with greater

  6. Biofilm development in a hotspot of mixing between shallow and deep groundwater in a fractured aquifer: field evidence from joint flow, chemical and microbiological characterization

    NASA Astrophysics Data System (ADS)

    Bochet, Olivier; Le Borgne, Tanguy; Pédrot, Mathieu; Labasque, Thierry; Lavenant, Nicolas; Petton, Christophe; Dufresne, Alexis; Ben Maamar, Sarah; Chatton, Eliot; De la Bernardie, Jérôme; Aquilina, Luc

    2015-04-01

    Biofilm development in a hotspot of mixing between shallow and deep groundwater in a fractured aquifer: field evidence from joint flow, chemical and microbiological characterization Olivier Bochet1, Tanguy Le Borgne1, Mathieu Pédrot1, Thierry Labasque1, Nicolas Lavenant1, Christophe Petton1, Alexis Dufresne2,Sarah Ben Maamar1-2, Eliot Chatton1, Jérôme de la Bernardie1, Luc Aquilina1 1: Géosciences Rennes, CNRS UMR 6118, Université de Rennes 1, Campus de Beaulieu bât 14B, Rennes, France 2: Ecobio, CNRS UMR 6553, Université de Rennes 1, Campus de Beaulieu, bât 14, Rennes, France Biofilms play a major role in controlling the fluxes and reactivity of chemical species transported in hydrological systems. Their development can have either positive impacts on groundwater quality (e.g. attenuation of contaminants under natural or stimulated conditions), or possible negative effects on subsurface operations (e.g. bio-clogging of geothermal dipoles or artificial recharge systems). Micro-organisms require both electron donors and electron acceptors for cellular growth, proliferation and maintenance of their metabolic functions. The mechanisms controlling these reactions derive from the interactions occurring at the micro-scale that depend on mineral compositions, the biota of subsurface environment, but also fluid mixing, which determines the local concentrations of nutriments, electron donors and electron acceptors. Hence, mixing zones between oxygen and nutriment rich shallow groundwater and mineralized deep groundwater are often considered as potential hotspots of microbial activity, although relatively few field data document flow distributions, transport properties, chemical gradients and micro-organisms distributions across these mixing interfaces. Here we investigate the origin of a localized biofilm development observed in the fractured granite aquifer at the Ploemeur observatory (H+ network hplus.ore.fr).This biofilm composed of ferro-oxidizing bacteria is

  7. Effect of irradiation dose on mechanical properties and fracture character of Cu//SS joints for ITER

    NASA Astrophysics Data System (ADS)

    Pokrovsky, A. S.; Fabritsiev, S. A.; Peacock, A.; Gerwash, A.; Barabash, V. R.

    2007-08-01

    Cu//SS type joints are essential for the heat-sink systems of the ITER high-heat flux components. A number of technologies have been proposed for the production of such bimetallic structures, including brazing, friction welding, HIP and cast-copper-to-steel. In this paper, the authors present the results of investigations into the irradiation resistance of GlidCopAl25//316L(N) and CuCrZr//316L(N)-type joints produced by the HIP and cast-copper-to-steel (CC) technologies. Specimens of the joints were irradiated in the RBT-6 reactor in the dose range of 10 -3-10 -1 dpa at Tirr = 150 °C. Irradiation causes strengthening of the joint specimens and the uniform elongation drops from 7% in the initial state to 1-2%. However, the total elongation remains at the relatively high level of ˜10%. The investigations performed make it possible to recommend joints of CuCrZr//316L(N) (CC) and CuCrZr//316L(N) (HIP) type produced by the cast-copper-to-steel and HIP technologies, respectively, for ITER applications.

  8. [Arthroscopic surgery of the ankle].

    PubMed

    Bojanić, Ivan; Franić, Miljenko; Ivković, Alan

    2007-05-01

    Arthroscopic surgery of the ankle has become indispensable method in the armamentarium of the modern orthopaedic surgeon. Technological advancement and thorough understanding of the anatomy have resulted in improved ability to perform arthroscopy of the ankle. The method is minimally invasive and it allows the direct visualization of intra-articular structures without arthrotomy or malleolar osteotomy. Anterior or posterior approach may be used, and various indications have become generally accepted: anterior soft tissue or bony impingement, loose bodies, osteochondral defects, synovitis (rheumatoid arthritis, infective arthritis, and hemophilic arthropathy), posterior impingement syndrome, posttraumatic conditions, osteoarthritis (arthrosis), ankle arthrodesis, tumor-like lesions (synovial osteochondromatosis, pigmented villonodular synovitis) and many combinations of these pathological entities. In this paper we will discuss technique, indications, complications and future perspective of the ankle arthroscopy. In addition we will review the most recent literature data regarding this appealing technique. PMID:17695197

  9. Foot, leg, and ankle swelling

    MedlinePlus

    ... feet - legs; Ankle swelling; Foot swelling; Leg swelling; Edema - peripheral; Peripheral edema ... 51. Trayes KP, Studdiford JS, Pickle S, Tully AS. Edema: Diagnosis and management. Am Fam Phys . 2013;88( ...

  10. Effects of ankle balance taping with kinesiology tape for a patient with chronic ankle instability.

    PubMed

    Kim, Byeong-Jo; Lee, Jung-Hoon; Kim, Chang-Tae; Lee, Sun-Min

    2015-07-01

    [Purpose] To report the effects of ankle balance taping for a patient with chronic ankle instability (CAI). [Subject] A 33-year-old man with a 10 year history of chronic ankle stability. [Methods] ABT with kinesiology tape was performed for 2 months (average, 16 h/day) around the right ankle. [Results] At the end of two months, no ankle instability was noted when ascending and descending the stairs, jumping, turning, operating the pedals while driving, and lifting heavy objects. [Conclusion] The repeated use of kinesiology tape in ankle balance taping may be an effective treatment for recovering the ankle stability of patients with chronic ankle instability. PMID:26311206

  11. Effects of ankle balance taping with kinesiology tape for a patient with chronic ankle instability

    PubMed Central

    Kim, Byeong-Jo; Lee, Jung-Hoon; Kim, Chang-Tae; Lee, Sun-Min

    2015-01-01

    [Purpose] To report the effects of ankle balance taping for a patient with chronic ankle instability (CAI). [Subject] A 33-year-old man with a 10 year history of chronic ankle stability. [Methods] ABT with kinesiology tape was performed for 2 months (average, 16 h/day) around the right ankle. [Results] At the end of two months, no ankle instability was noted when ascending and descending the stairs, jumping, turning, operating the pedals while driving, and lifting heavy objects. [Conclusion] The repeated use of kinesiology tape in ankle balance taping may be an effective treatment for recovering the ankle stability of patients with chronic ankle instability. PMID:26311206

  12. Prospective evaluation of syndesmotic ankle sprains without diastasis.

    PubMed

    Nussbaum, E D; Hosea, T M; Sieler, S D; Incremona, B R; Kessler, D E

    2001-01-01

    Sixty consecutive collegiate athletes with "high" ankle symptoms were prospectively evaluated over a 3-year period in an effort to better define this debilitating ankle injury. All athletes included in this study had tenderness over the distal anterior tibiofibular ligament, tenderness proximally along the interosseous membrane, and functional disability. No study subject had a fracture or frank tibia-fibula diastasis. The severity of the sprain was quantified using the interosseous "tenderness length." A standard rehabilitation protocol was followed by all patients. Athletes returned to competition when they could perform all functional testing without difficulty. Time to return to full competitive activity averaged 13.4 days. The number of days missed from competition was statistically related to the interosseous tenderness length (P = 0.0001) and to positive results on the squeeze test (P = 0.03). Fifty-three of the 60 injured athletes were evaluated at least 6 months after injury. Patients rated their outcomes as good or excellent. Six of the patients experienced occasional ankle pain and stiffness, four patients reported recurrent ankle sprains, and one patient had heterotopic ossification formation. PMID:11206253

  13. Diagnostic imaging of ankle impingement syndromes in athletes.

    PubMed

    Spiga, S; Vinci, V; Tack, S; Macarini, L; Rossi, M; Coppolino, F; Boi, C; Genovese, E A

    2013-08-01

    The chronic ankle pain is a very frequent clinical problem, which is often characterized by a painful mechanical limitation of full-range ankle movement. A large amount of causes are involved in its pathogenesis, but the most common forms are secondary to an osseous or soft tissue abnormality. Especially for professional athletes, impingement lesions are the most important causes of chronic pain; however, this symptomatology can also affect ordinary people, mostly in those who work in environments that cause severe mechanical stress on the joints. This group of pathologies is characterized by a joint conflict secondary to an abnormal contact among bone surfaces or between bones and soft tissues. Diagnosis is mainly clinic and secondly supported by imaging in order to localize the critical area of impingement and determine the organic cause responsible for the joint conflict. Treatments for different forms of impingement are similar. Usually, the first step is a conservative approach (rest, physiotherapy, ankle bracing, shoe modification and local injection of corticosteroids), and only in case of unsuccessful response, the second step is the operative treatment with open and arthroscopic techniques. The aim of the study is to describe different MR imaging patterns, comparing our data with those reported in the literature, in order to identify the best accurate diagnostic protocol. PMID:23949936

  14. The foot and ankle of Australopithecus sediba.

    PubMed

    Zipfel, Bernhard; DeSilva, Jeremy M; Kidd, Robert S; Carlson, Kristian J; Churchill, Steven E; Berger, Lee R

    2011-09-01

    A well-preserved and articulated partial foot and ankle of Australopithecus sediba, including an associated complete adult distal tibia, talus, and calcaneus, have been discovered at the Malapa site, South Africa, and reported in direct association with the female paratype Malapa Hominin 2. These fossils reveal a mosaic of primitive and derived features that are distinct from those seen in other hominins. The ankle (talocrural) joint is mostly humanlike in form and inferred function, and there is some evidence for a humanlike arch and Achilles tendon. However, Au. sediba is apelike in possessing a more gracile calcaneal body and a more robust medial malleolus than expected. These observations suggest, if present models of foot function are correct, that Au. sediba may have practiced a unique form of bipedalism and some degree of arboreality. Given the combination of features in the Au. sediba foot, as well as comparisons between Au. sediba and older hominins, homoplasy is implied in the acquisition of bipedal adaptations in the hominin foot. PMID:21903807

  15. Biomechanical Comparison of 3 Ankle Braces With and Without Free Rotation in the Sagittal Plane

    PubMed Central

    Alfuth, Martin; Klein, Dieter; Koch, Raphael; Rosenbaum, Dieter

    2014-01-01

    Context: Various designs of braces including hinged and nonhinged models are used to provide external support of the ankle. Hinged ankle braces supposedly allow almost free dorsiflexion and plantar flexion of the foot in the sagittal plane. It is unclear, however, whether this additional degree of freedom affects the stabilizing effect of the brace in the other planes of motion. Objective: To investigate the dynamic and passive stabilizing effects of 3 ankle braces, 2 hinged models that provide free plantar flexion–dorsiflexion in the sagittal plane and 1 ankle brace without a hinge. Design: Crossover study. Setting: University Movement Analysis Laboratory. Patients or Other Participants: Seventeen healthy volunteers (5 women, 12 men; age = 25.4 ± 4.8 years; height = 180.3 ± 6.5 cm; body mass = 75.5 ± 10.4 kg). Intervention(s): We dynamically induced foot inversion on a tilting platform and passively induced foot movements in 6 directions via a custom-built apparatus in 3 brace conditions and a control condition (no brace). Main Outcome Measure(s): Maximum inversion was determined dynamically using an in-shoe electrogoniometer. Passively induced maximal joint angles were measured using a torque and angle sensor. We analyzed differences among the 4 ankle-brace conditions (3 braces, 1 control) for each of the dependent variables with Friedman and post hoc tests (P < .05). Results: Each ankle brace restricted dynamic foot-inversion movements on the tilting platform as compared with the control condition, whereas only the 2 hinged ankle braces differed from each other, with greater movement restriction caused by the Ankle X model. Passive foot inversion was reduced with all ankle braces. Passive plantar flexion was greater in the hinged models as compared with the nonhinged brace. Conclusions: All ankle braces showed stabilizing effects against dynamic and passive foot inversion. Differences between the hinged braces and the nonhinged brace did not appear to be

  16. My Experience as a Foot and Ankle Trauma Surgeon in Montreal, Canada: What's Not in the Books.

    PubMed

    Leduc, Stéphane; Nault, Marie-Lyne; Rouleau, Dominique M; Hebert-Davies, Jonah

    2016-06-01

    Foot and ankle fractures are sometimes seen as routine and easy to treat. However, many fractures vary from typical patterns and require more complex management. Obtaining good outcomes in these situations can be challenging. Often, the difference between average and good results has to do with preoperative planning and good surgical technique. This article outlines numerous techniques and tricks that are not always mentioned in classic textbooks. It focuses on ankle, talus, calcaneus, and midfoot fractures, and discusses numerous techniques and aids to avoid potential problems that may be encountered intraoperatively. PMID:27261808

  17. Cartilage degeneration in different human joints.

    PubMed

    Kuettner, K E; Cole, A A

    2005-02-01

    Variations among joints in the initiation and progression of degeneration may be explained, in part, by metabolic, biochemical and biomechanical differences. Compared to the cartilage in the knee joint, ankle cartilage has a higher content of proteoglycans and water, as well as an increased rate of proteoglycan turnover and synthesis, all of which are responsible for its increased stiffness and reduced permeability. Chondrocytes within ankle cartilage have a decreased response to catabolic factors such as interleukin-1 and fibronectin fragments, compared to the chondrocytes of knee cartilage. Moreover, in response to damage, ankle chondrocytes synthesize proteoglycans at a higher rate than that found in knee cartilage chondrocytes, which suggests a greater capacity for repair. In addition to the cartilages of the two joints, the underlying bones also respond differently to degenerative changes. Taken together, these metabolic, biochemical and biomechanical differences may provide protection to the ankle. PMID:15694570

  18. Assessing the Relative Contributions of Active Ankle and Knee Assistance to the Walking Mechanics of Transfemoral Amputees Using a Powered Prosthesis

    PubMed Central

    Simon, Ann M.; Hargrove, Levi J.

    2016-01-01

    Powered knee-ankle prostheses are capable of providing net-positive mechanical energy to amputees. Yet, there are limitless ways to deliver this energy throughout the gait cycle. It remains largely unknown how different combinations of active knee and ankle assistance affect the walking mechanics of transfemoral amputees. This study assessed the relative contributions of stance phase knee swing initiation, increasing ankle stiffness and powered plantarflexion as three unilateral transfemoral amputees walked overground at their self-selected walking speed. Five combinations of knee and ankle conditions were evaluated regarding the kinematics and kinetics of the amputated and intact legs using repeated measures analyses of variance. We found eliminating active knee swing initiation or powered plantarflexion was linked to increased compensations of the ipsilateral hip joint during the subsequent swing phase. The elimination of knee swing initiation or powered plantarflexion also led to reduced braking ground reaction forces of the amputated and intact legs, and influenced both sagittal and frontal plane loading of the intact knee joint. Gradually increasing prosthetic ankle stiffness influenced the shape of the prosthetic ankle plantarflexion moment, more closely mirroring the intact ankle moment. Increasing ankle stiffness also corresponded to increased prosthetic ankle power generation (despite a similar maximum stiffness value across conditions) and increased braking ground reaction forces of the amputated leg. These findings further our understanding of how to deliver assistance with powered knee-ankle prostheses and the compensations that occur when specific aspects of assistance are added/removed. PMID:26807889

  19. Assessing the Relative Contributions of Active Ankle and Knee Assistance to the Walking Mechanics of Transfemoral Amputees Using a Powered Prosthesis.

    PubMed

    Ingraham, Kimberly A; Fey, Nicholas P; Simon, Ann M; Hargrove, Levi J

    2016-01-01

    Powered knee-ankle prostheses are capable of providing net-positive mechanical energy to amputees. Yet, there are limitless ways to deliver this energy throughout the gait cycle. It remains largely unknown how different combinations of active knee and ankle assistance affect the walking mechanics of transfemoral amputees. This study assessed the relative contributions of stance phase knee swing initiation, increasing ankle stiffness and powered plantarflexion as three unilateral transfemoral amputees walked overground at their self-selected walking speed. Five combinations of knee and ankle conditions were evaluated regarding the kinematics and kinetics of the amputated and intact legs using repeated measures analyses of variance. We found eliminating active knee swing initiation or powered plantarflexion was linked to increased compensations of the ipsilateral hip joint during the subsequent swing phase. The elimination of knee swing initiation or powered plantarflexion also led to reduced braking ground reaction forces of the amputated and intact legs, and influenced both sagittal and frontal plane loading of the intact knee joint. Gradually increasing prosthetic ankle stiffness influenced the shape of the prosthetic ankle plantarflexion moment, more closely mirroring the intact ankle moment. Increasing ankle stiffness also corresponded to increased prosthetic ankle power generation (despite a similar maximum stiffness value across conditions) and increased braking ground reaction forces of the amputated leg. These findings further our understanding of how to deliver assistance with powered knee-ankle prostheses and the compensations that occur when specific aspects of assistance are added/removed. PMID:26807889

  20. Biofilm development in a hotspot of mixing between shallow and deep groundwater in a fractured aquifer: field evidence from joint flow, chemical and microbiological measurements

    NASA Astrophysics Data System (ADS)

    Bochet, O.; Dufresne, A.; Pédrot, M.; Chatton, E.; Labasque, T.; Ben Maamar, S.; Burté, L.; de la Bernardie, J.; Guihéneuf, N.; Lavenant, N.; Petton, C.; Bour, O.; Aquilina, L.; Le Borgne, T.

    2015-12-01

    Biofilms play a major role