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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. Total ankle joint replacement.

    PubMed

    2016-02-01

    Ankle arthritis results in a stiff and painful ankle and can be a major cause of disability. For people with end-stage ankle arthritis, arthrodesis (ankle fusion) is effective at reducing pain in the shorter term, but results in a fixed joint, and over time the loss of mobility places stress on other joints in the foot that may lead to arthritis, pain and dysfunction. Another option is to perform a total ankle joint replacement, with the aim of giving the patient a mobile and pain-free ankle. In this article we review the efficacy of this procedure, including how it compares to ankle arthrodesis, and consider the indications and complications.

  3. Closed medial total subtalar joint dislocation without ankle fracture: a case report

    PubMed Central

    2014-01-01

    Introduction Total subtalar dislocation without fracture of the ankle is a rare clinical entity; it is usually due to a traumatic high-energy mechanism. Standard treatment is successful closed reduction under general anesthesia followed by non-weight bearing and ankle immobilization with a below-knee cast for 6 weeks. Case presentation We present the case of a 30-year-old Moroccan woman who was involved in a road traffic accident. She subsequently received a radiological assessment that objectified a total subtalar dislocation without fracture of her ankle. She was immediately admitted to the operating theater where an immediate reduction was performed under sedation, and immobilization in a plaster boot was adopted for 8 weeks. The management of this traumatic lesion is discussed in the light of the literature. Conclusions Medial subtalar dislocation is a rare dislocation and is not commonly seen as a sports injury because it requires transfer of a large amount of kinetic energy. The weaker talocalcaneal and talonavicular ligaments often bear the brunt of the energy and are more commonly disrupted, compared to the relatively stronger calcaneonavicular ligament. Urgent reduction is important, and closed reduction under general anesthesia is usually successful, often facilitated by keeping the knee in flexion to relax the gastrocnemius muscle. Long-term sequelae include talar avascular necrosis and osteochondral fracture, as well as chronic instability and pain. PMID:25240955

  4. Expedited Patient-Specific Assessment of Contact Stress Exposure in the Ankle Joint Following Definitive Articular Fracture Reduction

    PubMed Central

    Kern, Andrew M.; Anderson, Donald D.

    2015-01-01

    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 1 MPa 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±11.5 mm2. 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

  5. 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.

  6. Pediatric Ankle Fractures: Concepts and Treatment Principles.

    PubMed

    Su, Alvin W; Larson, A Noelle

    2015-12-01

    Current clinical concepts are reviewed regarding the epidemiology, anatomy, evaluation, and treatment of pediatric ankle fractures. Correct diagnosis and management relies on appropriate examination, imaging, and knowledge of fracture patterns specific to children. Treatment is guided by patient history, physical examination, plain film radiographs and, in some instances, computed tomography. Treatment goals are to restore acceptable limb alignment, physeal anatomy, and joint congruency. For high-risk physeal fractures, patients should be monitored for growth disturbance as needed until skeletal maturity. PMID:26589088

  7. Common fractures and injuries of the ankle and foot: functional anatomy, imaging, classification and management.

    PubMed

    Khan, Wasim; Oragui, Emeka; Akagha, Edwin

    2010-07-01

    The ankle and foot are functionally important and complex joints. Bony fractures and ligamentous injuries are common. In this review paper we will discuss the functional anatomy, imaging, classification and the management of common ankle and foot injuries including ankle fractures, Achilles tendon ruptures, Lisfranc joint injuries, calcaneo fractures and fractures of the metatarsals and phalanges.

  8. 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

  9. [Biomechanics of the ankle joint].

    PubMed

    Zwipp, H

    1989-03-01

    According to Fick, the tree-dimensional patterns of foot motion are best characterized as jawlike movement. Anatomically and biomechanically, this process represents conjoined, synchronous motion within the three mobile segments of the hindfoot: the ankle joint, the posterior subtalar joint, and the anterior subtalar joint. Foot kinematics can be described more completely if the anterior subtalar joint is defined not only as the talocalcaneal navicular joint, but as including the calcaneocuboid joint, thus representing the transverse joint of the tarsus, i.e., the Chopart joint. The axes of these three joints can be defined precisely. In some parts they represent a screwlike motion, clockwise or counter-clockwise, around the central ligamentous structures (fibulotibial ligament, talocalcaneal interosseous ligament, bifurcate ligament). The individual anatomy and structure of these ligaments provide variations in the degree and direction of foot motion. A precise knowledge of foot kinematics is important in surgical ligament and joint reconstruction and in selective foot arthrodeses.

  10. Ankle fracture - aftercare

    MedlinePlus

    ... that surgery can allow faster and more reliable healing. In children, the fracture involves the part of ... will use a special walking boot as the healing progresses. You will need to learn: How to ...

  11. 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

  12. Current concepts review: ankle fractures.

    PubMed

    Arastu, M H; Demcoe, R; Buckley, R E

    2012-01-01

    Ankle fractures are common injuries that require meticulous technique in order to optimise outcome. The Lauge-Hansen and Danis-Weber classifications in addition to careful evaluation of the injury mechanism can help guide treatment but surgeons must be aware that there are injury patterns that will not always fit the afore mentioned patterns. The principles of atraumatic soft tissue handling, rigid internal fixation and early range of motion exercises are critical for successfully treating these injuries. There are still areas of treatment uncertainty and future directed research is needed in order to address some of these questions.

  13. Foot and Ankle Stress Fractures in Athletes.

    PubMed

    Greaser, Michael C

    2016-10-01

    The incidence of stress fractures in the general athletic population is less than 1%, but may be as high as 15% in runners. Stress fractures of the foot and ankle account for almost half of bone stress injuries in athletes. These injuries occur because of repetitive submaximal stresses on the bone resulting in microfractures, which may coalesce to form complete fractures. Advanced imaging such as MRI and triple-phase bone scans is used to evaluate patients with suspected stress fracture. Low-risk stress fractures are typically treated with rest and protected weight bearing. High-stress fractures more often require surgical treatment. PMID:27637667

  14. Irreducible ankle fracture-dislocation due to tibialis anterior subluxation: a case report.

    PubMed

    Natoli, Roman M; Summers, Hobie D

    2015-01-01

    Irreducible ankle fracture-dislocations are rare. Several cases of irreducible ankle fracture-dislocation have been reported in published studies secondary to the tibialis posterior tendon, deltoid ligament, or extensor digitorum longus tendon blocking the reduction. We report a case of irreducible ankle fracture-dislocation resulting from posteromedial subluxation of the tibialis anterior tendon around a medial malleolar fracture fragment. Ultimately, the ankle required open reduction of the incarcerated tendon to reduce the joint and proceed with internal fixation of the associated fracture. The patient's postoperative course was uncomplicated, and the tibialis anterior tendon was functioning at 10 months postoperatively, after which he did not return for follow-up examinations. To our knowledge, this is the first reported case of the tibialis anterior tendon blocking closed reduction of an ankle fracture-dislocation. PMID:25618805

  15. Is Hardware Removal Recommended after Ankle Fracture Repair?

    PubMed Central

    Jung, Hong-Geun; Kim, Jin-Il; Park, Jae-Yong; Park, Jong-Tae; Eom, Joon-Sang

    2016-01-01

    The indications and clinical necessity for routine hardware removal after treating ankle or distal tibia fracture with open reduction and internal fixation are disputed even when hardware-related pain is insignificant. Thus, we determined the clinical effects of routine hardware removal irrespective of the degree of hardware-related pain, especially in the perspective of patients' daily activities. This study was conducted on 80 consecutive cases (78 patients) treated by surgery and hardware removal after bony union. There were 56 ankle and 24 distal tibia fractures. The hardware-related pain, ankle joint stiffness, discomfort on ambulation, and patient satisfaction were evaluated before and at least 6 months after hardware removal. Pain score before hardware removal was 3.4 (range 0 to 6) and decreased to 1.3 (range 0 to 6) after removal. 58 (72.5%) patients experienced improved ankle stiffness and 65 (81.3%) less discomfort while walking on uneven ground and 63 (80.8%) patients were satisfied with hardware removal. These results suggest that routine hardware removal after ankle or distal tibia fracture could ameliorate hardware-related pain and improves daily activities and patient satisfaction even when the hardware-related pain is minimal.

  16. 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 ...

  17. 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.

  18. Screening Characteristics of Ultrasonography in Detection of Ankle Fractures

    PubMed Central

    Shojaee, Majid; Hakimzadeh, Farhad; Mohammadi, Parisa; Sabzghabaei, Anita; Manouchehrifar, Mohammad; Arhami Dolatabadi, Ali

    2016-01-01

    Introduction: Ankle fracture is one of the most common joint fractures. X-ray and physical examination are its main methods of diagnosis. Recently, ultrasonography (US) is considered as a simple and non-invasive method of fracture diagnosis. This study evaluated the diagnostic accuracy of US in detection of ankle fracture in comparison to plain radiography. Methods: In this diagnostic accuracy study, which was done in emergency departments of Imam Hossein and Shohadaye Tajrish hospitals, Tehran, Iran, during 2014, 141 patients with suspected diagnosis of distal leg or ankle fracture were examined by US and radiography (gold standard), independently. Screening performance characteristics of US in detection of distal leg fractures were calculated using SPSS version 21. Results: 141 patients with the mean age of 34 ± 11.52 years (range: 15 – 50) were evaluated (75.9% male). Radiography confirmed ankle fracture in 102 (72.3%) patients. There was a significant correlation between the results of US and radiography [Agreement: 95%; kappa: 0.88 (95% CI: 0.80-0.97); P < 0.001]. The screening performance characteristics of US in detection ankle fracture were as follows: sensitivity 98.9% (95% CI: 93.5% - 99.9%), specificity 86.4% (95% CI: 71.9%-94.3%), PPV 94.1% (95% CI: 87.1% - 97.6%), NPV 97.4% (95% CI: 84.9% - 99.8%), PLR 16 (95% CI: 7.3 – 34.8), and NLR 0.02 (95% CI: 0.003 – 0.182). The area under the ROC curve of US in this regard was 95.8 (95% CI: 91.9 ± 99.7). Conclusion: According to the results of this study, we can use US as an accurate and non-invasive method with high sensitivity and specificity in diagnosis of malleolus fractures. However, the inherent limitations of US such as operator dependency should be considered in this regard. PMID:27800538

  19. Biomechanics of the normal and arthritic ankle joint.

    PubMed

    Snedeker, Jess G; Wirth, Stephan H; Espinosa, Norman

    2012-12-01

    Understanding biomechanics of the normal and arthritic ankle joint can aid in analysis of an underlying clinical problem and provide a strategic basis for a more optimal management. The challenge to the clinician and the biomechanist is that the mechanical complexity of the ankle joint still clouds current understanding. This article provides an overview of current understanding of functional ankle anatomy, how this function can be altered in the degenerated ankle, and how surgical intervention further affects foot and ankle biomechanics. The focus is on how altered loading of neighboring joints in the midfoot and hindfoot may induce postoperative joint remodeling and can manifest in secondary clinical problems.

  20. Dislocated ankle fracture complicated by near total distal ischaemia

    PubMed Central

    Duygun, Fatih; Sertkaya, Omer; Aldemir, Cengiz; Dogan, Ali

    2013-01-01

    Total arterial ischaemia is rarely seen following a dislocated ankle fracture but if it does and intervention is not made, it can lead to serious morbidity. We present a 39-year-old woman with almost total occlusion in the arteria tibialis and arteria dorsalis pedis following a dislocated ankle fracture as a result of a bicycle fall. PMID:24248319

  1. 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

  2. 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

  3. Bone alterations are associated with ankle osteoarthritis joint pain.

    PubMed

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

    2016-01-18

    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.

  4. [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

  5. Surgical treatment of ankle and foot fractures in the elderly.

    PubMed

    Kettunen, J; Kröger, H

    2005-03-01

    Ankle fractures are the most common lower extremity fractures. In younger age groups these fractures occur more often in men than in women, but after menopause there is a female predominance. Foot fractures show a similar trend. The primary goal in the treatment of ankle and foot fractures is to obtain exact reduction and stable fixation to facilitate early mobilization and good functional recovery. However, the need for internal fixation to secure fracture reduction must be weighed against the risk of operating on osteoporotic bone which lacks the strength to hold screws and plates. In the elderly, the preoperative evaluation of the peripheral blood supply is essential to avoid wound healing complications. We review here the surgical treatment of ankle and foot fractures with special reference to elderly patients.

  6. Posteromedial dislocation of the ankle without fracture or diastasis.

    PubMed

    Wang, L C; Love, M B

    1993-02-01

    This case report describes a patient with posteromedial dislocation of the ankle without fracture and without disruption of the tibiofibular syndesmosis. The pathogenesis of this uncommon lesion is discussed.

  7. Ankle dislocation without fracture in a young athlete.

    PubMed

    Larsen, J; Burzotta, J; Brunetti, V

    1998-01-01

    This is a case report of a 34-year-old male who sustained an ankle dislocation injury without any associated fractures to the foot, ankle, or leg while playing basketball. After an extensive review of the literature, it was found that this type of injury without any associated fractures is an extremely rare occurrence. A case report and a review of the literature are presented in this paper.

  8. 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...

  9. 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...

  10. Better Way to Treat Seniors' Ankle Fractures?

    MedlinePlus

    ... quality of life can suffer as they lose mobility," added Willett. He is a professor of orthopedics, ... two groups in terms of pain, ankle motion, mobility or quality of life, the study found. Patients ...

  11. Ankle pain

    MedlinePlus

    Pain - ankle ... Ankle pain is often due to an ankle sprain. An ankle sprain is an injury to the ligaments, which ... the joint. In addition to ankle sprains, ankle pain can be caused by: Damage or swelling of ...

  12. Ankle replacement

    MedlinePlus

    Ankle arthroplasty - total; Total ankle arthroplasty; Endoprosthetic ankle replacement; Ankle surgery ... You may not be able to have a total ankle replacement if you have had ankle joint infections ...

  13. Pediatric fractures of the foot and ankle.

    PubMed

    Polyzois, Vasilios D; Vasiliadis, Elias; Zgonis, Thomas; Ayazi, Angelos; Gkiokas, Andreas; Beris, Alexandros E

    2006-04-01

    Distal tibial physeal injuries are common in children, accounting for 10% to 40% of all injuries to skeletally immature patients. This article describes the classification, treatment, and complications of distal tibial fractures, fractures of the talus and calcaneus, midfoot and tarsometatarsal injuries, metatarsal fractures, and fractures of the phalanges in children.

  14. Stress fractures about the tibia, foot, and ankle.

    PubMed

    Shindle, Michael K; Endo, Yoshimi; Warren, Russell F; Lane, Joseph M; Helfet, David L; Schwartz, Elliott N; Ellis, Scott J

    2012-03-01

    In competitive athletes, stress fractures of the tibia, foot, and ankle are common and lead to considerable delay in return to play. Factors such as bone vascularity, training regimen, and equipment can increase the risk of stress fracture. Management is based on the fracture site. In some athletes, metabolic workup and medication are warranted. High-risk fractures, including those of the anterior tibial diaphysis, navicular, proximal fifth metatarsal, and medial malleolus, present management challenges and may require surgery, especially in high-level athletes who need to return to play quickly. Noninvasive treatment modalities such as pulsed ultrasound and extracorporeal shock wave therapy may have some benefit but require additional research.

  15. Ankle fractures in the elderly: an overlooked burden.

    PubMed

    Gee, Christopher W; Dahal, Luna; Rogers, Benedict A; Harry, Lorraine E

    2015-10-01

    Ankle fractures in the elderly are a complex under-recognized burden which require a multidisciplinary approach to management. This article discusses the holistic approach required, including the up-to-date surgical management options and the areas for future development.

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

    PubMed

    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.

  17. 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.

  18. 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

  19. 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...

  20. 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...

  1. 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...

  2. 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... metal/polymer non-constrained cemented prosthesis. (a) Identification. An ankle joint metal/polymer non... December 26, 1996 for any ankle joint metal/polymer non-constrained cemented prosthesis that was...

  3. 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... metal/polymer non-constrained cemented prosthesis. (a) Identification. An ankle joint metal/polymer non... December 26, 1996 for any ankle joint metal/polymer non-constrained cemented prosthesis that was...

  4. 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... metal/polymer non-constrained cemented prosthesis. (a) Identification. An ankle joint metal/polymer non... December 26, 1996 for any ankle joint metal/polymer non-constrained cemented prosthesis that was...

  5. 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... Ankle joint metal/composite semi-constrained cemented prosthesis. (a) Identification. An ankle joint metal/composite semi-constrained cemented prosthesis is a device intended to be implanted to replace...

  6. 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 metal/composite semi-constrained cemented prosthesis is a device intended to be implanted to replace...

  7. 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 metal/composite semi-constrained cemented prosthesis is a device intended to be implanted to replace...

  8. 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...

  9. 21 CFR 888.3120 - Ankle joint metal/polymer non-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 non-constrained cemented... metal/polymer non-constrained cemented prosthesis. (a) Identification. An ankle joint metal/polymer non... December 26, 1996 for any ankle joint metal/polymer non-constrained cemented prosthesis that was...

  10. 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...

  11. 21 CFR 888.3120 - Ankle joint metal/polymer non-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 non-constrained cemented... metal/polymer non-constrained cemented prosthesis. (a) Identification. An ankle joint metal/polymer non... December 26, 1996 for any ankle joint metal/polymer non-constrained cemented prosthesis that was...

  12. 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

  13. 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

  14. 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

  15. 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

  16. Immediate Weight-Bearing after Ankle Fracture Fixation

    PubMed Central

    Harnden, Emily

    2015-01-01

    We believe that a certain subset of surgical ankle fracture patients can be made weight-bearing as tolerated immediately following surgery. Immediate weight-bearing as tolerated (IWBAT) allows patients to return to ambulation and activities of daily living faster and may facilitate rehabilitation. A prospectively gathered orthopaedic trauma database at a Level 1 trauma center was reviewed retrospectively to identify patients who had ORIF after unstable ankle injuries treated by the senior author. Patients were excluded if they were not IWBAT based on specific criteria or if they did meet followup requirement. Only 1/26 patients was noted to have loss of fixation. This was found at the 6-week followup and was attributed to a missed syndesmotic injury. At 2-week followup, 2 patients had peri-incisional erythema that resolved with a short course of oral antibiotics. At 6-week followup, 20 patients were wearing normal shoes and 6 patients continued to wear the CAM Boot for comfort. To conclude, IWBAT in a certain subset of patients with stable osteosynthesis following an ankle fracture could potentially be a safe alternative to a period of protected weight-bearing. PMID:25785201

  17. Arthroscopically Assisted Open Reduction-Internal Fixation of Ankle Fractures: Significance of the Arthroscopic Ankle Drive-through Sign.

    PubMed

    Schairer, William W; Nwachukwu, Benedict U; Dare, David M; Drakos, Mark C

    2016-04-01

    Standalone open reduction-internal fixation (ORIF) of unstable ankle fractures is the current standard of care. Intraoperative stress radiographs are useful for assessing the extent of ligamentous disruption, but arthroscopic visualization has been shown to be more accurate. Concomitant arthroscopy at the time of ankle fracture ORIF is useful for accurately diagnosing and managing syndesmotic and deltoid ligament injuries. The arthroscopic ankle drive-through sign is characterized by the ability to pass a 2.9-mm shaver (Smith & Nephew, Andover, MA) easily through the medial ankle gutter during arthroscopy, which is not usually possible with both an intact deltoid ligament and syndesmosis. This arthroscopic maneuver indicates instability after ankle reduction and fixation and is predictive of the need for further stabilization. Furthermore, when this sign remains positive after fracture fixation, it may guide the surgeon to further evaluate the adequacy of fixation for the possible need for further fixation of the syndesmosis or deltoid. We present the case of an ankle fracture managed with arthroscopy-assisted ORIF and describe the clinical utility of the arthroscopic ankle drive-through sign. PMID:27462542

  18. 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

  19. 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

  20. Intelligent stretching of ankle joints with contracture/spasticity.

    PubMed

    Zhang, Li-Qun; Chung, Sun G; Bai, Zhiqiang; Xu, Dali; van Rey, Elton M T; Rogers, Mark W; Johnson, Marjorie E; Roth, Elliot J

    2002-09-01

    An intelligent stretching device was developed to treat the spastic/contractured ankle of neurologically impaired patients. The device stretched the ankle safely throughout the range of motion (ROM) to extreme dorsiflexion and plantarflexion until a specified peak resistance torque was reached with the stretching velocity controlled based on the resistance torque. The ankle was held at the extreme position for a period of time to let stress relaxation occur before it was rotated back to the other extreme position. Stretching was slow at the joint extreme positions, making it possible to reach a larger ROM safely and it was fast in the middle ROM so the majority of the treatment was spent in stretching the problematic extreme ROM. Furthermore, the device evaluated treatment outcome quantitatively in multiple aspects, including active and passive ROM, joint stiffness and viscous damping and reflex excitability. The stretching resulted in considerable changes in joint passive ROM, stiffness, viscous damping and reflex gain. The intelligent control and yet simple design of the device suggest that with appropriate simplification, the device can be made portable and low cost, making it available to patients and therapists for frequent use in clinics/home and allowing more effective treatment and long-term improvement. PMID:12503779

  1. Joint stiffness of the ankle and the knee in running.

    PubMed

    Günther, Michael; Blickhan, Reinhard

    2002-11-01

    The spring-mass model is a valid fundament to understand global dynamics of fast legged locomotion under gravity. The underlying concept of elasticity, implying leg stiffness as a crucial parameter, is also found on lower motor control levels, i.e. in muscle-reflex and muscle-tendon systems. Therefore, it seems reasonable that global leg stiffness emerges from local elasticity established by appropriate joint torques. A recently published model of an elastically operating, segmented leg predicts that proper adjustment of joint elasticities to the leg geometry and initial conditions of ground contact provides internal leg stability. Another recent study suggests that in turn the leg segmentation and the initial conditions may be a consequence of metabolic and bone stress constraints. In this study, the theoretical predictions were verified experimentally with respect to initial conditions and elastic joint characteristics in human running. Kinematics and kinetics were measured and the joint torques were estimated by inverse dynamics. Stiffnesses and elastic nonlinearities describing the resulting joint characteristics were extracted from parameter fits. Our results clearly support the theoretical predictions: the knee joint is always stiffer and more extended than the ankle joint. Moreover, the knee torque characteristic on the average shows the higher nonlinearity. According to literature, the leg geometry is a consequence of metabolic and material stress limitations. Adapted to this given geometry, the initial joint angle conditions in fast locomotion are a compromise between metabolic and control effort minimisation. Based on this adaptation, an appropriate joint stiffness ratio between ankle and knee passively safeguards the internal leg stability. The identified joint nonlinearities contribute to the linearisation of the leg spring.

  2. Knee and ankle joint torque-angle relationships of multi-joint leg extension.

    PubMed

    Hahn, Daniel; Olvermann, Matthias; Richtberg, Jan; Seiberl, Wolfgang; Schwirtz, Ansgar

    2011-07-28

    The force-length-relation (F-l-r) is an important property of skeletal muscle to characterise its function, whereas for in vivo human muscles, torque-angle relationships (T-a-r) represent the maximum muscular capacity as a function of joint angle. However, since in vivo force/torque-length data is only available for rotational single-joint movements the purpose of the present study was to identify torque-angle-relationships for multi-joint leg extension. Therefore, inverse dynamics served for calculation of ankle and knee joint torques of 18 male subjects when performing maximum voluntary isometric contractions in a seated leg press. Measurements in increments of 10° knee angle from 30° to 100° knee flexion resulted in eight discrete angle configurations of hip, knee and ankle joints. For the knee joint we found an ascending-descending T-a-r with a maximum torque of 289.5° ± 43.3 Nm, which closely matches literature data from rotational knee extension. In comparison to literature we observed a shift of optimum knee angle towards knee extension. In contrast, the T-a-r of the ankle joint vastly differed from relationships obtained for isolated plantar flexion. For the ankle T-a-r derived from multi-joint leg extension subjects operated over different sections of the force-length curve, but the ankle T-a-r derived from isolated joint efforts was over the ascending limb for all subjects. Moreover, mean maximum torque of 234.7 ± 56.6 Nm exceeded maximal strength of isolated plantar flexion (185.7 ± 27.8 Nm). From these findings we conclude that muscle function between isolated and more physiological multi-joint tasks differs. This should be considered for ergonomic and sports optimisation as well as for modelling and simulation of human movement.

  3. Effect of a 6-week dynamic neuromuscular training programme on ankle joint function: A Case report

    PubMed Central

    2011-01-01

    Background Ankle joint sprain and the subsequent development of chronic ankle instability (CAI) are commonly encountered by clinicians involved in the treatment and rehabilitation of musculoskeletal injuries. It has recently been advocated that ankle joint post-sprain rehabilitation protocols should incorporate dynamic neuromuscular training to enhance ankle joint sensorimotor capabilities. To date no studies have reported on the effects of dynamic neuromuscular training on ankle joint positioning during landing from a jump, which has been reported as one of the primary injury mechanisms for ankle joint sprain. This case report details the effects of a 6-week dynamic neuromuscular training programme on ankle joint function in an athlete with CAI. Methods The athlete took part in a progressive 6-week dynamic neuromuscular training programme which incorporated postural stability, strengthening, plyometric, and speed/agility drills. The outcome measures chosen to assess for interventional efficacy were: [1] Cumberland Ankle Instability Tool (CAIT) scores, [2] Star Excursion Balance Test (SEBT) reach distances, [3] ankle joint plantar flexion during drop landing and drop vertical jumping, and [4] ground reaction forces (GRFs) during walking. Results CAIT and SEBT scores improved following participation in the programme. The angle of ankle joint plantar flexion decreased at the point of initial contact during the drop landing and drop vertical jumping tasks, indicating that the ankle joint was in a less vulnerable position upon landing following participation in the programme. Furthermore, GRFs were reduced whilst walking post-intervention. Conclusions The 6-week dynamic neuromuscular training programme improved parameters of ankle joint sensorimotor control in an athlete with CAI. Further research is now required in a larger cohort of subjects to determine the effects of neuromuscular training on ankle joint injury risk factors. PMID:21658224

  4. 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.

  5. Fixation orientation in ankle fractures with syndesmosis injury.

    PubMed

    Nimick, Craig J; Collman, David R; Lagaay, Pieter

    2013-01-01

    Accurate reduction of the syndesmosis has been shown to be an important prognostic factor for functional outcome in ankle injuries that disrupt the syndesmosis. The purpose of the present case series was to assess the fixation orientation and the position of the fibula within the tibial incisura after open reduction and internal fixation of ankle fractures with syndesmosis injury. Computed tomography was used to assess the accuracy of the reduction. Twelve patients were included in the present case series. A ratio representing the relationship between the tibia and fibula and the orientation of the syndesmotic fixation was measured preoperatively and postoperatively and compared with the uninjured contralateral ankle, representing the patient's normal anatomy. The measurements were accomplished electronically to one tenth of 1 mm using Stentor Intelligent Informatics, I-site, version 3.3.1 (Phillips Electronics; Andover, MA). Posteriorly oriented syndesmotic fixation caused posterior translation of the fibula with respect to the tibia and anteriorly oriented syndesmotic fixation caused anterior translation. PMID:23540759

  6. Ultrasonography as a diagnostic tool in assessing deltoid ligament injury in supination external rotation fractures of the ankle.

    PubMed

    Henari, Shwan; Banks, Louisa N; Radovanovic, Ingrid; Radiovanovic, Ingrid; Queally, Joseph; Morris, Seamus

    2011-10-01

    The medial deltoid ligament is the primary stabilizing structure in the ankle joint following lateral malleolar fracture. However, medial deltoid ligament ruptures are difficult to diagnose using current imaging modalities. We hypothesized that ultrasonography can be used to accurately allow early clinical assessment of ankle fracture stability, thereby negating the need to perform plain film stress views of the acutely injured ankle. This prospective study included 12 patients (age range, 18-72) with supination external rotation fractures requiring operative fixation. Following induction of anesthesia, ultrasonography examination was performed, followed by an arthrogram under fluoroscopic screening. Radiographs, ultrasonography, and arthrographic findings were compared. There was 100% correlation between ultrasonography and arthrogram findings. Ultrasonography accurately diagnosed medial deltoid rupture with a sensitivity of 100% and specificity of 100%. Plain film radiographs of the ankle had a sensitivity of 57.1% and a specificity of 60%. The difference between these was significant (χ(2)=.0091). This study demonstrates diagnostic ultrasonography to be an accurate diagnostic modality in assessing medial deltoid ligament integrity in patients with supination external rotation fractures. It offers the same sensitivity and specificity as arthrography without the need for additional invasive procedures. Its relative ease of use and lack of ionizing radiation make it a potentially useful tool, particularly in a busy trauma service.

  7. The Foot and Ankle: An Overview of Arthrokinematics and Selected Joint Techniques

    PubMed Central

    Loudon, Janice K.; Bell, Stephania L.

    1996-01-01

    Limited range of motion of the ankle is common following a period of immobilization or injury to the lower extremity. If not corrected, this limited range of motion will disturb normal joint arthrokinematics and could affect the athlete's performance. Consequently, the athletic trainer must thoroughly evaluate the various joints of the ankle and foot in order to determine appropriate treatment. A comprehensive evaluation should include assessment of passive accessory motions at the foot and ankle. If accessory movements are restricted at any joint, mobilization techniques can be used to restore normal ankle/foot joint arthrokinematics. This article describes the biomechanics of the tibiofibular, talocrural, subtalar, and midtarsal joints and is a presentation of basic mobilization techniques for the ankle and related joints. ImagesFig 3.Fig 4.Fig 5.Fig 6.Fig 7.Fig 8.Fig 9.Fig 10.Fig 11.Fig 12.Fig 13. PMID:16558394

  8. The joints of the evolving foot. Part I. The ankle joint.

    PubMed Central

    Lewis, O J

    1980-01-01

    Evidence is presented to suggest that the eutherian ankle joint has been derived from a meniscus-containing joint such as that found in extant arboreal marsupials. Probable morphological derivatives of this meniscus are identifiable in the Eutheria. The form and function of the joint are described in sub-human Primates and the adaptations which characterize the joint in bipedal man are noted. These morphological findings permit some speculation about the palaeocology of the earliest mammals with particular reference to the emergence of the order Primates. PMID:7410197

  9. 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. PMID:27642647

  10. 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

  11. 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

  12. 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

  13. 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.

  14. Factors Contributing to Chronic Ankle Instability: Kinesthesia and Joint Position Sense

    PubMed Central

    Konradsen, Lars

    2002-01-01

    Objective: To present a comprehensive review of the influence of altered kinesthesia and joint position sense on chronic ankle instability and to present a model connecting deficits in ankle position sense with the increased risk of sustaining lateral ankle sprains. Data Sources: I searched MEDLINE for the years 1966–2001 using the key words ankle and kinesthesia or position sense and books on proprioception. Data Synthesis: Study findings suggest a risk for unprovoked lateral ankle sprains when the lateral border of the foot accidentally catches the ground surface during the late swing phase of normal locomotion. In normal situations, the lateral border of the foot clears the ground by only 5 mm, and a small increase in ankle-position error may substantially increase the risk of a collision. Findings of affected kinesthesia and joint position sense in subjects with chronically unstable ankles dominate over studies showing nonsignificant results, but the answer is far from clear. Conclusions/Recommendations: Changes in joint position sense and kinesthesia of a magnitude found in subjects with chronically unstable ankles can lead to an increased risk of sustaining lateral ankle sprains. Results from a small number of studies suggest that balance and coordination training can restore the increased uncertainty of joint positioning to normal levels. PMID:12937559

  15. 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

  16. Combined medial displacement calcaneal osteotomy, subtalar joint arthrodesis, and ankle arthrodiastasis for end-stage posterior tibial tendon dysfunction.

    PubMed

    Stapleton, John J; Belczyk, Ronald; Zgonis, Thomas; Polyzois, Vasilios D

    2009-04-01

    Combining an ankle arthrodiastasis with a medial displacement calcaneal osteotomy and a subtalar joint arthrodesis offers surgeons a joint-sparing procedure for young and active patients who have end-stage posterior tibial tendon dysfunction and ankle joint involvement. An isolated subtalar joint arthrodesis or triple arthrodesis combined with an ankle arthrodiastasis is an option that can be used in certain case scenarios. Delaying the need for a joint destructive procedure through an ankle arthrodiastasis, however, may have a great impact in the near future, as advancements are underway to improve the use of ankle endoprosthesis. PMID:19389602

  17. Acute Tibialis Posterior Tendon Rupture With Pronation-Type Ankle Fractures.

    PubMed

    Bernstein, Derek T; Harris, Joshua D; Cosculluela, Pedro E; Varner, Kevin E

    2016-09-01

    Tibialis posterior tendon rupture in the setting of pronation-type ankle fractures can lead to long-term debility as a result of chronic tendon dysfunction. This rare injury pattern presents a diagnostic challenge because thorough preoperative examination of the function of the tendon is limited by pain, swelling, and inherent instability of the fracture. As such, a high index of suspicion is necessary in ankle fractures with radiographs showing a medial malleolus fracture with an associated suprasyndesmotic fibula fracture. This report describes 3 cases of tibialis posterior tendon rupture associated with pronation-type ankle fractures treated acutely with open reduction and internal fixation and primary tendon repair. Additionally, common features of this injury pattern are discussed based on the current literature. In accordance with this report, the typical mechanism of injury is high energy and includes forced pronation, external rotation, and dorsiflexion of the ankle, which places maximal stress on the tibialis posterior tendon. Rupture most commonly occurs in a relatively hypovascular area of the tendon located at the posteromedial extent of the medial malleolus fracture. In the operative treatment of pronation-type ankle fractures, direct inspection of the tibialis posterior tendon allows for timely diagnosis and treatment of associated ruptures. [Orthopedics.2016; 39(5):e970-e975.]. PMID:27248337

  18. Closed posteromedial dislocation of the tibiotalar joint without fracture or diastasis: a case report.

    PubMed

    Soyer, A D; Nestor, B J; Friedman, S J

    1994-11-01

    Tibiotalar dislocation without fracture is an unusual injury. Seventy-three cases have been reported in the literature. Closed posteromedial dislocation of the tibiotalar joint without fracture or diastasis is a very rare phenomenon. Eight cases have been reported. A case of this unique injury is presented, along with a literature review of purely ligamentous ankle dislocations. The proposed mechanism and classification of these injuries are summarized.

  19. Effects of wearing ankle weight on knee joint repositioning sense in the elderly

    PubMed Central

    Kim, Sooyoung; Jung, Daeun; Han, Jintae; Jung, Jaemin

    2016-01-01

    [Purpose] To investigate the effects of different ankle weights on knee joint repositioning sense in elderly individuals. [Subjects and Methods] Twenty-one subjects were divided for assessment as follows: young (20–30 years, n=10) and elderly (60–70 years, n=11). Knee joint repositioning error was measured by asking the subjects to reposition the target angle of their knee joints while wearing different ankle weights (0%, 0.5%, 1%, and 1.5%) in an open kinetic chain. The Hawk Digital System (60 Hz; Motion Analysis, Santa Rosa, CA, USA) was used to measure knee joint repositioning error. Differences in knee joint repositioning error between the young and elderly groups according to ankle weight load were examined by using two-way mixed repeated-measures analysis of variance. [Results] The knee joint repositioning error was lower with than without ankle weights in both groups. The error value was lowest with the 1.0% weight, though not significantly. Knee joint repositioning error was significantly higher in the elderly under all the ankle weight conditions. [Conclusion] Knee joint repositioning sense can be improved in elderly individuals by wearing proper ankle weights. However, weights that are too heavy might disturb knee joint positioning sense. PMID:27799664

  20. 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

  1. [Sports-induced epiphyseal injuries of the knee and ankle joint].

    PubMed

    Krüger-Franke, M; Vaeltl, M; Trouillier, H; Pförringer, W

    1994-06-01

    We report on the clinical and radiological follow-up results of 37 patients with epiphyseal injuries of the knee and ankle joint who were treated in our hospital between 1985 and 1990. Most of the ankle joint injuries were sustained during track and field, soccer and basketball, and most of the knee injuries during alpine skiing. The different mechanisms of injuries of the knee and ankle joint are discussed on the basis of our own results. The therapy considers the age of patient as well as localisation and type of the epiphyseal injury. In spite of this, growth disturbances occurred in 12.5% of the ankle joint and in 9.5% of the knee joint injuries.

  2. Lower Extremity Kinematic Profile of Gait of Patients After Ankle Fracture: A Case-Control Study.

    PubMed

    Elbaz, Avi; Mor, Amit; Segal, Ganit; Bar, Dana; Monda, Maureen K; Kish, Benjamin; Nyska, Meir; Palmanovich, Ezequiel

    2016-01-01

    The present study examined the differences in the lower extremity gait kinematic profile of patients recovering from ankle fracture compared with healthy controls. In addition, we inquired whether the profile would differ among fracture severity groups. A total of 48 patients participated in the present prospective, case-control study. The gait of 24 patients recovering from an ankle fracture injury and 24 healthy matched controls was examined using an inertial measurement unit sensor system. The following gait parameters were evaluated: knee range of motion (ROM) during the swing phase, maximum knee flexion angle during stance, thigh and calf ROM, and stride duration. Statistically significant differences were found between the ankle fracture group and the control group for all parameters. The patients with ankle fracture had a lower knee ROM during swing phase compared with the control group (mean ± standard deviation 43.0° ± 15.5° compared with 66.7° ± 5.1°, respectively; p < .001). The maximum knee flexion angle during stance was lower in the patients with ankle fracture than in the control group (mean ± standard deviation 10.5° ± 6.1° compared with 21.2° ± 4.5°, respectively; p < .001). Patients with ankle fracture also had lower gait cycle thigh and calf ROM angles (p < .001) and a longer stride duration (p < .001) compared with the control group. No statistically significant differences were found among the severity groups. These results suggest that the gait kinematic characteristics vary between healthy people and patients recovering from an ankle fracture injury during the short-term period after injury. PMID:27267411

  3. 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

  4. 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.

  5. 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

  6. Footwear affects the gearing at the ankle and knee joints during running.

    PubMed

    Braunstein, Bjoern; Arampatzis, Adamantios; Eysel, Peer; Brüggemann, Gert-Peter

    2010-08-10

    The objective of the study was to investigate the adjustment of running mechanics by wearing five different types of running shoes on tartan compared to barefoot running on grass focusing on the gearing at the ankle and knee joints. The gear ratio, defined as the ratio of the moment arm of the ground reaction force (GRF) to the moment arm of the counteracting muscle tendon unit, is considered to be an indicator of joint loading and mechanical efficiency. Lower extremity kinematics and kinetics of 14 healthy volunteers were quantified three dimensionally and compared between running in shoes on tartan and barefoot on grass. Results showed no differences for the gear ratios and resultant joint moments for the ankle and knee joints across the five different shoes, but showed that wearing running shoes affects the gearing at the ankle and knee joints due to changes in the moment arm of the GRF. During barefoot running the ankle joint showed a higher gear ratio in early stance and a lower ratio in the late stance, while the gear ratio at the knee joint was lower during midstance compared to shod running. Because the moment arms of the counteracting muscle tendon units did not change, the determinants of the gear ratios were the moment arms of the GRF's. The results imply higher mechanical stress in shod running for the knee joint structures during midstance but also indicate an improved mechanical advantage in force generation for the ankle extensors during the push-off phase.

  7. Arthroscopic Assessment of Intra-Articular Lesion after Surgery for Rotational Ankle Fracture

    PubMed Central

    Cha, Seung-Do; Gwak, Heui-Chul; Ha, Dong-Jun; Kim, Jong-Yup; Kim, Ui-Cheol; Jang, Yue-Chan

    2015-01-01

    Background The purpose of this study was to report findings of exploratory arthroscopic assessment performed in conjunction with removal of internal fixation device placed in the initial surgery for rotational ankle fracture. Methods A total of 53 patients (33 male, 20 female) who underwent surgery for rotational ankle fracture between November 2002 and February 2008 were retrospectively reviewed. All patients gave consent to the exploratory arthroscopic surgery for the removal of internal fixation devices placed in the initial surgery. Lauge-Hansen classification system of ankle fractures was assessed for all patients. Intra-articular lesions (osteochondral lesion, loose body, and fibrosis) were evaluated via ankle arthroscopy. Comparative analysis was then performed between radiological classification of ankle fracture/patient's symptoms and arthroscopic findings. Results Lauge-Hansen classification system of ankle fractures included supination-external rotation type (n = 35), pronation-external rotation type (n = 9), and pronation-abduction type (n = 9). A total of 33 patients exhibited symptoms of pain or discomfort while walking whereas 20 exhibited no symptoms. Arthroscopic findings included abnormal findings around the syndesmosis area (n = 35), intra-articular fibrosis (n = 51), osteochondral lesions of the talus (n = 33), loose bodies (n = 6), synovitis (n = 13), and anterior bony impingement syndrome (n = 3). Intra-articular fibrosis was seen in 31 of symptomatic patients (93.9%). Pain or discomfort with activity caused by soft tissue impingement with meniscus-like intra-articular fibrosis were found in 19 patients. There was statistical significance (p = 0.02) between symptoms (pain and discomfort) and the findings of meniscus-like fibrosis compared to the group without any symptom. Conclusions Arthroscopic examination combined with treatment of intra-articular fibrosis arising from ankle fracture surgery may help improve surgical outcomes. PMID:26640633

  8. The effect of talo-crural joint manipulation on range of motion at the ankle joint in subjects with a history of ankle injury.

    PubMed

    Andersen, Skye; Fryer, Gary A; McLaughlin, Patrick

    2003-07-01

    Introduction: There is little research available on the effects of peripheral joint manipulation. Only a few studies have examined the effect of manipulation on ankle range of motion, with conflicting results. This study aimed to determine whether a single high-velocity, low-amplitude (HVLA) thrust manipulation to the talo-crural joint altered ankle range of motion in subjects with a history of lateral ligament sprain.Methods: Male and female volunteers (N=52) with a history of lateral ligament sprain were randomly assigned into either an experimental group (n=26) or a control group (n=26). Those in the experimental group received a single HVLA thrust to the talo-crural joint, whilst those in the control group received no treatment intervention. Pre-test and post-test measurements of passive dorsiflexion range of motion were taken.Results: No significant changes in dorsiflexion range of motion were detected between manipulated ankles and those of control subjects using dependent and independent t-tests. Ankles that cavitated displayed a greater mean DFR and large effect size (d=0.8) compared to those that did not gap and cavitate, but analysis with ANOVA revealed these differences to be not significant.Conclusion: HVLA manipulation of the ankle did not increase dorsiflexion range of motion in subjects with a history of lateral ligament sprain.

  9. 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.

  10. Closed posteromedial dislocation of the ankle without fracture: a case report.

    PubMed

    Lertwanich, Pisit; Santanapipatkul, Polasant; Harnroonroj, Thossart

    2008-07-01

    Ankle dislocation without fracture is an extremely rare injury. Open dislocations were more common in the previous reports. The authors report a case of closed posteromedial dislocation of the ankle in a 24-year-old basketball player. Closed reduction was performed. The ankle was initially immobilized with the short leg cast before using the functional brace. Details of the rehabilitation program were described. Follow up examination at one-year demonstrated good clinical and functional results confirmed with the inversion stress radiographs. The patient can participate in sports activities at the same level as pre-injury.

  11. In vivo kinematics of the talocrural and subtalar joints with functional ankle instability during weight-bearing ankle internal rotation: a pilot study.

    PubMed

    Kobayashi, Takumi; No, Yumi; Yoneta, Kei; Sadakiyo, Masashi; Gamada, Kazuyoshi

    2013-06-01

    Functional ankle instability (FAI) may involve abnormal kinematics. However, reliable quantitative data for kinematics of FAI have not been reported. The objective of this study was to determine if the abnormal kinematics exist in the talocrural and subtalar joints in patients with FAI. Five male subjects with unilateral FAI (a mean age of 33.4 ± 13.2 years) were enrolled. All subjects were examined with stress radiography and found to have no mechanical ankle instability (MAI). Lateral radiography at weight-bearing ankle internal rotation of 0° and 20° was taken with the ankle at 30° dorsiflexion and 30° plantar flexion. Patients underwent computed tomography scan at 1.0 mm slice pitch spanning distal one third of the lower leg and the distal end of the calcaneus. Three-dimensional (3D) kinematics of the talocrural and subtalar joints as well as the ankle joint complex (AJC) were determined using a 3D-to-2D registration technique using a 3D-to-2D registration technique with 3D bone models and plain radiography. FAI joints in ankle dorsiflexion demonstrated significantly greater subtalar internal rotation from 0° to 20° internal rotation. No statistical differences in plantar flexion were detected in talocrural, subtalar or ankle joint complex kinematics between the FAI and contralateral healthy joints. During ankle internal rotation in dorsiflexion, FAI joints demonstrated greater subtalar internal rotation. The FAI joints without mechanical instability presented abnormal kinematics. This suggests that abnormal kinematics of the FAI joints may contribute to chronic instability. FAI joints may involve unrecognized abnormal subtalar kinematics during internal rotation in ankle dorsiflexion which may contribute to chronic instability and frequent feelings of instability.

  12. 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

  13. Ultrasound-Guided Interventional Procedures in Pain Medicine: A Review of Anatomy, Sonoanatomy, and Procedures: Part VI: Ankle Joint.

    PubMed

    Soneji, Neilesh; Peng, Philip W H

    2016-01-01

    Ultrasound-guided injections in pain medicine are emerging as a popular technique for pain interventions. Ultrasound can be applied for procedures of the ankle joint and surrounding structures. This review describes the anatomy and sonoanatomy of the ankle joint, subtalar joint, and surrounding extra-articular structures relevant for intra-articular injection. Second, it reviews injection techniques and the accuracy and efficacy of these intra-articular ankle injections.

  14. 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

  15. Compensatory strategies during walking in response to excessive muscle co-contraction at the ankle joint.

    PubMed

    Wang, Ruoli; Gutierrez-Farewik, Elena M

    2014-03-01

    Excessive co-contraction causes inefficient or abnormal movement in several neuromuscular pathologies. How synergistic muscles spanning the ankle, knee and hip adapt to co-contraction of ankle muscles is not well understood. This study aimed to identify the compensation strategies required to retain normal walking with excessive antagonistic ankle muscle co-contraction. Muscle-actuated simulations of normal walking were performed to quantify compensatory mechanisms of ankle and knee muscles during stance in the presence of normal, medium and high levels of co-contraction of antagonistic pairs gastrocnemius+tibialis anterior and soleus+tibialis anterior. The study showed that if co-contraction increases, the synergistic ankle muscles can compensate; with gastrocmemius+tibialis anterior co-contraction, the soleus will increase its contribution to ankle plantarflexion acceleration. At the knee, however, almost all muscles spanning the knee and hip are involved in compensation. We also found that ankle and knee muscles alone can provide sufficient compensation at the ankle joint, but hip muscles must be involved to generate sufficient knee moment. Our findings imply that subjects with a rather high level of dorsiflexor+plantarflexor co-contraction can still perform normal walking. This also suggests that capacity of other lower limb muscles to compensate is important to retain normal walking in co-contracted persons. The compensatory mechanisms can be useful in clinical interpretation of motion analyses, when secondary muscle co-contraction or other deficits may present simultaneously in subjects with motion disorders.

  16. Pulmonary embolism following ankle fractures treated without an operation - an analysis using National Health Service data.

    PubMed

    Jameson, Simon S; Rankin, Kenneth S; Desira, Nicola L; James, Philip; Muller, Scott D; Reed, Mike R; Rangan, Amar

    2014-08-01

    The majority of ankle fractures are stable and can be treated without an operation, most commonly with cast immobilisation. Based on concerns regarding the risk of a venous thromboembolic event (VTE) while immobilised, there is currently debate as to whether these patients should receive VTE prophylaxis for the duration of treatment. Rates of pulmonary embolism (PE) in this patient group are unknown. This retrospective cohort study was designed to identify patients treated without an operation for ankle fracture and determine the occurrence of PE and inpatient mortality within 90 days of injury using the English National Health Service administrative databases. Logistic regression models were used to assess the influence of age, gender and Charlson co-morbidity score on these outcomes. We identified 14777 adult patients over a 54-month period (April 2007-September 2011) that met our linkage and inclusion criteria (isolated, unilateral closed ankle fracture that did not require hospitalisation). Mean age was 46.4 years (range 18-99) and the majority had a Charlson 0 score (97.7%). There were 32 (0.22%) PEs within 90 days of the fracture (including in one patient who subsequently died). After adjustment, Charlson score of ≥1 was associated with a greater risk of PE (Odds ratio = 11.97, p < 0.001) compared to Charlson 0. Risk for these patients was 2.08%. In total, fifteen patients (0.11%) died in hospital within 90 days. Pulmonary embolism is rare following ankle fractures treated without an operation. Patients with multiple co-morbidities are at a higher risk. Based on this evidence, an ankle fracture treated without an operation does not appear to be an indication for routine VTE prophylaxis.

  17. Reliability of metatarsophalangeal and ankle joint torque measurements by an innovative device.

    PubMed

    Man, Hok-Sum; Leung, Aaron Kam-Lun; Cheung, Jason Tak-Man; Sterzing, Thorsten

    2016-07-01

    The toe flexor muscles maintain body balance during standing and provide push-off force during walking, running, and jumping. Additionally, they are important contributing structures to maintain normal foot function. Thus, weakness of these muscles may cause poor balance, inefficient locomotion and foot deformities. The quantification of metatarsophalangeal joint (MPJ) stiffness is valuable as it is considered as a confounding factor in toe flexor muscles function. MPJ and ankle joint stiffness measurement is still largely depended on manual skills as current devices do not have good control on alignment, angular joint speed and displacement during measurement. Therefore, this study introduces an innovative dynamometer and protocol procedures for MPJ and ankle Joint torque measurement with precise and reliable foot alignment, angular joint speed and displacement control. Within-day and between-day test-retest experiments on MPJ and ankle joint torque measurement were conducted on ten and nine healthy male subjects respectively. The mean peak torques of MPJ and ankle joint of between-day and within-day measurement were 1.50±0.38Nm/deg and 1.19±0.34Nm/deg. The corresponding torques of the ankle joint were 8.24±2.20Nm/deg and 7.90±3.18Nm/deg respectively. Intraclass-correlation coefficients (ICC) of averaged peak torque of both joints of between-day and within-day test-retest experiments were ranging from 0.91 to 0.96, indicating the innovative device is systematic and reliable for the measurements and can be used for multiple scientific and clinical purposes.

  18. Prestress revealed by passive co-tension at the ankle joint.

    PubMed

    Souza, Thales R; Fonseca, Sérgio T; Gonçalves, Gabriela G; Ocarino, Juliana M; Mancini, Marisa C

    2009-10-16

    This study was designed to test the assumption that elastic tissues of the ankle are prestressed, by investigating the presence of simultaneous opposite passive elastic moments and thus, passive co-tension, at the ankle joint. A prestressed two-spring model used to generate qualitative predictions of the effects of stretching the posterior elastic structures of the ankle on the net passive moment of this joint was used. Twenty-seven healthy individuals were subjected to passive evaluation of the net elastic moment of the ankle in the sagittal plane, with the knee positioned at 90 degrees, 60 degrees, 30 degrees and 0 degrees of flexion, in order to change the length of the posterior biarticular elastic structures. The placement of the knee in the more extended positions caused changes in the net passive moment as predicted by the prestressed model. The ankle position in which the net passive moment was equal to zero was shifted to more plantar flexed positions (p<0.001) and there was a global increase in ankle stiffness since both passive dorsiflexion stiffness (p< or =0.037) and passive plantar flexion stiffness (p< or =0.029) increased. The normalized terminal plantar flexion stiffness also increased (p< or =0.047), suggesting that biarticular posterior elastic structures are pre-strained and still under tension when the ankle is maximally plantar flexed and the knee is positioned at 60 degrees of flexion. Resting positions were indicative of equilibrium between opposite passive elastic moments. The results revealed that there is passive co-tension at the ankle, demonstrating the existence of prestress in elastic structures of this joint.

  19. When Should Open Reduction and Internal Fixation Ankle Fractures Begin Weight Bearing? A Systematic Review.

    PubMed

    Smith, Toby O; Davies, Leigh

    2008-02-01

    The objective of this paper was to review the literature to assess when open reduction and internal fixation ankle fractures should commence weight bearing for the best outcome. An electronic search was undertaken of the databases AMED, Cinahl, Embase, Medline (via Ovid), Pedro and Pubmed, from their inception to November 2005. References lists were scrutinised and a hand search was also performed. We included all English language, human subject, controlled clinical trials, comparing the effects of early against later weight bearing following open reduction and internal fixation of ankle fractures. Two reviewers independently assessed the methodological quality of the literature using the PEDro (Physiotherapy Evidence Database) scoring system. Five papers comprising of 366 ankle fractures were reviewed. Overall, there was no significant difference between commencing early, compared to later weight bearing in subjects following open reduction and internal fixation, when evaluated against function, pain, range of movement, radiological assessment, complications, and return to work. The evidence reviewed was generally poor, with numerous methodological design limitations. The literature suggested that were was little difference between encouraging early or delayed weight bearing after open reduction and internal fixation of ankle fractures. Neither early nor later weight bearing significantly improves or jeopardises outcomes. However, due to the plethora of methodological limitations and limited evidence, it is not possible to reference this conclusion with conviction. Further large, well-designed randomized controlled trials are required to evaluate this area. PMID:26815494

  20. Epidemiology of foot and ankle fractures in the United States: an analysis of the National Trauma Data Bank (2007 to 2011).

    PubMed

    Shibuya, Naohiro; Davis, Matthew L; Jupiter, Daniel C

    2014-01-01

    Understanding the epidemiology of foot and ankle trauma could be useful in health services research and for policy makers. It can also define practice patterns. Using the National Trauma Data Bank data set from 2007 to 2011, we analyzed the frequency and proportion of each fracture in the foot and ankle in major trauma hospitals in the United States. A total of 280,933 foot and/or ankle fractures or dislocations were identified. Although oversampling of more severe trauma in younger patients might have occurred owing to the nature of the data set, we found that the most common fractures in the foot and ankle were ankle fractures. Midfoot fractures were the least common among all the foot and ankle fractures when categorized by anatomic location. Approximately 20% of all foot and ankle fractures were open.

  1. 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.

  2. Proprioceptive impairments associated with knee osteoarthritis are not generalized to the ankle and elbow joints.

    PubMed

    Shanahan, Camille J; Wrigley, Tim V; Farrell, Michael J; Bennell, Kim L; Hodges, Paul W

    2015-06-01

    The mechanisms for proprioceptive changes associated with knee osteoarthritis (OA) remain elusive. Observations of proprioceptive changes in both affected knees and other joints imply more generalized mechanisms for proprioceptive impairment. However, evidence for a generalized effect remains controversial. This study examined whether joint repositioning proprioceptive deficits are localized to the diseased joint (knee) or generalized across other joints (elbow and ankle) in people with knee OA. Thirty individuals with right knee OA (17 female, 66±7 [mean±SD] years) of moderate/severe radiographic disease severity and 30 healthy asymptomatic controls of comparable age (17 female, 65±8years) performed active joint repositioning tests of the knee, ankle and elbow in randomised order in supine. Participants with knee OA had a larger relative error for joint repositioning of the knee than the controls (OA: 2.7±2.1°, control: 1.6±1.7°, p=.03). Relative error did not differ between groups for the ankle (OA: 2.2±2.5°, control: 1.9±1.3°, p=.50) or elbow (OA: 2.5±3.3°, control: 2.9±2.8°, p=.58). These results are consistent with a mechanism for proprioceptive change that is localized to the knee joint. This could be mediated by problems with mechanoreceptors, processing/relay of somatosensory input to higher centers, or joint-specific interference with cognitive processes by pain.

  3. Risk of degenerative ankle joint disease in volleyball players: study of former elite athletes.

    PubMed

    Gross, P; Marti, B

    1999-01-01

    To estimate the influence of long-term, high-intensity volleyball playing on premature osteoarthritis (OA) of the ankle joint, we examined a group of 22 former elite volleyball-players age (34 +/- 6 yrs.) who had played for at least 3 years in the highest volleyball league in Switzerland, and 19 normal healthy untrained controls (35 +/- 6 yrs.). Volleyball-athletes had played during an average of 5.5 (+/- 2) h/wk for 8.5 (+/- 3) yrs. Twenty of the 22 players had suffered from at least one ankle sprain (average: 3.5), 10 had had ruptures of the lateral ligaments (8 of them operated). Four players had severe mechanical instability, 5 a talar varus tilt in the stress X-ray of more than 8 degrees. Subchondral sclerosis and osteophytes were more prevalent in volleyballers than in controls (p < 0.001), while the difference in joint space was not significant. No severe grades of OA could be observed in these former elite volleyball players. Yet, a radiologic score of degenerative ankle disease was elevated in 19/22 of them, but only in 2/19 controls (p<0.001). In multiple regression analysis among athletes, the anterior drawer sign and a feeling of instability were the only significant and independent predictors of an increased radiological index (p = 0.003 and p = 0.02, respectively) from an initial set of 9 variables covering career length and intensity as volleyball player, clinical signs of ankle instability and age. Even if in the present study, athletes had clearly more radiologic findings than controls--such as spur formation and subchondral sclerosis--long-term, high-intensity volleyball playing alone could not be confirmed as an independent risk factor for OA of the ankle joint however, a combination of chronic lateral ankle instability with intensive volleyball playing could marginally increase the risk of ankle OA. PMID:10090465

  4. Mediomalleolar fracture combined with Achilles tendon rupture--a rare simultaneous injury of the ankle.

    PubMed

    Pieper, H G; Radas, C B; Quack, G; Krahl, H

    1998-01-01

    Achilles tendon injuries are rarely associated with osseous lesions. The combination of mediomalleolar fracture with Achilles tendon rupture has been reported as a rare combination injury in alpine skiers, but never before in basketball. This report presents an Achilles tendon rupture in a senior basketball player in combination with a non-displaced fracture of the medial malleolus. The osseous lesion was initially missed, because the tendon injury with all typical clinical and sonographical signs predominated. The routine X-ray examination was only done in the lateral and axial plane, because the examiner did not even think of an ankle fracture, since the description of the sports accident and the clinical signs were so typical for a sole tendon injury. This case report should remind us not to exclude an osseous or ligamentous ankle injury in those cases of acute Achilles tendon rupture especially if postoperative swelling and pain persist for a prolonged period.

  5. Acute compartment syndrome of the foot following fixation of a pilon variant ankle fracture.

    PubMed

    Henning, Amy; Gaines, Robert J; Carr, Donald; Lambert, Edward

    2010-12-01

    Acute traumatic compartment syndrome of the foot is a serious potential complication after fractures, crush injuries, or reperfusion injury after vascular repair. Foot compartment syndrome in association with injuries to the ankle is rare. This article presents a case of acute compartment syndrome of the foot following open reduction and internal fixation of an ankle fracture. A 16-year-old girl presented after sustaining a left ankle injury. Radiographs demonstrated a length-stable posterior and lateral malleolar ankle fracture. Initial treatment consisted of a bulky splint and crutches pending the improvement of her swelling. Over the course of a week, the soft tissue environment of the distal lower extremity improved, and the patient underwent open reduction and internal fixation of both her fibula and distal tibia through 2 approaches. Approximately 2 hours from the completion of surgery, the patient reported worsening pain over the medial aspect of her foot and into her calcaneus. Physical examination of the foot demonstrated a swollen and tense abductor hallicus and heel pad. Posterior tibial and dorsalis pedis pulses were palpable and her sensation was intact throughout her foot. Emergently, fasciotomy of both compartments was performed through a medial incision. Postoperatively, the patient reported immediate pain relief. At 18-month follow-up, she reported no pain and had returned to all of her preinjury athletic activities.

  6. 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

  7. 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

  8. 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

  9. [Ultrasound in complex of radiological studies in diagnosis of ankle joint medial aspect pathologies].

    PubMed

    Gurgenidze, T; Mizandari, M

    2011-10-01

    The aim of the research is to study sonosemiotics of ankle joint pathology by means of ultrasound in order to optimize the diagnostic process and improve the treatment. 130 patients (age ranges from 5 to 70 years) underwent the radiological study of ankle joint medial aspect. Pathology types: degenerative-dystrophic diseases - 39 (30%), inflammatory pathology - 21 (16.2%), traumatic injuries - 20 (15.2%), vascular pathologies - 26 (20%), neurogenic problems -7 (5.4%), soft tissue neoplasms - 5 (3.8%), congenital anomalies - 7 (5.4%) and vertebral pathology - 5 (4.0%). The diagnostic studies include: a) Ultrasound, performed on digital ultrasound system using high frequency (7.5-12.0 MHz) linear probe with Doppler capability (all patients); b) X-Ray filming in antero-posterior and lateral projections (6 patients- 4.5%); c) MRI - T1 and T2 weighted images in saggital and transverse planes 10 patients (10.0%) and d) CT - 2 patients (1.5%); To 2 (1.5%) patient biopsy has been performed. This study showed that ultrasound was successful in ankle joint medial aspect pathology diagnosis in 108 cases (84.0%); It was ineffective in osseous pathology definition. In final diagnosis of impingment syndrom MRI was required in 4 (3.6%) cases. It is concluded that ultrasound should be used as a Gold Standard in diagnosis of localized pain and swelling in the ankle joint.

  10. 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.

  11. Diabetic ankle fractures: a review of the literature and an introduction to the Adelaide fracture in the diabetic ankle algorithm and score.

    PubMed

    Yee, Joshua; Pillai, Anand; Ferris, Linda

    2014-01-01

    Diabetics who have acquired an ankle fracture may be easily missed given their atypical presentation. As such, it is not infrequently seen that these patients are either initially misdiagnosed or ineffectively managed resulting in unnecessary hospital length of stay and procedures. Multiple review articles and retrospective studies have been previously published in the literature, but complete guidelines to assist in accurate diagnosis and cost-effective management for this complex problem do not currently exist. Through a critical analysis of the current literature, a proposed diagnostic and management algorithm and scoring system that can be used to quantify risks in the surgical management are presented for consideration.

  12. 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

  13. 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

  14. 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.

  15. Dynamic Postural-Stability Deficits After Cryotherapy to the Ankle Joint

    PubMed Central

    Fullam, Karl; Caulfield, Brian; Coughlan, Garrett F.; McGroarty, Mark; Delahunt, Eamonn

    2015-01-01

    Context  Decreased postural stability is a primary risk factor for lower limb musculoskeletal injuries. During athletic competitions, cryotherapy may be applied during short breaks in play or during half-time; however, its effects on postural stability remain unclear. Objective  To investigate the acute effects of a 15-minute ankle-joint cryotherapy application on dynamic postural stability. Design  Controlled laboratory study. Setting  University biomechanics laboratory. Patients or Other Participants  A total of 29 elite-level collegiate male field-sport athletes (age = 20.8 ± 1.12 years, height = 1.80 ± 0.06 m, mass = 81.89 ± 8.59 kg) participated. Intervention(s)  Participants were tested on the anterior (ANT), posterolateral (PL), and posteromedial (PM) reach directions of the Star Excursion Balance Test before and after a 15-minute ankle-joint cryotherapy application. Main Outcome Measure(s)  Normalized reach distances; sagittal-plane kinematics of the hip, knee, and ankle joints; and associated mean velocity of the center-of-pressure path during performance of the ANT, PL, and PM reach directions of the Star Excursion Balance Test. Results  We observed a decrease in reach-distance scores for the ANT, PL, and PM reach directions from precryotherapy to postcryotherapy (P < .05). No differences were observed in hip-, knee-, or ankle-joint sagittal-plane kinematics (P > .05). We noted a decrease in mean velocity of the center-of-pressure path from precryotherapy to postcryotherapy (P < .05) in all reach directions. Conclusions  Dynamic postural stability was adversely affected immediately after cryotherapy to the ankle joint. PMID:26285088

  16. Interventions for increasing ankle joint dorsiflexion: a systematic review and meta-analysis

    PubMed Central

    2013-01-01

    Background Ankle joint equinus, or restricted dorsiflexion range of motion (ROM), has been linked to a range of pathologies of relevance to clinical practitioners. This systematic review and meta-analysis investigated the effects of conservative interventions on ankle joint ROM in healthy individuals and athletic populations. Methods Keyword searches of Embase, Medline, Cochrane and CINAHL databases were performed with the final search being run in August 2013. Studies were eligible for inclusion if they assessed the effect of a non-surgical intervention on ankle joint dorsiflexion in healthy populations. Studies were quality rated using a standard quality assessment scale. Standardised mean differences (SMDs) and 95% confidence intervals (CIs) were calculated and results were pooled where study methods were homogenous. Results Twenty-three studies met eligibility criteria, with a total of 734 study participants. Results suggest that there is some evidence to support the efficacy of static stretching alone (SMDs: range 0.70 to 1.69) and static stretching in combination with ultrasound (SMDs: range 0.91 to 0.95), diathermy (SMD 1.12), diathermy and ice (SMD 1.16), heel raise exercises (SMDs: range 0.70 to 0.77), superficial moist heat (SMDs: range 0.65 to 0.84) and warm up (SMD 0.87) in improving ankle joint dorsiflexion ROM. Conclusions Some evidence exists to support the efficacy of stretching alone and stretching in combination with other therapies in increasing ankle joint ROM in healthy individuals. There is a paucity of quality evidence to support the efficacy of other non-surgical interventions, thus further research in this area is warranted. PMID:24225348

  17. 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)

  18. Return-to-activity levels in 96 athletes with stress fractures of the foot, ankle, and leg: a retrospective analysis.

    PubMed

    Heaslet, Michael W; Kanda-Mehtani, Sneh L

    2007-01-01

    Stress fractures of the foot and ankle are common in the athletic population. Because this population is especially eager to return to activity, such fractures can be challenging to treat. If the biomechanical faults are not addressed or gradual return to activity is not monitored appropriately, fractures occasionally recur. A retrospective analysis was conducted of 96 athletes who presented to a podiatric sports medicine practice over the course of 10 years with stress fractures confirmed by radiograph or bone scan. The most common type of fracture sustained by this population was tibial stress fracture, followed by second metatarsal fracture. Marathon training was the most common pre-injury activity overall, although fitness walking was the most common activity among those with metatarsal fractures. This study relates the most common types of stress fractures of the foot, ankle, and leg to certain athletic activities and correlates duration of symptoms before presentation with return-to-activity time.

  19. Primary meningococcal septic arthritis of the ankle joint: a case report.

    PubMed

    Gee, Christopher; Tandon, Tarang; Avasthi, Adish; Jerwood, Susie; Rao, Biyyam M; Cavanagh, Simon

    2014-01-01

    We present the case of a healthy 18-year-old female who presented with history of an acute onset, painful, swollen right ankle joint. Microbiologic samples from the ankle aspirate grew Neisseria meningitidis. She had had no previous contact with a patient with meningitis nor any existing or preceding clinical symptoms of meningitis. She was treated with surgical drainage with mini-open arthrotomy and a repeat washout at 48 hours. The identification of the organism was expedited using the Analytical Profiling Index (bioMérieux UK, Basingstoke, UK). Our patient was treated with 2 weeks of third-generation cephalosporin antibiotics. At the final follow-up visit, the inflammatory markers had returned to normal, with a normal ankle joint and no evidence of long-term sequelae of septic arthritis. Primary septic arthritis with N. meningitidis is exceptionally rare in the adult population and has been most often reported in the knee. To the best of our knowledge, this is the first reported case of primary septic arthritis of the native adult ankle joint in a healthy individual due to N. meningitides that was diagnosed and treated appropriately with no residual sequelae of the disease.

  20. Acute Effects of Two Massage Techniques on Ankle Joint Flexibility and Power of the Plantar Flexors

    PubMed Central

    McKechnie, Grant J.B.; Young, Warren B.; Behm, David G.

    2007-01-01

    The purpose of this study was to determine if three minutes of petrissage and tapotement forms of massage would influence plantar flexors’ flexibility, and muscle power. Nineteen participants were randomly subjected to three conditions (control and two massages) before performing two power tests. Prior to the intervention, subjects completed ankle joint flexibility assessments. The conditions were; (1) control, where subjects lay prone and had a therapist’s hands resting, (2) vigorous petrissage, and (3) tapotement applied at a rate of 4Hz; all on the triceps surae. Following completion of the intervention, subjects immediately completed a post- ankle joint flexibility test, followed by a drop-jump and concentric calf raise. The power measures were; concentric peak force, rate of force development, and drop-jump height / contact time. The data showed a significant increase (p < 0.05) in ankle joint angle on the right leg and a corresponding tendency on the left. No significant change was seen with the power measures. Results suggest that massage can increase plantar flexors’ flexibility without a change in power and thus may be an alternative to static stretching during an athletic warm-up. Key pointsThree minutes of petrissage and tapotement forms of massage increased ankle flexibility.Massage did not adversely affect jump power measures.Massage may be an effective alternative to static stretching as a component of a pre-event warm-up. PMID:24149484

  1. Ipsilateral carpal, metacarpal, and ankle fractures resulting from an attempted basketball slam-dunk. A case report.

    PubMed

    McClelland, S J; Fithian, D C

    1988-01-01

    A 23-year-old male recreational basketball player sustained an open ankle fracture and ipsilateral carpal and metacarpal fractures as a result of a fall while attempting a slam-dunk. The wrist and hand fractures were treated nonoperatively. The open ankle fracture required irrigation, debridement, and open reduction/internal fixation. In addition to the prerequisite leaping ability, long-term success in "playing above the rim" requires experience, exceptional physical agility, and the mental discipline to anticipate and avoid slam-dunk opportunities with high risk for personal injury.

  2. Salvage of a Failed Agility Total Ankle Replacement System Associated with Acute Traumatic Periprosthetic Midfoot Fractures.

    PubMed

    Roukis, Thomas S

    2015-10-01

    This article presents a rare case involving combined revision of a failed Agility Total Ankle Replacement System (DePuy Orthopaedics, Warsaw, Indiana) and open reduction with internal fixation of periprosthetic midfoot fractures secondary to acute traumatic injury. The rationale for these procedures, the operative sequence of events, and recovery course are presented in detail. Causes for concern regarding subsequent revision, should this be required, are raised.

  3. Variability in Fluoroscopic Image Acquisition During Operative Fixation of Ankle Fractures.

    PubMed

    Harris, Dorothy Y; Lindsey, Ronald W

    2015-10-01

    The goal of this study was to determine whether injury, level of surgeon training, and patient factors are associated with increased use of fluoroscopy during open reduction and internal fixation of ankle fractures. These relationships are not well defined. The study was a retrospective chart review of patients treated at an academic institution with primary open reduction and internal fixation of an ankle. Patient demographics, including sex, age, and body mass index, were collected, as was surgeon year of training (residency and fellowship). Image acquisition data included total number of images, total imaging time, and cumulative dose. Ankle fractures were classified according to the Weber and Lauge-Hansen classifications and the number of fixation points. Bivariate analysis and multiple regression models were used to predict increasing fluoroscopic image acquisition. Alpha was set at 0.05. Of 158 patients identified, 58 were excluded. After bivariate analysis, fracture complexity and year of training showed a significant correlation with increasing image acquisition. After multiple regression analysis, fracture complexity and year of training remained clinically significant and were independent predictors of increased image acquisition. Increasing fracture complexity resulted in 20 additional images, 16 additional seconds, and an increase in radiation of 0.7 mGy. Increasing year of training resulted in an additional 6 images and an increase of 0.35 mGy in cumulative dose. The findings suggest that protocols to educate trainee surgeons in minimizing the use of fluoroscopy would be beneficial at all levels of training and should target multiple fracture patterns.

  4. 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

  5. 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.

  6. 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

  7. Pure closed posteromedial dislocation of the tibiotalar joint without fracture.

    PubMed

    Wang, Yun-tao; Wu, Xiao-tao; Chen, Hui

    2013-08-01

    Pure tibiotalar dislocation without an associated fracture is an extremely rare injury. We present three cases of closed posteromedial tibiotalar dislocation without any associated fractures to the foot, ankle, or leg. All patients were treated conservatively with immediate closed reduction under general or local anaesthesia and immobilised in a short leg cast for six weeks without weight-bearing resulting in a satisfactory outcome at the final follow-up. A review of the literature is also presented in this paper.

  8. 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.

  9. 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.

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

    PubMed Central

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

    2015-01-01

    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

  11. 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.

  12. Long-term outcome after supination-external rotation type-4 fractures of the ankle.

    PubMed

    Stufkens, S A S; Knupp, M; Lampert, C; van Dijk, C N; Hintermann, B

    2009-12-01

    We have compared the results at a mean follow-up of 13 years (11 to 14) of two groups of supination-external rotation type-4 fractures of the ankle, in one of which there was a fracture of the medial malleolus and in the other the medial deltoid ligament had been partially or completely ruptured. Of 66 patients treated operatively between 1993 and 1997, 36 were available for follow-up. Arthroscopy had been performed in all patients pre-operatively to assess the extent of the intra-articular lesions. The American Orthopaedic Foot and Ankle Society hind-foot score was used for clinical evaluation and showed a significant difference in both the total and the functional scores (p < 0.05), but not in those for pain or alignment, in favour of the group with a damaged deltoid ligament (p < 0.05). The only significant difference between the groups on the short-form 36 quality-of-life score was for bodily pain, again in favour of the group with a damaged deltoid ligament. There was no significant difference between the groups in the subjective visual analogue scores or in the modified Kannus radiological score. Arthroscopically, there was a significant difference with an increased risk of loose bodies in the group with an intact deltoid ligament (p < 0.005), although there was no significant increased risk of deep cartilage lesions in the two groups. At a mean follow-up of 13 years after operative treatment of a supination-external rotation type-4 ankle fracture patients with partial or complete rupture of the medial deltoid ligament tended to have a better result than those with a medial malleolar fracture.

  13. Joint Loads in Marsupial Ankles Reflect Habitual Bipedalism versus Quadrupedalism

    PubMed Central

    Carlson, Kristian J.; Jashashvili, Tea; Houghton, Kimberley; Westaway, Michael C.; Patel, Biren A.

    2013-01-01

    Joint surfaces of limb bones are loaded in compression by reaction forces generated from body weight and musculotendon complexes bridging them. In general, joints of eutherian mammals have regions of high radiodensity subchondral bone that are better at resisting compressive forces than low radiodensity subchondral bone. Identifying similar form-function relationships between subchondral radiodensity distribution and joint load distribution within the marsupial postcranium, in addition to providing a richer understanding of marsupial functional morphology, can serve as a phylogenetic control in evaluating analogous relationships within eutherian mammals. Where commonalities are established across phylogenetic borders, unifying principles in mammalian physiology, morphology, and behavior can be identified. Here, we assess subchondral radiodensity patterns in distal tibiae of several marsupial taxa characterized by different habitual activities (e.g., locomotion). Computed tomography scanning, maximum intensity projection maps, and pixel counting were used to quantify radiodensity in 41 distal tibiae of bipedal (5 species), arboreal quadrupedal (4 species), and terrestrial quadrupedal (5 species) marsupials. Bipeds (Macropus and Wallabia) exhibit more expansive areas of high radiodensity in the distal tibia than arboreal (Dendrolagus, Phascolarctos, and Trichosurus) or terrestrial quadrupeds (Sarcophilus, Thylacinus, Lasiorhinus, and Vombatus), which may reflect the former carrying body weight only through the hind limbs. Arboreal quadrupeds exhibit smallest areas of high radiodensity, though they differ non-significantly from terrestrial quadrupeds. This could indicate slightly more compliant gaits by arboreal quadrupeds compared to terrestrial quadrupeds. The observed radiodensity patterns in marsupial tibiae, though their statistical differences disappear when controlling for phylogeny, corroborate previously documented patterns in primates and xenarthrans

  14. Joint loads in marsupial ankles reflect habitual bipedalism versus quadrupedalism.

    PubMed

    Carlson, Kristian J; Jashashvili, Tea; Houghton, Kimberley; Westaway, Michael C; Patel, Biren A

    2013-01-01

    Joint surfaces of limb bones are loaded in compression by reaction forces generated from body weight and musculotendon complexes bridging them. In general, joints of eutherian mammals have regions of high radiodensity subchondral bone that are better at resisting compressive forces than low radiodensity subchondral bone. Identifying similar form-function relationships between subchondral radiodensity distribution and joint load distribution within the marsupial postcranium, in addition to providing a richer understanding of marsupial functional morphology, can serve as a phylogenetic control in evaluating analogous relationships within eutherian mammals. Where commonalities are established across phylogenetic borders, unifying principles in mammalian physiology, morphology, and behavior can be identified. Here, we assess subchondral radiodensity patterns in distal tibiae of several marsupial taxa characterized by different habitual activities (e.g., locomotion). Computed tomography scanning, maximum intensity projection maps, and pixel counting were used to quantify radiodensity in 41 distal tibiae of bipedal (5 species), arboreal quadrupedal (4 species), and terrestrial quadrupedal (5 species) marsupials. Bipeds (Macropus and Wallabia) exhibit more expansive areas of high radiodensity in the distal tibia than arboreal (Dendrolagus, Phascolarctos, and Trichosurus) or terrestrial quadrupeds (Sarcophilus, Thylacinus, Lasiorhinus, and Vombatus), which may reflect the former carrying body weight only through the hind limbs. Arboreal quadrupeds exhibit smallest areas of high radiodensity, though they differ non-significantly from terrestrial quadrupeds. This could indicate slightly more compliant gaits by arboreal quadrupeds compared to terrestrial quadrupeds. The observed radiodensity patterns in marsupial tibiae, though their statistical differences disappear when controlling for phylogeny, corroborate previously documented patterns in primates and xenarthrans

  15. Closed posteromedial dislocation of the tibiotalar joint without fracture in a basketball player.

    PubMed

    Uyar, M; Tan, A; Işler, M; Cetinus, E

    2004-06-01

    Acute ankle injury is one of the most common problems in sports medicine. Although most are ankle sprains, dislocations are occasionally seen. The case is presented of a closed posteromedial ankle dislocation without fracture which occurred during a basketball match. The literature is also reviewed.

  16. 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

  17. 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

  18. The Effect of Cryotherapy on the Normal Ankle Joint Position Sense

    PubMed Central

    khanmohammadi, Roya; Someh, Marjan; Ghafarinejad, Farahnaze

    2011-01-01

    Purpose To determine whether a fifteen-minute water immersion treatment affects the normal ankle joint position sense (JPS) at the middle range of dorsiflexion and plantar flexion actively and passively. Methods Thirty healthy female volunteers aged between 18 and 30 years were treated by a 15-minute cryotherapy (6 ± 1°C). The subject's skin temperature over antromedial aspect of dominant ankle was measured by the Mayomed device before, immediate and 15 minutes after water immersion. Ankle JPS was tested trough the pedal goniometer at 3 stages similar to the skin temperature. ANOVA (α = 0.05) was performed on each of variables using SPSS 19.0 software. Results Skin temperature was seen to decrease after water immersion but subjects did not return to pre-test skin temperature after 15 minutes (P<0.001). The research found no significant difference in JPS at middle range of dorsiflexion and plantar flexion actively and passively before and after cryotherapy. Conclusion These findings suggest that 15-minute water immersion at 6°C dose not significantly alter the middle range of plantar flexion/ dorsiflexion JPS at the ankle and is not deleterious to JPS. PMID:22375224

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

    PubMed

    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.

  20. 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

  1. Consideration of equilibrium equations at the hip joint alongside those at the knee and ankle joints has mixed effects on knee joint response during gait.

    PubMed

    Adouni, M; Shirazi-Adl, A

    2013-02-01

    Accurate estimation of muscle forces during daily activities such as walking is critical for a reliable evaluation of loads on the knee joint. To evaluate knee joint muscle forces, the importance of the inclusion of the hip joint alongside the knee and ankle joints when treating the equilibrium equations remains yet unknown. An iterative kinematics-driven finite element model of the knee joint that accounts for the synergy between passive structures and active musculature is employed. The knee joint muscle forces and biomechanical response are predicted and compared with our earlier results that did not account for moment equilibrium equations at the hip joint. This study indicates that inclusion of the hip joint in the optimization along the knee and ankle joints only slightly (<10%) influences total forces in quadriceps, lateral hamstrings and medial hamstrings. As a consequence, even smaller differences are found in predicted ligament forces, contact forces/areas, and cartilage stresses/strains during the stance phase of gait. The distribution of total forces between the uni- and bi-articular muscle components in quadriceps and in lateral hamstrings; however, substantially alter at different stance phases.

  2. 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

  3. 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.

  4. 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

  5. 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

  6. A novel ultrasound technique for detection of osteochondral defects in the ankle joint: a parametric and feasibility study.

    PubMed

    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.

  7. A Biomechanical Comparison of Locking Versus Conventional Plate Fixation for Distal Fibula Fractures in Trimalleolar Ankle Injuries.

    PubMed

    Nguyentat, Annie; Camisa, William; Patel, Sandeep; Lagaay, Pieter

    2016-01-01

    Previous biomechanical studies have advocated the use of locking plates for isolated distal fibula fractures in osteoporotic bone. Complex rotational ankle injuries involve an increased number of fractures, which can result in instability, potentially requiring the same fixed angle properties afforded by locking plates. However, the mechanical indication for locking plate technology has not been tested in this fracture model. The purpose of the present study was to compare the biomechanical properties of locking and conventional plate fixation for distal fibula fractures in trimalleolar ankle injuries. Fourteen (7 matched pairs) fresh-frozen cadaver leg specimens were used. The bone mineral density of each was obtained using dual x-ray absorptiometry scans. The fracture model simulated an OTA 44-B3.3 fracture. The syndesmosis was not disrupted. Each fracture was fixated in the same fashion, except for the distal fibula plate construct: locking (n = 7) and one-third tubular (n = 7). The specimens underwent axial and torsional cyclic loading, followed by torsional loading to failure. No statistically significant differences were found between the locking and conventional plate constructs during both fatigue and torque to failure testing (p > .05). Our specimen bone mineral density averages did not represent poor bone quality. The clinical implication of the present study is that distal fibular locking plates do not provide a mechanical advantage for trimalleolar ankle injuries in individuals with normal bone density and in the absence of fracture comminution.

  8. Functional outcomes after fibula locking nail for fragility fractures of the ankle.

    PubMed

    Rajeev, Aysha; Senevirathna, Shanaka; Radha, Sarkhell; Kashayap, N S

    2011-01-01

    The aim of the present study was to assess the functional outcome of fragility fractures of the ankle treated with a fibular locking nail. A retrospective review of 24 patients with fragility fractures treated with a fibular locking nail from January 2005 to December 2007 was performed. The fibular nail used in our study was Biomet SST (stainless steel taper) small bone locking nail for the fibula. The Olerud and Molander scale was used to assess the functional outcome at the end of 1 year. The domains of the Olerud and Molander scale are pain, stiffness, swelling, stair climbing, running, jumping, squatting, support, and the activities of daily living. The patients were interviewed by telephone or the questionnaire was send by mail. Of the 24 patients, 2 were men and 22 were women. The left side was affected in 15 patients. The age group ranged from 71 to 91 years (average, 79). Of the fractures, 10 were lateral alveolus, 8 were bimalleolar, and 6 were trimalleolar fractures. All the patients were followed up at 6 weeks, 12 weeks, and after 6 months. The average period to fracture union was 8.7 weeks. No wound breakdown or any deep infections developed. The average Olerud and Molander scale score was 57 (range 30 to 65). The use of fibular locking nails to treat these difficult fracture are quite crucial to achieve early mobilization and also to maintain a good fracture position. In our study, the use of fibular nails was a very useful and successful method of treating fragility fractures with a very low risk of complications. It also helps to restore function and results in patient satisfaction.

  9. In Vivo Syndesmotic Over-Compression After Fixation of Ankle Fractures with a Syndesmotic Injury

    PubMed Central

    Cherney, Steven M.; Haynes, Jacob A.; Spraggs-Hughes, Amanda; McAndrew, Christopher M.; Ricci, William M.; Gardner, Michael J.

    2015-01-01

    Objectives The goals of this study were to assess syndesmotic reductions utilizing computerized tomography (CT) scans, and to determine if malreductions were associated with certain injury types or reduction forceps. Design Prospective cohort Setting Urban Level 1 Trauma center Patients Twenty-seven patients with operatively treated syndesmotic injuries were recruited prospectively. Intervention Patients underwent postoperative bilateral CT scans of the ankle and hindfoot to assess syndesmotic reduction. The uninjured extremity was used as a control. Main outcome measurement Side-to-side differences of fibula position within the tibial incisura were measured at several anatomic points and analyzed based on injury type, the presence of posterior malleolar injury, level of fracture, and type of reduction forceps used. Results On average, operatively treated syndesmotic injuries were over-compressed (fibular medialization) by 1mm (p < .001) and externally rotated by 5° (p = .002) when compared to the uninjured extremity. The absence of a posterior malleolar injury and Weber B (OTA 44-B) fractures seemed to have a protective effect against malrotation, but not against over-compression. There was no difference in malreduction based on type of clamp used. Conclusions It is possible, and highly likely based on these data, to over-compress the syndesmosis when using a reduction forceps. Care should be taken to avoid over-compression, as this may affect ankle motion and functional outcome. This is the first in vivo series of syndesmotic over-compression to our knowledge. PMID:26295735

  10. Foot-Ankle Fractures and Injury Probability Curves from Post-mortem Human Surrogate Tests.

    PubMed

    Yoganandan, Narayan; Chirvi, Sajal; Pintar, Frank A; Uppal, Harmeeth; Schlick, Michael; Banerjee, Anjishnu; Voo, Liming; Merkle, Andrew; Kleinberger, Michael

    2016-10-01

    This purpose of this study was to replicate foot-ankle injuries seen in the military and derive human injury probability curves using the human cadaver model. Lower legs were isolated below knee from seventeen unembalmed human cadavers and they were aligned in a 90-90 posture (plantar surface orthogonal to leg). The specimens were loaded along the tibia axis by applying short-time duration pulses, using a repeated testing protocol. Injuries were documented using pre- and post-test X-rays, computed tomography scans, and dissection. Peak force-based risk curves were derived using survival analysis and accounted for data censoring. Fractures were grouped into all foot-ankle (A), any calcaneus (B), and any tibia injuries (C), respectively. Calcaneus and/or distal tibia/pilon fractures occurred in fourteen tests. Axial forces were the greatest and least for groups C and B, respectively. Times attainments of forces for all groups were within ten milliseconds. The Weibull function was the optimal probability distribution for all groups. Age was significant (p < 0.05) for groups A and C. Survival analysis-based probability curves were derived for all groups. Data are given in the body of paper. Age-based, risk-specific, and continuous distribution probability curves/responses guide in the creation of an injury assessment capability for military blast environments.

  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. Foot and ankle joint kinematics in rheumatoid arthritis cannot only be explained by alteration in walking speed.

    PubMed

    Dubbeldam, R; Nene, A V; Buurke, J H; Groothuis-Oudshoorn, C G M; Baan, H; Drossaers-Bakker, K W; van de Laar, M A F J; Hermens, H

    2011-03-01

    Rheumatoid arthritis (RA) manifests itself in the foot and ankle of RA patients. The foot and ankle joint kinematics of these patients differ from that of healthy subjects. However, the factors that lead to these differences are not yet fully understood. The aim of this study was to analyse the effect of walking speed and the disease process on foot and ankle joint kinematics of RA subjects. Gait recordings of 23 RA and 14 age-matched healthy subjects were performed and their foot and ankle joint kinematics were analysed during the stance phase of the gait cycle. Stance phase characteristics of the group of RA subjects and of the group of healthy subjects were compared. The healthy subjects walked at 100% (Vc), 75% (V75) and 50% (V50) of their comfortable walking speed. In a multi-level linear model significant differences between the two groups due to the factors walking speed and the disease process were analysed. The ankle dorsi-flexion, medial arch and hallux abduction motion at single-stance and toe-off were only influenced by the walking speed. The hallux maximum flexion at toe-off and the midfoot supination at single-stance were influenced by both the walking speed and the disease process. The hindfoot eversion motion at single-stance was only influenced by the disease process. In conclusion, the reduction of walking speed of RA subjects compared to healthy subjects does not explain all of the observed foot and ankle kinematics differences.

  13. 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

  14. Best BETs from the Manchester Royal Infirmary. BET 3: does hydrotherapy help improve post ankle fracture symptoms?

    PubMed

    Hay, Laura

    2013-09-01

    A short-cut review was carried out to determine whether hydrotherapy is an effective treatment to reduce pain and improve function in patients recovering from an ankle fracture. Although 12 papers were found using the reported search, no studies were relevant to this three-part question. No evidence was found to support this treatment.

  15. 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.

  16. Mathematical models of passive motion at the human ankle joint by equivalent spatial parallel mechanisms.

    PubMed

    Di Gregorio, R; Parenti-Castelli, V; O'Connor, J J; Leardini, A

    2007-03-01

    The paper presents a theoretical model of the ankle joint, i.e. tibio-talar articulation, which shows how the articular surfaces and the ligaments, acting together as a mechanism, can control the passive kinematics of the joint. The authors had previously shown that, in virtually unloaded conditions, the ankle behaves as a single degree-of-freedom system, and that two ligament fibres remain nearly isometric throughout the flexion arc. Two different equivalent spatial parallel mechanisms together with corresponding kinematic models were formulated. These assumed isometricity of fibres within the calcaneal-fibular and tibio-calcaneal ligaments and rigidity of the articulating surfaces, taken as three sphere-plane contacts in one model, and as a single spherical pair in the other. Geometry parameters for the models were obtained from three specimens. Motion predictions compare quite well with the measured motion of the specimens. The differences are accounted for by the simplifications adopted to represent the complex anatomical structures, and might be reduced by future more realistic representations of the natural articular surfaces.

  17. Contractile and elastic ankle joint muscular properties in young and older adults.

    PubMed

    Hasson, Christopher J; Miller, Ross H; Caldwell, Graham E

    2011-01-01

    The purpose of this study was to investigate age-related differences in contractile and elastic properties of both dorsi- (DF) and plantarflexor (PF) muscles controlling the ankle joint in young and older adults. Experimental data were collected while twelve young and twelve older male and female participants performed maximal effort isometric and isovelocity contractions on a dynamometer. Equations were fit to the data to give torque-angle (Tθ) and torque-angular velocity (Tω) relations. Muscle series-elasticity was measured during ramped dynamometer contractions using ultrasonography to measure aponeurosis extension as a function of torque; second order polynomials were used to characterize the torque-extension (TΔL) relation. The results showed no age differences in DF maximal torque and none for female PF; however, older males had smaller maximal PF torques compared to young males. In both muscle groups and genders, older adults had decreased concentric force capabilities. Both DF and PF TΔL relations were more nonlinear in the older adults. Older PF, but not DF muscles, were stiffer compared to young. A simple antagonism model suggested age-related differences in Tθ and Tω relations would be magnified if antagonistic torque contributions were included. This assessment of static, dynamic, and elastic joint properties affords a comprehensive view of age-related modifications in muscle function. Although many clinical studies use maximal isometric strength as a marker of functional ability, the results demonstrate that there are also significant age-related modifications in ankle muscle dynamic and elastic properties.

  18. Criterion for mixed mode fracture in composite bonded joints

    NASA Technical Reports Server (NTRS)

    Mall, S.; Kochhar, N. K.

    1986-01-01

    A study was undertaken to characterize the debond growth mechanism of adhesively bonded composite joints under mode I, mixed mode I-II, and mode II static loadings. The bonded system consisted of graphite-epoxy composite adherends bonded with a toughened epoxy adhesive. The mode I, mode II and mixed mode I-II fracture energies of the tested adhesives were found to be equal to each other. The criterion for mixed mode fracture in composite bonded joints was found.

  19. 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

  20. 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

  1. Ankle impingement.

    PubMed

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

    2016-09-09

    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.

  2. 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

  3. 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

  4. Dislocation and fracture-dislocation of the carpometacarpal joints.

    PubMed

    Jebson, P J; Engber, W D; Lange, R H

    1994-02-01

    Dislocations and fracture-dislocations of the carpometacarpal joints are rare. Diagnosis requires a high index of suspicion, careful examination, and appropriate radiography. Treatment is controversial and is based upon the injury pattern and the surgeon's experience and preference. This article reviews the pertinent anatomy, mechanism of injury, evaluation, and treatment of patients with carpometacarpal joint injuries.

  5. Galeazzi fracture with volar dislocation of the distal radioulnar joint.

    PubMed

    Kim, Suezie; Ward, James P; Rettig, Michael E

    2012-11-01

    Galeazzi fracture dislocations are fractures of the distal one-third of the radial diaphysis with traumatic disruption of the distal radioulnar joint (DRUJ). This injury results in subluxation or dislocation of the ulnar head. We present a case of a Galeazzi fracture with a volar dislocation of the DRUJ. Open reduction of the DRUJ with Kirschner wire fixation in pronation was necessary to reduce the joint and maintain anatomic alignment. Repair of the triangular fibrocartilage complex was also necessary to maintain stability of the DRUJ.

  6. 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.

  7. Inverted Pendulum Standing Apparatus for Investigating Closed-Loop Control of Ankle Joint Muscle Contractions during Functional Electrical Stimulation

    PubMed Central

    Tan, John F.; Masani, Kei; Vette, Albert H.; Zariffa, José; Robinson, Mark; Lynch, Cheryl; Popovic, Milos R.

    2014-01-01

    The restoration of arm-free standing in individuals with paraplegia can be facilitated via functional electrical stimulation (FES). In developing adequate control strategies for FES systems, it remains challenging to test the performance of a particular control scheme on human subjects. In this study, we propose a testing platform for developing effective control strategies for a closed-loop FES system for standing. The Inverted Pendulum Standing Apparatus (IPSA) is a mechanical inverted pendulum, whose angular position is determined by the subject's ankle joint angle as controlled by the FES system while having the subject's body fixed in a standing frame. This approach provides a setup that is safe, prevents falling, and enables a research and design team to rigorously test various closed-loop controlled FES systems applied to the ankle joints. To demonstrate the feasibility of using the IPSA, we conducted a case series that employed the device for studying FES closed-loop controllers for regulating ankle joint kinematics during standing. The utilized FES system stimulated, in able-bodied volunteers, the plantarflexors as they prevent toppling during standing. Four different conditions were compared, and we were able to show unique performance of each condition using the IPSA. We concluded that the IPSA is a useful tool for developing and testing closed-loop controlled FES systems for regulating ankle joint position during standing. PMID:27350992

  8. Inverted Pendulum Standing Apparatus for Investigating Closed-Loop Control of Ankle Joint Muscle Contractions during Functional Electrical Stimulation.

    PubMed

    Tan, John F; Masani, Kei; Vette, Albert H; Zariffa, José; Robinson, Mark; Lynch, Cheryl; Popovic, Milos R

    2014-01-01

    The restoration of arm-free standing in individuals with paraplegia can be facilitated via functional electrical stimulation (FES). In developing adequate control strategies for FES systems, it remains challenging to test the performance of a particular control scheme on human subjects. In this study, we propose a testing platform for developing effective control strategies for a closed-loop FES system for standing. The Inverted Pendulum Standing Apparatus (IPSA) is a mechanical inverted pendulum, whose angular position is determined by the subject's ankle joint angle as controlled by the FES system while having the subject's body fixed in a standing frame. This approach provides a setup that is safe, prevents falling, and enables a research and design team to rigorously test various closed-loop controlled FES systems applied to the ankle joints. To demonstrate the feasibility of using the IPSA, we conducted a case series that employed the device for studying FES closed-loop controllers for regulating ankle joint kinematics during standing. The utilized FES system stimulated, in able-bodied volunteers, the plantarflexors as they prevent toppling during standing. Four different conditions were compared, and we were able to show unique performance of each condition using the IPSA. We concluded that the IPSA is a useful tool for developing and testing closed-loop controlled FES systems for regulating ankle joint position during standing.

  9. Kinesio-Taping Application and Corticospinal Excitability at the Ankle Joint

    PubMed Central

    Tremblay, Francois; Karam, Siobhan

    2015-01-01

    Context Physiotherapists and athletic trainers often use Kinesio Taping (KT) to prevent and treat musculoskeletal injuries in athletes, yet evidence about its effects on neuromuscular performance is conflicting. Objective To investigate the influence of a KT application directed at the ankle joint on measures of corticospinal excitability with transcranial magnetic stimulation. Design Controlled laboratory study. Setting Research laboratory. Patients or Other Participants Twelve healthy young women (age = 23.1 ± 1.9 years; range, 19–26 years). Intervention(s) Participants were tested under no-tape and KT conditions according to a random sequence order. The KT was applied to the skin overlying the dorsiflexor and plantar-flexor muscles of the ankle. Main Outcome Measure(s) We assessed changes in the amplitude of motor-evoked potentials elicited at rest and during movement and changes in the silent period and background muscle activity during movement. Results Taping conditions had no effect on motor-evoked potential amplitude at rest or during movement or on the silent-period duration and background muscle activity. Conclusions Our results concur with other recent reports, showing KT applications have little influence at the neuromuscular level. Alterations in sensory feedback ascribed to elastic taping are likely insufficient to modulate corticospinal excitability in a functionally meaningful manner. PMID:26090708

  10. Lateral fixation of AO type-B2 ankle fractures in the elderly: the Knowles pin versus the plate

    PubMed Central

    Huang, Hui-Ling; Lo, Ting-Ying; Huang, Chien-Rae

    2006-01-01

    The study was a retrospective evaluation and comparison. Seventy-five elderly patients (>50 years) with AO type-B2 ankle fractures were treated by open reduction and internal fixation. All patients were followed up retrospectively for at least 12 months. The 75 patients were divided into two groups, based on the method of treatment. The Knowles pin (KP) group included 45 patients with an average age of 62.7 years. The tubular plate (TP) group included 30 patients with an average age of 60.0 years. The clinical results were compared between the two groups. Both of the groups were similar in respect to the injury mechanisms, fracture pattern, open fracture grade, compounding medical conditions, and ankle score (all P values <0.28). However, the KP group had significantly smaller wound incisions, shorter surgery time, shorter hospital stay, less meperidine use, less symptomatic hardware, and lower complication rates than the TP group (all P values <0.03). In conclusion, lateral fixation of AO type-B2 ankle fractures in the elderly by the Knowles pin is recommended due to its simplicity, efficacy and low complication rate. PMID:17043861

  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.

  12. 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

  13. Contractile and Elastic Ankle Joint Muscular Properties in Young and Older Adults

    PubMed Central

    Hasson, Christopher J.; Miller, Ross H.; Caldwell, Graham E.

    2011-01-01

    The purpose of this study was to investigate age-related differences in contractile and elastic properties of both dorsi- (DF) and plantarflexor (PF) muscles controlling the ankle joint in young and older adults. Experimental data were collected while twelve young and twelve older male and female participants performed maximal effort isometric and isovelocity contractions on a dynamometer. Equations were fit to the data to give torque-angle (Tθ) and torque-angular velocity (Tω) relations. Muscle series-elasticity was measured during ramped dynamometer contractions using ultrasonography to measure aponeurosis extension as a function of torque; second order polynomials were used to characterize the torque-extension (TΔL) relation. The results showed no age differences in DF maximal torque and none for female PF; however, older males had smaller maximal PF torques compared to young males. In both muscle groups and genders, older adults had decreased concentric force capabilities. Both DF and PF TΔL relations were more nonlinear in the older adults. Older PF, but not DF muscles, were stiffer compared to young. A simple antagonism model suggested age-related differences in Tθ and Tω relations would be magnified if antagonistic torque contributions were included. This assessment of static, dynamic, and elastic joint properties affords a comprehensive view of age-related modifications in muscle function. Although many clinical studies use maximal isometric strength as a marker of functional ability, the results demonstrate that there are also significant age-related modifications in ankle muscle dynamic and elastic properties. PMID:21264315

  14. Ultrasound and magnetic resonance imaging of healthy paediatric ankles and knees: a baseline for comparison with haemophilic joints.

    PubMed

    Keshava, S N; Gibikote, S V; Mohanta, A; Poonnoose, P; Rayner, T; Hilliard, P; Lakshmi, K M; Moineddin, R; Ignas, D; Srivastava, A; Blanchette, V; Doria, A S

    2015-05-01

    The study was undertaken to document cartilage and soft tissue changes/findings in ankles and knees of normal children of different age groups to be used for comparison in the assessment of children with haemophilia. Cartilage thickness and soft tissue changes were recorded at predetermined sites of ankles/knees on both US and MRI in healthy boys in three age groups: 7-9; 10-14; and 15-18 years. To assess the validity of the ultrasound and MRI measurements, an ex vivo study was done using agar phantoms with techniques and scanners similar to those applied in vivo. Twenty (48%) knees and 22 (52%) ankles of 42 boys, were evaluated. There was a reduction in the thickness of joint cartilage with age. A difference in cartilage measurements was noted in most sites between the age groups on both US and MRI (P < 0.05 each), but such difference was not noted for joint fluid in ankles or knees (P = 0.20, P = 0.68 or P = 0.75, P = 0.63 for US, MRI, respectively). Although cartilage measurements were smaller on US than on MRI for both ankles and knees (P < 0.05 each), this observation was not recorded for fluid in knees (P = 0.02). For diminutive measurements (2 mm) mean US measurements were smaller than corresponding phantom's measurements, P = 0.02. Age-related measurements were noted for cartilage thickness on US and MRI in ankles and knees. US measurements were smaller than corresponding MRI measurements at most joint sites, which were supported by results on small-diameter phantoms.

  15. The effects of ankle joint muscle strengthening and proprioceptive exercise programs accompanied by functional electrical stimulation on stroke patients’ balance

    PubMed Central

    Kim, Kyunghoon; Lee, Sukmin; Kim, Donghoon; Kim, Kyou Sik

    2015-01-01

    [Purpose] The purpose of the present study was to examine the effects of ankle joint muscle strengthening and proprioceptive exercises accompanied by functional electrical stimulation on stroke patients’ balance ability. [Methods] For six weeks beginning in April 2015, 22 stroke patients receiving physical therapy at K Hospital located in Gyeonggi-do were divided into a functional electrical stimulation (FES), ankle proprioceptive exercise and ankle joint muscle strengthening exercise group (FPS group) of 11 patients and an FES and stretching exercise group (FS group) of 11 patients. The stimulation and exercises were conducted for 30 min per day, five days per week for six weeks. Balance ability was measured using a BioRescue and the Berg balance scale, functional reach test, and the timed up-and-go test were also used as clinical evaluation indices. Repeated measures ANOVA was conducted to examine differences between before the exercises and at three and six weeks after beginning the exercises within each group, and the amounts of change between the two groups were compared. [Results] In the comparison within each group, both groups showed significant differences between before and after the experiment in all the tests and comparison between the groups showed that greater improvement was seen in all values in the FPS group. [Conclusion] In the present study, implementing FES and stretching exercises plus ankle joint muscle strengthening and proprioceptive exercises was more effective at improving stroke patients balance ability than implementing only FES and stretching exercises. PMID:26504337

  16. The effects of ankle joint muscle strengthening and proprioceptive exercise programs accompanied by functional electrical stimulation on stroke patients' balance.

    PubMed

    Kim, Kyunghoon; Lee, Sukmin; Kim, Donghoon; Kim, Kyou Sik

    2015-09-01

    [Purpose] The purpose of the present study was to examine the effects of ankle joint muscle strengthening and proprioceptive exercises accompanied by functional electrical stimulation on stroke patients' balance ability. [Methods] For six weeks beginning in April 2015, 22 stroke patients receiving physical therapy at K Hospital located in Gyeonggi-do were divided into a functional electrical stimulation (FES), ankle proprioceptive exercise and ankle joint muscle strengthening exercise group (FPS group) of 11 patients and an FES and stretching exercise group (FS group) of 11 patients. The stimulation and exercises were conducted for 30 min per day, five days per week for six weeks. Balance ability was measured using a BioRescue and the Berg balance scale, functional reach test, and the timed up-and-go test were also used as clinical evaluation indices. Repeated measures ANOVA was conducted to examine differences between before the exercises and at three and six weeks after beginning the exercises within each group, and the amounts of change between the two groups were compared. [Results] In the comparison within each group, both groups showed significant differences between before and after the experiment in all the tests and comparison between the groups showed that greater improvement was seen in all values in the FPS group. [Conclusion] In the present study, implementing FES and stretching exercises plus ankle joint muscle strengthening and proprioceptive exercises was more effective at improving stroke patients balance ability than implementing only FES and stretching exercises.

  17. Dynamics of the ankle joint analyzed through moment-angle loops during human walking: gender and age effects.

    PubMed

    Crenna, Paolo; Frigo, Carlo

    2011-12-01

    Aim of this study was to provide a non-invasive assessment of the dynamic properties of the ankle joint during human locomotion, with specific focus on the effects of gender and age. Accordingly, flexion-extension angles and moments, obtained through gait analysis, were used to generate moment-angle loops at the ankle joint in 120 healthy subjects walking at a same normalized speed. Four reproducible types of loops were identified: Typical Loops, Narrow, Large and Yielding loops. No significant changes in the slopes of the main loop phases were observed as a function of gender and age, with the exception of a relative increase in the slope of the descending phase in elderly males compared to adult females. As for the ergometric parameters, the peak ankle moment, work produced and net work along the cycle were slightly, but significantly affected, with progressively decrease in the following order: Adult Males, Adult Females, Elderly Males and Elderly Females. The evidence that only few of the quantitative aspects of moment-angle loops were affected suggests that the control strategy which regulates the biomechanical properties of the ankle joint during walking is rather robust and qualitatively consistent across genders and age.

  18. Mobility of the ankle joint: recording of rotatory movements in the talocrural joint in vitro with and without the lateral collateral ligaments of the ankle.

    PubMed

    Rasmussen, O; Tovborg-Jensen, I

    1982-02-01

    A method for graphic recording of rotatory movements in osteoligamentous ankle preparations is described. By this method it is possible to record characteristic mobility patterns in two planes at the same time. The ankle is affected by a known torque, so that the individual mobility patterns are reproducible with unchanged condition of the ligaments. Six amputated legs were investigated in the sagittal and horizontal planes and another six in the sagittal and frontal planes. Mobility patterns were recorded with intact ligaments and after successive cutting of the lateral collateral ligaments of the ankle in the anteroposterior direction. In the sagittal plane increased dorsiflexion was observed after total cutting of the lateral ligaments, while plantar flexion remained unchanged. In the horizontal plane the internal rotation of the talus increased in step with increasing injury to the ligament, particularly when the ankle was plantar flexed. When all collateral ligaments had been cut, an increase in external rotation occurred, especially in dorsiflexion. In the frontal plane the talar tilt increased gradually with increasing injury to the ligaments. Talar tilt was at a maximum in the neutral position of the ankle or in plantar flexion. After total severing of the collateral ligaments, however, talar tilt was most marked in dorsiflexion of the ankle.

  19. Flap reconstruction for soft-tissue defects with exposed hardware following deep infection after internal fixation of ankle fractures.

    PubMed

    Ovaska, Mikko T; Madanat, Rami; Tukiainen, Erkki; Pulliainen, Lea; Sintonen, Harri; Mäkinen, Tatu J

    2014-12-01

    The aim of the present study was to determine the outcome for patients treated with flap reconstruction following deep ankle fracture infection with exposed hardware. Out of 3041 consecutive ankle fracture operations in 3030 patients from 2006 to 2011, we identified 56 patients requiring flap reconstruction following deep infection. Thirty-two of these patients could be examined at a follow-up visit. Olerud-Molander Ankle (OMA) score, 15D score, Numeric Rating Scale (NRS), and clinical examination were used to assess the outcome. A total of 58 flap reconstructions were performed in 56 patients with a mean age of 57 years (range 25–93 years) and mean follow-up time of 52 months. The most commonly used reconstruction was a distally based peroneus brevis muscle flap with a split-thickness skin graft. A microvascular free flap was required in only one patient. 22 (39%) patients required subsequent surgical interventions because of a flap-related complication. With flap reconstruction, hardware could eventually be salvaged in 53% of patients with a non-consolidated fracture. The mean OMA score was fair or poor in 53% of the patients, and only 56% had recovered their pre-injury level of function. Half of the patients had shoe wear limitations. The 15D score showed a significantly poorer health-related quality of life compared to an age-standardised sample of the general population. The mean pain NRS was 2.1 (range 0–6), and the mean satisfaction NRS was 6.6 (range 0–10). Our study showed that successful treatment of a soft-tissue defect with exposed hardware following ankle fracture infections can be achieved with local flaps. Despite eventual reconstructive success, complications are common. Patients perceive a poorer health-related quality of life, have shoe wear limitations, and only half of them achieve their pre-injury level of function. PMID:25458066

  20. Criterion for mixed mode fracture in composite bonded joints

    NASA Technical Reports Server (NTRS)

    Mall, S.; Kochhar, N. K.

    1986-01-01

    A study was undertaken to characterize the debond growth mechanism of adhesively bonded composite joints under mode I, mixed mode I-II, and mode II static loadings. The bonded system consisted of graphite/epoxy (T300/5208) composite adherends bonded with a toughened epoxy (EC 3445) adhesive. The mode I, mode II and mixed-mode I-II fracture energies of the tested adhesive were found to be equal to each other. Furthermore, the criterion for mixed mode fracture in composite bonded joints was determined.

  1. 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

  2. Biologic resurfacing of the ankle and first metatarsophalangeal joint: case studies with a 2-year follow-up.

    PubMed

    Brigido, Stephen A; Troiano, Michael; Schoenhaus, Harold

    2009-10-01

    The goal of biologic resurfacing is to provide a smooth joint surface with a low coefficient of friction, which allows the joint to function with near normal biomechanics, as well as provide intermittent pressure, to the subchondral and cancellous bone. This unique combination often results in the formation of a "neocartilage-like" structure that can reduce pain and restore biomechanics. As well as giving a brief history of cutis arthroplasty, this article describes cases in which the ankle and first metatarsophalangeal joint underwent biologic resurfacing, with a 2-year postoperative follow up.

  3. Human soleus muscle architecture at different ankle joint angles from magnetic resonance diffusion tensor imaging

    PubMed Central

    Sinha, Usha; Hodgson, John A.; Edgerton, Reggie V.

    2011-01-01

    The orientation of muscle fibers influences the physiological cross-sectional area, the relationship between fiber shortening and aponeurosis shear, and the total force produced by the muscle. Such architectural parameters are challenging to determine particularly in vivo in multicompartment structures such as the human soleus with a complex arrangement of muscle fibers. The objective of this study was to map the fiber architecture of the human soleus in vivo at rest in both neutral and plantarflexed ankle positions using an MRI-based method of diffusion tensor imaging (DTI). Six subjects were imaged at 3 Tesla with the foot at rest in the two ankle positions. Eigenvalues, fractional anisotropy (FA), and eigenvector orientations of fibers in the different soleus subcompartments were evaluated after denoising of the diffusion tensor. The fiber architecture from DTI was similar to earlier studies based on a 3D fiber model from cadavers. The three eigenvalues of the diffusion tensor increased by ∼14% on increasing the joint plantarflexion angle in all of the soleus subcompartments, whereas FA showed a trend to decrease in the posterior and marginal soleus and to increase in the anterior soleus. The angle change in the lead eigenvector between the two foot positions was significant: ∼41° for the posterior soleus and ∼48° for the anterior soleus. Fibers tracked from the subcompartments support these changes seen in the eigenvector orientations. DTI-derived, subject-specific, muscle morphological data could potentially be used to model a more complete description of muscle performance and changes from disease. PMID:21164150

  4. 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

  5. Proximal interphalangeal joint dislocations without fractures.

    PubMed

    Vicar, A J

    1988-02-01

    Injuries to the proximal interphalangeal joint are extremely common. An understanding of the complex anatomy of this joint is essential for diagnosis and treatment of proximal interphalangeal joint sprains and dislocations. Lateral injuries are among the commonest injuries in the hand. These are often stable after reduction, requiring only closed treatment. Occasionally, however, the collateral ligament can be trapped in the joint and require open reduction. Dorsal dislocations represent the most common dislocation in the hand. These, too, are usually stable after reduction and can be treated by closed methods. On occasion, however, these dislocations will be open or irreducible by closed means, requiring surgical intervention and repair of damaged structures. Complex rotary dislocations are exactly that: complex. An exact understanding of the damaged structures and causes of irreducibility frequently makes this an injury often requiring open reduction and selective repair of damaged soft tissue structures. Fortunately, prompt diagnosis, reduction, and institution of appropriate treatment can usually afford the patient good function after these injuries. It must be noted that stiffness is more common than instability, and active range-of-motion exercises instituted at the proper time are essential. These joints will often remain permanently thicker after injury in spite of optimal care, and tenderness and soreness with use may persist for 6 to 12 months.

  6. Changes of Achilles tendon properties via 12-week PNF based robotic rehabilitation of ankle joints with spasticity and/or contracture.

    PubMed

    Zhou, Zhihao; Zhou, Yuan; Wang, Ninghua; Gao, Fan; Wang, Long; Wei, Kunlin; Wang, Qining

    2014-01-01

    Ankle joint with spasticity and/or contracture can severely affect mobility and independence of stroke survivors. Due to that, the Achilles tendon(AT) is affected. In this paper, we aim to study changes of AT properties via proprioceptive neuromuscular facilitation (PNF) treatment. A robotic ankle-foot rehabilitation system has been proposed, which consists of a robotic ankle-foot platform and a graphic user interface. In this pilot study, two post-stroke patients participated and carried out a 12-week PNF treatment with the robotic system. The treatment is evaluated quantitatively in AT properties. The evaluation shows that after the PNF treatment, the average decrease of AT length is 4.1 mm (6.5%) and the recovery ratio is 30.4%, while the thickness has no change. The results indicate that the PNF based robotic rehabilitation for ankle joints with spasticity and/or contracture is effective to improve the ankle spasticity/contracture.

  7. [Fractures of the acetabulum: complications and joint replacement].

    PubMed

    Herath, S C; Holstein, J H; Pizanis, A; Pohlemann, T

    2014-08-01

    Acetabular fractures assume a special role amongst the fractures of the pelvis, because they involve a major weight-bearing joint. As those fractures mostly result from exposure to great force, and because of their location in an anatomically complex region, a high rate of complications has to be anticipated. Besides general and perioperative complications long-term consequences, especially post-traumatic arthrosis, are relevant problems when it comes to treating fractures of the acetabulum. The primary reconstruction of the acetabulum, as well as a possibly necessary prosthetic replacement of the hip joint, makes high demands on the diagnostic and operative capabilities of the attending physician. Exact knowledge of the specific risks and pitfalls for each type of fracture and for the specific surgical techniques is crucial for a successful treatment. Due to the much worse long-term outcome when compared to primary total hip replacement in patients with osteoarthritis, acetabular fractures should, regardless of the patient's age, whenever possible be treated by operative reconstruction.

  8. 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

  9. Effect of isotonic and isokinetic exercise on muscle activity and balance of the ankle joint

    PubMed Central

    Kim, Mi-Kyoung; Yoo, Kyung-Tae

    2015-01-01

    [Purpose] This study was performed to examine how the balance of lower limbs and the muscle activities of the tibialis anterior (TA), the medial gastrocnemius (GCM), and the peroneus longus (PL) are influenced by isotonic and isokinetic exercise of the ankle joint. [Subjects] The subjects of this study were healthy adults (n=20), and they were divided into two groups (isotonic=10, isokinetic=10). [Methods] Isotonic group performed 3 sets of 10 contractions at 50% of MVIC and Isokinetic group performed 3 sets of 60°/sec. Muscle activity was measured by EMG and balance was measured by one-leg standing test. [Results] For muscle activity, a main effect of group was found in the non-dominant TA, and the dominant TA, GCM and PL. For balance, a main effect of time was found in both groups for the sway area measured support was provided by the non-dominant side. [Conclusion] In terms of muscle activity, the two groups showed a significant difference, and the isokinetic group showed higher muscle activities. In terms of balance, there was a significant difference between the pre-test and the post-test. The results of this study may help in the selection of exercises for physical therapy, because they show that muscle activity and balance vary according to the type of exercise. PMID:25729181

  10. 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

  11. 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.

  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. A 4-Week Neuromuscular Training Program and Gait Patterns at the Ankle Joint

    PubMed Central

    Coughlan, Garrett; Caulfield, Brian

    2007-01-01

    Context: Previous research into the rehabilitation of ankle sprains has primarily focused on outcome measures that do not replicate functional activities, thus making it difficult to extrapolate the results relative to the weight-bearing conditions under which most ankle sprains occur. Objective: To measure the effects of a training program on gait during walking and running in an active athletic population. Design: Matched-pairs, controlled trial. Setting: University motion analysis laboratory. Patients or Other Participants: Ten subjects from an athletic population (7 healthy, 3 with functional ankle instability: age = 25.8 ± 3.9 years, height = 177.6 ± 6.1 cm, mass = 66.8 ± 7.4 kg) and 10 controls matched for age, sex, activity, and ankle instability (7 healthy, 3 with functional ankle instability: age = 27.4 ± 5.8 years, height = 178.7 ± 10.8 cm, mass = 71.6 ± 10.0 kg). Intervention(s): A 4-week neuromuscular training program undertaken by the treatment group. Main Outcome Measure(s): We measured ankle position and velocity in the frontal (x) and sagittal (y) planes in all subjects during treadmill walking and running for the periods 100 milliseconds before heel strike, at heel strike, and 100 milliseconds after heel strike. Results: A 4-week neuromuscular training program resulted in no significant changes in ankle position or velocity during treadmill walking and running. Conclusions: The mechanisms by which neuromuscular training improves function in normal subjects and those with functional ankle instability do not appear to result in measurable changes in gait kinematics. Our findings raise issues regarding methods of ankle sprain rehabilitation and the measurement of their effectiveness in improving functional activities. Further research in a larger population with functional ankle instability is necessary. PMID:17597944

  14. 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

  15. 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

    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.

  16. Kinetic Relationships between the Hip and Ankle Joints during Gait in Children with Cerebral Palsy: A Pilot Study.

    PubMed

    Ishihara, Misako; Higuchi, Yumi

    2014-05-01

    [Purpose] The purpose of this study was to evaluate kinetic relationships between the ankle and hip joints during gait, in the late stance, in children with spastic cerebral palsy (CP). [Subjects] The subjects were 3 ambulant children with spastic hemiplegic CP (aged 10, 13, and 14: CP group) and 3 typically developing children with the same ages (control). [Methods] A three-dimensional gait analysis including force data was performed to compare the peak moment, power, and ankle/hip power ratio between the hemiplegic (uninvolved and hemiplegic) and the control groups. In the statistical analysis, mean values from 5 gait cycles for each of 3 conditions (uninvolved, hemiplegic and control) were used. The three conditions were compared by performing a Kruskal-Wallis test and Steel-Dwass multiple comparisons. [Results] The peak moments of ankle plantar flexors in the 10-year-old case, were significantly lower on the uninvolved and hemiplegic sides compared with the control group, respectively. The peak flexion moments of the hip on the hemiplegic side were significantly higher compared with the control in the 14- and 13-year-old cases. The peak of ankle power generation (A2) in the 13- and 10-year-old cases were significantly lower on the uninvolved and hemiplegic sides, respectively, compared with the control. The peaks of hip flexor power generation (H3) in the 14- and 13-year-old cases were significantly higher on the uninvolved and hemiplegic sides, respectively. The A2/H3 ratios were significantly lower on the uninvolved and hemiplegic sides compared with the control, and the ratio for the hemiplegic side was lower than that for the uninvolved side. [Conclusion] This study shows that propulsion of walking is generated by hip, rather than the ankle, on both the hemiplegic and involved sides.

  17. 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

  18. 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

  19. 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

  20. 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

  1. 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 ...

  2. Ageing effects on knee and ankle joint angles at key events and phases of the gait cycle.

    PubMed

    Begg, R K; Sparrow, W A

    2006-01-01

    The objective of this research was to determine whether joint angles at critical gait events and during major energy generation/absorption phases of the gait cycle would reliably discriminate age-related degeneration during unobstructed walking. The gaits of 24 healthy adults (12 young and 12 elderly) were analysed using the PEAK Motus motion analysis system. The elderly participants showed significantly greater single (60.3% versus 62.3%, p < 0.01) and double ( p < 0.05) support times, reduced knee flexion (47.7 degrees versus 43.0 degrees , p < 0.05) and ankle plantarflexion (16.8 degrees compared to 3.3 degrees , p = 0.053) at toe off, reduced knee flexion during push-off and reduced ankle dorsiflexion (16.8 degrees compared to 22.0 degrees , p < 0.05) during the swing phase. The plantarflexing ankle joint motion during the stance to swing phase transition (A2) for the young group (31.3 degrees ) was about twice ( p < 0.05) that of the elderly (16.9 degrees ). Reduced knee extension range of motion suggests that the elderly favoured a flexed-knee gait to assist in weight acceptance. Reduced dorsiflexion by the elderly in the swing phase implies greater risk of toe contact with obstacles. Overall, the results suggest that joint angle measures at critical events/phases in the gait cycle provide a useful indication of age-related degeneration in the control of lower limb trajectories during unobstructed walking.

  3. Age and gender differences in the control of vertical ground reaction force by the hip, knee and ankle joints.

    PubMed

    Toda, Haruki; Nagano, Akinori; Luo, Zhiwei

    2015-06-01

    [Purpose] This study examined the relationships between joint moment and the control of the vertical ground reaction force during walking in the elderly and young male and female individuals. [Subjects and Methods] Forty elderly people, 65 years old or older (20 males and 20 females), and 40 young people, 20 to 29 years old (20 males and 20 females), participated in this study. Joint moment and vertical ground reaction force during walking were obtained using a 3D motion analysis system and force plates. Stepwise linear regression analysis determined the joint moments that predict the amplitude of the vertical ground reaction force. [Results] Knee extension moment was related to the vertical ground reaction force in the young males and females. On the other hand, in the elderly females, hip, ankle, and knee joint moments were related to the first peak and second peak forces, and the minimum value of vertical ground reaction force, respectively. [Conclusion] Our results suggest that the young males and females make use of the knee joint moment to control of the vertical ground reaction force. There were differences between the elderly and the young females with regard to the joints used for the control of the vertical ground reaction force.

  4. Age and gender differences in the control of vertical ground reaction force by the hip, knee and ankle joints

    PubMed Central

    Toda, Haruki; Nagano, Akinori; Luo, Zhiwei

    2015-01-01

    [Purpose] This study examined the relationships between joint moment and the control of the vertical ground reaction force during walking in the elderly and young male and female individuals. [Subjects and Methods] Forty elderly people, 65 years old or older (20 males and 20 females), and 40 young people, 20 to 29 years old (20 males and 20 females), participated in this study. Joint moment and vertical ground reaction force during walking were obtained using a 3D motion analysis system and force plates. Stepwise linear regression analysis determined the joint moments that predict the amplitude of the vertical ground reaction force. [Results] Knee extension moment was related to the vertical ground reaction force in the young males and females. On the other hand, in the elderly females, hip, ankle, and knee joint moments were related to the first peak and second peak forces, and the minimum value of vertical ground reaction force, respectively. [Conclusion] Our results suggest that the young males and females make use of the knee joint moment to control of the vertical ground reaction force. There were differences between the elderly and the young females with regard to the joints used for the control of the vertical ground reaction force. PMID:26180331

  5. Effects of Ankle Arthrodesis on Biomechanical Performance of the Entire Foot

    PubMed Central

    Wang, Yan; Li, Zengyong; Wong, Duo Wai-Chi; Zhang, Ming

    2015-01-01

    Background/Methodology Ankle arthrodesis is one popular surgical treatment for ankle arthritis, chronic instability, and degenerative deformity. However, complications such as foot pain, joint arthritis, and bone fracture may cause patients to suffer other problems. Understanding the internal biomechanics of the foot is critical for assessing the effectiveness of ankle arthrodesis and provides a baseline for the surgical plan. This study aimed to understand the biomechanical effects of ankle arthrodesis on the entire foot and ankle using finite element analyses. A three-dimensional finite element model of the foot and ankle, involving 28 bones, 103 ligaments, the plantar fascia, major muscle groups, and encapsulated soft tissue, was developed and validated. The biomechanical performances of a normal foot and a foot with ankle arthrodesis were compared at three gait instants, first-peak, mid-stance, and second-peak. Principal Findings/Conclusions Changes in plantar pressure distribution, joint contact pressure and forces, von Mises stress on bone and foot deformation were predicted. Compared with those in the normal foot, the peak plantar pressure was increased and the center of pressure moved anteriorly in the foot with ankle arthrodesis. The talonavicular joint and joints of the first to third rays in the hind- and mid-foot bore the majority of the loading and sustained substantially increased loading after ankle arthrodesis. An average contact pressure of 2.14 MPa was predicted at the talonavicular joint after surgery and the maximum variation was shown to be 80% in joints of the first ray. The contact force and pressure of the subtalar joint decreased after surgery, indicating that arthritis at this joint was not necessarily a consequence of ankle arthrodesis but rather a progression of pre-existing degenerative changes. Von Mises stress in the second and third metatarsal bones at the second-peak instant increased to 52 MPa and 34 MPa, respectively, after

  6. 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

  7. 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

  8. 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.

  9. Ankle sprains and instability.

    PubMed

    Czajka, Cory M; Tran, Elaine; Cai, Andrew N; DiPreta, John A

    2014-03-01

    Ankle injuries are among the most common injuries presenting to primary care providers and emergency departments and may cause considerable time lost to injury and long-term disability. Inversion injuries about the ankle involve about 25% of all injuries of the musculoskeletal system and 50% of all sports-related injuries. Medial-sided ankle sprains occur less frequently than those on the lateral side. High ankle sprains occur less frequently in the general population, but do occur commonly in collision sports. Providers should apply the Ottawa ankle rules when radiography is indicated and refer fractures and more severe injuries to orthopedic surgery as needed. PMID:24559877

  10. Inferring Muscle-Tendon Unit Power from Ankle Joint Power during the Push-Off Phase of Human Walking: Insights from a Multiarticular EMG-Driven Model

    PubMed Central

    2016-01-01

    Introduction Inverse dynamics joint kinetics are often used to infer contributions from underlying groups of muscle-tendon units (MTUs). However, such interpretations are confounded by multiarticular (multi-joint) musculature, which can cause inverse dynamics to over- or under-estimate net MTU power. Misestimation of MTU power could lead to incorrect scientific conclusions, or to empirical estimates that misguide musculoskeletal simulations, assistive device designs, or clinical interventions. The objective of this study was to investigate the degree to which ankle joint power overestimates net plantarflexor MTU power during the Push-off phase of walking, due to the behavior of the flexor digitorum and hallucis longus (FDHL)–multiarticular MTUs crossing the ankle and metatarsophalangeal (toe) joints. Methods We performed a gait analysis study on six healthy participants, recording ground reaction forces, kinematics, and electromyography (EMG). Empirical data were input into an EMG-driven musculoskeletal model to estimate ankle power. This model enabled us to parse contributions from mono- and multi-articular MTUs, and required only one scaling and one time delay factor for each subject and speed, which were solved for based on empirical data. Net plantarflexing MTU power was computed by the model and quantitatively compared to inverse dynamics ankle power. Results The EMG-driven model was able to reproduce inverse dynamics ankle power across a range of gait speeds (R2 ≥ 0.97), while also providing MTU-specific power estimates. We found that FDHL dynamics caused ankle power to slightly overestimate net plantarflexor MTU power, but only by ~2–7%. Conclusions During Push-off, FDHL MTU dynamics do not substantially confound the inference of net plantarflexor MTU power from inverse dynamics ankle power. However, other methodological limitations may cause inverse dynamics to overestimate net MTU power; for instance, due to rigid-body foot assumptions. Moving

  11. 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.

  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. 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

  14. 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.

  15. The main function of ankle braces is to control the joint position before landing.

    PubMed

    Eils, Eric; Rosenbaum, Dieter

    2003-03-01

    The aim of the present investigation was to evaluate the stabilizing effect of 10 different ankle braces during simulated inversion on a tilting platform. Twenty-five subjects participated in the study (23 +/- 3 yrs, 71 +/- 12 kg, 177 +/- 9 cm). Ten commercially available ankle braces and a trapdoor in combination with a goniometer system that measured hindfoot inversion inside the shoe were used. Inversion was subdivided into a free fall and a maximum inversion phase. Results showed that all braces restricted inversion significantly between 51% and 15% compared to the no-brace condition but distinct differences between models were found. Maximum inversion angle and inversion velocity were lower for those braces that restricted inversion most effectively during the free fall phase. Reaction times of the peroneus longus did not appear to influence the degree of inversion. Relatively constant differences between free fall and maximum inversion angles for all models (between 6 degrees and 10 degrees) and a high correlation between these two parameters suggests that the main function of ankle braces is to restrict inversion during the free fall phase and not at the extremes of motion.

  16. Understanding the effect of touchdown distance and ankle joint kinematics on sprint acceleration performance through computer simulation.

    PubMed

    Bezodis, Neil Edward; Trewartha, Grant; Salo, Aki Ilkka Tapio

    2015-06-01

    This study determined the effects of simulated technique manipulations on early acceleration performance. A planar seven-segment angle-driven model was developed and quantitatively evaluated based on the agreement of its output to empirical data from an international-level male sprinter (100 m personal best = 10.28 s). The model was then applied to independently assess the effects of manipulating touchdown distance (horizontal distance between the foot and centre of mass) and range of ankle joint dorsiflexion during early stance on horizontal external power production during stance. The model matched the empirical data with a mean difference of 5.2%. When the foot was placed progressively further forward at touchdown, horizontal power production continually reduced. When the foot was placed further back, power production initially increased (a peak increase of 0.7% occurred at 0.02 m further back) but decreased as the foot continued to touchdown further back. When the range of dorsiflexion during early stance was reduced, exponential increases in performance were observed. Increasing negative touchdown distance directs the ground reaction force more horizontally; however, a limit to the associated performance benefit exists. Reducing dorsiflexion, which required achievable increases in the peak ankle plantar flexor moment, appears potentially beneficial for improving early acceleration performance.

  17. 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

  18. Movement Behavior of High-Heeled Walking: How Does the Nervous System Control the Ankle Joint during an Unstable Walking Condition?

    PubMed Central

    Alkjær, Tine; Raffalt, Peter; Petersen, Nicolas C.; Simonsen, Erik B.

    2012-01-01

    The human locomotor system is flexible and enables humans to move without falling even under less than optimal conditions. Walking with high-heeled shoes constitutes an unstable condition and here we ask how the nervous system controls the ankle joint in this situation? We investigated the movement behavior of high-heeled and barefooted walking in eleven female subjects. The movement variability was quantified by calculation of approximate entropy (ApEn) in the ankle joint angle and the standard deviation (SD) of the stride time intervals. Electromyography (EMG) of the soleus (SO) and tibialis anterior (TA) muscles and the soleus Hoffmann (H-) reflex were measured at 4.0 km/h on a motor driven treadmill to reveal the underlying motor strategies in each walking condition. The ApEn of the ankle joint angle was significantly higher (p<0.01) during high-heeled (0.38±0.08) than during barefooted walking (0.28±0.07). During high-heeled walking, coactivation between the SO and TA muscles increased towards heel strike and the H-reflex was significantly increased in terminal swing by 40% (p<0.01). These observations show that high-heeled walking is characterized by a more complex and less predictable pattern than barefooted walking. Increased coactivation about the ankle joint together with increased excitability of the SO H-reflex in terminal swing phase indicates that the motor strategy was changed during high-heeled walking. Although, the participants were young, healthy and accustomed to high-heeled walking the results demonstrate that that walking on high-heels needs to be controlled differently from barefooted walking. We suggest that the higher variability reflects an adjusted neural strategy of the nervous system to control the ankle joint during high-heeled walking. PMID:22615997

  19. 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…

  20. Sodium Magnetic Resonance Imaging of Ankle Joint in Cadaver Specimens, Volunteers, and Patients After Different Cartilage Repair Techniques at 7 T

    PubMed Central

    Zbýň, Štefan; Brix, Martin O.; Juras, Vladimir; Domayer, Stephan E.; Walzer, Sonja M.; Mlynarik, Vladimir; Apprich, Sebastian; Buckenmaier, Kai; Windhager, Reinhard; Trattnig, Siegfried

    2015-01-01

    Objectives The goal of cartilage repair techniques such as microfracture (MFX) or matrix-associated autologous chondrocyte transplantation (MACT) is to produce repair tissue (RT) with sufficient glycosaminoglycan (GAG) content. Sodium magnetic resonance imaging (MRI) offers a direct and noninvasive evaluation of the GAG content in native cartilage and RT. In the femoral cartilage, this method was able to distinguish between RTs produced by MFX and MACT having different GAG contents. However, it needs to be clarified whether sodium MRI can be useful for evaluating RT in thin ankle cartilage. Thus, the aims of this 7-T study were (1) to validate our sodium MRI protocol in cadaver ankle samples, (2) to evaluate the sodium corrected signal intensities (cSI) in cartilage of volunteers, (3) and to compare sodium values in RT between patients after MFX and MACT treatment. Materials and Methods Five human cadaver ankle samples as well as ankles of 9 asymptomatic volunteers, 6 MFX patients and 6 MACT patients were measured in this 7-T study. Sodium values from the ankle samples were compared with histochemically evaluated GAG content. In the volunteers, sodium cSI values were calculated in the cartilages of ankle and subtalar joint. In the patients, sodium cSI in RT and reference cartilage were measured, morphological appearance of RT was evaluated using the magnetic resonance observation of cartilage repair tissue (MOCART) scoring system, and clinical outcome before and after surgery was assessed using the American Orthopaedic Foot and Ankle Society score and Modified Cincinnati Knee Scale. All regions of interest were defined on morphological images and subsequently transferred to the corresponding sodium images. Analysis of variance, t tests, and Pearson correlation coefficients were evaluated. Results In the patients, significantly lower sodium cSI values were found in RT than in reference cartilage for the MFX (P = 0.007) and MACT patients (P = 0.008). Sodium cSI and

  1. The influence of antagonist muscle control strategies on the isometric frequency response of the cat's ankle joint.

    PubMed

    Goodwin, A; Zhou, B H; Baratta, R V; Solomonow, M; Keegan, A P

    1997-07-01

    This study investigated the effect of various strategies to control the interaction between agonist and antagonist muscles on the frequency response of the isometric cat ankle joint actuated by the tibialis anterior (TA) and soleus (SOL) muscles. Some strategies were based on the physiologic need for increasing joint stability during forceful contractions; with these strategies, the proportional rate of physiologic antagonist activity was termed antagonist gain. Other strategies were based on the electrical stimulation literature, which advocates co-contraction at low force levels. The range of crossover of antagonist activity to the agonist's domain was termed overlap. Strategies consisting of 0%, 10%, and 20% antagonist gain were combined with 0%, 50%, and 100% overlap for a total of nine strategies. These were applied to the TA and SOL using sinusoidal input signals varying in frequency from 0.4 to 6 Hz. Gain and phase Bode plots were constructed through the use of the fast Fourier transforms (FFT's); and analysis of variance determined the significance of differences in gain and phase across frequencies. Best-fit models consisting of four poles and two zeroes were used to fit the experimental data and compared against an analytical model of muscles acting independently across the joint. Harmonic distortion was calculated to evaluate signal quality. It was found that changing the overlap and the antagonist gain produces significant changes in the dynamic response of the two-muscle joint system. The analytical approach to modeling such a system tends to consistently overestimate gain. It is suggested that signal quality is optimal when a moderate amount of antagonist gain (10%) is engaged, with overlap of 50% to smooth transitions between opposing movements. It is expected that this type of strategy will achieve optimum signal quality while preserving the long-term integrity of the joint. PMID:9210823

  2. 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

  3. 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.

  4. Fracture analyses of thin films, interfaces, and joints

    NASA Astrophysics Data System (ADS)

    Beuth, Jack Lee, Jr.

    This thesis presents fracture analyses related to three practical problems. Chapter 2 and 3 both address the problem of cracking of thin bonded films in tension. In Chapter 2, solutions are obtained for two plan strain problems relevant to the cracking of a thin elastic film bonded to a dissimilar, thick elastic substrate material. Complete results from the solution of each problem are given over the full range of practical elastic mismatches. Dimensionless quantities important in describing the cracking of thin films are introduced and accurate approximate formulas based on the solution results are given for them. Applications are discussed, including criteria for avoiding thin film crack extension and a formula for the curvature change induced by the cracking of a thin film bonded to a substrate of finite thickness. In Chapter 3, a numerical analysis is made extending some of the results from Chapter 2 so that plastic yielding of the substrate is allowed. A simple shear-lag model of the problem is also presented which gives reasonable predictions for the dependence of the dimensionless fracture quantities on the normalized loading over a wide range of material mismatches. In Chapter 4, a recently-developed interfacial fracture toughness specimen is analyzed to allow the determination of interfacial fracture toughness values as a function of mode mixity for any two bonded materials. An analytic steady-state formula for the complex stress intensity factor for the specimen is presented. All parameters in the formula are known except for a single parameter, omega, which can be interpreted as the difference in phase between the far-field applied displacements and the near-tip crack face displacements. The parameter w is solved for numerically and presented as a function of the problem parameters. Also, some work is presented on the role of crack face interpenetration or contact in the analysis and use of the specimen. In Chapter 5, an analysis is presented of MSD or

  5. 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

  6. Segmental clavicle fracture and acromio-clavicular joint disruption: an unusual case report.

    PubMed

    Marjoram, Tom P; Chakrabarti, Anil

    2015-07-01

    Clavicle fractures are common, accounting for 2.6% of all adult fractures. We describe a most unusual segmental fracture pattern of the clavicle with concurrent disruption of acromioclavicular (AC) joint. We were unable to find any publications or reports describing this fracture pattern. During surgery for a medial one-third shaft of clavicle fracture and AC joint dislocation, the medial clavicle was exposed, leading to the discovery (on table) of a previously unidentified additional undisplaced fracture of the medial clavicle cleaving the bone into three distinct fragments. An anatomical plate was successfully applied, fixing both fractures. The AC joint was then reduced with a hook plate. At 8 months, after removal of the hook plate, the patient has an excellent outcome with an Oxford Shoulder Score of 45/48 and a full range of movement without instability of the AC joint. We describe the operative management of this rare fracture pattern. This also highlights that segmental fractures of the clavicle are easily missed. It was successfully treated with a medial anatomic plate and lateral hook plate. We were unable to find any publications or reports describing the fracture pattern in this case. PMID:27582977

  7. 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

  8. 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.

  9. 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

  10. 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

  11. 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.

  12. Microseismic monitoring of columnar jointed basalt fracture activity: a trial at the Baihetan Hydropower Station, China

    NASA Astrophysics Data System (ADS)

    Chen, Bing-Rui; Li, Qing-Peng; Feng, Xia-Ting; Xiao, Ya-Xun; Feng, Guang-Liang; Hu, Lian-Xing

    2014-10-01

    Severe stress release has occurred to the surrounding rocks of the typically columnar jointed basalt after excavation at the Baihetan Hydropower Station, Jinsha River, China, where cracking, collapse, and other types of failure may take place occasionally due to relaxation fracture. In order to understand the relaxation fracture characteristics of the columnar jointed basalt in the entire excavation process at the diversion tunnel of the Baihetan Hydropower Station, real-time microseismic monitoring tests were performed. First, the applicability of a geophone and accelerometer was analyzed in the columnar jointed basalt tunnel, and the results show that the accelerometer was more applicable to the cracking monitoring of the columnar jointed basalt. Next, the waveform characteristics of the microseismic signals were analyzed, and the microseismic signals were identified as follows: rock fracture signal, drilling signal, electrical signal, heavy vehicle passing signal, and blast signal. Then, the attenuation characteristics of the microseismic signals in the columnar jointed basalt tunnel were studied, as well as the types and characteristics of the columnar jointed basalt fracture. Finally, location analysis was conducted on the strong rock fracture events, in which four or more sensors were triggered, to obtain the temporal and spatial evolution characteristics and laws of the columnar jointed basalt relaxation fracture after excavation. The test results are not only of important reference value to the excavation and support of diversion tunnel at the Baihetan Hydropower Station, but also of great referential significance and value to the conduction of similar tests.

  13. Weber C ankle fractures: a retrospective audit of screw number, size, complications, and retrieval rates.

    PubMed

    Walker, Logan; Willis, Nigel

    2015-01-01

    Tibiofibular transfixation of Weber C injuries using a diastasis screw is the current method of fixation. However, controversy remains regarding the screw size and number, number of cortices engaged, and the interval to screw removal. The present study reviewed the current practice in the Wellington Region. A retrospective audit of patients with documented Weber C injuries in the Capital & Coast District Health Board from June 2012 to December 2013 was performed. The clinical medical records and radiographs were reviewed, and the patient demographics, surgeon details, screw number, size, cortices engaged, screw removal period, and documented complications were recorded. A total of 36 operations were documented, of which 27 (75%) cases also required fibula plating. Of the 36 cases, 25 (69.44%) used a single diastasis screw, 33 (91.67%) used 4.5-mm screws, and 18 (50%) engaged 3 cortices. Surgical practice did not vary with the experience level. Of the 36 patients, 29 (80.56%) underwent routine screw removal at a median of 20 (25th to 75th quartile range 16 to 22) weeks. Also, 9 (25%) cases of screw fracture occurred, with a median documented interval to fracture of 18 (25th to 75th quartile range 15 to 20) weeks. The surgical management of Weber C injuries is consistent with current practice. The routine removal of diastasis screws by 20 weeks postoperatively was not different from the documented interval of screw removal when screw fractures had occurred. The timing of screw removal needs to be weighed against the fracture risk, patient symptoms, and the risk of secondary procedure complications.

  14. Nail hooks and elastic bands external dynamic traction for fractures of the proximal interphalangeal joint.

    PubMed

    Siddiqui, Farhaj; Hossain, Shahan; Huq, Nasimul

    2012-09-01

    Intra-articular fractures of the proximal interphalangeal joint remain a treatment challenge for hand specialists. The purpose of this investigation was to review the results of 12 patients, 6 men and 6 women (average age, 21 y), who were treated using the nail hooks and elastic bands external dynamic traction technique for their intra-articular proximal interphalangeal joint fractures. Of the total 12 fractures, 6 involved the proximal phalanx and 6 involved the middle phalanx. The final arc of motion at the proximal interphalangeal joint averaged 89 degrees (range, 25 to 111 degrees). At the conclusion of treatment: 1 patient developed a radial deviation and 1 developed a slight ulnar deviation. All patients were able to return to their preinjury level of functioning. Nail hooks and elastic bands external dynamic traction provides an effective treatment for intra-articular proximal interphalangeal joint fractures. It is an inexpensive, easily applied, nonoperative method of treatment. PMID:22913996

  15. The Ankle Injury Management (AIM) trial: a pragmatic, multicentre, equivalence randomised controlled trial and economic evaluation comparing close contact casting with open surgical reduction and internal fixation in the treatment of unstable ankle fractures in patients aged over 60 years.

    PubMed Central

    Keene, David J; Mistry, Dipesh; Nam, Julian; Tutton, Elizabeth; Handley, Robert; Morgan, Lesley; Roberts, Emma; Gray, Bridget; Briggs, Andrew; Lall, Ranjit; Chesser, Tim Js; Pallister, Ian; Lamb, Sarah E; Willett, Keith

    2016-01-01

    BACKGROUND Close contact casting (CCC) may offer an alternative to open reduction and internal fixation (ORIF) surgery for unstable ankle fractures in older adults. OBJECTIVES We aimed to (1) determine if CCC for unstable ankle fractures in adults aged over 60 years resulted in equivalent clinical outcome compared with ORIF, (2) estimate cost-effectiveness to the NHS and society and (3) explore participant experiences. DESIGN A pragmatic, multicentre, equivalence randomised controlled trial incorporating health economic evaluation and qualitative study. SETTING Trauma and orthopaedic departments of 24 NHS hospitals. PARTICIPANTS Adults aged over 60 years with unstable ankle fracture. Those with serious limb or concomitant disease or substantial cognitive impairment were excluded. INTERVENTIONS CCC was conducted under anaesthetic in theatre by surgeons who attended training. ORIF was as per local practice. Participants were randomised in 1 : 1 allocation via remote telephone randomisation. Sequence generation was by random block size, with stratification by centre and fracture pattern. MAIN OUTCOME MEASURES Follow-up was conducted at 6 weeks and, by blinded outcome assessors, at 6 months after randomisation. The primary outcome was the Olerud-Molander Ankle Score (OMAS), a patient-reported assessment of ankle function, at 6 months. Secondary outcomes were quality of life (as measured by the European Quality of Life 5-Dimensions, Short Form questionnaire-12 items), pain, ankle range of motion and mobility (as measured by the timed up and go test), patient satisfaction and radiological measures. In accordance with equivalence trial US Food and Drug Administration guidance, primary analysis was per protocol. RESULTS We recruited 620 participants, 95 from the pilot and 525 from the multicentre phase, between June 2010 and November 2013. The majority of participants, 579 out of 620 (93%), received the allocated treatment; 52 out of 275 (19%) who received CCC later

  16. The effect of varying the plantarflexion resistance of an ankle-foot orthosis on knee joint kinematics in patients with stroke.

    PubMed

    Kobayashi, Toshiki; Leung, Aaron K L; Akazawa, Yasushi; Hutchins, Stephen W

    2013-03-01

    Ankle-foot orthoses (AFOs) can improve gait in patients with hemiplegia. However, it is anecdotally known that excessive plantarflexion resistance of an AFO could induce undesired knee flexion at early stance. The aim of this study was to systematically investigate the effect of varying the degrees of plantarflexion resistance of an AFO on knee flexion angles at early stance in five subjects with chronic stroke who demonstrated two clear knee flexion peaks at early stance and swing. Each subject wore an experimental AFO constructed with an oil-damper type ankle joint and was instructed to walk at their self-selected walking speed under five plantarflexion resistance conditions. The sagittal plane ankle and knee joint kinematics and gait speed were analyzed using a 3-D Motion Analysis System. A number of significant differences (P<0.005) in maximum knee flexion angles at early stance amongst different plantarflexion resistance conditions were revealed. The knee flexion angle was 23.80 (3.25) degrees under the free hinge joint condition (condition 1), while that was 26.09 (3.79) degrees under the largest resistance condition (condition 5). It was therefore demonstrated that increasing the plantarflexion resistance of an AFO would induce more knee flexion at early stance phase in patients with stroke.

  17. Computer simulation analysis of fracture dislocation of the proximal interphalangeal joint using the finite element method.

    PubMed

    Akagi, T; Hashizume, H; Inoue, H; Ogura, T; Nagayama, N

    1994-10-01

    Stress is a proximal interphalangeal (PIP) joint model was analyzed by the two-dimensional and three-dimensional finite element methods (FEM) to study the onset mechanisms of the middle phalangeal base fracture. The structural shapes were obtained from sagittally sectioned specimens of the PIP joint for making FEM models. In those models, four different material properties were given corresponding to cortical bone, subchondral bone, cancellous bone and cartilage. Loading conditions were determined by estimating the amount and position of axial pressure added to the middle phalanx. A general finite element program (MARC) was used for computer simulation analysis. The results of the fracture experiments compared with the clinical manifestation of the fractures justify the applicability of the computer simulation models using FEM analysis. The stress distribution changed as the angle of the PIP joint changed. Concentrated stress was found on the volar side of the middle phalangeal base in the hyperextension position, and was found on the dorsal side in the flexion position. In the neutral position, the stress was found on both sides. Axial stress on the middle phalanx causes three different types of fractures (volar, dorsal and both) depending upon the angle of the PIP joint. These results demonstrate that the type of PIP joint fracture dislocation depends on the angle of the joint at the time of injury. The finite element method is one of the most useful methods for analyzing the onset mechanism of fractures.

  18. 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

  19. 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

  20. Rupture of molecules upon fracture of adhesive joint between two polymer samples

    NASA Astrophysics Data System (ADS)

    Boiko, Yu. M.; Mamalimov, R. I.; Vettegren, V. I.

    2013-07-01

    The surfaces formed after fracture of the joint of two polystyrene (PS) samples have been studied by attenuated total reflection Fourier-transform infrared spectroscopy. The adhesive joint between samples was created by pressing them one against another and holding at a pressure of 0.8 MPa and a temperature of 80°C, which is ˜23°C lower than the glass transition temperature of PS. It has been found that, after the joint fracture, the concentration of molecule ends formed after the rupture of carbon-carbon bonds in the back-bone of the PS molecule increases.

  1. Fracture toughness of partially welded joints of SUS316 in high magnetic field at 4K

    SciTech Connect

    Nishimura, A.; Yamamoto, J.; Motojima, O.

    1997-06-01

    Two kinds of partially welded austenitic stainless steel joints were prepared using SUS 316, 75 mm thick. One joint was fabricated using tungsten inert gas welding and metal arc gas welding, and the other was electron beam welded. Compact tension specimens for fracture toughness tests were machined out from these welded plates in the thickness direction. The fracture toughness tests of these specimens with natural cracks were carried out in 0, 8, and 14 T fields at 4 K. The test results show that there is no strong effect of the high magnetic field on the fracture toughness of these joints, and the electron beam welded joints give a very low toughness in any case because of the complicated natural crack front shape.

  2. 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.

  3. 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.

  4. 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

  5. Development of a joint hydrogeophysical inversion approach and application to a contaminated fractured aquifer

    SciTech Connect

    Jardine, Philip M; Hubbard, Susan; Fienen, Michael; Watson, David B

    2006-06-01

    This paper presents a joint inversion approach for combining crosshole seismic travel time and borehole flowmeter test data to estimate hydrogeological zonation. The approach is applied to a complex, fractured Department of Energy field site located at the Oak Ridge National Laboratory in Tennessee, United States. We consider seismic slowness (the inverse of seismic velocity) and hydrogeological zonation indicators as unknown variables and use a physically based model with unknown parameters to relate the seismic slowness to the zonation indicators. We jointly estimate all the unknown parameters in the model by conditioning them to the crosshole seismic travel times as well as the borehole flowmeter data using a Bayesian model and a Markov chain Monte Carlo sampling method. The fracture zonation estimates are qualitatively compared to bromide tracer breakthrough data and to uranium biostimulation experiment results. The comparison suggests that the joint inversion approach adequately estimated the fractured zonation and that the fracture zonation influenced biostimulation efficacy. Our study suggests that the new joint hydrogeophysical inversion approach is flexible and effective for integrating various types of data sets within complex subsurface environments and that seismic travel time data have the potential to provide valuable information about fracture zonation.

  6. 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.

  7. 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.

  8. 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.

  9. 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

  10. 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.

  11. 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

  12. The use of gravity or manual-stress radiographs in the assessment of supination-external rotation fractures of the ankle.

    PubMed

    Schock, H J; Pinzur, M; Manion, L; Stover, M

    2007-08-01

    Supination-external rotation (SER) fractures of the ankle may present with a medial ligamentous injury that is not apparent on the initial radiographs. A cadaver gravity-stress view has been described, but the manual-stress view is considered to be the examination of choice for the diagnosis of medial injuries. We prospectively compared the efficacy of these two examinations. We undertook both examinations in 29 patients with SER fractures. Of these, 16 (55%) were stress-positive, i.e. and had widening of the medial clear space of > 4 mm with a mean medial clear space of 6.09 mm (4.4 to 8.1) on gravity-stress and 5.81 mm (4.0 to 8.2) on manual-stress examination, and 13 patients (45%) were stress-negative with a mean medial clear space of 3.91 mm (3.3 to 5.1) and 3.61 mm (2.6 to 4.5) on examination of gravity- and manual-stress respectively. The mean absolute visual analgoue scale score for discomfort in the examination of gravity stress was 3.45 (1 to 6) and in the manual-stress procedure 6.14 (3 to 10). We have shown that examination of gravity-stress is as reliable and perceived as more comfortable than that of manual stress. We recommend using it as the initial diagnostic screening examination for the detection of occult medial ligamentous injuries in SER fractures of the ankle.

  13. 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

  14. [The potential of the modern methods for clinical diagnostics applied in the forensic medical assessment of functional disturbances of the ankle joint in the case of its injury].

    PubMed

    Khabova, Z S; Fetisov, V A

    2012-01-01

    The present paper is focused on the problems of clinical diagnostics of the functional disturbances in the locomotor apparatus as exemplified by the injuries to the ankle joint. The results of analysis of the entire range of up-to-date diagnostic tools for the purpose suggest the necessity of revision of obsolete methodological principles still adopted in forensic medicine as regards the problem being condidered. It is proposed based on the recent progress achieved by the specialists in traumatology, orthopedics, medicosocial expertise, and the related areas that a forensic medical expert should not confine oneself to the consideration of the sole criterion, such as "the range of articular movements", for the estimation of the severity of harm to health in the patients presenting with a joint injury.

  15. 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.

  16. Delayed distal radio-ulnar joint instability after Galeazzi type fracture fixation in a child.

    PubMed

    Jettoo, P; de Kiewiet, Gp

    2010-10-15

    We report a rare case of delayed distal radio-ulnar joint instability with malunion of a Galeazzi-type radius fracture in a 10- year-old boy. He underwent operative intervention with flexible intramedullary nailing of the radius. He had careful clinical and intra-operative evaluation under image intensifier, and regular clinical and radiological assessments subsequently in clinic, and his distal radio-ulnar joint (DRUJ) was stable. He nonetheless developed DRUJ instability with malunion of radial midshaft fracture at 4 months. Corrective osteotomy for forearm fracture malunion is an uncommon procedure in children. He underwent a corrective radial osteotomy at the site of malunion, held with a Pennig external fixator, with reconstruction of the DRUJ subluxation. He made a good recovery with full restoration of wrist and forearm function, which was maintained at 17 months.

  17. 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}.

  18. Isokinetic evaluation of knee joint flexor and extensor muscles after tibial eminence fractures.

    PubMed

    Melzer, Piotr; Głowacki, Maciej; Głowacki, Jakub; Misterska, Ewa

    2014-01-01

    The aim of the study was to evaluate the knee joint function in adolescent patients following operative treatment - fixation via arthroscopic or open surgery (arthrotomy), due to tibial eminence fractures. 28 patients, aged from 7 to 16 years, treated operatively between 1994-2009 in four orthopeadic centres underwent evaluation. Evaluation was performed 12-180 months following surgery. Patients were divided into two groups depending on the operative treatment received. Group A consisted of 14 patients who underwent arthroscopic reduction and stabilization. Group B consisted of 14 patients who were treated by open reduction (artrothomy) and stabilization. The results of clinical and radiological examinations and isokinetic tests used in the evaluation declared that operative treatment due to tibial eminence fracture, regardless of surgical method used, does not significantly disrupt knee joint function resulting in a slight weakening of knee joint extensor muscle strength.

  19. 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.

  20. A fracture mechanics approach for designing adhesively bonded joints

    NASA Technical Reports Server (NTRS)

    Johnson, W. S.; Mall, S.

    1985-01-01

    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.

  1. 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

  2. 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.

  3. 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.

  4. 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.

  5. Recreational Sports Activities After Calcaneal Fractures and Subsequent Subtalar Joint Arthrodesis.

    PubMed

    Romeo, Giovanni; Martinelli, Nicolò; Bonifacini, Carlo; Bianchi, Alberto; Sartorelli, Elena; Malerba, Francesco

    2015-01-01

    Subtalar joint arthrodesis is a common treatment for the management of hindfoot pathologic entities. Despite pain reduction, hindfoot stiffness is a common concern of active patients, who wish to continue or start exercising for fitness. The purpose of the present retrospective observational clinical study was to assess the rate and type of recreational sports activities in patients before and after subtalar joint arthrodesis and to correlate the clinical outcome and the level of sports activities. In 33 patients (22 males, 11 females) treated with subtalar joint arthrodesis, the pre- and postoperative participation in sports and recreational activities was evaluated. The American Orthopaedic Foot and Ankle Society hindfoot scale score, 36-item Short Form Health Survey, and a visual analog scale for pain were used as clinical outcome measures. The weekly session number, session time, and interval to activity recovery after surgery were registered. Patients with a subtalar joint arthrodesis returned to a satisfactory level of activity postoperatively. The sports participation almost reached levels similar to those preoperatively but with a shift from high- to low-impact activities.

  6. Temporary transarticular K-wire fixation of critical ankle injuries at risk: a neglected "damage control" strategy?

    PubMed

    Friedman, Jamie; Ly, Anhchi; Mauffrey, Cyril; Stahel, Philip F

    2015-02-01

    High-energy ankle fracture-dislocations are at significant risk for postoperative complications. Closed reduction and temporary percutaneous transarticular K-wire fixation was first described more than 50 years ago. This simple and effective "damage control" strategy is widely practiced in Europe, yet appears largely forgotten and abandoned in the United States. Anecdotal opposing arguments include the notion that drilling K-wires through articular cartilage may damage the joint and contribute to postinjury arthritis. This article describes the experience in a US academic level I trauma center with transarticular pinning of selected critical ankle fracture-dislocations followed by delayed definitive fracture fixation once the soft tissues are healed. Median patient follow-up of 2 years showed that the transarticular pinning technique was performed safely, not associated with increased postoperative complication rates, and characterized by good subjective outcomes using the American Academy of Orthopaedic Surgeons Foot and Ankle Outcome Score questionnaire.

  7. 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.

  8. Development of a joint hydrogeophysical inversion approach andapplication to a contaminated fractured aquifer

    SciTech Connect

    Chen, J.; Hubbard, S.; Peterson, J.; Williams, K.; Fienen, M.; Jardine, P.; Watson, D.

    2006-02-24

    Thispaper presents a joint inversion approach for combiningcrosshole seismic traveltime and borehole flowmeter test data to estimatehydrogeological zonation. The approach is applied to a complex, fracturedDOE field site located at the Oak Ridge National Laboratory in Tennessee,USA. We consider seismic slowness (the inverse of seismic velocity) andhydrogeological zonation indicators as unknown variables, and use aphysically based model with unknown parameters to relate the seismicslowness to the zonation indicators. We jointly estimate all the unknownparameters in the model by conditioning them to the crosshole seismictraveltimes as well as the borehole flowmeter data using a Bayesian modeland a Markov chain Monte Carlo sampling method. The fracture zonationestimates are qualitatively compared to bromide tracer breakthrough dataand to Uranium biostimulation experiment results. The comparison suggeststhat the joint inversion approach adequately estimated the fracturedzonation, and that the fracture zonation influenced biostimulationefficacy. Our study suggests that the new joint ydrogeophysical inversionapproach is flexible and effective for integrating various types ofdatasets within complex subsurface environments, and that seismictraveltime data have the potential to provide valuable information aboutfracture zonation.

  9. Acromioclavicular Joint Dislocation with Ipsilateral Mid Third Clavicle, Mid Shaft Humerus and Coracoid Process Fracture – A Case Report

    PubMed Central

    Sharma, Naveen; Mandloi, Avinash; Agrawal, Ashish; Singh, Shailendra

    2016-01-01

    Introduction: The clavicle, humerus and acromioclavicular (AC) joint separately are very commonly involved in traumatic injuries around the shoulder. Acromioclavicular joint dislocation with distal clavicle fracture is a well recognized entity in clinical practice. AC joint dislocation with mid shaft clavicle fracture is uncommon and only few cases have been reported in literature. However, to the best of our knowledge, this is the first case report to describe an acromioclavicular dislocation with ipsilateral mid shaft clavicle, mid shaft humerus and coracoid process fracture. Fractures of the humerus and clavicle along with the acromioclavicular joint dislocation were fixed at the same setting. Case Report: A 65-year-old male met with a high velocity road traffic accident. Plain radiographs showed displaced mid third clavicle fracture with acromioclavicular joint dislocation with mid shaft humerus fracture. Surgical fixation was planned for humerus with interlocking nail, clavicle with locking plate and acromioclavicular joint with reconstruction of coracoclavicular ligaments. Intraoperatively, coracoid process was found to have a comminuted fracture. The operative plan had to be changed on table as coracoclavicular fixation was not possible. So acromioclavicular joint fixation was done using tension band wiring and the coracoclavicular ligament was repaired using a 2-0 ethibond. The comminuted coracoid fracture was managed conservatively. K wires were removed at 6 weeks. Early mobilization was started. Conclusion: In acromioclavicular joint injuries, clavicle must be evaluated for any injury. Although it is more commonly associated with distal clavicle fractures, it can be associated with middle third clavicle fractures. As plain radiographs, AP view are most of the times insufficient for viewing integrity of coracoid process, either special views like Stryker notch or CT scan may help in diagnosing such concealed injuries. When associated with fractures of the

  10. Local infiltration of liposome bupivacaine in foot and ankle surgery: case-based reviews.

    PubMed

    Herbst, Steven A

    2014-10-01

    Foot and ankle surgical procedures, ranging from simple procedures, such as bunionectomy and correction of hammer toe, to more complex surgery, such as ankle fusion and ankle replacement, are extremely painful. Moreover, there is increasing interest in performing these procedures in an outpatient setting. Nerve blocks are extensively used in foot and ankle surgery, and commonly used techniques include sciatic nerve block with saphenous nerve augmentation; ankle block; and local, digital, or field block. Whereas more extensive blocks are associated with increased medical risk, higher cost, and delayed ambulation, more local approaches may not provide an adequate duration of effect. EXPAREL® (bupivacaine liposome injectable suspension) is an extended-release local anesthetic that can be infiltrated directly into the surgical site by the orthopedic surgeon to provide continuous and effective analgesia at the site of surgical injury for up to 72 hours. Two cases that illustrate the use of EXPAREL® in foot and ankle surgery are described. The first case involves ankle replacement in an active 58-year-old man with a 20-plus-year history of arthritis. The second case involves a young woman undergoing surgery for a talar neck fracture-dislocation with an open injury, dislocated subtalar joint, avascular talus, and considerable deformity. Both patients reported excellent control of postsurgical pain. PMID:25303454

  11. A fracture mechanics analysis of adhesive failure in a single lap shear joint.

    NASA Technical Reports Server (NTRS)

    Devries, K. L.; Williams, M. L.; Chang, M. D.

    1972-01-01

    Discussion of adhesive fracture of single lap shear joints in terms of a maximum stress criterion and an energy balance. The Goland and Reissner (1944) analysis is used to determine the stress distribution in the adhesive assembly, and the results obtained are introduced into an energy balance to determine the initiation of adhesive fracture. In the stress analysis the loads at the edges of the joint are first determined. This is a problem in which the deformation of the joint sheets must be taken into account and is solved by using the finite-deflection theory of cylindrically bent plates. Then the stress in the joint due to applied loads is determined. This problem is formulated as one in plane strain consisting of two rectangular sheets of equal thickness and unit width. With the aid of this stress analysis and the stresses obtained from the conditions of equilibrium the contributions to the energy change with crack length are calculated. The analysis performed is then compared with a maximum stress criterion for a lap joint.

  12. Evolving fracture patterns: columnar joints, mud cracks and polygonal terrain.

    PubMed

    Goehring, Lucas

    2013-01-01

    When cracks form in a thin contracting layer, they sequentially break the layer into smaller and smaller pieces. A rectilinear crack pattern encodes information about the order of crack formation, as later cracks tend to intersect with earlier cracks at right angles. In a hexagonal pattern, in contrast, the angles between all cracks at a vertex are near 120°. Hexagonal crack patterns are typically seen when a crack network opens and heals repeatedly, in a thin layer, or advances by many intermittent steps into a thick layer. Here, it is shown how both types of pattern can arise from identical forces, and how a rectilinear crack pattern can evolve towards a hexagonal one. Such an evolution is expected when cracks undergo many opening cycles, where the cracks in any cycle are guided by the positions of cracks in the previous cycle but when they can slightly vary their position and order of opening. The general features of this evolution are outlined and compared with a review of the specific patterns of contraction cracks in dried mud, polygonal terrain, columnar joints and eroding gypsum-sand cements.

  13. 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

  14. Effect of bond thickness on fracture and fatigue strength of adhesively bonded composite joints

    NASA Technical Reports Server (NTRS)

    Mall, S.; Ramamurthy, G.

    1989-01-01

    An experimental investigation of composite to composite bonded joints was undertaken to study the effect of bond thickness on debond growth rate under cyclic loading and critical strain energy release rate under static loading. Double cantilever beam specimens of graphite/epoxy adherends bonded with EC 3445 were tested under mode I loading. A different behavior of fracture and fatigue strength was observed with variation of bondline thickness.

  15. Reliability of sagittal plane hip, knee, and ankle joint angles from a single frame of video data using the GAITRite camera system.

    PubMed

    Ross, Sandy A; Rice, Clinton; Von Behren, Kristyn; Meyer, April; Alexander, Rachel; Murfin, Scott

    2015-01-01

    The purpose of this study was to establish intra-rater, intra-session, and inter-rater, reliability of sagittal plane hip, knee, and ankle angles with and without reflective markers using the GAITRite walkway and single video camera between student physical therapists and an experienced physical therapist. This study included thirty-two healthy participants age 20-59, stratified by age and gender. Participants performed three successful walks with and without markers applied to anatomical landmarks. GAITRite software was used to digitize sagittal hip, knee, and ankle angles at two phases of gait: (1) initial contact; and (2) mid-stance. Intra-rater reliability was more consistent for the experienced physical therapist, regardless of joint or phase of gait. Intra-session reliability was variable, the experienced physical therapist showed moderate to high reliability (intra-class correlation coefficient (ICC) = 0.50-0.89) and the student physical therapist showed very poor to high reliability (ICC = 0.07-0.85). Inter-rater reliability was highest during mid-stance at the knee with markers (ICC = 0.86) and lowest during mid-stance at the hip without markers (ICC = 0.25). Reliability of a single camera system, especially at the knee joint shows promise. Depending on the specific type of reliability, error can be attributed to the testers (e.g. lack of digitization practice and marker placement), participants (e.g. loose fitting clothing) and camera systems (e.g. frame rate and resolution). However, until the camera technology can be upgraded to a higher frame rate and resolution, and the software can be linked to the GAITRite walkway, the clinical utility for pre/post measures is limited.

  16. 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

  17. 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

    2016-05-06

    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.

  18. Ankle Sprains.

    PubMed

    1986-02-01

    In brief: Ankle sprain is a risk for many athletes, especially those in the jumping sports (eg, volleyball and basketball) as well as football and soccer, where players tend to roll over on the ankle. Lateral sprains occur much more frequently than medial eversion sprains, but the latter are more devastating. In addition to types of sprains, this panel of specialists discussed surgical vs nonsurgical treatment, tape vs brace for support, rehabilitation and exercise, and ways to prevent ankle sprains.

  19. Fracture of Sn-Ag-Cu Solder Joints on Cu Substrates: I. Effects of Loading and Processing Conditions

    NASA Astrophysics Data System (ADS)

    Huang, Z.; Kumar, P.; Dutta, I.; Pang, J. H. L.; Sidhu, R.; Renavikar, M.; Mahajan, R.

    2012-02-01

    During service, microcracks form inside solder joints, making microelectronic packages highly prone to failure on dropping. Hence, the fracture behavior of solder joints under drop conditions at high strain rates and under mixed-mode conditions is a critically important design consideration for robust joints. This study reports on the effects of joint processing and loading conditions on the microstructure and fracture response of Sn-3.8%Ag-0.7%Cu (SAC387) solder joints attached to Cu substrates. The impact of parameters which control the microstructure (reflow condition, aging) as well as loading conditions (strain rate and loading angle) are explicitly studied. A methodology based on the calculation of the critical energy release rate, G C, using compact mixed-mode (CMM) samples was developed to quantify the fracture toughness of the joints under conditions of adhesive (i.e., interface-related) fracture. In general, higher strain rate and increased mode-mixity resulted in decreased G C. G C also decreased with increasing dwell time at reflow temperature, which produced a thicker intermetallic layer at the solder-substrate interface. Softer solders, produced by slower cooling following reflow, or post-reflow aging, showed enhanced G C. The sensitivity of the fracture toughness to all of the aforementioned parameters reduced with an increase in the mode-mixity. Fracture mechanisms, elucidating the effects of the loading conditions and process parameters, are briefly highlighted.

  20. 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.

  1. 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

  2. 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

  3. 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 ...

  4. Extension block pinning for the treatment of a dorsal fracture dislocation of the distal interphalangeal joint: case report.

    PubMed

    Xiong, Ge; Zheng, Wei; Wang, Shuhuan

    2008-01-01

    A relatively rare case of dorsal dislocation of the distal interphalangeal (DIP) joint associated with compression fracture of volar base of the distal phalanx is presented. An extension block pin was used to maintain the reduction of the DIP joint during active flexion and extension exercise after surgery. At 49-month follow-up, the clinical results and radiographic findings were satisfactory.

  5. 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

  6. 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

  7. Fracture analysis of multi-site cracking in fuselage lap joints

    NASA Astrophysics Data System (ADS)

    Beuth, J. L.; Hutchinson, J. W.

    1994-09-01

    A two-dimensional plane stress elastic fracture mechanics analysis of a cracked lap joint fastened by rigid pins is presented and results are applied to the problem of multi-site damage (MSD) in riveted lap joints of aircraft fuselage skins. Two problems are addressed, the problem of equal length MSD cracks and the problem of alternating length MSD cracks. For the problem of equal length cracks, two models of rivet/skin interactions are studied and the role of residual stresses due to the riveting process is explored. Stress intensity factors are obtained as a function of normalized crack length. Also, the load distribution among rivet rows and the compliance change of the joint due to MSD cracking are obtained. For the problem of alternating length cracks, attention is focussed on how load is distributed between columns of rivets and how this load shedding can alter crack tip stress intensity factors. The equal and alternating length crack analyses reveal no clear-cut mechanism to explain the relative uniformity of fatigue cracks emerging from lap joint rivet holes in actual aircraft and in mechanical lap joint tests.

  8. 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

  9. Operative exploration and reduction of syndesmosis in Weber type C ankle injury

    PubMed Central

    Yang, Yunfeng; Zhou, Jiaqian; Li, Bing; Zhao, Hongmou; Yu, Tao; Yu, Guangrong

    2013-01-01

    OBJECTIVE: To investigate the surgical methods in treating Weber type C ankle injury and estimate the necessity of syndesmosis operative exploration. METHODS: Forty three patients of Weber type C ankle injury were treated with open reduction and internal fixation from October 2004 to December 2009. Twenty nine patients were treated with routine procedure by open reduction and internal fixation, syndesmosis exploration and repair were performed in addition in the others. Thirty four patients were followed during an average time of 31.2 months (range 18 to 50 months), amomg them 22 patients were treated with routine procedures and 12 were treated with additional syndesmosis surgical exploration. RESULTS: All the fractures were reunited in an average time of 13.1 weeks (range 10 to 18 weeks) and full weight bearing began. The mean ankle and hindfoot scale of the American Orthopaedic Foot and Ankle Society (AOFAS) score was 79.86(range 65 to 98) in the routine procedures group and 86.67 (range 78 to 100) in the syndesmosis exploration group and Olerud-Molander score was 77.27 (range 55 to 100) and 86.67 (range 75 to 100) respectively. Statistically significant difference was found between the two groups (P<0.05). CONCLUSION: Syndesmosis surgical exploration is an essential treatment in some Weber type C ankle injuries, which make debridement and direct reduction of the syndesmosis possible, providing thus a more stabilized ankle joint. Level of Evidence III, Retrospective Comparative Study PMID:24453652

  10. [Combined treatment of long tubular bone fractures and false joints using the bioplastic material collapan (Russia)].

    PubMed

    Kesian, G A; Berchenko, G N; Urazgil'deev, R Z; Arsen'ev, I G; Mikelaishvili, D S; Karapetian, G S

    2008-01-01

    This experimental morphological study on 32 dogs was designed to evaluate the efficiency of hydroxyapatite containing preparation collapan used to promote healing of segmented femur defects. Implantation of collapan was shown to greatly contribute to the formation, maturation and remodelling of bone callus. Combined treatment of 165 patients with comminuted fractures and 148 ones with false joints of long tubular bones using collapan implants proved to efficaciously promote bone consolidation in 99.4% of the total 313 subjects. Collapan activated reparative osteogenesis, reduced the duration of hospitalization, the frequency of inflammatory complications, and the requirement of secondary inpatient care.

  11. Posterior malleolus fracture.

    PubMed

    Irwin, Todd A; Lien, John; Kadakia, Anish R

    2013-01-01

    Posterior malleolus fractures are a common component of ankle fractures. The morphology is variable; these fractures range from small posterolateral avulsion injuries to large displaced fracture fragments. The integrity of the posterior malleolus and its ligamentous attachment is important for tibiotalar load transfer, posterior talar stability, and rotatory ankle stability. Fixation of posterior malleolus fractures in the setting of rotational ankle injuries has certain benefits, such as restoring articular congruity and rotatory ankle stability, as well as preventing posterior talar translation, but current indications are unclear. Fragment size as a percentage of the anteroposterior dimension of the articular surface is often cited as an indication for fixation, although several factors may contribute to the decision, such as articular impaction, comminution, and syndesmotic stability. Outcome studies show that, in patients with ankle fractures, the presence of a posterior malleolus fracture negatively affects prognosis. Notable variability is evident in surgeon practice. PMID:23281469

  12. [Reduction of postoperative swelling. Objective measurement of swelling of the upper ankle joint in treatment with serrapeptase-- a prospective study].

    PubMed

    Esch, P M; Gerngross, H; Fabian, A

    1989-02-10

    Using a quantitative standardized procedure, the swelling of the ankle produced by supination trauma was measured. In the 66 patients with fresh rupture of the lateral ligament treated surgically at our Department between December 1986 and April 1987, a prospective study of the effect of serrapeptase (Aniflazym) on post-operative swelling and pain was carried out in 3 randomized groups of patients. In the group receiving the test substance, the swelling had decreased by 50% on the third post-operative day, while in the other two control groups (elevation of the leg, bed rest, with and without the application of ice) no reduction in swelling had occurred at that time. The difference is statistically significant (p = 0.013). Decreasing pain correlated for the most part with the reduction in swelling. Thus, the patients receiving the test substance more rapidly became pain-free than did the control groups. On the basis of these results, serrapeptase would appear to be an effective preparation for the post-operative reduction of swelling, in comparison with the classical conservative measures, for example, the application of ice.

  13. Physical Validation of a Patient-Specific Contact Finite Element Model of the Ankle

    PubMed Central

    Anderson, Donald D.; Goldsworthy, Jane K.; Wendy, Li; Rudert, M. James; Tochigi, Yuki; Brown, Thomas D.

    2007-01-01

    A validation study was conducted to determine the extent to which computational ankle contact finite element (FE) results agreed with experimentally measured tibio-talar contact stress. Two cadaver ankles were loaded in separate test sessions, during which ankle contact stresses were measured with a high-resolution (Tekscan) pressure sensor. Corresponding contact FE analyses were subsequently performed for comparison. The agreement was good between FE-computed and experimentally measured mean (3.2% discrepancy for one ankle, 19.3% for the other) and maximum (1.5% and 6.2%) contact stress, as well as for contact area (1.7% and 14.9%). There was also excellent agreement between histograms of fractional areas of cartilage experiencing specific ranges of contact stress. Finally, point-by-point comparisons between the computed and measured contact stress distributions over the articular surface showed substantial agreement, with correlation coefficients of 90% for one ankle, and 86% for the other. In the past, general qualitative, but little direct quantitative agreement has been demonstrated with articular joint contact FE models. The methods used for this validation enable formal comparison of computational and experimental results, and open the way for objective statistical measures of regional correlation between FE-computed contact stress distributions from comparison articular joint surfaces (e.g., those from an intact versus those with residual intra-articular fracture incongruity). PMID:17433333

  14. 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

  15. An unusual variety of simultaneous fracture dislocation pattern: medial swivel dislocation of talonavicular joint with displaced fractures of the fourth and fifth metatarsals.

    PubMed

    Inal, Sermet; Inal, Canan

    2013-01-01

    In published studies, a very rare, special type of Chopart dislocation termed a swivel dislocation has been reported. This injury is characterized by dislocation of the talonavicular joint, but the calcaneocuboid joint remains intact. The foot creates a typical rotational movement without inversion or eversion. The axis of rotation is the interosseous talocalcaneal ligament, which remains intact. We report the case of an 18-year-old male who had experienced a medial swivel dislocation of the talonavicular joint associated with displaced fractures of the fourth and fifth metatarsals. The occurrence, features, and method of treatment of this rare injury are presented.

  16. 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

  17. Effects of laser heat treatment on the fracture morphologies of X80 pipeline steel welded joints by stress corrosion

    NASA Astrophysics Data System (ADS)

    Kong, De-jun; Ye, Cun-dong

    2014-09-01

    The surfaces of X80 pipeline steel welded joints were processed with a CO2 laser, and the effects of laser heat treatment (LHT) on H2S stress corrosion in the National Association of Corrosion Engineers (NACE) solution were analyzed by a slow strain rate test. The fracture morphologies and chemical components of corrosive products before and after LHT were analyzed by scanning electron microscopy and energy-dispersive spectroscopy, respectively, and the mechanism of LHT on stress corrosion cracking was discussed. Results showed that the fracture for welded joints was brittle in its original state, while it was transformed to a ductile fracture after LHT. The tendencies of hydrogen-induced corrosion were reduced, and the stress corrosion sensitivity index decreased from 35.2% to 25.3%, indicating that the stress corrosion resistance of X80 pipeline steel welded joints has been improved by LHT.

  18. Individual-specific muscle maximum force estimation using ultrasound for ankle joint torque prediction using an EMG-driven Hill-type model.

    PubMed

    de Oliveira, Liliam Fernandes; Menegaldo, Luciano Luporini

    2010-10-19

    EMG-driven models can be used to estimate muscle force in biomechanical systems. Collected and processed EMG readings are used as the input of a dynamic system, which is integrated numerically. This approach requires the definition of a reasonably large set of parameters. Some of these vary widely among subjects, and slight inaccuracies in such parameters can lead to large model output errors. One of these parameters is the maximum voluntary contraction force (F(om)). This paper proposes an approach to find F(om) by estimating muscle physiological cross-sectional area (PCSA) using ultrasound (US), which is multiplied by a realistic value of maximum muscle specific tension. Ultrasound is used to measure muscle thickness, which allows for the determination of muscle volume through regression equations. Soleus, gastrocnemius medialis and gastrocnemius lateralis PCSAs are estimated using published volume proportions among leg muscles, which also requires measurements of muscle fiber length and pennation angle by US. F(om) obtained by this approach and from data widely cited in the literature was used to comparatively test a Hill-type EMG-driven model of the ankle joint. The model uses 3 EMGs (Soleus, gastrocnemius medialis and gastrocnemius lateralis) as inputs with joint torque as the output. The EMG signals were obtained in a series of experiments carried out with 8 adult male subjects, who performed an isometric contraction protocol consisting of 10s step contractions at 20% and 60% of the maximum voluntary contraction level. Isometric torque was simultaneously collected using a dynamometer. A statistically significant reduction in the root mean square error was observed when US-obtained F(om) was used, as compared to F(om) from the literature.

  19. The Independent and Joint Association of Blood Pressure, Serum Total Homocysteine, and Fasting Serum Glucose Levels With Brachial-Ankle Pulse Wave Velocity in Chinese Hypertensive Adults.

    PubMed

    Liu, Xiaoyun; Sun, Ningling; Yu, Tao; Fan, Fangfang; Zheng, Meili; Qian, Geng; Wang, Binyan; Wang, Yu; Tang, Genfu; Li, Jianping; Qin, Xianhui; Hou, Fanfan; Xu, Xiping; Yang, Xinchun; Chen, Yundai; Wang, Xiaobin; Huo, Yong

    2016-09-28

    This study aimed to investigate the independent and joint association of blood pressure (BP), homocysteine (Hcy), and fasting blood glucose (FBG) levels with brachial-ankle pulse wave velocity (baPWV, a measure of arterial stiffness) in Chinese hypertensive adults.The analyses included 3967 participants whose BP, Hcy, FBG, and baPWV were measured along with other covariates. Systolic BP (SBP) was analyzed as 3 categories (SBP < 160 mmHg; 160 to 179 mmHg; ≥ 180 mmHg); Hcy as 3 categories (< 10 μmol/L; 10 to 14.9 μmol/L; ≥ 15.0 μmol/L) and FBG: normal (FBG < 5.6 mmol/L), impaired (5.6 mmol/L ≤ FBG < 7.0 mmol/L), and diabetes mellitus (FBG ≥ 7.0 mmol/L). We performed linear regression analyses to evaluate their associations with baPWV with adjustment for covariables.When analyzed individually, BP, Hcy, and FBG were each associated with baPWV. When BP and FBG were analyzed jointly, the highest baPWV value (mean ± SD: 2227 ± 466 cm/s) was observed in participants with FBG ≥ 7.0 mmol/L and SBP ≥ 180 mmHg (β = 432.5, P < 0.001), and the lowest baPWV value (mean ± SD: 1692 ± 289 cm/s) was seen in participants with NFG and SBP < 160 mmHg. When Hcy and FBG were analyzed jointly, the highest baPWV value (2072 ± 480 cm/s) was observed in participants with FBG ≥ 7.0 mmol/L and Hcy ≥ 15.0 μmol/L (β = 167.6, P < 0.001), while the lowest baPWV value (mean ± SD: 1773 ± 334 cm/s) was observed in participants with NFG and Hcy < 10 μmol/L.In Chinese hypertensive adults, SBP, Hcy, and FBG are individually and jointly associated with baPWV.Our findings underscore the importance of identifying individuals with multiple risk factors of baPWV including high SBP, FBG, and Hcy.

  20. 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.

  1. Arthroscopic Management of Complications Following Total Ankle Replacement.

    PubMed

    Lui, Tun Hing; Roukis, Thomas S

    2015-10-01

    There is great potential of managing the complications of total ankle replacement arthroscopically and endoscopically, and these procedures can be summarized into 3 groups. Group 1 includes procedures of the ankle joint proper with close proximity to the articular components of the total ankle replacement. Group 2 includes procedures of the tibia and talus with close proximity to the nonarticular parts of the total ankle replacement. Group 3 includes procedures that are away from the total ankle replacement. However, these remain master arthroscopist procedures and should be performed by foot and ankle surgeons who perform them with regularity.

  2. Metatarsal stress fractures - aftercare

    MedlinePlus

    The metatarsal bones are the long bones in your foot that connect your ankle to your toes. A stress fracture is a break in the bone that happens with repeated injury or stress. Stress fractures are caused ...

  3. Combined Posterior and Anterior Ankle Arthroscopy

    PubMed Central

    Scholten, Peter E.; van Dijk, C. Niek

    2012-01-01

    Treatment of combined anterior and posterior ankle pathology usually consists of either combined anterior and posterior arthrotomies or anterior ankle arthroscopy with an additional posterolateral portal. The first technique bears the risk of complications associated with the extensive exposure, the latter technique provides limited access to the posterior ankle joint. A case is described of combined anterior and posterior arthroscopy, with the patient lying prone and then turned supine, addressing both anterior and posterior ankle pathologies in one tempo. This minimally invasive combined approach allows quick recovery and early return to work and sports activities. PMID:23227391

  4. [Topographological-anatomic changes in the structure of temporo-mandibular joint in case of fracture of the mandible condylar process at cervical level].

    PubMed

    Volkov, S I; Bazhenov, D V; Semkin, V A

    2011-01-01

    Pathological changes in soft tissues surrounding the fracture site as well as in the structural elements of temporo-mandibular joint always occured in condylar process fracture with shift at cervical mandibular jaw level. Other changes were also seen in the joint on the opposite normal side. Modelling of condylar process fracture at mandibular cervical level by means of three-dimensional computer model of temporo-mandibular joint contributed to proper understanding of this pathology emergence as well as to prediction and elimination of disorders arising in adjacent to the fracture site tissues.

  5. 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 ...

  6. 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.

  7. 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.

  8. 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.

  9. 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

  10. 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

  11. 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.

  12. Ankle osteoarthritis: etiology, diagnostics, and classification.

    PubMed

    Barg, Alexej; Pagenstert, Geert I; Hügle, Thomas; Gloyer, Marcel; Wiewiorski, Martin; Henninger, Heath B; Valderrabano, Victor

    2013-09-01

    Osteoarthritis (OA) is defined as the syndrome of joint pain and dysfunction caused by substantial joint degeneration. In general, OA is the most common joint disease and is one of the most frequent and symptomatic health problems for middle-aged and older people: OA disables more than 10% of people who are older than 60 years. This article reviews the etiology of ankle OA, and describes the onset and development of posttraumatic ankle OA, the most common form of OA in the tibiotalar joint. Various methods of clinical and radiographic assessment are described in detail.

  13. 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.

  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.

  15. The foot and ankle examination.

    PubMed

    Papaliodis, Dean N; Vanushkina, Maria A; Richardson, Nicholas G; DiPreta, John A

    2014-03-01

    Most foot and ankle disorders can be diagnosed after a proper history and clinical examination and can be effectively managed in a primary care setting. It is important to assess the entirety of patient disorders that present as they can be multifactorial in cause. A broad differential should include disorders of bones, joints, muscles, neurovasculature, and surrounding soft tissue structures. Physical examination should be thorough and focused on inspection, palpation, range of motion, and appropriate special tests when applicable. This article highlights some of the salient features of the foot and ankle examination and diagnostic considerations.

  16. External rotation views in the diagnosis of posterior colliculus fracture of the medial malleolus.

    PubMed

    Ebraheim, N A; Wong, F Y

    1996-05-01

    A 25-year-old white man sustained a fracture dislocation of the right ankle with a displaced fracture of the lateral malleolus while playing basketball. He also sustained a fracture of the medial aspect of the distal tibia, in addition to an apparent deltoid ligament injury. The patient underwent open reduction and internal fixation of the lateral malleolus and insertion of a syndesmotic screw. Intraoperatively, external rotation radiographs of the ankle were obtained to determine the origin of the fracture of the medial side of the ankle joint. The radiographs clearly showed a minimally displaced fracture of the posterior colliculus. Posterior colliculus fracture can be occult. This fracture may not be clearly visible on plain antero-posterior or mortise-view radiographs and external rotation is necessary for its diagnosis. This fracture is usually minimally displaced and can be satisfactorily treated conservatively. The patient's leg was placed in a short-leg cast for 6 weeks. Follow-up radiographs revealed healing of the fracture.

  17. 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.

  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. Participation in sports after arthrodesis of the foot or ankle.

    PubMed

    Vertullo, Christopher J; Nunley, James A

    2002-07-01

    Currently no data or guidelines exist for the surgeon on how to advise patients about returning to sports participation after arthrodesis within the foot or ankle. Sequelae of inappropriate activity after arthrodesis includes periarticular arthrosis, arthrodesis failure and stress fracture. Some arthrodeses will preclude certain sports because it limits the patient's ability to perform movement vital to the game, for example, ankle arthrodesis preventing basketball players from jumping. Questionnaires were sent to members of the American Orthopaedic Foot and Ankle Society (AOFAS) and to trainers of professional basketball and American football teams. This paper reports on the responses of orthopaedic foot and ankle surgeons about return to sports participation, after arthrodeses within the foot and ankle, and suggests guidelines for sports participation after an arthrodesis of the lower extremity. A selective sports participation policy is advised. Patients with an ankle or triple fusion should avoid high-impact sports, while those with more distal arthrodeses should be monitored for arthrosis and stress fracture.

  20. 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.

  1. Extraarticular Supramalleolar Osteotomy for Managing Varus Ankle Osteoarthritis, Alternatives for Osteotomy: How and Why?

    PubMed

    Lee, Woo-Chun

    2016-03-01

    The supramalleolar osteotomy has been reported to be a joint preserving surgery with good clinical outcome for asymmetric ankle osteoarthritis, especially varus ankle osteoarthritis. Conventional supramalleolar osteotomy of the tibia and fibula creates angulation and translation of the ankle joint without changing the width of the ankle mortise. Distal tibial oblique osteotomy improved the preoperative clinical and radiological parameters; however, mean talar tilt angle did not decrease. Assessment of the ankle arthritis in sagittal, axial, and coronal planes may be helpful to achieve a decrease of the talar tilt in ankle osteoarthritis.

  2. Does metaphyseal cement augmentation in fracture management influence the adjacent subchondral bone and joint cartilage?: an in vivo study in sheep stifle joints.

    PubMed

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

    2015-01-01

    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.

  3. 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

  4. Ankle impingement syndromes: a review of etiology and related implications.

    PubMed

    Hess, Gregory William

    2011-10-01

    Ankle injuries are common occurrences in athletics involving and requiring extreme ranges of motion. Ankle sprains specifically occur with a 1 in 10,000 person rate in active individuals each day. If trauma is repetitive, the ankle structures have potential to experience secondary injury and dysfunction. Included in this category of dysfunction are both anterior and posterior ankle impingement syndromes where disruption of the bony structures, joint capsule, ligaments, and tendons typically occurs. Ankle impingement is described as ankle pain that occurs during athletic activity, with recurrent, extreme dorsiflexion or plantar flexion with the joint under a load. Ankle impingements can be classified according to what structures become involved both anteriorly and posteriorly. Osseous impingement, soft tissue impingement, impingement of the distal fascicle of anterior inferior tibiofibular ligament, and meniscoid lesions are all documented causes of ankle impingement. These changes tend to be brought about and exacerbated by extreme ranges of motion. Understanding various impingement types will better enable the clinician to prevent, identify, treat, and rehabilitate affected ankles. Acknowledging activities that predispose to ankle impingement syndrome will enhance prevention and recovery processes. Description of ankle impingement etiology and pathology is the objective of the current review.

  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. 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.

  7. 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

  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. 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.

  10. The knees and ankles in sport and veteran military parachutists.

    PubMed Central

    Murray-Leslie, C F; Lintott, D J; Wright, V

    1977-01-01

    112 actively parachuting sport (free fall) parachutists with more than 200 descents each and 109 veteran military parachutists no longer active returned a postal questionnaire about their parachuting activities, injuries, and current and past musculoskeletal symptoms. A high frequency of fractures and injuries was reported by each group, both in relation to parachuting and to other activities. 58 sport parachutists aged 23 to 57 years (mean 33 - 3 years) had weight-bearing anteroposterior and lateral radiographs taken of each knee. These showed a prevalence of radiological osteoarthrosis of 10 - 4% which was mild in degree in all but one knee in one subject. 46 ex-military parachutists aged 50 to 70 years (mean 55 - 2 years) had weight-bearing anteroposterior radiographs taken of both knees and showed a prevalence of radiological osteroarthrosis of 41 - 3%. Moderate and severe changes were found in 10 - 9%. In both groups of parachutists six of the eight knee joints showing either moderate or severe radiological osteroarthrosis had been subjected to a previous meniscectomy. Forty ex-military parachutists had anteroposterior radiographs of the ankles (talotibial articulation) and showed a prevalence of osteoarthrosis of 17 - 5%, with the majority showing mild changes. There was a poor correlation between radiological osteoarthrosis, ankle symptoms, and previous fractures. With the reservation that the great majority of the sport group are still young (95% aged less than 50 years), it is concluded that parachutists as a group do not show an increased prevalence of radiological osteoarthrosis of the knee or ankle. PMID:409358

  11. 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

  12. A dual injury of the shoulder: acromioclavicular joint dislocation (type IV) coupled with ipsilateral mid-shaft clavicle fracture.

    PubMed

    Madi, Sandesh; Pandey, Vivek; Khanna, Vikrant; Acharya, Kiran

    2015-11-23

    A direct blow to the shoulder, as may be sustained in a road traffic accident (RTA), can result in various combinations of fracture dislocations in the shoulder joint complex. Among these, a rare variety is an acromioclavicular joint (ACJ) dislocation coupled with ipsilateral mid-shaft clavicle fracture. Diverse treatment options have been described in the literature, ranging from non-operative and operative, to hybrid management. Treatment for this complex injury is predominantly dictated by the type of dislocation and displacement of the clavicle fracture, as well as age and demand of the patient. Acute high grades of ACJ dislocation require restoration of the coracoclavicular relationship (in place of torn coracoclavicular (CC) ligament) by some form of internal fixation, thereby maintaining the ACJ reduction. An arthroscopic reinstatement of the coracoclavicular relationship using a dog bone button and fibre tape implant for this composite injury pattern has not been previously described. Furthermore, a comprehensive review of the literature associated with this injury pattern is briefly described.

  13. Factors affecting the functional results of open reduction and internal fixation for fracture-dislocations of the proximal interphalangeal joint.

    PubMed

    Watanabe, Kentaro; Kino, Yoshitake; Yajima, Hiroki

    2015-01-01

    To clarify the factors affecting functional results of fracture-dislocations of the proximal interphalangeal (PIP) joint treated by open reduction and internal fixation (ORIF), 60 patients, including 38 patients with a dorsal fracture-dislocation and 22 with a pilon fracture, were analysed. The mean ratio of articular surface involvement was 48.5% and a depressed central fragment existed in 75.3% of the cases. ORIF was performed in 47 patients through a lateral approach using Kirschner wires and in 13 through a palmar approach using a plate or screws. The mean flexion, extension and range of motion (ROM) of the PIP joint was 89.5°, 11.5° and 78.0°, respectively. Stepwise regression analysis revealed that a delayed start of active motion exercise after surgery, elderly age and ulnar ray digit were factors affecting functional outcomes. Although ORIF allows accurate restoration of the articular surfaces, an early start of motion exercise is essential for good results.

  14. 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

  15. 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

  16. 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.

  17. The management of hip fracture in the older population. Joint position statement by Gruppo Italiano Ortogeriatria (GIOG).

    PubMed

    Pioli, Giulio; Barone, A; Mussi, C; Tafaro, L; Bellelli, G; Falaschi, P; Trabucchi, M; Paolisso, G

    2014-10-01

    This document is a Joint Position Statement by Gruppo Italiano di OrtoGeriatria (GIOG) supported by Società Italiana di Gerontologia e Geriatria (SIGG), and Associazione Italiana Psicogeriatria (AIP) on management of hip fracture older patients. Orthogeriatric care is at present the best model of care to improve results in older patients after hip fracture. The implementation of orthogeriatric model of care, based on the collaboration between orthopaedic surgeons and geriatricians, must take into account the local availability of resources and facilities and should be integrated into the local context. At the same time the programme must be based on the best available evidences and planned following accepted quality standards that ensure the efficacy of the intervention. The position paper focused on eight quality standards for the management of hip fracture older patients in orthogeriatric model of care. The GIOG promotes the development of a clinic database with the aim of obtaining a qualitative improvement in the management of hip fracture. PMID:24566982

  18. 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

  19. An instrumented pendulum system for measuring energy absorption during fracture insult to large animal joints in vivo.

    PubMed

    Diestelmeier, B W; Rudert, M J; Tochigi, Y; Baer, T E; Fredericks, D C; Brown, T D

    2014-06-01

    For systematic laboratory studies of bone fractures in general and intra-articular fractures in particular, it is often necessary to control for injury severity. Quantitatively, a parameter of primary interest in that regard is the energy absorbed during the injury event. For this purpose, a novel technique has been developed to measure energy absorption in experimental impaction. The specific application is for fracture insult to porcine hock (tibiotalar) joints in vivo, for which illustrative intra-operative data are reported. The instrumentation allowed for the measurement of the delivered kinetic energy and of the energy passed through the specimen during impaction. The energy absorbed by the specimen was calculated as the difference between those two values. A foam specimen validation study was first performed to compare the energy absorption measurements from the pendulum instrumentation versus the work of indentation performed by an MTS machine. Following validation, the pendulum apparatus was used to measure the energy absorbed during intra-articular fractures created in 14 minipig hock joints in vivo. The foam validation study showed close correspondence between the pendulum-measured energy absorption and MTS-performed work of indentation. In the survival animal series, the energy delivered ranged from 31.5 to 48.3 Js (41.3±4.0, mean±s.d.) and the proportion of energy absorbed to energy delivered ranged from 44.2% to 64.7% (53.6%±4.5%). The foam validation results support the reliability of the energy absorption measure provided by the instrumented pendulum system. Given that a very substantial proportion of delivered energy passed--unabsorbed--through the specimens, the energy absorption measure provided by this novel technique arguably provides better characterization of injury severity than is provided simply by energy delivery.

  20. 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 ...

  1. 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

  2. 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.

  3. Clinical therapeutic effects of AO/ASIF clavicle hook plate on distal clavicle fractures and acromioclavicular joint dislocations

    PubMed Central

    Dou, Qingjun; Ren, Xiaofeng

    2014-01-01

    Objective: The aim of this study was to evaluate the security and effectiveness of AO/ASIF clavicle hook plate in the treatment of distal clavicle fractures and acromioclavicular joint dislocations. Methods: One hundred patients with distal clavicle fractures and acromioclavicular joint dislocations who were admitted in our hospital from January 2012 to January 2013 were selected as the study subjects. They were then randomly divided into a control group and an observation group (n=50). The observation group was treated with AO/ASIF clavicle hook plates, and the control group was treated with Kirschner-wire tension bands. The outcomes were recorded and compared. Results: The JOA scores of the two groups were similar before surgery (P>0.05). The two groups both had obviously increased JOA scores in the postoperative 6th and 12th weeks, and the score in the postoperative 12th week was higher. There were statistically significant intra-group differences (P<0.05). The postoperative 6th-week and 12th-week JOA scores of the observation group were (83.2±1.8) and (97.4±1.5) respectively, and those of the control group were (71.6±2.2) and (82.3±2.6) respectively, with statistically significant inter-group differences (P<0.05). Significantly more patients in the observation group (100%) were evaluated as excellent or good outcomes after fixation than those in the control group (60%). After removal of the surgical apparatus, the recurrence rates of bone fracture and joint dislocation in the observation group were significantly lower than those of the control group (P<0.05). Conclusion: AO/ASIF clavicle hook plate functioned more effectively than Kirschner-wire tension band in clinical treatment of distal clavicle fractures and acromioclavicular joint dislocations. The former protocol enjoyed small incisions, firm fixation and early shoulder mobility. Therefore, it is a safe and effective surgical method that is worthy of being widely applied in clinical practice. PMID

  4. Preliminary results on the fracture analysis of multi-site cracking of lap joints in aircraft skins

    NASA Astrophysics Data System (ADS)

    Beuth, J. L., Jr.; Hutchinson, John W.

    1992-07-01

    Results of a fracture mechanics analysis relevant to fatigue crack growth at rivets in lap joints of aircraft skins are presented. Multi-site damage (MSD) is receiving increased attention within the context of problems of aging aircraft. Fracture analyses previously carried out include small-scale modeling of rivet/skin interactions, larger-scale two-dimensional models of lap joints similar to that developed here, and full scale three-dimensional models of large portions of the aircraft fuselage. Fatigue testing efforts have included flat coupon specimens, two-dimensional lap joint tests, and full scale tests on specimens designed to closely duplicate aircraft sections. Most of this work is documented in the proceedings of previous symposia on the aging aircraft problem. The effect MSD has on the ability of skin stiffeners to arrest the growth of long skin cracks is a particularly important topic that remains to be addressed. One of the most striking features of MSD observed in joints of some test sections and in the joints of some of the older aircraft fuselages is the relative uniformity of the fatigue cracks from rivet to rivet along an extended row of rivets. This regularity suggests that nucleation of the cracks must not be overly difficult. Moreover, it indicates that there is some mechanism which keeps longer cracks from running away from shorter ones, or, equivalently, a mechanism for shorter cracks to catch-up with longer cracks. This basic mechanism has not been identified, and one of the objectives of the work is to see to what extent the mechanism is revealed by a fracture analysis of the MSD cracks. Another related aim is to present accurate stress intensity factor variations with crack length which can be used to estimate fatigue crack growth lifetimes once cracks have been initiated. Results are presented which illustrate the influence of load shedding from rivets with long cracks to neighboring rivets with shorter cracks. Results are also included

  5. Preliminary results on the fracture analysis of multi-site cracking of lap joints in aircraft skins

    NASA Technical Reports Server (NTRS)

    Beuth, J. L., Jr.; Hutchinson, John W.

    1992-01-01

    Results of a fracture mechanics analysis relevant to fatigue crack growth at rivets in lap joints of aircraft skins are presented. Multi-site damage (MSD) is receiving increased attention within the context of problems of aging aircraft. Fracture analyses previously carried out include small-scale modeling of rivet/skin interactions, larger-scale two-dimensional models of lap joints similar to that developed here, and full scale three-dimensional models of large portions of the aircraft fuselage. Fatigue testing efforts have included flat coupon specimens, two-dimensional lap joint tests, and full scale tests on specimens designed to closely duplicate aircraft sections. Most of this work is documented in the proceedings of previous symposia on the aging aircraft problem. The effect MSD has on the ability of skin stiffeners to arrest the growth of long skin cracks is a particularly important topic that remains to be addressed. One of the most striking features of MSD observed in joints of some test sections and in the joints of some of the older aircraft fuselages is the relative uniformity of the fatigue cracks from rivet to rivet along an extended row of rivets. This regularity suggests that nucleation of the cracks must not be overly difficult. Moreover, it indicates that there is some mechanism which keeps longer cracks from running away from shorter ones, or, equivalently, a mechanism for shorter cracks to catch-up with longer cracks. This basic mechanism has not been identified, and one of the objectives of the work is to see to what extent the mechanism is revealed by a fracture analysis of the MSD cracks. Another related aim is to present accurate stress intensity factor variations with crack length which can be used to estimate fatigue crack growth lifetimes once cracks have been initiated. Results are presented which illustrate the influence of load shedding from rivets with long cracks to neighboring rivets with shorter cracks. Results are also included

  6. Measurement of passive ankle stiffness in subjects with chronic hemiparesis using a novel ankle robot

    PubMed Central

    Roy, Anindo; Bever, Christopher T.; Forrester, Larry W.; Macko, Richard F.; Hogan, Neville

    2011-01-01

    Our objective in this study was to assess passive mechanical stiffness in the ankle of chronic hemiparetic stroke survivors and to compare it with those of healthy young and older (age-matched) individuals. Given the importance of the ankle during locomotion, an accurate estimate of passive ankle stiffness would be valuable for locomotor rehabilitation, potentially providing a measure of recovery and a quantitative basis to design treatment protocols. Using a novel ankle robot, we characterized passive ankle stiffness both in sagittal and in frontal planes by applying perturbations to the ankle joint over the entire range of motion with subjects in a relaxed state. We found that passive stiffness of the affected ankle joint was significantly higher in chronic stroke survivors than in healthy adults of a similar cohort, both in the sagittal as well as frontal plane of movement, in three out of four directions tested with indistinguishable stiffness values in plantarflexion direction. Our findings are comparable to the literature, thus indicating its plausibility, and, to our knowledge, report for the first time passive stiffness in the frontal plane for persons with chronic stroke and older healthy adults. PMID:21346215

  7. 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

  8. Management of Osseous and Soft-Tissue Ankle Equinus During Total Ankle Replacement.

    PubMed

    Roukis, Thomas S; Simonson, Devin C

    2015-10-01

    Obtaining functional alignment of a total ankle replacement, including physiologic sagittal plane range of motion, is paramount for a successful outcome. This article reviews the literature on techniques available for correction of osseous and soft-tissue equinus at the time of index total ankle replacement. These techniques include anterior tibiotalar joint cheilectomy, posterior superficial muscle compartment lengthening, posterior ankle capsule release, and release of the posterior portions of the medial and lateral collateral ligament complexes. The rationale for these procedures and the operative sequence of events for these procedures are presented.

  9. Effect of treadmill walking with ankle stretching orthosis on ankle flexibility and gait

    PubMed Central

    Cho, Young-ki; Kim, Si-hyun; Jeon, In-cheol; Ahn, Sun-hee; Kwon, Oh-yun

    2015-01-01

    [Purpose] The purpose of this study was to evaluate the kinematics of the ankle in the lunge to estabilish effectiveness of an ankle stretching orthosis (ASO) on the ankle dorsiflexion range of motion (ROM) of individuals with limited dorsiflexion ROM. [Subjects and Methods] Forty ankles with decreased dorsiflexion ROM of 20 participants were evaluated in this study. After wearing the ASO, participants walked on a treadmill for 15 minutes. Participants walked on the treadmill at a self-selected comfortable speed. Ankle dorsiflexion ROM, maximum dorsiflexion ROM before heel-off, and time to heel-off during the stance phase of gait were measured before and after 15 minutes of treadmill walking with the ASO. The differences in all variables between before and after treadmill walking with ASO were analyzed using the paired t-test. [Results] Ankle active and passive ROM, and dorsiflexion ROM during lunge increased significantly after treadmill walking with ASO. Treadmill walking with the ASO significantly increased the angle of maximal dorsiflexion before heel-off and time to heel-off during the stance phase. [Conclusion] The results of this study show that treadmill walking with the ASO effectively improved ankle flexibility and restored the normal gait pattern of the ankle joint by increasing dorsiflexion ROM, maximal angle of dorsiflexion, and time to heel-off in the stance phase. PMID:25995601

  10. Ankle replacement - discharge

    MedlinePlus

    Murphy GA. Total ankle arthroplasty. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics . 12th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 10. Wexler D, Grosser DM. Ankle arthrtitis. ...

  11. Salvage arthrodesis for failed total ankle arthroplasty

    PubMed Central

    Zürcher, Arthur W

    2010-01-01

    Background and purpose Total ankle arthroplasty (TAA) has gained popularity in recent years. If it fails, however, salvage arthrodesis must be reliable as a rescue procedure. We therefore investigated the clinical, radiographic, and subjective outcome after salvage arthrodesis in a consecutive group of patients, and concentrated on the influence of the method of fixation on union rate and on salvage in inflammatory joint disease. Patients and methods Between 1994 and 2005, salvage arthrodesis was performed on 18 ankles (18 patients). Diagnosis was inflammatory joint disease (IJD) in 15 cases and osteoarthritis (OA) in 3. Tibio-talar fusion was performed in 7 ankles, and tibio-talocalcaneal fusion in 11. Serial radiographs were studied for time to union. Clinical outcome at latest follow-up was measured by the AOFAS score, the foot function index (FFI) and by VAS scores for pain, function, and satisfaction. Results Blade plates were used in 7 ankles (4 IJD, 3 OA); all united. Nonunion developed in 7 of the 11 rheumatic ankles stabilized by other methods. 11 patients (8 fused ankles, 3 nonunions) were available for clinical evaluation. Their mean AOFAS score was 62 and mean overall FFI was 70. VAS score for pain was 20, for function 64, and for satisfaction 74. The scores were similar in united and non-united ankles. Interpretation Blade plate fixation is successful in salvage arthrodesis for failed TAA. A high nonunion rate was found after salvage ankle arthrodesis in IJD with other methods of fixation. Clinical results were fair to good. PMID:20175648

  12. 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…

  13. 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.

  14. 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

  15. 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

  16. Are there any relationships among ankle proprioception acuity, pre-landing ankle muscle responses, and landing impact in man?

    PubMed

    Fu, Siu Ngor; Hui-Chan, Christina Wan Ying

    2007-05-01

    Proprioceptive input has been suggested to contribute to the pre-landing muscle responses associated with drop-landing, but its precise role has yet to be delineated. This study set out to examine the relationships among ankle proprioception, pre-landing muscle responses, and landing impact on drop-landing in healthy man. Fifteen healthy male basketball players aged 18 to 26 participated in this study. Passive ankle joint repositioning errors were used to examine ankle joint proprioception. Pre-landing EMG responses in the ankle muscles and the impact force on landing were recorded while the players performed self-initiated drops from a height of 30 cm. Results demonstrated that averaged ankle repositioning errors were significantly correlated with the co-contraction indexes between left tibialis anterior and medial gastrocnemius muscles (TA/MG CoI) (r=0.67, p=0.006), and showed a trend towards a relationship with the right TA/MG CoI (r=0.47, p=0.079). TA/MG CoI from both ankles were further related to the magnitude of the total impact force on landing (r=0.54 and 0.53, respectively; p<0.05). We concluded that male basketball players with less accurate ankle joint sense adopted greater co-contraction of ankle dorsiflexors and platarflexors, which was in turn associated with greater impact force at the moment of landing.

  17. Atlantoaxial Joint Interlocking Following Type II Odontoid Fracture Associated with Posterolateral Atlantoaxial Dislocation: a Case Report and Review of Published Reports.

    PubMed

    He, Deng-Wei; Huang, Wen-Jun; Sheng, Xiao-Yong; Wu, Li-Jun; Fan, Shun-Wu

    2016-08-01

    A rare case of atlantoaxial lateral mass joint interlocking secondary to traumatic posterolateral C1,2 complete dislocation associated with type II odontoid fracture is herein reported and the impact of atlantoaxial joint interlocking on fracture reduction discussed. A 72-year-old man presented with traumatic atlantoaxial lateral mass joint interlocking without spinal cord signal change, the diagnosis being confirmed by radiography and 3-D reconstruction digital anatomy. Posterior internal fixation was performed after failure to achieve closed reduction by skull traction. After many surgical attempts at setting had failed because of interlocking of the lateral mass joints, reduction was achieved by compressing the posterior parts of the atlantal and axial screws. Odontoid bone union and C1,2 posterior bone graft fusion were eventually obtained by the 12-month follow-up. The patient had a complete neurological recovery with no residual neck pain or radiculopathy.

  18. Fracture dislocation of the sacro-coccygeal joint in a 12-year-old boy. A case report and literature review.

    PubMed

    Hamoud, K; Abbas, J

    2015-11-01

    A case report and literature review. To present a rare case of facture dislocation of the sacro-coccygeal joint in a 12-year-old boy who was treated conservatively. Fracture dislocations of the sacrum or the sacro-coccygeal joint are infrequent injuries and are rarely reported. The treatment for these disorders is usually conservative. Detailed description of the anterior dislocation (Salter-Harris type I) of the sacro-coccygeal joint in this child and its management are presented, with review of the relevant literature. A conservative treatment was performed, with excellent clinical and radiological result at three years after the injury. MR imaging obtained at two years showed very good healing and alignment. Fracture dislocation of the sacro-coccygeal joint in the pediatric population should be treated conservatively, as the potential of healing and remodeling is great. Closed reduction should not be attempted.

  19. Atlantoaxial Joint Interlocking Following Type II Odontoid Fracture Associated with Posterolateral Atlantoaxial Dislocation: a Case Report and Review of Published Reports.

    PubMed

    He, Deng-Wei; Huang, Wen-Jun; Sheng, Xiao-Yong; Wu, Li-Jun; Fan, Shun-Wu

    2016-08-01

    A rare case of atlantoaxial lateral mass joint interlocking secondary to traumatic posterolateral C1,2 complete dislocation associated with type II odontoid fracture is herein reported and the impact of atlantoaxial joint interlocking on fracture reduction discussed. A 72-year-old man presented with traumatic atlantoaxial lateral mass joint interlocking without spinal cord signal change, the diagnosis being confirmed by radiography and 3-D reconstruction digital anatomy. Posterior internal fixation was performed after failure to achieve closed reduction by skull traction. After many surgical attempts at setting had failed because of interlocking of the lateral mass joints, reduction was achieved by compressing the posterior parts of the atlantal and axial screws. Odontoid bone union and C1,2 posterior bone graft fusion were eventually obtained by the 12-month follow-up. The patient had a complete neurological recovery with no residual neck pain or radiculopathy. PMID:27627726

  20. Summary of Human Ankle Mechanical Impedance During Walking

    PubMed Central

    Rouse, Elliott J.; Krebs, Hermano Igo

    2016-01-01

    The human ankle joint plays a critical role during walking and understanding the biomechanical factors that govern ankle behavior and provides fundamental insight into normal and pathologically altered gait. Previous researchers have comprehensively studied ankle joint kinetics and kinematics during many biomechanical tasks, including locomotion; however, only recently have researchers been able to quantify how the mechanical impedance of the ankle varies during walking. The mechanical impedance describes the dynamic relationship between the joint position and the joint torque during perturbation, and is often represented in terms of stiffness, damping, and inertia. The purpose of this short communication is to unify the results of the first two studies measuring ankle mechanical impedance in the sagittal plane during walking, where each study investigated differing regions of the gait cycle. Rouse et al. measured ankle impedance from late loading response to terminal stance, where Lee et al. quantified ankle impedance from pre-swing to early loading response. While stiffness component of impedance increases significantly as the stance phase of walking progressed, the change in damping during the gait cycle is much less than the changes observed in stiffness. In addition, both stiffness and damping remained low during the swing phase of walking. Future work will focus on quantifying impedance during the “push off” region of stance phase, as well as measurement of these properties in the coronal plane. PMID:27766187

  1. 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

  2. Severe thalassaemia intermedia with multiple fractures: role of transfusion therapy.

    PubMed

    Ahmad, Saqib Qayyum; Iqbal, Mudassar; Wahla, Madiha Saeed; Tarrar, Aimel Munir

    2011-11-01

    Thalassaemia intermedia includes thalassaemias with clinical severity intermediate between asymptomatic thalassaemia minor and transfusion dependent thalassaemia major. By definition patients of thalassaemia intermedia maintain a haemoglobin level of 7-10 g/dl and do not, or only occasionally, require blood transfusion. An eight-year-old girl who was a known case of thalassaemia intermedia and had been occasionally transfused presented with fever, pain and swelling over the wrists, ankles and above the right knee joint. Radiographs showed medullary widening, cortical thinning and; multiple, recent and old, partially healed fractures of metadiaphseal regions of long bones. Her fractures have been immobilized by means of back slabs. In view of her recurrent fractures and growth retardation we advised a regular transfusion-chelation regimen to our patient to suppress her ineffective dyserythropoiesis. The treatment is expected to prevent further bone fragility and fractures, as well as improve her life quality. PMID:22125999

  3. 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

  4. 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.

  5. 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.

  6. 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.

  7. 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

  8. An examination of ankle, knee, and hip torque production in individuals with chronic ankle instability.

    PubMed

    Gribble, Phillip A; Robinson, Richard H

    2009-03-01

    There is some debate in the literature as to whether strength deficits exist at the ankle in individuals with chronic ankle instability (CAI). Additionally, there is evidence to suggest that knee and hip performance is altered in those with CAI. Therefore, the purpose of this study was to determine whether CAI is associated with deficits in ankle, knee, and hip torque. Fifteen subjects with unilateral CAI and fifteen subjects with healthy ankles participated. Subjects reported to the laboratory for one session during which the torque production of ankle plantar flexion/dorsiflexion, knee flexion/extension, and hip flexion/extension were measured with an isokinetic device. Subjects performed 5 maximum-effort repetitions of a concentric/concentric protocol at 60 degrees .s for both extremities. Average peak torque (APT) values were calculated. The subjects with CAI demonstrated significantly less APT production for knee flexion (F1,28 = 5.40; p = 0.03) and extension (F1,28 = 5.34; p = 0.03). Subjects with CAI exhibited significantly less APT for ankle plantar flexion in the injured limb compared with their noninjured limb (F1,28 = 6.51; p = 0.02). No significant difference in ankle dorsiflexion or hip flexion/extension APT production existed between the 2 groups. Individuals with CAI, in addition to deficits in ankle plantar flexion torque, had deficits in knee flexor and extensor torque, suggesting that distal joint instability may lead to knee joint neuromuscular adaptations. There were no similar deficits at the hip. Future research should determine what implications this has for prevention and rehabilitation of lower-extremity injury. Clinicians may need to consider including rehabilitation efforts to address these deficits when rehabilitating patients with CAI.

  9. Predictive Factors for Lateral Ankle Sprains: A Literature Review

    PubMed Central

    Beynnon, Bruce D.; Murphy, Darlene F.; Alosa, Denise M.

    2002-01-01

    Objective: To review the prospective studies of ankle-ligament-injury risk factors. Data Sources: We searched MEDLINE from 1978 to 2001 using the terms ankle, ligament, injury, risk factor, and epidemiology. Data Synthesis: The results included many studies on the treatment and prevention of ankle injuries. There were, however, very few prospective studies focusing on identifying the risk factors that predispose an athlete to ankle-ligament trauma. Conclusions/Recommendations: There is some agreement among authors with regard to the risk factors for ankle-ligament injury; however, considerable controversy remains. Although female athletes are at significantly greater risk of suffering a serious knee sprain, such as disruption of the anterior cruciate ligament, this does not appear to be the case for ankle-ligament sprains. Therefore, sex does not appear to be a risk factor for suffering an ankle-ligament sprain. Athletes who have suffered a previous sprain have a decreased risk of reinjury if a brace is worn, and the consensus is that generalized joint laxity and anatomical foot type are not risk factors for ankle sprains. However, the literature is divided with regard to whether or not height, weight, limb dominance, ankle-joint laxity, anatomical alignment, muscle strength, muscle-reaction time, and postural sway are risk factors for ankle sprains. Future research is needed on this topic to develop a consensus on all ankle-injury risk factors. This will allow future intervention studies to be designed that will reduce the incidence and severity of this common injury. PMID:12937558

  10. Proximal fifth metatarsal fractures.

    PubMed

    Ramponi, Denise R

    2013-01-01

    The most common fracture of the foot is a fracture of the proximal fifth metatarsal. In general, there are 3 types of fractures involving the proximal fifth metatarsal area, including a proximal diaphyseal stress fracture, a Jones fracture, and an avulsion fracture of the tuberosity. Some fractures of the fifth metatarsal heal without difficulty, whereas some have the potential for nonunion or delayed healing. Each fracture has some variation in the anatomical location on the fifth metatarsal, the mechanism of injury, the radiographic findings, and the treatment plan. Avulsion fractures of the tuberosity often heal without difficulty, yet fractures distal to the area of insertion of the peroneus brevis tendon are prone to nonunion and delayed healing (). Differential diagnosis of a fifth metatarsal midfoot injury includes ankle sprains, midfoot sprains, plantar facial ruptures, peroneus tendon ruptures, and other foot fractures.

  11. Mixed-mode fatigue fracture of adhesive joints in harsh environments and nonlinear viscoelastic modeling of the adhesive

    NASA Astrophysics Data System (ADS)

    Arzoumanidis, Alexis Gerasimos

    A four point bend, mixed-mode, reinforced, cracked lap shear specimen experimentally simulated adhesive joints between load bearing composite parts in automotive components. The experiments accounted for fatigue, solvent and temperature effects on a swirled glass fiber composite adherend/urethane adhesive system. Crack length measurements based on compliance facilitated determination of da/dN curves. A digital image processing technique was also utilized to monitor crack growth from in situ images of the side of the specimen. Linear elastic fracture mechanics and finite elements were used to determine energy release rate and mode-mix as a function of crack length for this specimen. Experiments were conducted in air and in a salt water bath at 10, 26 and 90°C. Joints tested in the solvent were fully saturated. In air, both increasing and decreasing temperature relative to 26°C accelerated crack growth rates. In salt water, crack growth rates increased with increasing temperature. Threshold energy release rate is shown to be the most appropriate design criteria for joints of this system. In addition, path of the crack is discussed and fracture surfaces are examined on three length scales. Three linear viscoelastic properties were measured for the neat urethane adhesive. Dynamic tensile compliance (D*) was found using a novel extensometer and results were considerably more accurate and precise than standard DMTA testing. Dynamic shear compliance (J*) was determined using an Arcan specimen. Dynamic Poisson's ratio (nu*) was extracted from strain gage data analyzed to include gage reinforcement. Experiments spanned three frequency decades and isothermal data was shifted by time-temperature superposition to create master curves spanning thirty decades. Master curves were fit to time domain Prony series. Shear compliance inferred from D* and nu* compared well with measured J*, forming a basis for finding the complete time dependent material property matrix for this

  12. 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

  13. Ankle-Knee prosthesis with powered ankle and energy transfer for CYBERLEGs α-prototype.

    PubMed

    Geeroms, J; Flynn, L; Jimenez-Fabian, R; Vanderborght, B; Lefeber, D

    2013-06-01

    Restoring natural walking for amputees has been increasingly investigated because of demographic evolution, leading to increased number of amputations, and increasing demand for independence. The energetic disadvantages of passive pros-theses are clear, and active prostheses are limited in autonomy. This paper presents the simulation, design and development of an actuated knee-ankle prosthesis based on a variable stiffness actuator with energy transfer from the knee to the ankle. This approach allows a good approximation of the joint torques and the kinematics of the human gait cycle while maintaining compliant joints and reducing energy consumption during level walking. This first prototype consists of a passive knee and an active ankle, which are energetically coupled to reduce the power consumption.

  14. 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.

  15. A retrospective analysis evaluating allogeneic cancellous bone sponge for foot and ankle arthrodesis.

    PubMed

    Brigido, Stephen A; Bleazey, Scott T; Protzman, Nicole M; D'Angelantonio, Albert; Schoenhaus, Harold D

    2013-01-01

    The present retrospective case crossover study was conducted to determine the effectiveness and safety data associated with the use of an allogeneic, cancellous bone sponge in an orthopedic foot and ankle population. We reviewed the medical records of 47 subjects (80 joints) who had undergone foot and/or ankle fusion with the cancellous bone sponge. The records were reviewed up to 12 months postoperatively. The joints included in the present study were 12 ankles, 3 ankle syndesmotic fusions (with concurrent total ankle arthroplasty), 17 subtalar joints, 17 talonavicular joints, 9 calcaneocubiod joints, 1 naviculocuneiform joint, 13 first tarsometatarsal joints, 6 lesser tarsometatarsal joints, and 2 first metatarsophalangeal joints. The endpoints of the present study were solid, sustained foot and ankle fusion, as demonstrated radiographically, and the occurrence of unexpected adverse effects related to the graft. The fusion rates were compared with those reported in other studies. The patient-reported outcome variables for the present study included the visual analog pain scale and the American Orthopaedic Foot and Ankle Score. The use of a cancellous sponge showed statistically significant improvements in pain and function and comparable or better fusion rates compared with outcomes reported in other published reports.

  16. 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

  17. 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.

  18. 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

  19. Functional Design in Rehabilitation: Modular Mechanisms for Ankle Complex.

    PubMed

    Aggogeri, Francesco; Pellegrini, Nicola; Adamini, Riccardo

    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.

  20. Functional Design in Rehabilitation: Modular Mechanisms for Ankle Complex.

    PubMed

    Aggogeri, Francesco; Pellegrini, Nicola; Adamini, Riccardo

    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

  1. The effects of ankle Kinesio taping on ankle stiffness and dynamic balance.

    PubMed

    Fayson, Shirleeah D; Needle, Alan R; Kaminski, Thomas W

    2013-01-01

    The purpose of this study was to determine the effects of Kinesio® taping on static restraint and dynamic postural control of the ankle joint. Thirty female subjects with no history of ankle injury participated in this study. Subjects were tested for passive ankle laxity and stiffness, and time to stabilization following forward, backward, medial, and lateral hops. Subjects were tested prior to tape application, immediately following application, and following 24 hours of use. Differences between taping conditions were investigated using analyses of variance and pairwise comparisons. Stiffness increased following initial application and 24 hours of Kinesio® tape use (F = 6.99, p = .003), despite no observed changes in ankle laxity (F = 0.77, p = .49); however, no changes were observed in time-to-stabilization (F = 0.03, p = .97). Our results suggest that Kinesio® tape may improve static restraint in the ankle joint without altering peak motion or dynamic postural control. A future investigation into Kinesio® tape efficacy in injury prevention or rehabilitation is warranted. PMID:23777376

  2. The effects of ankle Kinesio taping on ankle stiffness and dynamic balance.

    PubMed

    Fayson, Shirleeah D; Needle, Alan R; Kaminski, Thomas W

    2013-01-01

    The purpose of this study was to determine the effects of Kinesio® taping on static restraint and dynamic postural control of the ankle joint. Thirty female subjects with no history of ankle injury participated in this study. Subjects were tested for passive ankle laxity and stiffness, and time to stabilization following forward, backward, medial, and lateral hops. Subjects were tested prior to tape application, immediately following application, and following 24 hours of use. Differences between taping conditions were investigated using analyses of variance and pairwise comparisons. Stiffness increased following initial application and 24 hours of Kinesio® tape use (F = 6.99, p = .003), despite no observed changes in ankle laxity (F = 0.77, p = .49); however, no changes were observed in time-to-stabilization (F = 0.03, p = .97). Our results suggest that Kinesio® tape may improve static restraint in the ankle joint without altering peak motion or dynamic postural control. A future investigation into Kinesio® tape efficacy in injury prevention or rehabilitation is warranted.

  3. Surgical removal of fragmented coronoid processes and fractured anconeal process in an older dog with evidence of severe degenerative joint disease.

    PubMed

    Flo, G L

    1998-12-15

    A 10-year-old Labrador Retriever was admitted because of severe unilateral (left) forelimb lameness of 6 weeks' duration. Computerized tomography revealed bilateral fragmented coronoid processes (FCP) and unilateral fracture of the anconeal process. Surgery on the left elbow to remove the loose anconeal process and FCP resolved the severe lameness and improved the dog's overall activity, compared with that of the preceding 2 years. Unstable FCP can develop late in life, and a degenerative anconeal process may fracture. Surgical removal of loose fragments in a severely arthritic joint may be beneficial. PMID:9861974

  4. 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

  5. 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.

  6. Independent ankle motion control improves robotic balance simulator.

    PubMed

    Pospisil, Eric R; Luu, Billy L; Blouin, Jean-Sébastien; Van der Loos, H F Machiel; Croft, Elizabeth A

    2012-01-01

    We present a validation study for the effectiveness of an additional ankle-tilt platform to enhance somatosensory ankle feedback available to subjects actuating a 6-axis robotic balance simulator platform. To address this need, we have developed and integrated a device to permit independent manipulation of ankle rotation while the whole-body is actuated by the balance simulator. The addition of ankle rotation is shown to provide both quantitative and qualitative improvements to the balance simulation experience compared to when the ankle joint is referenced to the motion of the balance simulator. Eight out of ten subjects reported that balancing on the simulator with ankle motion required less conscious effort. This self-reported improvement corresponded to a 32% decrease in the mean-removed RMS amplitude for sway angle, demonstrating better balance control for subjects actuating the simulator. The new ankle-tilt platform enables examination of the contributions of ankle proprioception to the control of standing balance in human subjects.

  7. 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

  8. Adaptive sports ankle prosthetics. Interview by Sarah A. Curran.

    PubMed

    Lyle, David K

    2012-09-01

    Participating in sport at all levels is gaining a dedicated following and this is also apparent in individuals with an amputation. Currently, there is a wide variety of ankle prostheses available which attempt to provide function, control, and comfort, as well as good aesthetic appeal. Participation in sport, however, increases the demands placed upon ankle prostheses. This can compromise function and performance, and constrain the opportunities of participation in various outdoor and water sports. In acknowledging this limitation and the need to develop more versatile ankle prostheses, this article introduces the evolution of a prototype ankle prosthesis referred to as "Adaptive Sports Ankle." The ankle prosthesis, which is compatible with any foot pyramid adapter, offers the same range of motion as the normal human ankle joint and is made up of components that are chemical and corrosion resistant. These design features that are specifically created to accommodate below-the-knee amputees provide an ideal prosthesis for those wishing to lead an active lifestyle and participate in aquatic (i.e. swimming, surfing, and scuba diving), snowboarding, and equestrian activities. Although it is acknowledged that there is a need to establish research on the Adaptive Sports Ankle, its introduction to the market will enhance and expand opportunities of those individuals with a lower limb amputation to lead an active and healthy lifestyle.

  9. 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.

  10. Effects of repeated ankle stretching on calf muscle-tendon and ankle biomechanical properties in stroke survivors

    PubMed Central

    Gao, Fan; Ren, Yupeng; Roth, Elliot J.; Harvey, Richard; Zhang, Li-Qun

    2011-01-01

    Background The objective of this study was to investigate changes in active and passive biomechanical properties of the calf muscle-tendon unit induced by controlled ankle stretching in stroke survivors. Methods Ten stroke survivors with ankle spasticity/contracture and ten healthy control subjects received intervention of 60-min ankle stretching. Joint biomechanical properties including resistance torque, stiffness and index of hysteresis were evaluated pre- and post-intervention. Achilles tendon length was measured using ultrasonography. The force output of the triceps surae muscles was characterized via the torque-angle relationship, by stimulating the calf muscles at a controlled intensity across different ankle positions. Findings Compared to healthy controls, the ankle position corresponding to the peak torque of the stroke survivors was shifted towards plantar flexion (P<0.001). Stroke survivors showed significantly higher resistance torques and joint stiffness (P<0.05), and these higher resistances were reduced significantly after the stretching intervention, especially in dorsiflexion (P = 0.013). Stretching significantly improved the force output of the impaired calf muscles in stroke survivors under matched stimulations (P<0.05). Ankle range of motion was also increased by stretching (P<0.001). Interpretation At the joint level, repeated stretching loosened the ankle joint with increased passive joint range of motion and decreased joint stiffness. At the muscle-tendon level, repeated stretching improved calf muscle force output, which might be associated with decreased muscle fascicle stiffness, increased fascicle length and shortening of the Achilles tendon. The study provided evidence of improvement in muscle tendon properties through stretching intervention. PMID:21211873

  11. 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.

  12. Prevention of ankle sprains.

    PubMed

    Walsh, W M; Blackburn, T

    1977-01-01

    Ankles are sprained when supported on an unstable foundation, while too rididly fixed to the playing surface, or when forced into unnatural positions by extrinsic muscle tightness. The unstable foundation may be the shoe itself, a chuck-hole, or another player's foot. Undue fixation may be by 1-inch mud cleats, baseball spikes, or a modern wrestling mat. When these circumstances occur, heel cord tightness may alter the ankle's response. Thus, prevention of ankle sprains may be by modification of any of these factors.

  13. 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

  14. 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.

  15. 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

  16. 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

  17. 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.

  18. 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.

  19. Intra-articular Fractures of the Sigmoid Notch of the Distal Radius: Analysis of Progression to Distal Radial Ulnar Joint Arthritis and Impact on Upper Extremity Function in Surgically Treated Fractures.

    PubMed

    Vitale, Mark A; Brogan, David M; Shin, Alexander Y; Berger, Richard A

    2016-03-01

    Background Studies have established an increased risk of radiocarpal joint posttraumatic arthritis in patients with displaced intra-articular fractures of the distal radius, although this phenomenon has yet to be evaluated in the distal radioulnar joint (DRUJ). Purpose We hypothesized that patients with displaced intra-articular fractures of the sigmoid notch would have a higher prevalence of DRUJ arthritis and greater upper extremity dysfunction after operative treatment of distal radius fractures compared with fractures without sigmoid notch involvement. We also hypothesized that the degree of sigmoid notch incongruity would be correlated with the grade of DRUJ arthritis and the severity of upper extremity dysfunction. Patients and Methods A retrospective review was conducted on surgically treated patients with distal radius fractures with pre- and/or postoperative computed tomography (CT) scans. Patients were divided into groups based on presence or absence of fracture extension into the sigmoid notch. Within the sigmoid notch group, postoperative CT scans were used to measure sigmoid notch fracture step-off and diastasis (mm), as well as volar or dorsal DRUJ subluxation (%). Patients were administered Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires and radiographs were obtained to grade DRUJ arthritis using the Kellgren-Lawrence (KL) radiographic criteria. Results Thirty-three patients were included (19 with sigmoid notch involvement and 14 without) with an average radiographic follow-up of 6.3 years (range: 3.5-10.1 years). DASH scores were available for all patients, and radiographic follow-up was available in 24 patients (73%). A trend toward higher grade of DRUJ arthritis and poorer average DASH was found in those with sigmoid notch involvement, but was not statistically different. In the sigmoid notch group there were poorer DASH scores in patients with coronal step-off > 1.0-mm (p < 0.05). There were no significant

  20. Reconstruction of compound loss of lateral malleolus and lateral ankle ligaments with double-bundle Achilles tendon-bone allograft.

    PubMed

    Ko, Dukhwan; Jung, Hong-Geun; Kim, Hyeung-June; Cha, Seung-Han; Nam, Kyoung-Mo

    2014-01-01

    Open ankle fracture, including compound loss of the lateral malleolus, lateral ankle ligaments, and overlying skin, is a severe injury and can result in ankle instability and permanent disability. Treatment of this injury is challenging and requires bone grafting and soft tissue reconstruction. In the present report, we describe a unique reconstruction technique for compound loss of the lateral malleolus, lateral ankle ligaments, and the overlying skin using a double-bundle Achilles tendon-bone allograft combined with a reverse sural fasciocutaneous flap. The patient obtained a stable ankle with nearly full range of motion and displayed satisfactory function during the follow-up period.

  1. Metatarsal fractures.

    PubMed

    Rammelt, Stefan; Heineck, Jan; Zwipp, Hans

    2004-09-01

    Metatarsal fractures are relatively common and if malunited, a frequent source of pain and disability. Nondisplaced fractures and fractures of the second to fourth metatarsal with displacement in the horizontal plane can be treated conservatively with protected weight bearing in a cast shoe for 4-6 weeks. In most displaced fractures, closed reduction can be achieved but maintenance of the reduction needs internal fixation. Percutaneous pinning is suitable for most fractures of the lesser metatarsals. Fractures with joint involvement and multiple fragments frequently require open reduction and plate fixation. Transverse fractures at the metaphyseal-diaphyseal junction of the fifth metatarsal ("Jones fractures") require an individualized approach tailored to the level of activity and time to union. Avulsion fractures of the fifth metatarsal bone are treated by open reduction and tension-band wiring or screw fixation if displaced more than 2 mm or with more that 30% of the joint involved. The metatarsals are the most common site of stress fractures, most of which are treated nonoperatively. Symptomatic posttraumatic deformities need adequate correction, in most cases by osteotomy across the former fracture site.

  2. The Ilizarov method in the treatment of pilon fractures.

    PubMed

    Zarek, Sławomir; Othman, Mohamed; Macias, Jarosław

    2002-08-30

    Background. Comminuted fractures of the distal epiphysis and metaphysis of the tibia with penetration to the ankle joint, which occur rarely, are known as "pilon fractures". Material and methods. From 1996 to 2001, eight cases of distal tibia epiphysis fractures (pilon fractures), including four cases of open fractures, were treated by the Ilizarow technique. According to the Rüedi-Allgöwer classification, there were two patients with type I fractures, four patients with type II fractures, and two patients with type III fractures. Four patients were treated on an emergency basis, while two other patients underwent planned surgery 2 weeks after injury. In two patients previously treated by internal fixation the Ilizarow method was applied after 4 months due to pseudoarthrosis. Repositioning of the fractures was performed under x-ray control. The construction of the apparatus allows for weight bearing and early movement of the foot.The average period of treatment by this method was 5 months. Follow up examinations were performed from 2 months to 5 years after conclusion of treatment. Results. Bone consolidation was achieved in all cases. There were no deviations of bone axis, apart from one case of 10-degree varus deformity. A good range of motion was obtained in seven cases. Only in one case was the range of motion of the crurotalar joint reduced to 0 degrees dorsiflexion and 20 degrees plantar flexion. There were no cases of osteomyelitis or deep infections. Pin-tract infections occured in three patients. Conclusions. The Ilizarov technique is a safe and very effective method for the treatment of pilon fractures.

  3. Open and arthroscopic surgical anatomy of the ankle.

    PubMed

    Frank, Rachel M; Hsu, Andrew R; Gross, Christopher E; Walton, David M; Lee, Simon

    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

  4. 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

  5. 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

  6. 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

  7. Sonographic anatomy of the ankle.

    PubMed

    Precerutti, M; Bonardi, M; Ferrozzi, G; Draghi, F

    2014-06-01

    Ankle sonography is one of the most commonly ordered examinations in the field of osteoarticular imaging, and it requires intimate knowledge of the anatomic structures that make up the joint. For practical purposes, the examination can be divided into four compartments, which are analyzed in this pictorial essay: the anterior compartment, which includes the tibialis anterior, extensor hallucis longus, and extensor digitorum longus tendons; the accessory peroneus tertius tendon; and the extensor retinaculum; the medial compartment (tibialis posterior, flexor digitorum longus, and flexor hallucis longus tendons; the flexor retinaculum; the medial collateral-or deltoid-ligament, and the neurovascular bundle); the lateral compartment (peroneus longus, peroneus brevis, and peroneus quartus tendons; superior and inferior peroneal retinacula, lateral collateral ligament); and the posterior compartment (Achilles tendon, plantaris tendon, Kagar's triangle, superficial, and deep retrocalcaneal bursae). Scanning techniques are briefly described to ensure optimal visualization of the various anatomic structures.

  8. Sonographic anatomy of the ankle.

    PubMed

    Precerutti, M; Bonardi, M; Ferrozzi, G; Draghi, F

    2014-06-01

    Ankle sonography is one of the most commonly ordered examinations in the field of osteoarticular imaging, and it requires intimate knowledge of the anatomic structures that make up the joint. For practical purposes, the examination can be divided into four compartments, which are analyzed in this pictorial essay: the anterior compartment, which includes the tibialis anterior, extensor hallucis longus, and extensor digitorum longus tendons; the accessory peroneus tertius tendon; and the extensor retinaculum; the medial compartment (tibialis posterior, flexor digitorum longus, and flexor hallucis longus tendons; the flexor retinaculum; the medial collateral-or deltoid-ligament, and the neurovascular bundle); the lateral compartment (peroneus longus, peroneus brevis, and peroneus quartus tendons; superior and inferior peroneal retinacula, lateral collateral ligament); and the posterior compartment (Achilles tendon, plantaris tendon, Kagar's triangle, superficial, and deep retrocalcaneal bursae). Scanning techniques are briefly described to ensure optimal visualization of the various anatomic structures. PMID:24883130

  9. 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

  10. Cutaneous mechanisms of isometric ankle force control.

    PubMed

    Choi, Julia T; Lundbye-Jensen, Jesper; Leukel, Christian; Nielsen, Jens Bo

    2013-07-01

    The sense of force is critical in the control of movement and posture. Multiple factors influence our perception of exerted force, including inputs from cutaneous afferents, muscle afferents and central commands. Here, we studied the influence of cutaneous feedback on the control of ankle force output. We used repetitive electrical stimulation of the superficial peroneal (foot dorsum) and medial plantar nerves (foot sole) to disrupt cutaneous afferent input in 8 healthy subjects. We measured the effects of repetitive nerve stimulation on (1) tactile thresholds, (2) performance in an ankle force-matching and (3) an ankle position-matching task. Additional force-matching experiments were done to compare the effects of transient versus continuous stimulation in 6 subjects and to determine the effects of foot anesthesia using lidocaine in another 6 subjects. The results showed that stimulation decreased cutaneous sensory function as evidenced by increased touch threshold. Absolute dorsiflexion force error increased without visual feedback during peroneal nerve stimulation. This was not a general effect of stimulation because force error did not increase during plantar nerve stimulation. The effects of transient stimulation on force error were greater when compared to continuous stimulation and lidocaine injection. Position-matching performance was unaffected by peroneal nerve or plantar nerve stimulation. Our results show that cutaneous feedback plays a role in the control of force output at the ankle joint. Understanding how the nervous system normally uses cutaneous feedback in motor control will help us identify which functional aspects are impaired in aging and neurological diseases.

  11. 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

  12. 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.

  13. Radiographic evaluation of foot and ankle injuries in the athlete.

    PubMed

    Rettig, A C; Shelbourne, K D; Beltz, H F; Robertson, D W; Arfken, P

    1987-10-01

    Injuries of the ankle and foot in athletes are quite common. They range from the extremely simple sprain to the difficult stress fracture, and may result in long-term disability. In all cases, the athlete is best treated after an accurate diagnosis is achieved.

  14. 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.

  15. Intermediate-Term Follow-up After Ankle Distraction for Treatment of End-Stage Osteoarthritis

    PubMed Central

    Nguyen, Mai P.; Pedersen, Douglas R.; Gao, Yubo; Saltzman, Charles L.; Amendola, Annunziato

    2015-01-01

    Background: Treatment of end-stage ankle osteoarthritis remains challenging, especially in young patients. Initial reports have shown early benefits of joint distraction for the treatment of ankle osteoarthritis. We report the five to ten-year results of a previously described patient cohort following ankle distraction surgery. Methods: All thirty-six patients who had undergone ankle distraction surgery between December 2002 and October 2006 were contacted. Patients were evaluated by a clinical investigator and completed the Ankle Osteoarthritis Scale (AOS) and Short Form-36 (SF-36) surveys. Radiographs as well as computed tomography and magnetic resonance imaging scans of the ankles were obtained at the follow-up visits. Results: Twenty-nine patients (81%) were followed for a minimum of five years (mean and standard deviation, 8.3 ± 2.2 years). Sixteen (55%) of the twenty-nine patients still had the native ankle joint whereas thirteen patients (45%) had undergone either ankle arthrodesis or total ankle arthroplasty. Positive predictors of ankle survival included a better AOS score at two years (hazard ratio [HR] = 0.048, 95% confidence interval [CI] = 0.0028 to 0.84, p = 0.04), older age at surgery (HR = 0.91, 95% CI = 0.83 to 0.99, p = 0.04), and fixed distraction (HR = 0.094, 95% CI = 0.017 to 0.525, p < 0.01). Radiographs and advanced imaging revealed progression of ankle osteoarthritis at the time of final follow-up. Conclusions: Ankle function following joint distraction declines over time. Patients should be well informed of the commitment that they must make during the treatment period as well as the long-term results after surgery. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. PMID:25834084

  16. 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.

  17. Foot, leg, and ankle swelling

    MedlinePlus

    Swelling of the ankles - feet - legs; Ankle swelling; Foot swelling; Leg swelling; Edema - peripheral; Peripheral edema ... Painless swelling may affect both legs and may include the calves or ... of gravity makes the swelling most noticeable in the lower ...

  18. Multivariable dynamic ankle mechanical impedance with relaxed muscles.

    PubMed

    Lee, Hyunglae; Krebs, Hermano Igo; Hogan, Neville

    2014-11-01

    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.

  19. 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

  20. Systematic ankle stabilization and the effect on performance.

    PubMed

    Robinson, J R; Frederick, E C; Cooper, L B

    1986-12-01

    Stabilization of the ankle joint is used as a deterrent to injury, however, insufficient or excessive ankle control can cause negative effects. This study determined the effects of systematic changes in ankle and subtalar joint stabilization on performance through an obstacle course. Data were collected on six subjects as they completed two test procedures. Ankle range of motion in the sagittal and frontal planes was determined using a modified Inman apparatus. Completion time through an obstacle course, set up on a basketball court, was used as a measure of performance. High-top basketball shoes were constructed with pockets which allowed strips of plastic (stiffeners) to be positioned just anterior and posterior to the medial and lateral malleoli. Four shoe conditions were used including the shoe with no stiffeners. Significant differences (P less than 0.05) in eversion, flexion, and inversion were found between the shoe conditions. A general trend of decreased range of motion with increased restriction was observed. Significant differences (P less than 0.05) in performance were found between the shoe conditions, with a general trend of increased times with increased restriction. These results indicate that systematic changes in the range of motion of the ankle and subtalar joints can measurably affect performance. PMID:3784875

  1. Systematic ankle stabilization and the effect on performance.

    PubMed

    Robinson, J R; Frederick, E C; Cooper, L B

    1986-12-01

    Stabilization of the ankle joint is used as a deterrent to injury, however, insufficient or excessive ankle control can cause negative effects. This study determined the effects of systematic changes in ankle and subtalar joint stabilization on performance through an obstacle course. Data were collected on six subjects as they completed two test procedures. Ankle range of motion in the sagittal and frontal planes was determined using a modified Inman apparatus. Completion time through an obstacle course, set up on a basketball court, was used as a measure of performance. High-top basketball shoes were constructed with pockets which allowed strips of plastic (stiffeners) to be positioned just anterior and posterior to the medial and lateral malleoli. Four shoe conditions were used including the shoe with no stiffeners. Significant differences (P less than 0.05) in eversion, flexion, and inversion were found between the shoe conditions. A general trend of decreased range of motion with increased restriction was observed. Significant differences (P less than 0.05) in performance were found between the shoe conditions, with a general trend of increased times with increased restriction. These results indicate that systematic changes in the range of motion of the ankle and subtalar joints can measurably affect performance.

  2. 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

  3. Acute fracture of the os trigonum.

    PubMed

    Escobedo, Eva M; MacDonald, Taylor L; Hunter, John C

    2006-12-01

    A 21-year-old man presented with ankle pain after a motor vehicle accident. Imaging revealed an acute fracture of the os trigonum in addition to multiple, other lower-extremity fractures. In this case, the fracture of the os trigonum was a result of a significant traumatic injury. Thus, the presence of this fracture in an acute setting should prompt a search for other associated fractures.

  4. Negative pressure wound therapy for Gustilo Anderson grade IIIb open tibial fractures

    PubMed Central

    Park, Chul Hyun; Shon, Oog Jin; Kim, Gi Beom

    2016-01-01

    Background: Traditionally, Gustilo Anderson grade IIIb open tibial fractures have been treated by initial wide wound debridement, stabilization of fracture with external fixation, and delayed wound closure. The purpose of this study is to evaluate the clinical and radiological results of staged treatment using negative pressure wound therapy (NPWT) for Gustilo Anderson grade IIIb open tibial fractures. Materials and Methods: 15 patients with Gustilo Anderson grade IIIb open tibial fractures, treated using staged protocol by a single surgeon between January 2007 and December 2011 were reviewed in this retrospective study. The clinical results were assessed using a Puno scoring system for severe open fractures of the tibia at the last followup. The range of motion (ROM) of the knee and ankle joints and postoperative complication were evaluated at the last followup. The radiographic results were assessed using time to bone union, coronal and sagittal angulations and a shortening at the last followup. Results: The mean score of Puno scoring system was 87.4 (range 67–94). The mean ROM of the knee and ankle joints was 121.3° (range 90°–130°) and 37.7° (range 15°–50°), respectively. Bone union developed in all patients and the mean time to union was 25.3 weeks (range 16–42 weeks). The mean coronal angulation was 2.1° (range 0–4°) and sagittal was 2.7° (range 1–4°). The mean shortening was 4.1 mm (range 0–8 mm). Three patients had partial flap necrosis and 1 patient had total flap necrosis. There was no superficial and deep wound infection. Conclusion: Staged treatment using NPWT decreased the risks of infection and requirement of flap surgeries in Gustilo Anderson grade IIIb open tibial fractures. Therefore, staged treatment using NPWT could be a useful treatment option for Gustilo Anderson grade IIIb open tibial fractures. PMID:27746498

  5. Measurement of T2 value by using 3.0T MRI for patient with ankle arthritis.

    PubMed

    Ahn, Jae Ouk

    2013-01-01

    This study intended to evaluate shape of ankle joint cartilage and damage to the ankle joint cartilage by measuring changes in T2 value of cartilage of healthy people without ankle arthritis and patients with ankle arthritis. The multi-echo technique was used for 20 healthy persons who had no ankle arthritis in the past or in the present clinically and 20 patients who were examined to have ankle arthritis in order to obtain T2 map image of knee joint cartilage. We divided the talotibial joint into medial position, middle position and lateral position to calculate the mean values of T2 in 18 spots that included anterior part, middle part and posterior part of cartilage of neck bone and ankle bone. Mean T2 values were measured in the healthy people group and the ankle arthritis patient group. According to the measurement results, the mean T2 value of the ankle arthritis patient group was measured to be higher than that of the healthy people group.

  6. Ankle Arthritis: You Can't Always Replace It.

    PubMed

    Hayes, Brandon J; Gonzalez, Tyler A; Smith, Jeremy T; Chiodo, Christopher P; Bluman, Eric M

    2016-01-01

    End-stage arthritis of the tibiotalar joint is disabling and causes substantial functional impairment. End-stage arthritis of the tibiotalar joint is often the residual effect of a previous traumatic injury. Nonsurgical treatment for end-stage arthritis of the ankle includes bracing, shoe wear modifications, and selective joint injections. For patients who fail to respond to nonsurgical modalities, the two primary treatment options are arthroplasty and arthrodesis. Each treatment option has strong proponents who argue the superiority of their treatment algorithm. Although there is no ideal treatment for ankle arthritis, there are high-quality studies that help guide treatment in patients of varying demographics. Many inherent risks are linked with each treatment option; however, the risks of greatest concern are early implant loosening after arthroplasty that requires revision surgery and the acceleration of adjacent joint degeneration associated with arthrodesis. PMID:27049200

  7. 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

  8. 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

  9. [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

  10. Anatomical factors affecting the selection of an operative approach for fibular fractures involving the posterior malleolus

    PubMed Central

    WANG, XU; MA, XIN; ZHANG, CHAO; HUANG, JIAZHANG; JIANG, JIANYUAN

    2013-01-01

    Several operative approaches are available at present for the exposure and fixation of distal fibular fractures combined with posterior malleolus fractures. The present study was designed to study the anatomical characteristics of the distal fibula and to thereby evaluate the advantages and limitations of various operative approaches, as well as their indications for specific conditions. Ten leg specimens from below the knee joint were dissected using posterior, lateral and posterolateral approaches to the fibula. The adjacent vulnerable structures, including nerves, blood vessels, tendons and ligaments, were carefully examined and their distances from the posterior malleolus were recorded. The distance was 7.2±4.1 mm between the sural nerve and the posterior section of the fibula, 79.2±23.5 mm between the lateral malleolus tip and the point where the shape changes in the lower fibula and 66.4±17.4 mm between the lateral malleolus and the jointed tendon of the peroneal and flexor hallux longus muscles. The widest anteroposterior diameter of the distal fibula was 27.3±3.5 mm. Various approaches have certain advantages and limitations when these anatomical factors are taken into account. The choice should be based on the height of the fibular fracture line, the type of posterior malleolus fracture, the effect of the fracture on the stability of the ankle joint and the materials used for internal fixation. PMID:23403714

  11. Lisfranc fractures.

    PubMed

    Wright, Amanda; Gerhart, Ann E

    2009-01-01

    Injuries of the tarsometatarsal, or Lisfranc, joint are rarely seen. Lisfranc fractures and fracture dislocations are among the most frequently misdiagnosed foot injuries in the emergency department. A misdiagnosed injury may have severe consequences including chronic pain and loss of foot biomechanics. Evaluation of a foot injury should include a high level of suspicion of a Lisfranc injury, and a thorough work-up is needed for correct diagnosis.

  12. The mid-term outcome of total ankle arthroplasty and ankle fusion in rheumatoid arthritis: a systematic review

    PubMed Central

    2013-01-01

    Background While arthrodesis is the standard treatment of a severely arthritic ankle joint, total ankle arthroplasty has become a popular alternative. This review provides clinical outcomes and complications of both interventions in patients with rheumatoid arthritis. Methods Studies were obtained from Pubmed, Embase and Web of Science (January 1980 – June 2011) and additional manual search. Inclusion criteria: original clinical study, > 5 rheumatoid arthritis (population), internal fixation arthrodesis or three-component mobile bearing prosthesis (intervention), ankle scoring system (outcome). The clinical outcome score, complication- and failure rates were extracted and the methodological quality of the studies was analysed. Results 17 observational studies of 868 citations were included. The effect size concerning total ankle arthroplasty ranged between 1.9 and 6.0, for arthrodesis the effect sizes were 4.0 and 4.7. Reoperation due to implant failure or reoperation due to non-union, was 11% and 12% for respectively total ankle arthroplasty and arthrodesis. The methodological quality of the studies was low (mean 6.4 out of a maximum of 14 points) and was lower for arthrodesis (mean 4.8) as compared to arthroplasty (mean 7.8) (p = 0.04). Conclusions 17 observational and no (randomized) controlled clinical trials are published on the effectiveness of arthroplasty or arthrodesis of the ankle in rheumatoid arthritis. Regardless of the methodological limitations it can be concluded that both interventions show clinical improvement and in line with current literature neither procedure is superior to the other. PMID:24161014

  13. Effects of 24-week Tai Chi exercise on the knee and ankle proprioception of older women.

    PubMed

    Chang, Shuwan; Zhou, Jihe; Hong, Youlian; Sun, Wei; Cong, Yan; Qin, Meiqin; Lian, Jianhua; Yao, Jian; Li, Weiping

    2016-01-01

    This study examined the effects of regular Tai Chi (TC) exercise on the kinaesthesia of the knee and ankle joints of older women. A total of 43 women aged 55-68 years participated in this study. In a 24-week study period, the TC group (n = 22) underwent an organized TC exercise, whereas the control group (n = 21) maintained a sedentary lifestyle. Customized instruments were used to measure the threshold for the detection of the passive motion of the knee and ankle joints. After 24 weeks, the TC group showed a significantly smaller threshold for the detection of passive motion of knee extension (31.4%, p = 0.009), knee flexion (27.0%, p = 0.044), and ankle dorsal flexion (28.9%, p = 0.014) than the control group. Other comparisons showed no significant differences. The 24-week TC exercise benefited the lower-limb kinaesthesia of the knee joint flexion and extension and ankle dorsal flexion.

  14. When something is not quite right: an ankle sprain.

    PubMed

    da Encarnação, António Paulo Martins

    2014-10-01

    Ankle sprains are a common musculoskeletal injury in sport. Older people are increasingly participating in sports such as running. The specificities of musculoskeletal injuries in older people pose a different diagnostic challenge from that in young people participating in the same activities. A clinical case is presented of a 64-year-old patient diagnosed with a grade 1, plantar flexion/inversion ankle sprain that was later diagnosed as a quite different and rare injury. Fractures of the fibular malleolus, talar neck and dome are possible differential diagnoses for an ankle sprain, as are talar dome chondral defects. Response to treatment may help to guide the diagnostic procedure when pain persists after appropriate treatment.

  15. Simultaneous bilateral total knee and ankle arthroplasty as a single surgical procedure

    PubMed Central

    2011-01-01

    Background Simultaneous osteoarthritis (OA) of the ankle joint complicates primary total knee arthroplasty (TKA). In such cases, rehabilitation of TKA is limited by debilitating ankle pain, but varus or valgus ankle arthritis may even compromise placement of knee prosthetic components. Case presentation We present a patient with simultaneous bilateral valgus and patellofemoral OA of the knees and bilateral varus OA of the ankle joints that equally contributed to overall disability. This 63 years old, motivated and otherwise healthy patient was treated by simultaneous bilateral total knee and ankle arthroplasty (quadruple total joint arthroplasty, TJA) during the same anesthesia. Two years outcome showed excellent alignment and function of all four replaced joints. Postoperative time for rehabilitation, back to work (6th week) and hospital stay (12 days) of this special patient was markedly reduced compared to the usual course of separate TJA. Conclusions Simultaneous quadruple TJA in equally disabling OA of bilateral deformed knees and ankles resulted in a better functional outcome and faster recovery compared to the average reported results after TKA and TAA in literature. However, careful preoperative planning, extensive patient education, and two complete surgical teams were considered essential for successful performance. To the best of our knowledge this is the first case report in literature about quadruple major total joint arthroplasty implanted during the same anesthesia in the same patient. PMID:21995682

  16. Estimation of human ankle impedance during the stance phase of walking.

    PubMed

    Rouse, Elliott J; Hargrove, Levi J; Perreault, Eric J; Kuiken, Todd A

    2014-07-01

    Human joint impedance is the dynamic relationship between the differential change in the position of a perturbed joint and the corresponding response torque; it is a fundamental property that governs how humans interact with their environments. It is critical to characterize ankle impedance during the stance phase of walking to elucidate how ankle impedance is regulated during locomotion, as well as provide the foundation for future development of natural, biomimetic powered prostheses and their control systems. In this study, ankle impedance was estimated using a model consisting of stiffness, damping and inertia. Ankle torque was well described by the model, accounting for 98 ±1.2% of the variance. When averaged across subjects, the stiffness component of impedance was found to increase linearly from 1.5 to 6.5 Nm/rad/kg between 20% and 70% of stance phase. The damping component was found to be statistically greater than zero only for the estimate at 70% of stance phase, with a value of 0.03 Nms/rad/kg. The slope of the ankle's torque-angle curve-known as the quasi-stiffness-was not statistically different from the ankle stiffness values, and showed remarkable similarity. Finally, using the estimated impedance, the specifications for a biomimetic powered ankle prosthesis were introduced that would accurately emulate human ankle impedance during locomotion.

  17. Effects of ankle biofeedback training on strength, balance, and gait in patients with stroke

    PubMed Central

    Kim, Sung-jin; Cho, Hwi-young; Kim, Kyung-hoon; Lee, Suk-min

    2016-01-01

    [Purpose] This study aimed to investigate the effects of ankle biofeedback training on muscle strength of the ankle joint, balance, and gait in stroke patients. [Subjects and Methods] Twenty-seven subjects who had had a stroke were randomly allocated to either the ankle biofeedback training group (n=14) or control group (n=13). Conventional therapy, which adhered to the neurodevelopmental treatment approach, was administered to both groups for 30 minutes. Furthermore, ankle strengthening exercises were performed by the control group and ankle biofeedback training by the experimental group, each for 30 minutes, 5 days a week for 8 weeks. To test muscle strength, balance, and gait, the Biodex isokinetic dynamometer, functional reach test, and 10 m walk test, respectively, were used. [Results] After the intervention, both groups showed a significant increase in muscle strength on the affected side and improved balance and gait. Significantly greater improvements were observed in the balance and gait of the ankle biofeedback training group compared with the control group, but not in the strength of the dorsiflexor and plantar flexor muscles of the affected side. [Conclusion] This study showed that ankle biofeedback training significantly improves muscle strength of the ankle joint, balance, and gait in patients with stroke. PMID:27799701

  18. [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.

  19. 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.

  20. An exoskeleton using controlled energy storage and release to aid ankle propulsion.

    PubMed

    Wiggin, M Bruce; Sawicki, Gregory S; Collins, Steven H

    2011-01-01

    Symmetric ankle propulsion is the cornerstone of efficient human walking. The ankle plantar flexors provide the majority of the mechanical work for the step-to-step transition and much of this work is delivered via elastic recoil from the Achilles' tendon - making it highly efficient. Even though the plantar flexors play a central role in propulsion, body-weight support and swing initiation during walking, very few assistive devices have focused on aiding ankle plantarflexion. Our goal was to develop a portable ankle exoskeleton taking inspiration from the passive elastic mechanisms at play in the human triceps surae-Achilles' tendon complex during walking. The challenge was to use parallel springs to provide ankle joint mechanical assistance during stance phase but allow free ankle rotation during swing phase. To do this we developed a novel `smart-clutch' that can engage and disengage a parallel spring based only on ankle kinematic state. The system is purely passive - containing no motors, electronics or external power supply. This `energy-neutral' ankle exoskeleton could be used to restore symmetry and reduce metabolic energy expenditure of walking in populations with weak ankle plantar flexors (e.g. stroke, spinal cord injury, normal aging).

  1. Strength and fracture behaviour of diffusion bonded joints in Al-Li (8090) alloy. III - Peel strength

    NASA Astrophysics Data System (ADS)

    Dunford, D. V.; Partridge, P. G.

    1992-11-01

    Peel strengths at room temperature and under superplastic forming conditions at 530 C were measured for diffusion-bonded joints in Al-Li 8090 alloy sheet. The bonds were made in the solid state, or via a transient liquid phase using interlayers. The effect of strain rate, sheet thickness and heat treatment were investigated. The significance of these results for the testing of DB joints and for their use in DB/SPF structures is discussed.

  2. Vascularized iliac bone graft in cases of ankle tuberculosis.

    PubMed

    Yoshida, Tatsuya; Sakamoto, Akio; Iwamoto, Yukihide

    2009-02-01

    Ankle tuberculosis is a very rare occurrence. Because the ankle is a weightbearing joint, the affected ankle tends to become damaged. Consequently, the surgical procedure of arthrodesis is necessary, which usually proves effective. We report two cases of ankle tuberculosis, in patients 53 and 71 years of age. The former case had been diagnosed initially as osteoarthritis and then later as pyogenic osteomyelitis; the latter case had been diagnosed as pigmented villonodular synovitis, a benign but aggressive lesion that involves the joints. In addition to antitubercular medicine, these cases were treated with debridement for necrotic tissue and arthrodesis. In the former case, an iliac osteocutaneous flap was performed, and arthrodesis between the tibia, talus, and calcaneus was obtained. In the other case, a vascularized iliac bone graft was performed that resulted in arthrodesis between the tarsal bones, talus, and calcaneus but with pseudoarthrosis between the tibia and the talus. Settlement of the joint tuberculosis and gait ability without resorption or corruption of the grafted bone was obtained in both cases. Vascularized bone graft offers the benefits of achieving bone defect reconstruction with promotion of bone union, and the infection can be expected to resolve through medication delivered via the circulation.

  3. 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.

  4. US in ankle impingement syndrome.

    PubMed

    Pesquer, Lionel; Guillo, Stephane; Meyer, Philippe; Hauger, Olivier

    2014-06-01

    Ankle impingement is a common condition occurring secondary to sprain or repeated microtrauma. Clinical symptoms are chronic pain located in the affected region and limited range of ankle motion. There are three types of ankle impingement syndrome: anterior impingement, which can be subdivided into anterolateral, anteromedial and purely anterior impingement; posterior impingement, which can be subdivided into posterior and posteromedial impingement; and calcaneal peroneal impingement which is secondary to planovalgus foot deformity. This paper evaluates physiological and clinical elements of these three types of ankle impingement syndrome as well as the role of ultrasound (US) imaging and US-guided treatment.

  5. Elastic stable intramedullary nailing for severely displaced distal tibial fractures in children.

    PubMed

    Shen, Kaiying; Cai, Haiqing; Wang, Zhigang; Xu, Yunlan

    2016-09-01

    Elastic stable intramedullary nailing (ESIN) has became a well-accepted method of osteosynthesis of diaphyseal fractures in the skeletally immature patient for many advantages, the purpose of this study is to evaluate the preliminary results of this minimally invasive treatment for severely displaced distal tibial diaphyseal metaphyseal junction (DTDMJ) fractures.This study was carried out over a 6-year period. Twenty-one severely displaced DTDMJ fractures treated using ESIN were evaluated clinically and radiographically. Complications were assessed: the patients were evaluated with regard to nonunion, malunion, infection, growth arrest, leg length discrepancy, implant irritation, and joint function.Mean age at the time of surgery was 7.8 years (range between 5.3 and 14.8 years), mean body weight 34.1 kg, all fractures were transverse or mild oblique type, including 3 open fractures, 5 multifragmented fractures, and 4 fractures associated with polytrauma; 6 cases were treated with antegrade ESIN of tibia while 15 cases need combined retrograde fibula and antegrade tibia fixation treatments. Follow-ups were ranging from 11 to 36 months, 19 fractures showed both clinical and radiographic evidence of healing within 5 months; all cases had full range motion of knee and ankle with symmetrical foot progress angle. Nail removal was at a mean 7.1 months, at final follow-up, no growth arrest or disturbances occurred. Five patients had complications; leg length discrepancy had decreased yet affected 2 patients, 2 cases showed delayed union, and 1 case developed restricted dorsal extension at the metatarsophalangeal joint of the hallux.ESIN is the treatment of choice for pediatric severely displaced DTDMJ fractures that cannot be reduced by closed reduction or ones that cannot be casted. The advantages include faster fracture healing, excellent functional and cosmetic results, safe and reliable surgical technique, and lower severe complication rate. PMID:27684849

  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. 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

  8. 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.

  9. 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.

  10. 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

  11. Injuries and disorders among young ice skaters: relationship with generalized joint laxity and tightness

    PubMed Central

    Okamura, Shinobu; Wada, Naoki; Tazawa, Masayuki; Sohmiya, Makoto; Ibe, Yoko; Shimizu, Toru; Usuda, Shigeru; Shirakura, Kenji

    2014-01-01

    This study retrospectively investigated 192 teenage speed and figure skaters with prior injuries documented by an athletes’ questionnaire, who underwent a physical examination to assess their muscle tightness and generalized joint laxity. In all athletes, the degree of muscle tightness and joint laxity were measured by a standardized physical examination. A descriptive report of the types of injuries showed a predominance of fractures, ligament injuries, enthesitis, and lower back pain. Approximately 5% of all skaters tested positive for tightness, while 25.8% of figure skaters and 15.2% of speed skaters had generalized ligamentous laxity. Statistical testing showed an association between ankle sprains and muscle tightness, and an association between knee enthesitis and muscle tightness in skating athletes. There was also an association between lower back pain and generalized joint laxity, which held true only for the male skaters. PMID:25177155

  12. Time-Varying Ankle Mechanical Impedance During Human Locomotion.

    PubMed

    Lee, Hyunglae; Hogan, Neville

    2015-09-01

    In human locomotion, we continuously modulate joint mechanical impedance of the lower limb (hip, knee, and ankle) either voluntarily or reflexively to accommodate environmental changes and maintain stable interaction. Ankle mechanical impedance plays a pivotal role at the interface between the neuro-mechanical system and the physical world. This paper reports, for the first time, a characterization of human ankle mechanical impedance in two degrees-of-freedom simultaneously as it varies with time during walking. Ensemble-based linear time-varying system identification methods implemented with a wearable ankle robot, Anklebot, enabled reliable estimation of ankle mechanical impedance from the pre-swing phase through the entire swing phase to the early-stance phase. This included heel-strike and toe-off, key events in the transition from the swing to stance phase or vice versa. Time-varying ankle mechanical impedance was accurately approximated by a second order model consisting of inertia, viscosity, and stiffness in both inversion-eversion and dorsiflexion-plantarflexion directions, as observed in our previous steady-state dynamic studies. We found that viscosity and stiffness of the ankle significantly decreased at the end of the stance phase before toe-off, remained relatively constant across the swing phase, and increased around heel-strike. Closer investigation around heel-strike revealed that viscosity and stiffness in both planes increased before heel-strike occurred. This finding is important evidence of "pretuning" by the central nervous system. In addition, viscosity and stiffness were greater in the sagittal plane than in the frontal plane across all subgait phases, except the early stance phase. Comparison with previous studies and implications for clinical study of neurologically impaired patients are provided.

  13. Outcome at 12 to 22 years of 1502 tibial shaft fractures.

    PubMed

    Connelly, C L; Bucknall, V; Jenkins, P J; Court-Brown, C M; McQueen, M M; Biant, L C

    2014-10-01

    Fractures of the tibial shaft are common injuries, but there are no long-term outcome data in the era of increased surgical management. The aim of this prospective study was to assess the clinical and functional outcome of this injury at 12 to 22 years. Secondary aims were to determine the short- and long-term mortality, and if there were any predictors of clinical or functional outcome or mortality. From a prospective trauma database of 1502 tibial shaft fractures in 1474 consecutive adult patients, we identified a cohort of 1431 tibial diaphyseal fractures in 1403 patients, who fitted our inclusion criteria. There were 1024 men, and mean age at injury was 40.6 years. Fractures were classified according to the AO system, and open fractures graded after Gustilo and Anderson. Requirement of fasciotomy, time to fracture union, complications, incidence of knee and ankle pain at long-term follow-up, changes in employment and the patients' social deprivation status were recorded. Function was assessed at 12 to 22 years post-injury using the Short Musculoskeletal Function Assessment and short form-12 questionnaires. Long-term functional outcome data was available for 568 of the surviving patients, 389 were deceased and 346 were lost to follow-up. Most fractures (90.7%, n = 1363) united without further intervention. Fasciotomies were performed in 11.5% of patients; this did not correlate with poorer functional outcome in the long term. Social deprivation was associated with a higher incidence of injury but had no impact on long-term function. The one-year mortality in those over 75 years of age was 29 (42%). At long-term follow-up, pain and function scores were good. However, 147 (26%) reported ongoing knee pain, 62 (10%) reported ankle pain and 97 (17%) reported both. Such joint pain correlated with poorer functional outcome. PMID:25274924

  14. 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

  15. Lateral ankle stabilization. Modified Lee and Chrisman-Snook.

    PubMed

    Saltrick, K R

    1991-07-01

    Chronic lateral ankle instability is not always a severe disability, but surgical reconstruction may be necessary in patients with instability or when conservative measures fail. Although recent articles by Ahlgren and Larsson and Bergsten et al provide evidence of satisfactory results with late ligamentous repair of chronic ankle instability via imbrication, lateral ankle stabilization procedures that use tenodesing of fasciodesing techniques continue to provide good results. Prolonged disability after acute lateral ankle ligament disruption has been reported in 20% of patients. With long-term instability, uneven stress distribution with recurrent sprains can lead to osteoarthritis. Various methods for evaluation of the chronically unstable ankle include inversion stress testing, anterior drawer sign, arthrography, and tenography. All of these methods are controversial with false negative results, unreliability, and variations in measurements and interpretation being cited. With this in mind, radiographic instability must be correlated with mechanical and clinical instability. Once all of these findings are correlated the physician can determine the appropriate procedure that will provide the patient with long-term stability. Although more recent studies have addressed repair of chronic instability with ligamentous reinforcement or imbrication, these procedures remain controversial in lieu of Freeman's deafferentiation theory with loss of proprioception. There is also mechanical instability of the subtalar joint, which may also require stabilization. Use of the modified Lee and the Chrisman-Snook techniques as described have provided good results.

  16. [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.

  17. 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.

  18. 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 in controlling the fluxes and reactivity of chemical species transported in hydro-logical 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 observed in an 130m deep artesian well. Borehole video logs show an important colonization of the well by the biofilm in the shallower part (0 to 60m), while it is inexistent in the deeper part (60 to 130m). As flow is localized in a few deep and shallow fractures, we presume that the spatial distribution of biofilm is controlled by mixing between shallow and deep groundwater. To verify this hypothesis we conducted a field campaign with joint characterization of the flow and chemical composition of water flowing from the different fractures, as well as the microbiological composition of the biofilm at different depth, using pyrosequencing techniques. We will discuss in this presentation the results of this interdisciplinary dataset and their implications for the occurrence of hotspots of microbiological activity in the subsurface.

  19. 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

  20. 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.

  1. 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

  2. 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.

  3. 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.

  4. 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.

  5. Total ankle replacement or ankle fusion in painful advanced hemophilic arthropathy of the ankle.

    PubMed

    Rodriguez-Merchan, E Carlos

    2015-12-01

    In advanced painful hemophilic arthropathy of the ankle, the last resort is surgical treatment (ankle arthrodesis [AA] or total ankle replacement [TAR]). There is a controversy in the literature on which of the two procedures is more appropriate. A review of the literature was performed to clarify such a controversy. The first search engine was MedLine (keywords: total ankle replacement, ankle arthrodesis). Seventy articles were found in MedLine. Of these, only 16 were selected and reviewed because they were strictly focused on the topic of this article. The second search engine was the Cochrane Library, where only nine systematic reviews were found on the role of TAR and AA in non-hemophilia patients. TAR and AA provide pain relief and patient satisfaction in hemophilia patients in the short term. The available non-hemophilia literature is insufficient to conclude which treatment is superior. My current view is that AA may be preferable in most hemophilia patients.

  6. 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

  7. 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.

  8. Impulsive ankle push-off powers leg swing in human walking.

    PubMed

    Lipfert, Susanne W; Günther, Michael; Renjewski, Daniel; Seyfarth, Andre

    2014-04-15

    Rapid unloading and a peak in power output of the ankle joint have been widely observed during push-off in human walking. Model-based studies hypothesize that this push-off causes redirection of the body center of mass just before touch-down of the leading leg. Other research suggests that work done by the ankle extensors provides kinetic energy for the initiation of swing. Also, muscle work is suggested to power a catapult-like action in late stance of human walking. However, there is a lack of knowledge about the biomechanical process leading to this widely observed high power output of the ankle extensors. In our study, we use kinematic and dynamic data of human walking collected at speeds between 0.5 and 2.5 m s(-1) for a comprehensive analysis of push-off mechanics. We identify two distinct phases, which divide the push-off: first, starting with positive ankle power output, an alleviation phase, where the trailing leg is alleviated from supporting the body mass, and second, a launching phase, where stored energy in the ankle joint is released. Our results show a release of just a small part of the energy stored in the ankle joint during the alleviation phase. A larger impulse for the trailing leg than for the remaining body is observed during the launching phase. Here, the buckling knee joint inhibits transfer of power from the ankle to the remaining body. It appears that swing initiation profits from an impulsive ankle push-off resulting from a catapult without escapement.

  9. Review of control algorithms for robotic ankle systems in lower-limb orthoses, prostheses, and exoskeletons.

    PubMed

    Jiménez-Fabián, R; Verlinden, O

    2012-05-01

    This review focuses on control strategies for robotic ankle systems in active and semiactive lower-limb orthoses, prostheses, and exoskeletons. Special attention is paid to algorithms for gait phase identification, adaptation to different walking conditions, and motion intention recognition. The relevant aspects of hardware configuration and hardware-level controllers are discussed as well. Control algorithms proposed for other actuated lower-limb joints (knee and/or hip), with potential applicability to the development of ankle devices, are also included.

  10. Calcaneal Insufficiency Fracture after Ipsilateral Total Knee Arthroplasty

    PubMed Central

    Jeong, Min; Shin, Sung Jin; Kang, Byoung Youl

    2016-01-01

    Insufficiency fracture of the calcaneus is a rare entity. In the absence of trauma, evaluating a painful ankle in an elderly patient can be difficult and also it might be overlook the insufficiency fracture. We experienced a case of insufficiency calcaneus fracture that occurred after ipsilateral total knee arthroplasty. Here, we report our case with a review of literatures. PMID:26981521

  11. Technical considerations for surgical intervention of Jones fractures.

    PubMed

    Mendicino, Robert W; Hentges, Matthew J; Mendicino, Michael R; Catanzariti, Alan R

    2013-01-01

    Jones fractures are a common injury treated by foot and ankle surgeons. Surgical intervention is recommended because of the high rate of delayed union, nonunion, and repeat fracture, when treated conservatively. Percutaneous intramedullary screw fixation is commonly used in the treatment of these fractures. We present techniques that can increase the surgical efficiency and decrease the complications associated with percutaneous delivery of internal fixation.

  12. Modeling and stress analyses of a normal foot-ankle and a prosthetic foot-ankle complex.

    PubMed

    Ozen, Mustafa; Sayman, Onur; Havitcioglu, Hasan

    2013-01-01

    Total ankle replacement (TAR) is a relatively new concept and is becoming more popular for treatment of ankle arthritis and fractures. Because of the high costs and difficulties of experimental studies, the developments of TAR prostheses are progressing very slowly. For this reason, the medical imaging techniques such as CT, and MR have become more and more useful. The finite element method (FEM) is a widely used technique to estimate the mechanical behaviors of materials and structures in engineering applications. FEM has also been increasingly applied to biomechanical analyses of human bones, tissues and organs, thanks to the development of both the computing capabilities and the medical imaging techniques. 3-D finite element models of the human foot and ankle from reconstruction of MR and CT images have been investigated by some authors. In this study, data of geometries (used in modeling) of a normal and a prosthetic foot and ankle were obtained from a 3D reconstruction of CT images. The segmentation software, MIMICS was used to generate the 3D images of the bony structures, soft tissues and components of prosthesis of normal and prosthetic ankle-foot complex. Except the spaces between the adjacent surface of the phalanges fused, metatarsals, cuneiforms, cuboid, navicular, talus and calcaneus bones, soft tissues and components of prosthesis were independently developed to form foot and ankle complex. SOLIDWORKS program was used to form the boundary surfaces of all model components and then the solid models were obtained from these boundary surfaces. Finite element analyses software, ABAQUS was used to perform the numerical stress analyses of these models for balanced standing position. Plantar pressure and von Mises stress distributions of the normal and prosthetic ankles were compared with each other. There was a peak pressure increase at the 4th metatarsal, first metatarsal and talus bones and a decrease at the intermediate cuneiform and calcaneus bones, in

  13. Modeling and stress analyses of a normal foot-ankle and a prosthetic foot-ankle complex.

    PubMed

    Ozen, Mustafa; Sayman, Onur; Havitcioglu, Hasan

    2013-01-01

    Total ankle replacement (TAR) is a relatively new concept and is becoming more popular for treatment of ankle arthritis and fractures. Because of the high costs and difficulties of experimental studies, the developments of TAR prostheses are progressing very slowly. For this reason, the medical imaging techniques such as CT, and MR have become more and more useful. The finite element method (FEM) is a widely used technique to estimate the mechanical behaviors of materials and structures in engineering applications. FEM has also been increasingly applied to biomechanical analyses of human bones, tissues and organs, thanks to the development of both the computing capabilities and the medical imaging techniques. 3-D finite element models of the human foot and ankle from reconstruction of MR and CT images have been investigated by some authors. In this study, data of geometries (used in modeling) of a normal and a prosthetic foot and ankle were obtained from a 3D reconstruction of CT images. The segmentation software, MIMICS was used to generate the 3D images of the bony structures, soft tissues and components of prosthesis of normal and prosthetic ankle-foot complex. Except the spaces between the adjacent surface of the phalanges fused, metatarsals, cuneiforms, cuboid, navicular, talus and calcaneus bones, soft tissues and components of prosthesis were independently developed to form foot and ankle complex. SOLIDWORKS program was used to form the boundary surfaces of all model components and then the solid models were obtained from these boundary surfaces. Finite element analyses software, ABAQUS was used to perform the numerical stress analyses of these models for balanced standing position. Plantar pressure and von Mises stress distributions of the normal and prosthetic ankles were compared with each other. There was a peak pressure increase at the 4th metatarsal, first metatarsal and talus bones and a decrease at the intermediate cuneiform and calcaneus bones, in

  14. Individuals with multiple sclerosis redistribute positive mechanical work from the ankle to the hip during walking.

    PubMed

    Davies, Brenda L; Hoffman, Rashelle M; Kurz, Max J

    2016-09-01

    Individuals with multiple sclerosis (MS) typically walk slower, have reduced cadences and shorter step lengths. While these spatiotemporal gait alterations have been thought to be due to decreased power generation at the ankle, the distribution of mechanical work across the ankle, knee and hip joints during walking is not well understood. By quantifying the mechanical work at each joint, the compensatory mechanisms utilized by individuals with MS to maintain gait speed may be better understood. Fifteen subjects with MS (EDSS: 4.4±1.0) and fifteen healthy age-matched control subjects completed a three-dimensional gait analysis. The net mechanical work at the ankle, knee and hip joints was quantified for the stance phase of gait. Our results found that the less impaired leg of the subjects with MS generated a similar amount of mechanical work as the control group; however, the ankle joint produced less positive mechanical work, and the hip joint generated more positive mechanical work. Additionally, the less impaired leg of the subjects with MS and the leg of the control group generated more positive work than the more impaired leg of the subjects with MS. These outcomes suggest that individuals with MS may adopt a hip compensatory strategy with their less impaired leg during gait due to the limited amount of mechanical work generated at the ankle.

  15. Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures in elderly patients.

    PubMed

    Basile, Attilio

    2010-01-01

    We compared the outcomes of displaced intra-articular calcaneal fractures in 33 patients aged 65 to 75 years, who were treated either operatively (n = 18) or nonsurgically (n = 15), between December 2001 and December 2005. The operative treatment group scored higher on the American Orthopaedic Foot & Ankle Society ankle-hindfoot score and had less pain as measured with the 10-cm visual analog scale than did the nonsurgically treated group, with the differences being statistically significant (P < or = .05), suggesting that results can be improved by operative treatment. Böhler's angle, the quality of operative reduction, subtalar joint motion, gender, and the Sanders type of fracture were also analyzed and compared between the treatment groups. The results confirmed that Böhler's angle, the quality of the reduction, and subtalar joint motion were important prognostic factors related to outcome, regardless of treatment; whereas gender and Sanders type had less influence on the results at the 2-year follow-up evaluation. The prevalence of complications observed in the surgically treated group was similar to that reported in prior publications, except for subtalar arthritis (38.9%), which may have been higher because of the age of our patients and the duration of follow-up.

  16. 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

  17. 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

  18. 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.

  19. 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

  20. Reconsideration of the Effects of Age on Proximal Femur Structure: Implications for Joint Replacement and Hip Fracture

    PubMed Central

    Khoo, B. C. C.; Brown, J. K.; Prince, R. L.

    2016-01-01

    Objectives In recent years quantitative computed tomography (QCT) has allowed precise non-invasive, three dimensional, in vivo measurement of hip structure in large numbers of individuals. The effects of ageing on proximal femur structure are reported and implications for the prevention of hip prosthesis loosening and hip fracture considered. Design, Setting and Participants An observational cross-sectional study of proximal femur QCT in 719 unselected female European descent aged 20 to 89 years recruited from US and Australian populations. Main Outcomes Measures QCT scans were obtained using software that separates cortical and cancellous bone by a thresholding technique. Voxel based mineral volume and mass was computed for the integral (external), cancellous and cortical compartments of 1 mm wide sections through the femoral neck (FN), trochanter (TR) and intertrochanter (IT) regions. Results Over the adult life span total integral volumes at the FN, TR and IT sites expand linearly by between 18 and 37% at the same time as bone mass decreased by 22 to 25% resulting in massive reductions in true volumetric BMD (vBMD) of 40 to 50%. Cancellous volume expansion was larger at 65 to 79% at the three sites. Between the ages of 65 and 75 the average increase in cancellous volume at the IT site was 3.74 cm3 (12.1%). Voxel determined FN cortical volume decreased linearly by 43%, as did cortical bone mass so that vBMD did not change substantially. TR and IT cortical volumes decreased 54 and 28% respectively, small reductions in TR and IT cortical vBMD also occurred. Conclusions Large endosteal expansion in the area in which hip replacement stem placement occurs may contribute to loosening. Regarding the propensity to hip fracture, periosteal expansion contributes to increased resistance to bending but cortical thinning contributes to loss of bone to resistance to bending forces. Understanding individual hip structure may contribute to individualisation of risk and

  1. Conservative treatments for rheumatoid arthritis in the foot and ankle.

    PubMed

    Anain, Joseph M; Bojrab, Angela R; Rhinehart, Francine C

    2010-04-01

    Rheumatoid arthritis (RA) is a systemic inflammatory disease that attacks peripheral joints, causing their destruction. Several pharmacologic therapies and physical modalities are available for its treatment. Because of the progressive nature of RA, complementary and alternative medicine therapy in conjunction with conventional medicine is administered to patients with RA. This article discusses the presence of undiagnosed RA in the foot and ankle and reviews the concurrent nonoperative measures in treatment, including pharmacologic and physical modalities.

  2. Comparison of our self-designed rotary self-locking intramedullary nail and interlocking intramedullary nail in the treatment of long bone fractures

    PubMed Central

    2014-01-01

    Objective The purpose of this study is to compare the clinical effects of our self-designed rotary self-locking intramedullary nail (RSIN) and interlocking intramedullary nail (IIN) for long bone fractures. Methods A retrospective study was performed in 1,704 patients who suffered bone fractures and underwent RSIN or IIN operation in our hospital between March 1999 and March 2013, including 494 with femoral fractures, 572 with humeral fractures, and 638 with tibial fractures. Among them, 634 patients were followed up for more than 1 year. The operative time, intraoperative blood loss, postoperative complications, healing rate, and the excellent and good rate of functional recovery were compared between two groups. Results Compared with IIN group, RSIN group exhibited significantly shorter operative time and less intraoperative blood loss no matter for humeral, femoral, or tibial fractures (all p < 0.001). The healing rate in patients with more than 1 year follow-up was significantly higher in RSIN group for femoral and tibial fractures (both p < 0.05). In RSIN group, no nail breakage or loosening occurred, but radial nerve injury and incision infection were respectively observed in one patient with humeral fracture. In IIN group, nail breakage or loosening occurred in 7 patients with femoral fractures and 16 patients with tibial fractures, radial nerve injury was observed in 8 patients with humeral fractures, and incision infection was present in 2 patients with humeral fractures and 1 patient with femoral fracture. The complication rate of IIN group was significantly higher than that of RSIN group (p < 0.05). However, there were no significant differences in the excellent and good rate of shoulder, elbow, knee, and ankle joint functional recovery between RSIN group and IIN group. Conclusion RSIN may be a reliable and practical alternative method for the treatment of long bone fractures. PMID:25047454

  3. Imaging findings in arthrofibrosis of the ankle and foot.

    PubMed

    Linklater, James M; Fessa, Chris K

    2012-07-01

    Arthrofibrosis is defined as joint pain and stiffness that does not allow functional range of motion and is due to adhesions or contracture of the joint. Arthrofibrosis is characterized by an abnormal proliferation of fibrous tissue that may be focal or diffuse and intra-articular or extra-articular. Trauma and surgery are the most common etiological factors. In the ankle and foot symptomatic arthrofibrosis is not uncommonly seen in the talocrural joint, posterior subtalar joint, and the metatarsophalangeal joints. Imaging can assist with diagnosis and planning treatment, most commonly using MRI and occasionally ultrasound. Typical imaging findings consist of capsular and pericapsular thickening and scarring, best demonstrated on proton-density MR images but also demonstrable on ultrasound.

  4. Pathogenesis of Fifth Metatarsal Fractures in College Soccer Players

    PubMed Central

    Fujitaka, Kohei; Taniguchi, Akira; Isomoto, Shinji; Kumai, Tsukasa; Otuki, Shingo; Okubo, Mamoru; Tanaka, Yasuhito

    2015-01-01

    Background: The pathogenesis of fifth metatarsal stress fractures remains uncertain. Hypothesis: Physical characteristics and environmental factors, which have received limited attention in the literature thus far, might be involved in the development of fifth metatarsal stress fractures. Study Design: Case-control study; Level of evidence, 3. Methods: To test the study hypothesis, a medical examination and survey of the living environment of collegiate soccer players was conducted and correlated with the existence of fifth metatarsal stress fractures. The survey and measurements were conducted in 273 male athletes from the same college soccer team between 2005 and 2013. A medical examination comprising assessment of stature, body weight, body mass index, foot–arch height ratio, toe-grip strength, quadriceps angle, leg-heel angle, functional reach test, single-leg standing time with eyes closed, straight-leg raise angle, finger-floor distance, heel-buttock distance, ankle joint range of motion, and a general joint laxity test were performed once a year, along with a questionnaire survey. The survey was also repeated when a fifth metatarsal stress fracture was diagnosed. The study participants were separated into a fifth metatarsal stress fracture injury group and a noninjury group. The measurement items and survey items were compared, and the association between the factors and the presence or absence of injuries was analyzed. Results: Toe-grip strength was significantly weaker in the injury group compared with the noninjury group, suggesting that weak toe-grip is associated with fifth metatarsal stress fracture (P < .05). In addition, fifth metatarsal stress fractures were more common in the nondominant leg (P < .05). Between-group comparisons of the other items showed no statistically significant differences. Conclusion: The association between weak toe-grip strength and fifth metatarsal fracture suggests that weak toe-grip may lead to an increase in the load

  5. 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

  6. 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.

  7. Treatment of common deficits associated with chronic ankle instability.

    PubMed

    Holmes, Alison; Delahunt, Eamonn

    2009-01-01

    Lateral ankle sprains are amongst the most common injuries incurred by athletes, with the high rate of reoccurrence after initial injury becoming of great concern. Chronic ankle instability (CAI) refers to the development of repetitive ankle sprains and persistent residual symptoms post-injury. Some of the initial symptoms that occur in acute sprains may persist for at least 6 months post-injury in the absence of recurrent sprains, despite the athlete having returned to full functional activity. CAI is generally thought to be caused by mechanical instability (MI) or functional instability (FI), or both. Although previously discussed as separate entities, recent research has demonstrated that deficits associated with both MI and FI may co-exist to result in CAI. For clinicians, the main deficits associated with CAI include deficits in proprioception, neuromuscular control, strength and postural control. Based on the literature reviewed, it does seem that subjects with CAI have a deficit in frontal plane ankle joint positional sense. Subjects with CAI do not appear to exhibit any increased latency in the peroneal muscles in response to an external perturbation. Preliminary data suggest that feed-forward neuromuscular control may be more important than feed-back neuromuscular control and interventions are now required to address deficits in feed-forward neuromuscular control. Balance training protocols have consistently been shown to improve postural stability in subjects with CAI. Subjects with CAI do not experience decreased peroneus longus strength, but instead may experience strength deficits in the ankle joint invertor muscles. These findings are of great clinical significance in terms of understanding the mechanisms and deficits associated with CAI. An appreciation of these is vital to allow clinicians to develop effective prevention and treatment programmes in relation to CAI.

  8. Nose fracture

    MedlinePlus

    Fracture of the nose; Broken nose; Nasal fracture; Nasal bone fracture; Nasal septal fracture ... A fractured nose is the most common fracture of the face. It ... with other fractures of the face. Sometimes a blunt injury can ...

  9. 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

  10. Onset Time of Nerve Block: A Comparison of Two Injection Locations in Patients Having Lower Leg/ Foot Surgery

    ClinicalTrials.gov

    2014-03-20

    Strain of Muscle and/or Tendon of Lower Leg; Fracture of Lower Leg; Crushing Injury of Lower Leg; Fracture Malunion - Ankle and/or Foot; Disorder of Joint of Ankle and/or Foot; Complete Tear, Ankle and/or Foot Ligament; Pathological Fracture - Ankle and/or Foot; Loose Body in Joint of Ankle and/or Foot

  11. 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

  12. 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.

  13. Semiextending Nailing for Combined Shaft and Ankle Injuries of the Leg.

    PubMed

    Probe, Robert

    2016-08-01

    Over recent years, orthopaedic traumatologists have been gaining experience with tibial nailing in the extended position. Originally developed to address the complexities of alignment in proximal tibial fractures, this technique has also proven valuable in the treatment of tibial shaft fractures combined with ankle injuries. Depicted in this video presentation is the surgical techniques used to simultaneously address a spiral fracture of the distal tibia associated with a large coronal plane fracture of the tibial articular surface. Discussed are leg positioning, technical aspects of the medial approach, strategies for preliminary ankle stabilization, and fine details of aligning the tibial component of the injury. With a growing body of evidence suggesting similar knee outcomes with semiextended and conventional infrapatellar approaches, it is anticipated that this technique will become increasingly popular in coming years. PMID:27441937

  14. Galeazzi fracture.

    PubMed

    Atesok, Kivanc I; Jupiter, Jesse B; Weiss, Arnold-Peter C

    2011-10-01

    Galeazzi fracture is a fracture of the radial diaphysis with disruption at the distal radioulnar joint (DRUJ). Typically, the mechanism of injury is forceful axial loading and torsion of the forearm. Diagnosis is established on radiographic evaluation. Underdiagnosis is common because disruption of the ligamentous restraints of the DRUJ may be overlooked. Nonsurgical management with anatomic reduction and immobilization in a long-arm cast has been successful in children. In adults, nonsurgical treatment typically fails because of deforming forces acting on the distal radius and DRUJ. Open reduction and internal fixation is the preferred surgical option. Anatomic reduction and rigid fixation should be followed by intraoperative assessment of the DRUJ. Further intraoperative interventions are based on the reducibility and postreduction stability of the DRUJ. Misdiagnosis or inadequate management of Galeazzi fracture may result in disabling complications, such as DRUJ instability, malunion, limited forearm range of motion, chronic wrist pain, and osteoarthritis.

  15. Natural fracturing, by depth

    NASA Astrophysics Data System (ADS)

    Hooker, John; Laubach, Stephen

    2013-04-01

    Natural opening-mode fractures commonly fall upon a spectrum whose end-members are veins, which have wide ranges of sizes and are mostly or thoroughly cemented, and joints, which have little opening displacement and little or no cement. The vein end-member is common in metamorphic rocks, whose high temperature and pressure of formation place them outside typical reservoir settings; conversely, many uncemented joints likely form near the surface and so too have limited relevance to subsurface exploration. Sampling of cores retrieved from tight-gas sandstone reservoirs suggest that it is intermediate fractures, not true joints or veins, that provide natural porosity and permeability. Such fractures have abundant pore space among fracture-bridging cements, which may hold fractures open despite varying states of stress through time. Thus the more sophisticated our understanding of the processes that form veins and joints, i.e., how natural fracturing varies by depth, the better our ability to predict intermediate fractures. Systematic differences between veins and joints, in terms of size-scaling and lateral and stratigraphic spatial arrangement, have been explained in the literature by the mechanical effects of sedimentary layering, which likely exert more control over fracture patterns at shallower depths. Thus stratabound joints commonly have narrow size ranges and regular spacing; non-stratabound veins have a wide range of sizes and spacings. However, new fieldwork and careful literature review suggest that the effects of mechanical layering are only half the story. Although atypical, veins may be highly stratabound and yet spatially clustered; non-stratabound fractures may nonetheless feature narrow size ranges. These anomalous fracture arrangements are better explained by the presence of precipitating cements during fracture opening than by mechanical layering. Cement is thought to be highly important for fracture permeability, but potential effects of

  16. TOTAL ANKLE ARTHROPLASTY: BRAZILIAN EXPERIENCE WITH THE HINTEGRA PROSTHESIS.

    PubMed

    Nery, Caio; Fernandes, Túlio Diniz; Réssio, Cibele; Fuchs, Mauro Luiz; Godoy Santos, Alexandre Leme de; Ortiz, Rafael Trevisan

    2010-01-01

    Ankle arthrosis is becoming more and more common. The search for solutions that preserve joint function has led to a new generation of prosthesis with three components and more degrees of freedom. This paper presents the results achieved for ten patients treated with the HINTEGRA Prosthesis (Integra, New Deal), through collaborative action between the Foot and Ankle Groups of the Orthopedics and Traumatology divisions of Escola Paulista de Medicina, Unifesp, and the School of Medicine of the University of São Paulo (USP). The ten patients (six women and four men, aged between 29 and 66 years), underwent a surgical procedure consisting of Hintermann's technique, between January and June 2005. They were evaluated at prearranged intervals, and the data were subjected to statistical analysis. The surgery led to a significant improvement in ankle mobility. Radiological evaluation showed no signs of loosening or failure in the prosthetic components in any of the patients studied. Although the complication rate in our sample was high, it was equivalent to the rates found by other authors, and directly represents the learning curve associate with this kind of procedure. Four years after the procedure, it was found that the patients pain levels had significantly decreased, and that their functional patterns had significantly improved, with AOFAS and Hintermann scores indicating results that were excellent for 20%, good for 70% and poor for 10%. Treatment of ankle arthritis by means of total arthroplasty using the HINTEGRA prosthesis was capable of providing good results over an average observation period of four years.

  17. Incidence and clinical significance of bone bruises after supination injury of the ankle. A double-blind, prospective study.

    PubMed

    Alanen, V; Taimela, S; Kinnunen, J; Koskinen, S K; Karaharju, E

    1998-05-01

    We used MRI to study a prospective series of 95 patients with inversion injuries of the ankle and no fracture on plain radiographs. We found an incidence of bone bruises of 27%, but these made no difference to the time of return to work, limitation of walking or physical activity, or the clinical outcome scores at three months. We conclude that bone bruises have very little clinical significance after inversion injuries of the ankle.

  18. Proximal humerus fractures.

    PubMed

    Price, Matthew C; Horn, Pamela L; Latshaw, James C

    2013-01-01

    Proximal humerus fractures are among the most common fractures associated with osteoporosis. With an aging population, incidence of these fractures will only increase. The proximal humerus not only forms the lateral portion of the shoulder articulation but also has significant associations with musculoskeletal and neurovascular structures. As a result, fractures of the proximal humerus can significantly impact not only the function of the shoulder joint, but the health and function of the entire upper extremity as well. Understanding of these fractures, the management options, and associated nursing care, can help reduce morbidity rate and improve functional outcomes.

  19. Use of Soft-Tissue Procedures for Managing Varus and Valgus Malalignment with Total Ankle Replacement.

    PubMed

    Roukis, Thomas S; Elliott, Andrew D

    2015-10-01

    Achieving frontal plane alignment of the ankle joint during total ankle replacement is essential for long-term success. Tendon and ligament lengthening, ligament reinforcement, tendon transfer, nonanatomic tendon transfer ligament reconstruction, and periarticular osteotomies are safe, straightforward, minimally invasive, and reproducible procedures to correct varus and valgus deformities associated with end-stage degenerative joint disease. Using reproducible topographic anatomic landmarks is essential to these techniques properly and limit complications. The approach to frontal plane deformities is stepwise, with liberal use of tendon and ligament lengthening and reconstruction, a low threshold for nonanatomic tendon transfer ligament reconstructions, and tendon transfers and/or periarticular osteotomies.

  20. The effect of ankle muscle strength and flexibility on dolphin kick performance in competitive swimmers.

    PubMed

    Willems, Tine M; Cornelis, Justien A M; De Deurwaerder, Lien E P; Roelandt, Filip; De Mits, Sophie

    2014-08-01

    The velocity of a swimmer is determined by biomechanical and bioenergetics factors. However, little is known about the effect of ankle flexibility on dolphin kick performance. Next to this, scientific evidence is lacking concerning the influence of ankle muscle strength. Therefore, the aim of this study was to investigate the effect of ankle flexibility and muscle strength on dolphin kick performance in competitive swimmers. Ankle range of motion (ROM) and ankle muscle strength were measured in 26 healthy competitive swimmers. The effect of both was assessed on the swimmer's velocity and lower extremity joint angles during three maximal dolphin kick trials. Additionally, the effect of a flexibility restriction by a tape on the dolphin kick performance was assessed. Correlations were calculated between the flexibility, muscle strength and dolphin kick performance and differences were investigated between the unrestricted and restricted condition. Muscle strength of dorsal flexors and internal rotators were positively significantly correlated with the velocity. Active and passive plantar flexion ROM and internal rotation ROM were not significantly correlated. A plantar flexion-internal rotation restriction during the dolphin kick showed a significant decrease in velocity. This restriction was associated with a changed movement pattern in the knee towards more flexion. The results suggest that dolphin kick velocity might be enhanced by ankle muscle strength exercises and that subjects with a restricted ankle flexibility might profit from a flexibility program. PMID:24984154