Adolescent ; Adult ; Ankle Injuries ; Ankle Joint ; diagnostic imaging ; Female ; Humans ; Ligaments, Articular ; diagnostic imaging ; injuries ; Male ; Middle Aged ; Radiography ; Rupture

OBJECTIVETo explore the characteristics of the talonavicular joint movement in vivo and its effects on changes of the medial longitudinal arch.

METHODSFoot CT images in the initial position (neutral position) and terminal position (maximum varus-adduction-dorsiflexion position) were acquired from 9 cases (5 healthy volunteers, including 4 males and 1 female) during foot varus-adduction-dorsiflexion motion. Based on the principle of rigid body kinematics, the CT data were reconstructed and analyzed with Mimics and Geomagic reverse engineering software. The changes of the talonavicular joint in three-dimensional in 6 degrees of freedom were calculated to determine its correlation to the medial longitudinal arch angle.

RESULTSDuring foot varus-adduction-dorsiflexion motion, the talonavicular joint underwent varus-adduction-plantarflexion motion, with the motion range of 38.82∓5.98° in varus, 19.71∓6.33° in adduction, and -5.09∓6.89° in plantarflexion. During talonavicular joint motion, the medial shift of the navicular was significantly correlated to the changes of foot medial longitudinal arch (P<0.05).

CONCLUSIONDigital technology can solve the problem of measurement of talonavicular joint three-dimensional motion in vivo. Though as a ball-and-socket joint, the talonavicular joint mainly rotates around the sagittal axis, and its movement is a major factor to cause changes of foot medial longitudinal arch.

Adult ; Ankle Joint ; diagnostic imaging ; Biomechanical Phenomena ; Female ; Humans ; Imaging, Three-Dimensional ; Male ; Movement ; Range of Motion, Articular ; Subtalar Joint ; diagnostic imaging ; Talus ; diagnostic imaging ; Tomography, X-Ray Computed ; Young Adult

Accessory ossicles are normal variants that are frequently seen but often overlooked or misdiagnosed. Commonly seen at the foot and ankle, they may be mistaken for fracture fragments or loose bodies, or not be recognised as a cause of the patient's symptoms. This pictorial essay aimed to review commonly encountered accessory ossicles of the foot and ankle by highlighting anatomic landmarks and associated pathologic processes through the use of both basic and advanced imaging modalities, in an effort to increase awareness of these clinical entities.
Adult ; Aged, 80 and over ; Ankle Joint ; diagnostic imaging ; Female ; Foot ; diagnostic imaging ; Fractures, Bone ; diagnostic imaging ; Humans ; Magnetic Resonance Imaging ; Male ; Sesamoid Bones ; diagnostic imaging ; Tomography, X-Ray Computed

OBJECTIVETo explore operative method in the treatment of syndesmosis injury of ankle fractures.

METHODSTwenty-four patients with ankle fractures and syndesmosis diastasis were treated with shape memory fracture staples, including 10 males and 14 females ranging in age from 19 to 71 years, with an average of 43 years. All patients were diagnosised with history, body examination and image data and were operated according to classification of Lauge-Hansen.

RESULTSAll patients were followed up from 6 to 28 months with an average of 16 months, and all fractures healed, with a mean time 9.2 (8 to 14) weeks. Only one case had radiological and clinical manifestations of traumatic arthritis, but no breakage of shape memory fracture staple in all cases. Sixteen patients got excellent results, good in 5, fair in 2, poor in 1.

CONCLUSIONShape memory staple fixation for the treatment of syndesmosis diastasis in ankle fractures not only can perseve the physical motion of ankles, but also be remove earlier before weight bearing.

Adult ; Aged ; Ankle Fractures ; Ankle Injuries ; complications ; diagnostic imaging ; surgery ; Ankle Joint ; diagnostic imaging ; surgery ; Female ; Fracture Fixation, Internal ; instrumentation ; Humans ; Male ; Middle Aged ; Radiography ; Treatment Outcome ; Young Adult

OBJECTIVE: According to the features of epiphyseal development of knee and ankle joints in male and female teenagers, the trend of epiphyseal development was analyzed and the possibility of its application in age estimation was discussed. METHODS: Firstly, radiographs of adem position were taken from both sides of knee and ankle joints from 1709 individuals from Eastern China, Central China, and Southern China (Age: 11-21 years old). Secondly, 5 osteal loci were selected as bone age markers from the two joints. Thirdly, characteristics of epiphyseal development were observed systematically and comprehensively. Fourthly, the proportions of "epiphyseal fusion" in different age groups were calculated, and confirmed the numbers of people which were included by epiphyseal fusion of knee and ankle joints. Finally, age range of each epiphyseal fusion was calculated by mathematical statistical analysis. RESULTS: Compared with the data of 1960s', the age of 5 epiphyseal fusions was earlier about 2-3 years. However, the results were basically the same as the recent studies. CONCLUSION The data on the time of epiphyseal fusion were updated. It is important to determine the accuracy in age estimation in male and female teenagers.
Adolescent ; Age Determination by Skeleton/methods* ; Ankle Joint/diagnostic imaging* ; Arthrography ; Bone Development/physiology* ; Child ; China/epidemiology* ; Epiphyses/diagnostic imaging* ; Female ; Forensic Anthropology/methods* ; Humans ; Knee Joint/diagnostic imaging* ; Male ; Young Adult

OBJECTIVETo compare the diagnostic value between digital photography (DR) and multi-slice spiral CT (MSCT) in fracture and dislocation of foot and ankle.

METHODSFrom August 2010 to August 2012, the DR and MSCT data of 52 patients with fracture and dislocation of foot and ankle were compared according to results of surgery or discharge diagnosis. There were 37 males and 15 females, aged from 15 to 49 years old. Wilcoxon signed rank test was used for statistical analysis.

RESULTSThe results of 52 cases of MSCT were matched with the postoperative or discharge diagnosis. A total of 172 fractures were found on MSCT and 98 fractures were found on DR, the results had significant difference in detecting fracture (V=1 081, P<0.05); A total of 24 dislocations were found on MSCT and 16 dislocations were found on DR,the results also had significant difference in detecting dislocation (V=21, P<0.05). Fractures of 6 cases with DR diagnosis were corrected and located by MSCT.

CONCLUSIONMSCT is significantly better than DR in diagnosis of fracture and dislocation of foot and ankle. The examination of two parts should be performed in DR. MSCT and multi-planar reconstruction (MPR) examination should be further performed if DR results are unclear or do not match with clinical symptoms, missed diagnosis and misdiagnosis can be avoided.

Adolescent ; Adult ; Ankle Injuries ; diagnostic imaging ; Female ; Foot Injuries ; diagnostic imaging ; Fractures, Bone ; diagnostic imaging ; Humans ; Image Processing, Computer-Assisted ; methods ; Joint Dislocations ; diagnostic imaging ; Male ; Middle Aged ; Multidetector Computed Tomography ; methods ; Photography

OBJECTIVETo measure the stability of Evans procedure and Chrisman-Snook technique in the treatment of II degree lateral collateral ligament of ankle joint, and provide basis for treatment and prognosis.

METHODSFrom July 2008 to June 2009,18 frozen corpes were collected, including 10 males and 8 females, with an average age of fresh 39.3 +/- 11.2 years. The frozen corpes were randomly divided into three group, including normal controls(group A), Evans procedure (group B) and Chrisman-Snook technique ( group C), 6 specimens in each group. Anterior talofibular ligament and calcaneofibular ligament were cut off to cause II degree lateral collateral ligament in group B and C. Evans procedure or Chrisman-Snook technique were applied to restore lateral collateral ligament, and measure biomechnics. The displacement of tibiotalar joint and subtalar joint were observed.

RESULTS(1) The lateral stress results of tibiotalar joint showed the displacement by Evans procedure (group B) was greater than other groups (P < 0.0001). There were no significant differences between group A and C (P > 0.05). (2) The lateral stress results of subtalar joint showed the displacement by Evans procedure (group B) was greater than other groups (P< 0.0001). There were no significant differences between group A and C (P > 0.05).

CONCLUSIONAnkle instability is caused by ankle joint lateral collateral ligament injury. Chrisman-Snook technique is better than Evans procedure in stability on the early stage of ankle joint restoration, and conform to principle of biomechanics.

Adult ; Ankle Joint ; Biomechanical Phenomena ; Female ; Humans ; Lateral Ligament, Ankle ; diagnostic imaging ; injuries ; surgery ; Male ; Mechanical Phenomena ; Prognosis ; Radiography ; Reconstructive Surgical Procedures ; methods

The posterior tibial muscle is considered a plantar flexor as well as an invertor of the foot, which acts as a key muscle to the medial longitudinal arch by locking the talar joints in normal gait. Rupture of the posterior tibial tendon can cause a valgus deformity of the hindfoot and an abduction deformity of the forefoot which produces a typical flat foot and a talar dislocation in severe cases. The tendon of posterior tibial muscle can be ruptured spontaneously after the age of 40 from chronic stress at the ankle joint, or by sports injury and trauma. Severe foot deformity which can be prevented by early diagnosis and appropriate treatment often occurs from misdiagnosis as a chronic ankle sprain or a congenital flat foot. We report two cases of foot deformities caused by spontaneous and traumatic rupture of posterior tibial tendons with their clinical manifestations and MRI findings.
Ankle Injuries ; Ankle Joint ; Athletic Injuries ; Congenital Abnormalities ; Diagnostic Errors ; Dislocations ; Early Diagnosis ; Flatfoot* ; Foot ; Foot Deformities ; Gait ; Joints ; Magnetic Resonance Imaging ; Rupture* ; Tendons*

Radial head excision has always been a safe commonly used surgical procedure with a satisfactory clinical outcome for isolated comminuted radial head fractures. However, diagnosis of elbow instability is still very challenging and often underestimated in routine orthopaedic evaluation. We present the case of a 21-years old female treated with excision after radial head fracture, resulting in elbow instability. The patient underwent revision surgery after four weeks. We believe that ligament reconstruction without radial head substitution is a safe alternative choice for Mason III radial head fractures accompanied by complex ligament lesions.
Adult ; Elbow Joint ; injuries ; Female ; Fracture Fixation ; Humans ; Joint Instability ; therapy ; Lateral Ligament, Ankle ; surgery ; Radius Fractures ; complications ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed

OBJECTIVETo study clinical effects of the over-articular external fixator combined with limited internal fixation for the treatment of Pilon fractures caused by high energy.

METHODSFrom September 2003 to April 2011, 36 patients with Pilon fractures caused by high energy were treated with the over-articular external fixator combined with limited internal fixator. There were 25 males and 11 females, ranging in age from 16 to 72 years old,with an average of 38 years old. The diagnoses of all patients were determined by conventional X-ray examination or three-dimensional spiral CT examination. The AOFAS scoring criteria was used to evaluate the therapeutic effects. The patients with comminuted fractures were treated with screw or Kirschner wire fixation without uncovering periost so as to enhance stability between fracture end and bone blocks,followed by the fixation with over-articular external fixators.

RESULTSAll the patients were followed up, and the duration ranged from 4 to 27 months, with an average of 13 months. Thirty-two patients got wound healing at the first stage. And the bone union duration ranged from 2 to 6 months, with a mean of 3 months. According to the AOFAS ankle-hindfoot subjective scoring standard, 13 patients got an excellent result, 20 good and 3 fair, with an score of 88.2 +/- 3.6. Twelve patients had infections at pinhole, 5 patients had pinhole pain. One patient had the fixator broken induced by over loading, who was cured after treatment. There were no complications such as nerve or vascular injuries, or osteomyelitis.

CONCLUSIONThe over-articular external fixation combined with limited internal fixation for the treatment of Pilon fractures caused by high energy is an ideal method, which has such advantages as reliable fixation, simple operation, coincidence with principles of biomechanical fixation, and benefit for fracture healing.

Adolescent ; Adult ; Aged ; Ankle Injuries ; diagnostic imaging ; surgery ; Ankle Joint ; diagnostic imaging ; surgery ; External Fixators ; Female ; Fracture Fixation ; Fracture Fixation, Internal ; Humans ; Internal Fixators ; Male ; Middle Aged ; Radiography ; Treatment Outcome ; Young Adult