OBJECTIVETo evaluate the short-term effects of ankle joint replacement for the patients with hemophilic arthritis. To find out the main points for improving the joint function and the patients' life quality. To accumulate more experience for clinical treatment.

METHODSThe Kofoed evaluation system and the AOFAS evaluation system were used to follow-up 6 hemophilic patients with ankle arthritis (6 males, ranging in age from 23 to 57 years, with an average of 41.2 years), who were treated with ankle joint replacement from 2004.7 to 2007.7. The scores before operation, and the 6th,12th months after operation were compared.

RESULTSThe Kofoed evaluation system showed the joint replacement significantly improved the scores for relieving pain, joint function, range of motion and the total score (P<0.05). Except the score for relieving pain, the other three also had significant differences between the 6th month and the 12th month after the operation (P<0.05). Compared with each details of the joint function, there was significant improvement before and after the operation (P<0.05). The ankle got more extended range of motion in the 12th month after operation than the 6th month (P<0.05). The AOFAS evaluation system showed the joint replacement significantly improved the scores for relieving pain, joint function, X-ray measurement and the total score (P<0.05). There was no differences between the 6th month after operation and the 12th month in the results for relieving pain and the X-ray measurement (P>0.05). However, the joint function and the total score had significant differences (P<0.05). Compared with each details of the joint function, there was also significant improvement before and after the operation (P< 0.05), and the walk distance, as well as the joint flexion and extension activities, had differences between the 6th month and the 12th month after the operation. Both of the two evaluation system showed the operation could get good curative effects (P< 0.05), and the artificial joint could constantly be in good condition from the 6th month to the 12th month after operation (P> 0.05).

CONCLUSIONIn this short-term observation, the joint replacement can significantly improve the life quality for the hemophilic patients with ankle arthritis.

Adult ; Ankle Joint ; physiopathology ; surgery ; Arthritis ; etiology ; physiopathology ; surgery ; Arthroplasty, Replacement ; methods ; Hemophilia A ; complications ; Humans ; Male ; Middle Aged

OBJECTIVETo evaluate the effects of arthroscopic debridement for acute gouty arthritis of the ankle.

METHODSForty-one patients with acute gouty arthritis of the ankle were treated under arthroscopy from January 2010 to June 2012. All the patients were male, age in ranging from 28 to 69 years with an average of 43 years. Eighteen patients were in the left ankles and 23 in the right ankles; 12 cases were firstly attack and 29 cases were recurrent attack. Course of disease was from 2 weeks to 30 months. The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score was used to evaluate the clinical effects. Number of acute attacks of gouty arthritis were observed.

RESULTSAll the patients were followed up at least 12 months. The mean AOFAS Ankle-Hindfoot Scale score increased from 58.44 +/- 9.45 preoperatively to 86.15 +/- 7.36, 83.41 +/- 9.22, 84.10 +/- 8.22 postoperatively at 6, 12, months and the last follow-up respectively. Swelling of the ankle were improved significantly, pain was relieved and the mean number of acute attacks of gouty arthritis decreased significantly.

CONCLUSIONArthroscopy is helpful for the diagnosis of acute gouty arthritis of the ankle and improvement of clinical symptoms and ankle function.

Adult ; Aged ; Ankle Joint ; physiopathology ; surgery ; Arthritis, Gouty ; physiopathology ; surgery ; Arthroscopy ; Debridement ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome

OBJECTIVETo evaluate effects of arthroscopic debridement and visco supplement for the treatment of degenerative osteoarthropathy of ankle.

METHODSFrom October 2008 to May 2012, 30 patients with degenerative osteoarthropathy of ankle were treated with arthroscopy after ineffective treatment with conservative methods. Two patients lost follow-up. Among the patients, 19 patients were male and 9 patients were female, ranging in age from 28 to 56 years old, with a mean of (40.0+ 5.9)years old. Patients who had inflammatory or postinfectious arthritis,rheumatoid,gout,tuberculosis were excluded. Other exclusion criteria included previous arthroscopic treatment for ankle osteoarthropathy, intraarticular corticosteroid injection within the previous 6 months, a major neurologic deficit, serious medical illness and pregnancy. Articular cartilage iijuries were classified according to Outerbridge by the same doctor. Follow procedures were involved in the surgery: synovectomy,debridement or excision of fragments of articular cartilage or chondral flaps and osteophytes that prevented full extension. Microfracture of chondral defects was not performed. Ogilvie-Harris criteria was used to evaluate therapeutic effects.

RESULTSAccording to Ogilvie-Harris criteria, 10 patients got an excellent results, 14 good, 3 poor and 1 bad. The mean VAS score of pain decreased from preoperative 7.5+/-1.3 to postoperative 2.4+/-2.3. The score of dorsiflexion range (ROM-D) had no obvious change after operation [preoperative(27.0+/-7.3)degree and postoperative(29.0+/-5.6)degree]. The mean Tegner score increased from preoperative 2.7+/-1.3 to postoperative 5.6+/-2.2.

CONCLUSIONSynovectomy, debridement or excision of chondral flaps and osteophytes under arthroscopy, as well as scheduled intraarticular sodium hyaluronate injection should be recommened to treat ankle degenerative osteoarthropathy.

Adult ; Ankle Joint ; physiopathology ; surgery ; Arthroscopy ; methods ; Debridement ; methods ; Female ; Humans ; Male ; Middle Aged ; Osteoarthritis ; physiopathology ; surgery ; Range of Motion, Articular

The purpose of this study was to evaluate how soft tissue surgery for correcting equinus deformity affects the kinematic and kinetic parameters of the ankle and proximal joints. Sixteen children with spastic hemiplegic cerebral palsy and equinus deformities (age range 3-16 years) were included. Soft tissue surgeries were performed exclusively on the ankle joint area in all subjects. Using computerized gait analysis (Vicon 370 Motion Analysis System), the kinematic and kinetic parameters during barefoot ambulation were collected preoperatively and postoperatively. In all 16 children, the abnormally increased ankle plantar flexion and pelvis anterior tilting on the sagittal plane were significantly improved without a weakening of push-off (p < 0.05). In a group of 8 subjects with a recurvatum knee gait pattern before operation, the postoperative kinematic and kinetic parameters of the knee joint were significantly improved (p < 0.05). In a group of 8 subjects with ipsilateral pelvic external rotation before operation, the postoperative pelvic deviations on the transverse plane were significantly decreased (p < 0.05). These findings suggest that the soft tissue surgery for correcting equinus deformity improves not only the abnormal gait pattern of the ankle, but also that of the knee and pelvis.
Male ; Kinetics ; Joints/physiopathology/surgery ; Humans ; Hemiplegia/*surgery ; Gait/physiology ; Female ; Equinus Deformity/*surgery ; Child, Preschool ; Child ; Cerebral Palsy/*surgery ; Biomechanics ; Ankle Joint/physiopathology/surgery ; Adolescent

OBJECTIVETo evaluate biomechanical properties in different methods of internal fixation combined with distal tibiofibular syndesmosis injury, in order to provide a theoretical basis for clinical choice.

METHODSSix lower limbs specimens were collected and divided into 5 groups, including normal group, distal tibiofibular syndesmosis injury (injury group), 3 cortexes group, 4 cortexes group and hook-plate fixation group. Neutral position, plantar flexion position (30°), dorsiflexion (20°) supination external rotation position of foot movement were simulated on universal materials tester. Strength, stiffness and stability of ankle joint in 4 kinds of motion conditions were measured.

RESULTSThere was significant differences in strength and stiffness of ankle joint between injury group and normal group in 4 different kinds of motion conditions (P<0.05). Strength and stiffness of ankle joint in 3 cortexes group, 4 cortexes group and hook-plate fixation group were improved obviously in 4 different kinds of motion conditions, and biomechanical indexes were recovered normally or better than normal group. Stiffness of the three fixation groups were better than normal group,but there was no significant differences among three groups (P > 0.05), while stiffness of hook-plate fixation group was closed to normal group.

CONCLUSIONFor distal tibiofibular syndesmosis injury, 1 screw with 3 cortexes, 4 cortexes and hook-plate had a positive impact on strength, stiffness and stability of distal tibiofibular syndesmosis injury stress,and could restore the normal stabllity of ankle joint after reconstruction. While fixing by screw fixation would limit the rototary motion of ankle joint,ankle mortise could not adapt to changes of talus bone, thus induces screw breakage and traumatic arthritis. Hook-plate fixation is more suitable than 3 cortexes or 4 cortexes fixation for bilmechanical properties,and its' stress is more balance and can reduce postoperative complcations.

Ankle Injuries ; physiopathology ; surgery ; Biomechanical Phenomena ; Fibula ; injuries ; surgery ; Fracture Fixation, Internal ; methods ; Humans ; Joint Instability ; physiopathology ; prevention & control ; Reconstructive Surgical Procedures ; methods ; Tibia ; injuries ; surgery

OBJECTIVETo explore the surgical method and its clinical effects of minimally invasive osteosynthesis on the treatment of complex ankle fractures.

METHODSFrom January 2007 to December 2011, 53 patients with complex ankle fractures were treated with minimally invasive osteosynthesis. There were 31 males and 22 females, with an average age of 38.2 years old (ranged, 18 to 65). According to the system of Lauge-Hansen, 32 fractures were supination external rotation injury (grade WV), 13 fractures were pronation external rotation (grade III or IV), 5 fractures were pronation abduction (grade III); and 3 fractures can not be classified due to serious comminution fracture of fibula. According to the system of Denis-Weber, there were 4 cases with type A, 34 cases with type B and 15 cases with type C. Seven cases were open fractures. The duration from injuries to operation ranged from 2 hours to 14 days with an average of 5 days. The sequence of reduction and fixation of ankle fractures was firstly posterior malleolus, then medial malleolus and lateral malleolus, and inferior tibiofibular syndesmosis lastly. The fractures of posterior malleolus were reduced and fixed through anterior ankle approaches; the fractures of medial and lateral malleolus were percutaneously fixed with bolts or blade plate or tensile force band; and inferior tibiofibular syndesmosis were firmly fixed if necessary. Baird-Jackson scoring system was used to evaluate clinical effects.

RESULTSForty-eight patients were followed up from 10 to 36 months with an average of 13 months. The fractures got healing with an average time of 12 weeks (ranged, 10 to 18). According to the Baird-Jackson scoring system, the mean score of ankle function was 94.7 +/- 4.2, and 28 cases obtained excellent results, 15 good, 3 fair and 2 poor. One case experienced superficial infections and was cured by changing dressings, 2 cases experienced fixed syndesmosis screw breakage.

CONCLUSIONThe surgical method of minimally invasive osteosynthesis can ensure the anatomical join restoration, protect the blood supply of fracture end, rebuild the function of ankle joint, obtain satisfactory clinical results in treating complex ankle fractures.

Adolescent ; Adult ; Aged ; Ankle Fractures ; Ankle Joint ; physiopathology ; surgery ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods

Adolescent ; Adult ; Aged ; Ankle Joint ; pathology ; physiopathology ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Tuberculosis, Osteoarticular ; drug therapy ; pathology ; physiopathology ; surgery ; Young Adult

OBJECTIVETo study the therapeutic effects of combined anterior-posterior (small incision or micro-incision) approach for complex tibial plateau and posterior condylar fractures.

METHODSFrom 2000 to 2008, 79 patients (81 limbs) with complex tibial plateau and posterior condylar fractures were reviewed. There were 45 males and 34 females, ranging in age from 19 to 66 years, with an average of 40.6 years. Thirty-nine limbs were treated using small incision through combined anterior-posterior approach, in which 13 limbs were Schatzker type IV, 15 limbs were type V ,and 11 limbs were type VI. Other 42 limbs were treated using micro-incision through combined anterior-posterior approach, in which 18 limbs were Schatzker type IV, 16 limbs were type V, and 8 limbs were type VI. The Rasmussen scores for knee joint and radio scores were used to evaluate therapeutic effects after the treatment. The complications such as cutaneous necrosis and incision infection were observed.

RESULTSAll the patients were followed up. According to Rasmussen criterion, in small incision group, 16 limbs got an excellent result, 13 good, 7 fair and 3 bad; in micro-incision group,above data were 19, 11, 8 and 4 respectively. Comparison between the two groups, P = 0.924. Comparison of complications such as cutaneous necrosis and incision infection: in small incision group,10 limbs had the complications, and in micro-incision group were 4 limbs; the occurrence rate of small incision group were higher than that of micro-incision group (P = 0.047).

CONCLUSIONThere are no significant differences between the two groups in the knee joint function rehabilitation; however, there is smaller rate for cutaneous necrosis and incision infection in micro-incision group.

Adult ; Aged ; Ankle Injuries ; surgery ; Case-Control Studies ; Female ; Fracture Fixation ; methods ; Humans ; Knee Joint ; physiopathology ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; Retrospective Studies ; Tibial Fractures ; surgery

OBJECTIVETo compare the clinical efficacy of grade III, IV supination-eversion fractures-dislocations of ankle joint between manipulative treatment and operative treatment.

METHODSFrom September 2007 to December 2008, the clinical data of 60 patients with grade III, IV supination-eversion fractures-dislocations of ankle joint were retrospectively analyzed. There were 32 males and 28 females, ranging in age from 18 to 70 years with an average age of 38.17 years. All patients were respectively treated with manipulative treatment (conservative group, 30 cases) and operative treatment (operative group, 30 cases). The joint function was compared with Mazur standard; the reduction and shifting of fractures were observed with X-ray; the hospitalization day and the therapeutic cost were compared between two groups.

RESULTSAll patients were followed up with an average of 15.27 months (ranged, 6 to 25 months). In conservative group, 16 cases got excellent result in joint function, 10 good, 3 fair, 1 poor; in operative group, 20 cases got excellent result, 8 good, 2 fair, 0 poor. In conservative group in the X-ray showed 25 cases obtained excellent and good reduction, 4 fair, 1 poor; and in operative group in the X-ray showed 28 cases obtained excellent and good reduction, 2 fair, 0 poor. There was no significant difference at the joint function and X-ray film after treatment between two groups (P > 0.05). The hospital day was respectively (7.87 +/- 3.34), (17.37 +/- 4.64) d in conservative group and operative group; and the therapeutic cost was respectively (2 506.67 +/- 649.10), (11 473.33 +/- 1 564.90) yuan. There was significant difference at hospital day and therapeutic cost between two groups (P < 0.05).

CONCLUSIONConservative treatment and operative treatment can both reach a very good result in treating grade III, IV supination-eversion fractures and dislocations of ankle joint. However, conservative treatment has advantage of high safety factor, low therapeutic cost, can reduce medical costs for patients.

Adolescent ; Adult ; Aged ; Ankle Joint ; physiopathology ; Case-Control Studies ; Female ; Fracture Fixation, Internal ; Fractures, Bone ; surgery ; Humans ; Joint Dislocations ; surgery ; Male ; Middle Aged ; Supination ; X-Ray Film ; X-Rays ; Young Adult

Ankle spasticity following brain injury leads to abnormal posture and joint contracture; making standing or walking impossible. This study investigates the efficacy of selective tibial neurotomy (STN) and intensive rehabilitation in a patient who suffered ankle spasticity after brain injury. This case describes a 37-year-old man whose traumatic brain injury (TBI) resulted in severe right ankle spasticity and contracture. He was unable to stand due to severe right ankle spasticity and contracture. Intensive rehabilitation and STN allowed him to walk without brace at 6 months and run at 12 months after STN. STN is an effective procedure to resolve localized spasticity of the ankle and it may be considered as a management strategy after local injection to alleviate ankle spasticity and/or contracture prior to orthopaedic surgery.
Adult ; Ankle Joint/innervation ; Brain Injuries/*complications ; Contracture/etiology/rehabilitation/surgery ; Humans ; Male ; Muscle Spasticity/etiology/*rehabilitation/*surgery ; Quadriplegia/*complications/*rehabilitation/surgery ; Recovery of Function ; Research Support, Non-U.S. Gov't ; Tibial Nerve/physiopathology/*surgery ; Walking