Compartment syndrome is a limb threatening condition. Prior research has been limited by an inability to assess functional and histologic changes in muscle over time. This study was designed to assess and quantify functional deficits and histologic changes following acute compartment syndrome of the lower limb in a novel rat model. Twenty-three male Wistar rats were trained to perform an incentive-based standard task on an optical gait tracking system. Animals were then randomized to three groups: Control (n=4), Sham (n=4) and Compartment Syndrome (CS, n=15). Control and sham animals had no elevation of intracompartmental pressure, while CS animals had elevated intracompartmental pressure to 30mmHg for 180 minutes in the anterior compartment of the left hind limb using a saline infusion technique. Following intervention, gait analysis was performed at 2hrs, 24hrs, 48hrs, 72hrs and 7days following injury. Several parameters for the injured hind limb were analyzed including: print area, print intensity, maximum contact timing, duty cycle and stance phase time. A 2-way ANOVA with Bonferroni post-hoc analysis was performed. The EDL muscle was harvested (n=17), fixed in formalin and prepared with an H&E stain. Mid-muscle sections were analyzed by a blinded senior pathologist for cell infiltration, necrosis and regeneration.Purpose
Method
Educational handouts designed for patients are promoted as a tool to educate, increase satisfaction, and potentially improve outcome. However, the value of these educational handouts as an adjunct to standard surgical care has not been formally assessed after ankle fracture. The purpose of this study was to compare standard post-operative care following surgically treated rotational ankle fracture to care supplemented with the use of adjunctive educational handouts. Fifty-one patients who sustained a rotational ankle fracture requiring open reduction and internal fixation were randomized to receive either standard care (group S) for an ankle fracture, or to additionally receive the AAOS handout on ankle fractures and a handout describing appropriate mobilization exercises (group H). Standard care included follow up visits at 2, 6, and 12 weeks postoperatively in a busy orthopaedic fracture clinic, including brief instructions on mobilization exercises. A bulky plaster-reinforced dressing was used for immobilization for the first two weeks following surgery, followed by a removable boot. Range of motion exercises were encouraged after the first two weeks and weight bearing was encouraged six weeks after surgery. Surgeons and outcome assessors were blinded to treatment group. Patients completed functional outcome assessment (Olerud-Molander ankle score), objective measurement of ankle motion, and visual analog scale questions related to satisfaction at 6 and 12 weeks after surgery.Purpose
Method
The anterior inferior tibiofibular ligament (AiTFL) is the primary lateral ligamentous stabilizer of the ankle syndesmosis. Current syndesmosis repair techniques traverse the tibia and fibula, but do not anatomically reconstruct the AiTFL. We compared a novel AiTFL anatomic repair technique (ART) to rigid syndesmosis screw fixation (SCREW). Twelve cadaveric below knee specimens were compared radiographically and using a biomechanical testing protocol. All specimens underwent a CT scan of the ankle joint prior to testing. Next, the AiTFL, interosseous membrane and deltoid ligament were sectioned, and the posterior malleolus osteotomized, to recreate a trimalleolar-equivalent ankle fracture. The posterior malleolus was repaired with the posterior ligamentous insertions intact and functional (PMALL). Ankles were examined under fluoroscopy with an external rotation stress exam and the medial clear space (MCS) measured. Specimens were then randomized to receive either a conventional syndesmosis screw (SCREW), or the novel anatomic repair technique (ART). External rotation stress fluoroscopy was repeated. A second CT was completed and the fibular position compared to the pre-injury CT. Each specimen was then loaded in external rotation until failure using a custom biomechanical jig.Purpose
Method
