The morphology of medial malleolar fracture is highly variable and difficult to characterize without 3D reconstruction. There is also no universally accepeted classification system. Thus, we aimed to characterize fracture patterns of the medial malleolus and propose a classification scheme based on 3D CT reconstruction. We retrospectively reviewed 537 consecutive cases of ankle fractures involving the medial malleolus treated in our institution. 3D fracture maps were produced by superimposing all the fracture lines onto a standard template. We sliced fracture fragments and the standard template based on selected sagittal and coronal planes to create 2D fracture maps, where angles α and β were measured. Angles α and β were defined as the acute angles formed by the fracture line and the horizontal line on the selected planes.Aims
Methods
To evaluate the donor site morbidity and tendon morphology after harvesting whole length, full-thickness peroneus longus tendon (PLT) proximal to the lateral malleolus for ligament reconstructions or tendon transfer. A total of 21 eligible patients (mean age 34.0 years (standard deviation (SD) 11.2); mean follow-up period 31.8 months (SD 7.7), and 12 healthy controls (mean age, 26.8 years (SD 5.9) were included. For patients, clinical evaluation of the donor ankle was performed preoperatively and postoperatively. Square hop test, ankle strength assessment, and MRI of distal calf were assessed bilaterally in the final follow-up. The morphological symmetry of peroneal tendons bilaterally was evaluated by MRI in healthy controls.Aims
Methods
It is difficult to determine the safe timing
of weight-bearing or reconstructive surgery in patients with Charcot arthropathy
of the foot and ankle. In this study the Doppler spectrum of the
first dorsal metatarsal artery was used to monitor the activity
of the disease activity and served as a guideline for management.
A total of 15 patients (seven men and eight women) with acute diabetic
Charcot arthropathy of the foot and ankle were immobilised in a non-weight-bearing
cast. They were followed at two-week intervals and bilateral Doppler
spectra of the first dorsal metatarsal arteries were obtained using
a 10 MHz linear ultrasound probe. The patients were allowed to start weight-bearing
or undergo surgery after the Doppler spectrum had returned to normal
pattern. The Doppler spectra in the unaffected limbs were triphasic
in pattern, whereas those in limbs with active Charcot arthropathy
showed monophasic forward flow. They returned to normal after a
mean of 13.6 weeks (6 to 20) of immobilisation. Three patients underwent
pan-talar arthrodesis to correct gross instability and deformity. Doppler spectrum analysis of the foot may reflect the activity
of the disease in patients with Charcot arthropathy, and may be
used as a guide to begin weight-bearing or undergo reconstructive
surgery.
The consequences of breakdown of the wound after surgery to tendo Achillis are considerable. Complex surgery is often required to reconstruct the tendon and to provide soft-tissue cover. We describe a new incision which approaches the tendon by using a distally-based fasciocutaneous flap. This reduces the risk of breakdown of the wound since it avoids making an incision directly over the tendon, provides good exposure, and maintains the vascularity of the skin overlying the tendon.
