Risks Associated With Posterior Ankle Hindfoot Arthroscopy Complications
Karthikeyan ChinnakkannuNacime Salomão Barbachan MansurNatalie GlassPhinit PhisitkulAnnunziato AmendolaJohn E. Femino
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The use of posterior ankle and hindfoot arthroscopy (PAHA) has been expanding over time. Many new indications have been reported in the literature. The primary objective of this study was to report the rate of PAHA complication in a large cohort of patients and describe their potential associations with demographical and surgical variables.In this IRB-approved retrospective comparative study, patients who underwent posterior ankle and/or hindfoot arthroscopy in a single institution from December 2009 to July 2016 were studied. Three fellowship-trained orthopaedic foot and ankle surgeon performed all surgeries. Demographic data, diagnosis, tourniquet use, associated procedures, and complications were recorded. To investigate a priori factors predictive of neurologic complication after PAHA, univariate and multivariable logistic regression was utilized. Where appropriate, sparse events sensitivity analysis was tested by fitting models with Firth log-likelihood approach.A total of 232 subjects with 251 surgeries were selected. Indications were posterior ankle impingement (37%), flexor hallux longus disorders (14%), subtalar arthritis (8%), and osteochondral lesions (6%). Complications were observed in 6.8% (17/251) of procedures. Neural sensory lesions were noted in 10 patients (3.98%), and wound complications in 4 ankles (1.59%). Seven neurologic lesions resolved spontaneously and 3 required further intervention. In a multivariable regression model controlled for confounders, the use of accessory posterolateral portal was the significant driver for neurologic complications (odds ratio [OR] 32.19, 95% CI 3.53-293.50).The complication rate in this cohort that was treated with posterior ankle and/or hindfoot arthroscopy was 6.8%. Most complications were due to neural sensorial injuries (sural 5, medial plantar nerve 4, medial calcaneal nerve 1 ) and 3 required additional operative treatment. The use of an accessory posterolateral portal was significantly associated with neurologic complications. The provided information may assist surgeons in establishing diagnoses, making therapeutic decisions, and instituting surgical strategies for patients that might benefit from a posterior arthroscopic approach.Level III, retrospective comparative study.Keywords:
Univariate analysis
Arthroscopic assessment of the ankle joint can be an important diagnostic aid for intra-articular pathologic conditions. The major portals of entry are anteromedial and anterolateral. In one patient with loose bodies of the ankle, the authors successfully localized the loose bodies and determined the status of the articular surface by arthroscopy. In a second patient with pain and a roentgenogram suggestive of an osteochondral fracture, arthroscopic evaluation determined that the articular surface was intact, and the patient was successfully treated nonsurgically. Precise indications for arthroscopy of the ankle have not yet been determined, but its role will certainly be less extensive in the ankle than in the knee.
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The ranges of motions of the ankle have been studied only rarely in children. The authors examined the mobility of the ankle joint complex of 245 healthy children. The mean age was 10.2 years. In healthy children ages 7 to 14 years, the variation of the ankle joint complex range of motion was wide. The largest gender-related difference was recorded for passive plantarflexion, which was greater in girls. Other statistically significant gender differences do exist, but they are small and probably lack clinical meaning. Some of the children had remarkable left–right difference in the range of motions of the ankle joint complex. This means that the "healthy ankle" cannot necessarily be used in clinical practice as a reference when evaluating, for example, treatments of foot and ankle injuries in children.
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Arthroscopic assessment of the ankle joint can be an important diagnostic aid for intra-articular pathologic conditions. The major portals of entry are anteromedial and anterolateral. In one patient with loose bodies of the ankle, the authors successfully localized the loose bodies and determined the status of the articular surface by arthroscopy. In a second patient with pain and a roentgenogram suggestive of an osteochondral fracture, arthroscopic evaluation determined that the articular surface was intact, and the patient was successfully treated non-surgically. Precise indications for arthroscopy of the ankle have not yet been determined, but its role will certainly be less extensive in the ankle than in the knee.
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Physiological effects of use of sand bags during walking exercise are verified, while there is no quantitatively verification of various attaching position. Therefore, the purpose of this study was to compare the differences of attaching position(wrist & ankle) of sand bags on lower extr emities dynamics during walking. The partici -pants of this study were fifteen male college students(year, height, weight). The results are as follows. First, the range of motion of ankle joint was decreased, while knee and hi p joints were increased attached to the ankle joint. Second, the eccentric work of ankle joint was increased, while the concentric work of ankle joint was decreased attached to the ankle joint. Third, rate of concentric work of ankle joint was decreased, while hip joint was increased. Our findings implies that sand bag attached to the ankle joint has a high efficiency of exercise, however has increasing the compensation in knee and hip joints. Therefore, we recommended attached to the wrist during walking exercise.
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The ranges of motions of the ankle have been studied only rarely in children. The authors examined the mobility of the ankle joint complex of 245 healthy children. The mean age was 10.2 years. In healthy children ages 7 to 14 years, the variation of the ankle joint complex range of motion was wide. The largest gender-related difference was recorded for passive plantarflexion, which was greater in girls. Other statistically significant gender differences do exist, but they are small and probably lack clinical meaning. Some of the children had remarkable left-right difference in the range of motions of the ankle joint complex. This means that the "healthy ankle" cannot necessarily be used in clinical practice as a reference when evaluating, for example, treatments of foot and ankle injuries in children.
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Objective:To explore the curative effect of operation on the ankle joint fracture in supination-external rotation type(S-E-R type).Methods:Eighty-two cases with ankle joint fracture in S-E-R type were processed with operation from January 2006 to September 2010.The ankle joint functions were compared between the diseased side and the healthy side at the 6th and the 12th months after the operation respectively,The ankle joint functions at the 6th months after the operation were compared with that at the 12th months after the operation.Results:Six months after the operation,the ankle joint function of diseased side was worse than that of the healthy side,and there was statistical difference between them(t=-8.286,P=0.000).Twelve months after the operation,the ankle joint function of diseased side was close to that of the healthy side,and there was no statistical difference between them(t=1.179,P=0.240).Ankle joint function of diseased side at the 12th months after the operation was improved a lot compared with that at the 6th months after the operation,and there was statistical difference between them(t=-10.769,P=0.000);and the same situation also occurred in the healthy side(t=-6.819,P=0.000).Conclusion:It can improve the curative effects of operation on ankle joint fracture in S-E-R type and effectively recover the ankle joint functions through the following methods as accurate evaluation of the injuries,proper operation opportunity and fixation methods,the recovery of the complete articular surface and the stable ankle joints,effective functional exercises after the operation.
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This article presents a series of case reports to describe the technique of ankle joint manipulation and its effects on common problems of the foot and ankle. The relationship between motion and pain is described, as are the effects of muscular inhibition on the presence of joint restriction and their association with pain in various joints remote to the ankle joint. (J Am Podiatr Med Assoc 94(4): 395–399, 2004)
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Use of the ankle distractor with ankle arthroscopy is well known to allow improved evaluation of the intraarticular surfaces. A less common application of the ankle distractor is for the treatment of complex ankle fractures. We evaluated the use of the ankle distractor in the treatment of six patients with ankle trauma. Five of these cases involved comminuted intraarticular fractures of the distal tibia, and one case involved a malunion of an ankle fracture with widening of the mortise. In each case, the ankle distractor increased the exposure of the ankle joint and allowed better access for fracture fragment reduction. There were no complications associated with the use of the distractor. The technique of using the ankle distractor in these situations is described.
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Two thousand five hundred and sixty-two participants in a college intramural basketball program were studied during two successive intramural "seasons" with regard to the frequency of ankle and knee sprains, as related to the use of external ankle support. The influence on injury rates of high- and low-top shoes and the use of prophylactic ankle taping were examined, and an additional group of players was supported with a disposable elastic material during the second season of study. The use of both high-top shoes and prophylactic ankle taping appeared to decrease the frequency of ankle sprains. This decrease was particularly marked in those subjects who had suffered previous ankle sprains. The size of the additional group was too small to permit valid comparisons. No increase in the frequency of occurrence of knee sprains was observed to result from the use of high-top shoes and/or prophylactic ankle taping.
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